Richard Smith was the editor of The BMJ until 2004.
Integrating the fractured and fractious components of health and social care systems seems to be everybody’s current favoured “solution” for healthcare problems, but it’s hard to make happen. We now have evidence that it may literally take an earthquake or some other natural disaster to make it happen. Conceptually it’s easy to see why integration […]
Until last weekend it never crossed my mind that I wouldn’t die. Now after conversations with my brilliant friend Alex Jadad I fear that I might be hopelessly out of step with modern thinking and way behind the times. Three weeks ago Time magazine asked “Can Google solve death?” The provisional answer is “if anybody […]
How when you are a 20 year old medical student with almost no clinical experience and no experience at all of death do you talk to a dying patient? What do you say? Do you avoid the topic of death altogether or do you put it top of the agenda? Should you look sad? Can […]
On Christmas Day 1976 I kissed 500 women. All of them were over 70 and institutionalised, and one was either dead or killed by my kiss. I was a houseman, working in the Eastern General in Edinburgh, close to the city’s inadequate sewerage works. The hospital was built in 1906 by Leith Parish Council as […]
In the early 80s I kissed a hand that Hitler had kissed. Once I realised what I’d done I felt like spitting, but I didn’t. This is how my physical connection with one of history’s monsters came about. In those days I was the BBC Breakfast Time doctor. Twice, sometimes thrice, a week I would […]
Doctors, who prescribe drugs, are at the top of the health hierarchy, whereas nutritionists are near the bottom. At medical school students learn a huge amount about drugs, but little or nothing about food. When managing patients doctors think drugs first and any other response a long way second. We’ve had pharmacopeias for over a […]
Global health 1.0 was called tropical medicine and was primarily concerned with keeping white men alive in the tropics. Global health 2.0 was called international health and comprised clever people in rich countries doing something to help people in poor countries. It had Cold War overtones. Global health 3.0, which is still the main manifestation […]
I’m the minister of health in a poor country. Until last year I was a urologist. I was the president’s urologist and took out his prostate. To be honest, I don’t think it needed to come out, but he insisted. You don’t resist the president. He was delighted with the result and rewarded me by […]
We knew that we had “a colossal problem of quality” when we began the peer review congresses in 1989, said Drummond Rennie, creator of the congresses, at the seventh congress in Chicago earlier this month. That problem is now better described and defined, in large part because of the congresses, but it’s even bigger than […]
Earlier this week I attended a meeting at the Royal College of Physicians of Edinburgh on global health to beat my drum on the importance of non-communicable disease (NCD). Others were there to beat other global health drums, and I tried to learn all that I could from them. My main learning was that there […]