Richard Smith: Will economic problems finally fix London healthcare?

There were no dissenters from the view at last week’s Cambridge Health Network meeting that London has chronic overcapacity in its acute hospitals. It’s been the case for decades. One reason for the continuing failure to reform lies in the story of one woman that all three local candidates in her constituency in the last […]

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Richard Smith: Can Devi Shetty make healthcare affordable across the globe?

It’s impossible not to be impressed by Devi Shetty, heart surgeon and the “the Henry Ford of healthcare.” We can be impressed by his surgical skill and his refusal to turn away the poor. But perhaps even more impressive is his entrepreneurship and his vision of making healthcare affordable for everybody. […]

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Richard Smith: Are we too concerned with confidentiality? A fable

I am the chief medical officer of our family. I am the bridge between my family members, some of them eccentric and one of them demented, and an unforgiving health system. Many doctors—indeed, anybody familiar with the strange language and rigidities of health systems—fulfil the same role, and it gives us some useful bottom up […]

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Richard Smith: Disclosure of conflicts of interest may increase bias

I’ve worried that disclosing conflicts of interest may be counterproductive ever since we did an experiment that showed that readers of articles with declared conflicts discounted not only the believability of the results, but every aspect of the paper, including its importance and originality.  Now my worries are increased by a paper in JAMA and […]

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Richard Smith: Our need for clockware and swarmware

Tackling the global pandemic problem of non-communicable disease (NCDs) is a complex problem that needs clockware and swarmware. I imagine that most BMJ readers have no idea what that sentence means, but read a few more paragraphs and you may learn something useful. Problems, said Sian Williams, executive officer of the International Primary Care Research […]

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Richard Smith: Doctors are not interested in health or prevention

“Doctors are not interested in health” is one of my many wild generalisations. My evidence is my experience, a 40 year collection of anecdotes, and the observation that a thousand page medical textbook usually comprises five desultory pages on health and 995 pages detailing disease. Now I have further evidence. I’ve just attended the World […]

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