Richard Smith was the editor of The BMJ until 2004.
“If a minister from England asked you about breaking the English NHS into regions, what would you say?” I asked this of a senior official in the Andalucian ministry of health. “Break it up. No question. You can’t manage a system for more than 10 million people well.” Spain has made this transition. In the […]
My wife hates walking. For her it means trudging through the rain and mist, cold, exhausted, wet to her underwear, and with five miles still to go to a smelly bed and breakfast. It can be exactly that, but for me walking 15 miles day after day is one of life’ s greatest pleasures. […]
At the end of my class on leadership at Warwick Medical School comes a dreadful moment. I’ve enjoyed myself and am packing up, when the only student left, a woman, says to me “Why were no women leaders mentioned?” I don’t panic, but I at once recognise that we’ve discussed many male leaders and not […]
Developing interventions that work to, say, reduce malaria, combat obesity, or prevent cardiovascular disease is hard, but scaling them up to benefit whole populations is harder. Yet the interventions must be scaled up to make any important difference to global problems like malaria, obesity, and cardiovascular disease. The Oxford Health Alliance meeting in Delhi last […]
The cholera hospital in Matlab, Bangladesh, has patients in the corridors and every nook and cranny, but as we walk through the mood is calm. Most beds have two people, usually a mother and child. The mood may be calm because acute, watery diarrhoea is part of life in Bangladesh, and the parents and patients […]
About 200 million adults a year undergo major surgery that is not cardiac surgery, and about 5 million of those people suffer a major vascular complication. That, said P J Devereaux from McMaster University at the Oxford Health Alliance meeting in Delhi last week, is about the same as the number of people contracting HIV each […]
“The village is the real India,” said an Indian friend, echoing Gandhi and the continuing belief of many Indian intellectuals. “What is the village but a sink of localism, a den of ignorance, narrow mindedness, and communalism [putting your own ethnic group ahead of society],” said Bhimrao Ambedkar, who drafted the Indian constitution and was the […]
“Anna [Donald] has left a remarkable legacy to other patients like myself with advanced disease,” says Helen Owens, a patient with cancer, on the website Anna’s Adventure. Anna Donald, as many BMJ readers know, was a doctor, Rhode’s Scholar, and one of the founders of evidence based medicine who died of breast cancer last year […]
What will you be doing on 6 April? There is a high chance that you’ll spend much of the day sat in front of a computer, perhaps seeing patients at the same time. You’re also likely some time in the day to be in a car, bus, or train, consuming carbon. Well, I urge you […]
Reading the accounts in the BMJ of how various doctors and mangers would make savings in the NHS, I thought back to a series based on the same idea that I edited when I first arrived at the BMJ in 1979. Then I thought that in 1979 the cost of the NHS was about £35 […]