Martin Shkreli is the man who became infamous through buying the rights to Darapim (pyrethamine) and raising the price by 5000% from $13.50 to $750 per pill. There is, I suggest, an inescapable logic to his move that Hillary Clinton described as “outrageous.” Pyrethamine has been around since 1959 and used, usually in combination, to […]
Category: Richard Smith
Richard Smith was the editor of The BMJ until 2004.
Richard Smith: The optimal peer review system?
Peer review is faith not evidence based, but most scientists believe in it as some people believe in the Loch Ness monster. Research into peer review has mostly failed to show benefit but has shown a substantial downside (slow, expensive, largely a lottery, wasteful of scientific time, fails to detect most errors, rejects the truly […]
Richard Smith: Holbein’s Dance of Death—the perfect Christmas present
Hans Holbein produced his Dance of Death in Basle in 1526, mainly because he needed the money. Pictures of the dance of death were fashionable, featuring on the walls of cemeteries, and people wanted their own pictures. The pictures have been reproduced many times in many forms since then, and the latest version is a […]
Richard Smith: STPs—too much sustainability, too little transformation?
STPs (Sustainability and Transformation Plans) are the device that it is hoped will save the NHS in England by dramatically improving efficiency and allowing NHS bodies to balance their budgets. They are being drawn up in the 44 “footprints” of England and are intended to cover acute hospitals, mental health, community services, and social care. […]
Richard Smith: What should a patient ask before entering a clinical trial?
“What,” a Finnish journalist asks me, “should a patient ask before entering a clinical trial?” That’s a good question, I think, as on my feet I try to answer the question. So here’s an attempt at an answer. She asked me the question because I’d been saying that much that is published in medical journals […]
Richard Smith: Can the NHS ever manage to analyse data to improve patient care?
In order to improve patient outcomes the NHS badly needs to collect data on all that is happening, analyse it intelligently, and present the information to clinicians and managers in an understandable and actionable form. That was the central message from Keith McNeil, who recently became chief clinical information officer health and social care for […]
Richard Smith: Is flexible working good or bad for health?
Australia, like Britain, pushed hard for more flexible working in the labour market in the 80s, and all political parties and trade unions supported it because they assumed that it would both boost productivity and give workers more control of their lives. More control, it was thought, would improve health. But is more flexible working […]
Richard Smith: Epidemiology—big problems and an identity crisis
The Germans probably have a more precise word for it, but it’s close to schadenfreude as an outsider to watch a professional group agonise over who they are, whether they matter, whether their methods are adequate, and whether they are missing something important. I had this experience in Bristol last week as a gaggle of […]
Richard Smith: Finding meaning in life through neurosurgery
Paul Kalanithi, a neurosurgeon, wanted badly to understand life and its meaning, and he knew that to do so he would need to understand death. So when in his 30s he developed a cancer that he knew would kill him, he thought (and subsequently wrote): “Shouldn’t terminal illness, then, be the perfect gift to that […]
Richard Smith: The challenge of high need, high cost patients
A challenge to all health systems is how best to manage “high need, high cost patients,” a term developed by the Commonwealth Fund. Its president, David Blumenthal, discussed the best response in last week’s annual health lecture of Imperial College’s Institute of Global Health Innovation. The first reason for caring about such patients is that […]