Primary care covers the whole population, but it’s underfunded and has increasing difficulty recruiting doctors; and there are worries about equity and the quality of care. This could be the NHS in Britain, but it’s the health system in Florianópolis, Brazil. The NHS can learn from the Brazilian experience, and Jorge Zepeda, a family physician […]
Category: Richard Smith
Richard Smith was the editor of The BMJ until 2004.
Richard Smith: Teaching children to make better health decisions
After 30 years of trying to teach clinicians, policymakers, journalists, and patients the basic concepts of deciding if claims about health interventions are valid, Andy Oxman, one of the originators of evidence based medicine, decided that it’s tough to teach adults new ways of thinking because of all the baggage in our heads. So he […]
Richard Smith: Mental health—has the tide finally turned?
When I spoke to this group four years ago about mental health services all was doom and gloom, but now I feel optimistic. This is how Paul Farmer, chief executive officer of MIND, began his talk this week to the Cambridge Health Network. Despite about three quarters of patients with mental health problems still not […]
Richard Smith: The “micro-macro problem” and the difficulty of using evidence to make policy
Doctors commonly complain that they consider evidence before they treat a patient, but politicians and policy makers don’t use the same rigour when making changes to health services. Indeed, Margaret McCartney—GP, BMJ columnist, and now stand up comedian—calls for this in her show at the Edinburgh Fringe Festival: “What do we want: evidence based policy […]
Richard Smith: How humans might divide into a superclass and a useless class
Many people think Sapiens: A Brief History of Humankind by Yuval Noah Harari the single most important book they have read, and a nonagenarian friend said it made him see the world in a new way. The book has been translated into 40 languages, but the commonest question Harari was asked in his interviews about […]
Richard Smith: Making workplace health work after 40 years of failure
What is it that makes a company successful? Could it be strategy, leadership, funding, great products, luck, or something else? All of those things are secondary to the “essence” that make for a successful company—which is the habits of the employees—argued Andrew Sykes, an actuary who is the founder of a company called Habits at […]
Richard Smith: In search of scandal in Scotland
I’m on my way to Dumfries to investigate the state of the NHS in that region, and the thought of the town is making me remember when I travelled there in 1974, 42 years ago, to investigate what I and a friend believed to be a scandal, a scandal of those times. I was a […]
Richard Smith: Preparing to be demented
My mother who is 86 has had no short term memory for nine years. She’s been in a nursing home for three years. My grandmother was also demented and died in a nursing home. My mother was 22 when I was born, so perhaps my dementia is close. I need to prepare myself. My mother […]
Richard Smith: What if everyone over 55 was offered a pill to prevent heart attacks and strokes?
The NHS, like other health systems, is facing huge financial pressure. Bold thinking is needed, and the King’s Fund, a British health think tank, has commissioned a series of articles asking authors to explore radical questions of “What if . . .” All of the articles can be accessed at The NHS if—essays on the future […]
Richard Smith: Doctors phishing for phools
In their influential book Phishing for Phools: The Economics of Manipulation and Deception two Nobel prize winners, George A Akerlof and Robert J Shiller, describe how businesses profit from exploiting human weakness. Politicians do the same and so, I suggest, do doctors. (I was about to assume that all BMJ readers know about phishing, but […]