11 March 2016 was an important day for global public health. It was the day the UN adopted a hygiene indicator as part of Sustainable Development Goal (SDG) 6–the goal that covers the availability and sustainable management of water and sanitation for all, and which will guide funding and policy in this area for the […]
After Hurricane Matthew: The fight to prevent a cholera epidemic in Haiti
Cholera has been in Haiti since shortly after the earthquake in 2010. Before Hurricane Matthew hit Haiti this month, it was predicted there would be 50 000 cases by the end of this year. Sadly, with some areas showing as much as a 91% increase in cases last weekend, this number is now feared to be […]
William Cayley: Numerical minimal change disease
What difference makes a difference? We often encourage patients to make small behavioral changes, in the hope that even one step in the right direction is at least small progress. However, when it comes to medical care, and testing in particular, I think we forget that some changes are not really changes at all. As […]
Jeffrey Aronson: When I use a word . . . A word about empathy
Empathy is becoming a 21st century biomedical fashion, judging by the number of papers on the subject (figure). But the concept is not new. The word is first recorded in English in the Philosophical Review in 1895, in a summary by E L Hinman of a paper by Kurd Lasswitz, a Kantean philosopher and science […]
Paul Aylin: Weekend Gravity Waves
On 15th September 2016, a letter appeared in The Guardian with an unlikely collection of signatories including Lords, an MP, a number of medics, a leader in evidence based medicine and the physicist Professor Stephen Hawking. [1] The letter drew attention to the “freshly disputed evidence surrounding a weekend effect”, suggesting that claims for this […]
Tiago Villanueva: Family medicine and private health insurance in Portugal
I read with interest some recent articles about the interplay between private healthcare insurance and state provided healthcare. [1][2][3] A substantial proportion of the population has private health insurance in Portugal, where I work as a GP. Funding cuts and raised co-payments because of the financial crisis have decreased the appeal of public healthcare, prompting […]
Rammya Mathew and James McGowan: The role of shared decision making in a value based NHS
Last month a controversial proposal was made by Vale of York clinical commissioning group (CCG) to deny obese patients access to elective surgery for up to a year. The headlines were alarming and the approach felt wrong. The CCG defended its position by saying that it was “the best way of achieving maximum value from […]
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 […]
Anna Miller: Asking all pregnant women for a passport before giving birth is simply wrong
St George’s University Hospitals Foundation trust is reportedly devising a pilot scheme to ask all pregnant women to show a passport to prove their right to NHS care before giving birth. Although in some ways this does not mark a policy change—undocumented migrants are already charged for maternity care—it marks a departure from NHS guidelines […]
Laurence Gerlis: Is private medical practice that bad?
During my 30 years as a private GP I have become used to being insulted by other doctors. Some see us as mercenary quacks, with little genuine interest in patients’ needs, who overprescribe and bombard NHS GPs with useless health screening reports. NHS doctors are not volunteers, they are paid. All patients pay for NHS […]