Patient charges have featured in the British press in recent weeks after Malcolm Grant, the head of NHS England, raised their spectre last month. Until recently I was undecided about patient charging. There’s mixed evidence and obvious downsides, but health spending is a bottomless pit, and £5 judiciously applied here or there seems like a […]
Kailash Chand on NHS 111
It is now more than a month since the BMA first blew the whistle on the gathering failures bedevilling the government’s flagship NHS 111 service—and regrettably the problems show no sign of abating. In many areas of the country, such as Greater Manchester, NHS 111 was overwhelmed by call demand during its pilot phase before […]
David Kerr: Signals from the crowd—making a diagnosis
For very many years making a medical diagnosis was based loosely on the application of the principle of Occam’s Razor otherwise known as diagnostic parsimony—look for the fewest possible causes to explain a patient’s symptoms. However, with the increase in longevity of the background population, Occam’s Razor was eventually superseded by the Hickam’s Dictum which […]
Trish Groves: Data sharing: where are we?
The movement towards open science is gathering pace, driven by scientific and ethical imperatives—not simply by the technological possibilities. In medicine such openness has real potential to benefit patients and society. Indeed, the arguments for open registration and publication of studies’ protocols, methods, and main results are underpinned by ethical arguments that are focused on […]
Richard Lehman’s journal review—7 May 2013
JAMA 1 May 2013 Vol 309 This week’s JAMA is devoted to child health. This was a mistake, because although children are generally interesting, health generally is not. A study from Quebec tries out various doses of vitamin D in babies and finds you can only get to a reliably high value by using doses […]
Richard Smith: The irrationality of the REF
The Saturday before last I was rung up by a fellow of the Royal Society who was having trouble with the New England Journal of Medicine, and our conversation soon moved to the irrationality of “the REF” [research excellence framework]. We made the move because I asked why the results of a major trial undertaken […]
Sarah Venis: MSF Scientific Day 2013
Does blogging help patients cope with the lengthy and toxic treatment for multidrug resistant tuberculosis? Do humanitarian responses to crises fail to take sufficient account of the plight of elderly people? Is giving money more effective than giving food supplements to tackle child malnutrition? And will global health expert and Ted Talks alumnus Hans Rosling […]
Nigel Edwards: Can we keep up with the demand for urgent and emergency care?
The urgent and emergency care system is under severe pressure. Performance on a number of important indicators, including the four hour wait and ambulance handover targets, is heading in the wrong direction. Demand is growing and calls for work to be shifted out of hospital look oddly out of line with a system that cannot […]
Soumyadeep Bhaumik’s review of Indian medical papers—2 May 2013
People say India is the land of frugal medicine, and a decade ago I would have agreed. But the advent of technology coincided with the rapid growth of private hospital chains in the Indian medical sector. Healthcare has become costly, with expenditure on everything including medicines becoming huge. This brings me straight to the most […]
David Lock on integrated care experiments: at last some sensible thinking from the government for the NHS
The HSJ reports that the government is about to signal a series of large scale integrated care “experiments,” which could result in a movement away from the straightjacket of payment by results, with all of the biases towards activity, and away from prevention that have been reported on so often. Is this a first step […]