JAMA 27 June 2012 Vol 307 2595 Of all the things that made me glad to retire from general practice two years ago, pay for performance must top the list. Here’s a Viewpoint piece from the USA which explains why: “Focusing on specific outcomes does not reward skills or result in managing complexity, solving problems, […]
JAMA 6 June 2012 Vol 307 2269 As I near my fifteenth year of writing comments on the medical journals every weekend, I sometimes envy columnists who can write their copy ahead of time and take the odd week—or even month—off. I don’t have any prepared store of fine phrases or worked up indignation, but […]
The regulation and governance of clinical research continues to be a key discussion for the clinical research community. Last year, following increasing pressure the government and regulators began to look at ways to reform the system to support and increase the amount of research taking place in the UK. The good news is that we’re […]
JAMA 23 May 2012 Vol 307 2161 Daytime sleepiness is one of the main reasons for treating obstructive sleep apnoea, another one being the risk of cardiovascular events and hypertension in untreated OSA. Continuous positive airway pressure is the standard treatment, and observational evidence suggests that as well as keeping people more alert by day, […]
JAMA 16 May 2012 Vol 307 Do we all live on the same planet? I’m nearing the end of an amazing year at Yale, surrounded by superlatively intelligent people working on the outcomes of US healthcare. I myself occupy a space with brilliant newly qualified young doctors from India, Iran, and Brazil, putting together a […]
JAMA 4 Apr 2012 Vol 307 1394 A special dread settles on me this week as I know I am going to have to write about breast cancer screening. But let’s leave the dread question of whole-population mammography for later, and consider the add-on benefit of annual ultrasound or single-screening MRI in selected high-risk women. […]
JAMA 28 Mar 2012 Vol 307 1257 Medical conferences exist to affirm everything that hinders the progress of medicine as a compassionate and honest enterprise. They are a showcase for authority figures, pharma-funded research, half-completed work in the form of abstracts and late-breaking sessions; they use up prodigious amounts of money and carbon fuels; they […]
JAMA 22 Feb 2012 Vol 307 813 When an Italian team of physicists reported that they had detected neutrinos travelling faster than light, the televisual physicist Jim Al-Khalili promised to eat his boxer shorts if it proved to be true. It turns out to have been a measurement error due to faulty wiring. Unbelievable results […]
JAMA 15 Feb 2012 Vol 306 669 This week’s star Viewpoint piece is about The Unintended Consequences of Conflict of Interest Disclosure. It seems to me that twenty-first century medicine operates on roughly the same principle as the court of the Grand Vizier of the Ottoman Empire – prestige is judged by the number of […]
JAMA 25 Jan 2012 Vol 307 373 Here’s the kind of study that’s all too rare in the medical literature: an important interventional trial that is not funded by pharma. The question is whether giving a proton pump inhibitor can improve outcomes in poorly controlled childhood asthma: a reasonable hypothesis to test, since a high […]