Archive for the ‘medicine’ Category

Feb 26, 2014

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medicine, research

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A paper I published late last year. Paper here (paywall). Evidence-based medicine is a redundant term to the extent that doctors have always claimed they practiced medicine on the basis of evidence. They have, however, disagreed about what exactly constitutes legitimate evidence and how to synthesize the totality of evidence in a way that supports […]

Jan 25, 2014

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medicine, quote

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“ Every day the scorecards went up, where they could be seen by all of the hospital’s emergency room doctors. Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were […]

Jan 16, 2014

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medicine

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Nature carries a rightly critical piece about the lack of meaningful consent of collection of what was once private data between a doctor and patient. “The name of the programme is care.data — not that you would know that from the leaflet, which neglects to mention it. From this spring, information from medical consultations, for […]

Oct 29, 2013

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medicine

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This paper, “Urologists’ Use of Intensity-Modulated Radiation Therapy for Prostate Cancer” by Jean M Mitchell, caught my eye. Not my normal bedtime reading but… First, a single author paper in the NEJM. How refreshing. Two of my first three publications (one in the BMJ) were single author papers. Traditions of science change, but in my […]

“The place to begin may be the US Senate. At the end of July 2012 the Senate Committee on Health, Education, Labour and Pensions presented an 800-page report, the culmination of a two-year investigation into ‘for-profit’ higher education institutions.?1 The senators found that at such institutions a mere 17.4 per cent of annual revenue was spent […]

Oct 23, 2013

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medicine, research

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I wrote an article just published in Clinics in Dermatology: Why we should let “evidence-based medicine” rest in peace [paywall]. The abstract is below. Will people let it RIP? No, because as Bruce Charlton has written, EBM is Zombie science. You cannot kill zombies, because they are dead already: they are the undead, they will not […]

Aug 13, 2013

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learning, medicine

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Medical education in Brazil has been extended by two years. Previously, it involved four years prior to medical school, and six years at medical school. Graduates are now forced to work for a further two years in public hospitals with a temporary medical license. Brazilian medics are not impressed, viewing it as a way of […]

Jun 12, 2013

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medicine, research

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Open access paper here in Acta.  An old message, but one frequently forgotten because everybody wants to ‘process’ patients too quickly to be safe or thorough. The Importance of a Full Clinical Examination: Assessment of Index Lesions Referred to a Skin Cancer Clinic Without a Total Body Skin Examination Would Miss One in Three Melanomas Roger […]

Apr 28, 2013

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learning, medicine

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Fascinating piece in the Economist WHEN Stephen A. Schwarzman, chairman of Blackstone Group, a private-equity firm, announced in Beijing on Sunday the $300m Schwarzman Scholars programme to send students to China to study, it was a testament to China’s place in the world as a new centre of gravity. Its gravitational pull on corporate money […]

Apr 27, 2013

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learning, medicine

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Well written piece in the NYRB. And as for doing no evil, nice quote about Google’s attempt to order (or close) the world: They agreed on a settlement, which transformed Google’s original enterprise, a search service that would display only short snippets of the books, into a commercial library. By purchasing subscriptions, research libraries would […]

Mar 13, 2013

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medicine

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I followed  up what I wrote about yesterday by looking at other (Scottish) NHS sources of information and advice. I had seen NHS Inform previously (branded as ‘Health Information you can trust’), and wrote to them pointing out that the skin section of their site contained lots of inaccuracies. I have just looked again, and […]

Mar 12, 2013

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medicine

1

Most science — and I am going to include medicine here — had been based on the idea that you build on the work of others. “Publish and be damned”, “Standing on the shoulders of others” etc. Peer review, as in challenge by one’s peers (rather than just the two rivals the journal editors chose) […]

Mar 05, 2013

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medicine

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A third way that health IT in America differs from consumer IT is usability. The design of most consumer Web sites is so obvious that one needs no instructions to use them. Within minutes, a seven year old can teach herself to play a complex game on an iPad. But a newly hired neurosurgeon with […]

Jan 24, 2013

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learning, medicine

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I have a commentary on a nice paper on the accuracy of skin cancer diagnosis coming out in Acta. Opening paragraph below. Frank Davidoff, the celebrated US physician, has a telling metaphor for medical competence: he likens it to Dark Matter, the material physicists think makes up most of the Universe, and about which we […]

Dec 31, 2012

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humour, medicine

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There is a paper in Academic Medicine entitled ‘Can Medical Students Afford to Choose Primary Care? An Economic Analysis of Physician Education Debt Repayment’ (DOI: 10.1097/ACM.0b013e318277a7df). The background being that primary care salaries in the US are below those of specialists. In the UK, as far as I can see, the salary differentials are reversed. […]

Dec 05, 2012

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medicine

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There is an interesting article from Randall and Downie in Clinical Medicine (December 2012— I cannot see it online yet). The issue is about consent for transplantation, and my interest and knowledge is as a lay person, rather than an expert in this area. The gist of  the article is that statements about ‘donation’ made […]

David Healy’s Pharmageddon is reviewed in Health Affairs. It is a must read if you are interesting in medical care and the role of Pharma. The review by Donald Light  is very favourable: “In my view, Healy’s book is the most powerful and deeply thought of a new crop of books on pharmaceuticals and medicine”. […]

Nov 26, 2012

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medicine

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John Ioannidis has been very successful in pointing out what had been  hidden in plain sight: we should assume that many— if not most— publications about therapy, including RCTs, are wrong. Here he shows his pen can muster a lovely turn of phrase. He is reviewing ‘Seeking Sickness’ by Alan Cassels in Lancet Oncology. The […]

Musing on markets and health care, and what happens when literally it is your own skin at risk. The man had good insurance, and he and his family used it freely to provide him with as much comfort and care as possible. I can’t imagine they’d have acted differently were they paying out of pocket. […]

Sep 27, 2012

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medicine

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Global industrial output was 57 times greater in 2010 than it was in 1900. In other words, manufacturing has grown far faster than the overall economy. The main reason for this is that factories keep getting smarter in ways that hair salons do not. From a review of Peter Marsh’s new book in the Economist. […]

Sep 25, 2012

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medicine

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I wrote quite a few articles (EBM) many years ago on the inadequacies of the EBM sect and their dogmas. My take is that EBM is now slowly dying as a serious attempt to understand the natural world or clinical practice except at an institutional level. EBM remains popular with bureaucracies such as the NHS or […]

Sep 25, 2012

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medicine

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My article in the BMJ continues to attract a few letters. Worth reading them. This link should get you behind the paywall. I have had a small number of emails from GPs direct. Some clearly believe they are the only people who do any work in the UK and, not surprisingly, they reserve their scorn […]

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