Researching the FT’s first Combating Tuberculosis report in the last few weeks, I was a little disappointed  by the lack of dissonance. HIV and increasingly malaria activists have been important advocates in raising the profile of those killer diseases, and in highlighting important issues of disagreement. The TB community, by contrast, still feels neglected, small and even overly consensual.

Apart from the obvious but difficult demands for more funding, and more effective drugs, diagnostics and vaccines, there are important short term and less costly actions that could be taken. Here are a few thoughts on what more needs to be done. Do reply to disagree or add to them!

Continue reading "Tackling tuberculosis"

Read the FT 2010 Combating Tuberculosis report: http://www.ft.com/reports/tb-2010

Watch videos: Andrew Jack, FT pharmaceuticals correspondent, talks to experts

And post your comments here

Illuminating reading in the Journal of the Royal Society of Medicine this month: Mis investigating alleged research misconduct can cause widespread, unpredictable damage

When investigations into alleged misconduct do not accept the reports commissioned, trouble is afoot. The more I read, the more naive I feel.

The past few years “whistleblowing” in the NHS has been seen as a dramatic act somewhat separate to the common activities of the clinical day.

The truth about how unnecessarily high-risk situations are brought to the attention of management is rather more complex and subtle. You observe that your community child clinic is overworked to dangerous levels, and you note that notes are not arriving: you tell management.

There are meant to be 4 paediatricians in clinic; however, during the period 2006-2008, one was off sick, one was on special leave, and two resigned. Juniors were left to take on tasks that would normally have been done by consultant staff. During this time baby P was seen.

Kim Holt - Support for Baby P clinic whistleblower Dr Kim Holt - a consultant paediatrician, was one doctor who raised these concerns, well before baby Peter was seen.

Her observations were not acted on: instead, cuts were made to the service. Dr Holt was off sick when baby Peter attended - Great Ormond Street Hospital - senior management must take responsibility over Baby Peter - and while it is easy to blame a single doctor for not picking up his problems, it is more realistic to view this failure in the context of more generalised problems within the clinic structure.

Dr Holt remains on full pay but has not been allowed back to her job. A report has recommended that she should be allowed to return: regardless, she remains in an extra-numerary part time position while the shortage of paediatricians remains. A petition to support her is here: Support for Baby P Clinic Whistleblower Dr Kim Holt. Whistleblowing should not need to come at such personal cost.

Up to now, doctors have issued a small but vital piece of paper, the sick note, to confirm that a patient is unfit to work. This extends beyond the seven days which an employee can self-certify first. But now the certificate, known as a Med 3, is being replaced by a system of “fit notes”, about which I have several doubts.

Instead of highlighting an illness that prevents a certain type of work, the new fit notes will point out what a patient might be able to do instead. This has been celebrated as a great advance for everyone, most notably the economy – as if people unable to work in “sick note Britain” are lounging around in the sun, drinking beer in some kind of immoral stupor.

Continue reading ‘The sick note is poorly’

By Rebecca Knight

Finally, some health news I can get behind: it’s possible to get more fit by doing less exercise.
 
A study, conducted by researchers at McMaster University in Canada, finds that brief spurts of high-intensity interval training - a form of exercise with the accurate acronym: HIT - produces the same benefits to your body as conventional long duration endurance training. (HIT means doing a number of short bursts of concentrated exercise with short recovery breaks in between.)
 
“Doing 10 one-minute sprints on a standard stationary bike with about one minute of rest in between, three times a week, works as well in improving muscle as many hours of conventional long-term biking less strenuously,” says Prof Martin Gibala, one of the authors of the research.
 

Continue reading "‘Not enough time’ to go to the gym is no longer a good excuse"

The BMJ noted the blog post  - The long arm of pharmaceuticals and PR - about generic drugs and asked for a piece on it - Generic drugs: protest group was not quite what it seemed

In case anyone is interested there is also a review - Suicide Watch - published on the BMJ of an amusing Dan Rhodes book called Little Hands Clapping - on the subject of a suicide museum.

An excellent piece by London GP Iona Heath: Do not sit on the bed in this weeks BMJ.

Hospitals are forbidding doctors from sitting on the bed, in the name of infection control. But no link has been made between sitting on the bed and increased rates of infection and as Dr Heath concludes:

“can we not campaign for home within hospital and encourage flowers and sitting on the bed and every other informality, unless there is robust evidence to deter us? ‘Do not sit on the bed’ and ‘No flowers’ are injunctions that are all too similar to ‘Do not walk on the grass’ and ‘No ball games’ rules that mostly diminish the joys of life rather than enhance them, and such rules, unless absolutely necessary, have no place in hospitals, where joy is too often in short supply.”

Having seen many ward rounds conducted from a standing position at the end of the bed, I have to agree.