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    Where will the next pandemic come from?

    Where will the next pandemic come from?

    Filed on Friday, 30th August 2013.

    Varicella zoster virus

    My recommended read for this week is a long but very engaging extract from David Quammen’s book Spillover. It was published in PopSci. It reads like some sort of adventure novel, but discusses the reality of tracking where the next pandemic virus might come from, and the work scientists do to prevent it. It’s well-worth reading!

    The electron micrograph of a varicella zoster virus at the top of this post is from NIAID’s Flickr feed, and is used under its Creative Commons Licence.

    Posted on 30th August 2013. You can view all my previous selections here, or comment here.

    2D: The economics of science & healthcare

    Filed by sjhoward at 12:30 on 17th July 2013 under 2D, Health

    The link between the two articles in this 2D is health and economics. It’s a reasonably weak link, granted… but it’s a link nonetheless!

    The first article I’d like to recommend is this long and thoughtful interview with Bill Gates by Ezra Klein of the Washington Post, which carries the arresting title “death is something we really understand extremely well”. He talks through some of the financial decisions his Foundation makes, and the economics of disease eradication. I found it quite fascinating.

    The second article is really rather different. For Priceonomics, Alex Mayyasi gives a history and economics lesson to explain why articles in scientific journals are, more often than not, behind a paywall. He argues, too, that the system needs to move on and develop in the 21st century. As someone who spends a disproportionate amount of time whining about medical journals and their paywalls, I found this detailed blog post very interesting and informative.

    2D posts appear on alternate Wednesdays. For 2D, I pick two interesting articles that look at an issue from two different – though not necessarily opposing – perspectives. I hope you enjoy them! The picture at the top of this post was uploaded to Flickr by Howard Lake, and has been modified and used under Creative Commons licence.

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    I don’t often post videos on here these days, but this one I really enjoyed. First Officer Jeff Skiles of the flight that ended up in the Hudson, and healthcare safety expert Terry Fairbanks lecture on what healthcare can learn from airline safety.

    This post was added to my scrapbook on on 13th June 2013.
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    Some thoughts on GMC social media guidance

    Filed by sjhoward at 13:29 on 5th April 2013 under Health, News and Comment, Technology

    On the 25th March – approximately a lifetime ago in internet terms – the GMC published guidelines for doctors’ use of social media. The guidelines come into effect later this month.

    Publication of the guidelines caused something of a social media uproar, particularly around the anonymity clause. The brilliant Anne Marie Cunningham, who has written and spoken a lot about social media in medicine, has hosted a particularly fascinating conversation about this on her blog, with well made points on both sides.

    With all the high-quality discussion and carefully thought-through points flying back and forth, I’ve taken a back seat on this one. I’m not sure that I have all that much that’s new to add, and I don’t blog all that much about medical matters any more. But a nagging feeling in the back of my head says that this is exactly the sort of debate I would once have jumped into with both feet, and the focus hasn’t been on the part of the guidelines to which I most object. So here goes.

    In all guidelines, I’ve always been lead to believe that definitions are crucial. For a guideline to be effective, let alone for it to be enforced, it must be clear what it covers. And yet, the GMC’s definition of social media is absurdly wide:

    Social media describes web-based applications that allow people to create and exchange content.

    Later in the guidelines, it is clarified that this definition includes non-public, professional social networks too. As I’ve discussed this issue with tech friends and colleagues over the last couple of weeks, this definition has caused several to – literally – laugh out loud.

    It, of course, includes all manner of things that are not social media, and essentially describes any form of cloud-based application. If we interpret this guidance as written, then from 22nd April patient-identifiable information can no longer be uploaded to web-based GP note systems, or to HPZone used by Public Health England to track outbreaks, or indeed transferred via NHSMail, the restricted-level security email system designed exactly for that purpose. Use of Choose and Book will be against the GMC’s rules. All of these are online applications which allow people to create and share content. All are clearly not supposed to be covered by this guidance.

    It can be argued that even if the definition as written is unclear, it is perfectly clear to most people what it is supposed to refer to. I don’t buy that, for two reasons. Firstly, what’s the point in publishing the guidance at all if we aren’t to interpret it as written? Some might say that the definition has to be broad in a fast-moving environment, and that the guidance would quickly be outdated if it were too pinned down.

    Which brings me to my second problem: you may understand it, but I don’t. I actually don’t know whether this guidance applies in edge cases. Office 365 and Google Drive are both web-based applications which allow the creation and exchange of content. Applications like these are almost certain to replace locally hosted applications like the Word and Excel of today within this decade. Indeed, some organisations have already made the switch.

    Is use of these outlawed by the guidance? I can see arguments why it, perhaps, should be. There are inherent risks about patient confidentiality in these systems. But to ban their use for patient identifiable information is a big statement, and I suspect that they didn’t actually mean it. But I’m far from certain.

    To me, the nub of the problem here is that this is guidance on using a particular medium – and one that is ill-defined, at that. Publication might feel relevant now, and everyone from the BMA to the RCGP is helping people to understand how to use this medium safely. But I don’t think this is the place of a regulator. I’m acutely aware that others will strongly disagree with this position.

    By and large, I think the GMC should stick to outlining principles. I no more expect to see supplementary guidelines on social media use than I would on letter writing or telephone conversations. Although, if – like many hospitals – you’re using a VOIP system, it could be argued that these guidelines apply. Just like the GMC does with those two media, I think case studies would have been a better way to illustrate the application of principles, rather than a list of inflexible “rules”. I don’t think it’s sensible or advisable to try and give over-arching “explanatory guidance” about an area of life which is changing so rapidly.

    After all, these are only supposed to be explanatory. They are not intended to introduce new regulation. Though, to my reading, their poor formulation does lead to new regulatory burdens being placed on doctors.

    When the last Good Medical Practice was published, Twitter had barely been conceived, and Facebook had yet to open to the general public. These guidelines aren’t clear now, so goodness knows what we’ll think of them in seven years’ time. I think they should be withdrawn.

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    This is how you healthcare

    This is how you healthcare

    Filed on Friday, 22nd February 2013.

    Sarah Bee published this moving story earlier this week over at NSFWCORP. Just occasionally, I come across a story that stops me in my tracks, moves me, and makes me think a little bit differently about life and medicine. This powerfully personal article about Sarah Bee’s experience as she watched her own father die in an intensive care unit in London is one of those stories.

    Posted on 22nd February 2013. You can view all my previous selections here, or comment here.
    15th January 2013

    Lectures can, in short, bring a subject alive and make it more meaningful. Alternatively, they can kill it.

    A true, but not altogether encouraging, sentiment in this excellent 2001 paper by Brown and Manogue, sent to me by Newcastle Medical School to help me prepare my first big scary lecture for their students.

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    » Access this online at http://sjhoward.co.uk/archive/2013/01/15/how-to-lecture-medical-students

    So given that I’ve stopped posting pictures of my face, I’m trying to record something in my scrapbook each day that means something to me – whether that’s something memorable that I’ve done in the day, something that summarises what I’m up to, something meaningful I’ve read, or something that’s brought back memories.

    Today, I’m going for the final category. This article about autopsies* (I’d say post-mortems) from the Student BMJ really reminded me of my time studying Forensic Pathology in Calgary. The description of the autopsy process was particularly redolent of my experience, and the quote above certainly made me smile! The aromas were particularly unfamiliar when dealing with “decomps” – corpses that had lain decomposing for some time before being discovered!

    It was a great experience, and I’m really glad I chose to take the opportunity to do something completely different to the rest of my medical career when I had the chance.

    *You need to complete a free registration to read the whole of this article. Irritating, isn’t it?

    This post was added to my scrapbook on on 10th January 2013.
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    9th January 2013

    Mr Dispenser, Twitter’s highly entertaining anonymous pharmacist, has gone and written a book. He’s compiled just over 130 pages worth of pharmacy-based jokes, anecdotes, and blog posts – and the result is genuinely laugh-out-loud funny.

    As a former hospital doctor, I didn’t really know what pharmacists got up to – least of all community pharmacists. The ward pharmacists were friendly folk who stalked the wards correcting my prescriptions in green ink, and putting up with incessant questions posed by curious junior doctors like me. They always seemed to know the answers. I guess my closest brush with community pharmacists came when I worked in general practice, and I’d occasionally get a phone call asking if I really meant to prescribe a drug – to which the answer was almost invariably “No”.

    I guess what I’m trying to say is that pharmacists were generally the people, along with nurses, who routinely saved my ass, so I guess I’m pretty well disposed towards them. And from Mr Dispenser’s tweets, I was fairly sure they had a good sense of humour, too.

    Pills, Thrills and Methadone Spills removed any doubt. Community pharmacists share a similar geeky and absurdist sense of humour with many GPs and hospital doctors, which means that the humour in this volume aimed directly at my funny bone. I laughed out loud repeatedly when reading this, most often at the pithy anecdotes of insane situations in which pharmacists find themselves – and even when the book is gently (or not so gently!) ribbing doctors. I even get quoted in there at one point!

    More than just humour, though, Pills, Thrills and Methadone Spills gave me a better appreciation for what community pharmacists do all day. In that sense, it was even a little bit educational. And a proportion of the profits from the book is being donated to charity.

    All of that said, this probably isn’t a book for a general audience. It’s very much aimed at pharmacists. As a non-pharmacist, some bits went over my head to some extent, and I’d imagine that those outside of healthcare would struggle to see the funny side of much of the book. And, if I’m being very picky, I’d probably have liked a bit of a narrative thread in there somewhere too. But Pills, Thrills and Methadone Spills is sure to raise a smile among pharmacists, pharmacy students, and perhaps some more of the medical community besides.

    Pills, Thrills and Methadone Spills is available now from amazon.co.uk on Kindle. A paperback is coming later in the year. Mr Dispenser is @MrDispenser on Twitter.

    In the interests of full transparency, I declare that I was sent a free electronic review copy of this book. In accordance with this site’s ethical review policy, I have not accepted payment for this review, I have written this review without regard to the source of the product, and I have made a charitable donation equivalent to the retail cost of the e-book.

    There's a book review every other Wednesday on sjhoward.co.uk. If you want to follow them, subscribe to the book review RSS feed or get the fortnightly review delivered automatically to your Kindle.

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    Photo-a-day 340: Cold relief capsules

    Photo-a-day 340: Cold relief capsules

    Filed on Thursday, 6th December 2012.
    Filed on Thursday, 6th December 2012 under Health, Photo-a-day 2012.


    With both Wendy and me feeling under the weather at the moment, we’ve been through a fair few over the counter medications in the past week or so… although I have to admit that, in line with gender stereotypes, I’m more often sighted rummaging through the medicine cabinet!

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    » Access this online at http://sjhoward.co.uk/archive/2012/12/06/photo-a-day-340-cold-relief-capsules

    Blood donation by numbers

    Blood donation by numbers

    Filed on Sunday, 2nd December 2012.
    Filed on Sunday, 2nd December 2012 under Health.

    Regular readers will know I’m a fan of infographics, and I thought this was was particularly powerful (though clearly more “graphic” than “info” – what’s with that 50% reduction “graph”?). Still, it’s a powerful message – 100,000 new donors needed in the next few weeks. Sign up to give blood today.

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    » Access this online at http://sjhoward.co.uk/archive/2012/12/02/blood-donation-by-numbers


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