Die Vorstufe zum Paradies

Medical Nemesis

Seamus O’Mahony, a gastroenterologist from Cork, has written the most devastating critique of modern medicine since Ivan Illich in Medical Nemesis in 1975. O’Mahony cites Illich and argues that many of his warnings of the medicalisation of life and death; runaway costs; ever declining value; patients reduced to consumers; growing empires of doctors, other health workers, and researchers; and the industrialisation of healthcare have come true. There is a widespread feeling that medicine has lost its way, and Can Medicine Be Cured? The Corruption of Medicine, which has been published this month, describes the loss. The book is as readable as O’Mahony’s last book The Way We Die Now, and the book provides a strange cocktail of pleasure and despair.
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Aufruf zum Aufstand der Heilberufe

Do Hospitals Still Make Sense? The Case for Decentralization of Health Care

From their humble origins as charitable almshouses for the poor and destitute who could not afford to receive care at home, hospitals have evolved into large, profitable, expensive, technology-laden institutions at the epicenter of the health care universe. Almost every community has at least one general centralized hospital, and most have more than one — with those that don’t being considered “underserved” or “frontier” communities, and with the hospitals in such communities sometimes receiving the designation of “critical access.” But health care is changing. The exponential growth of digital and virtual health, the deployment of advanced technology deeper into the community, and the movement of higher-acuity care into the outpatient environment create opportunities to shift from a large, centralized health care system to a smaller, faster, more cost-effective one in which health care is more accessible, more affordable, more personal, and closer to home.
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Could artificial intelligence make doctors obsolete?

Verallgemeinerung oder Wie viele Körner ergeben einen Haufen?

Neulich war ich am Flughafen in Stuttgart. Ein Sicherheitsmann suchte in meinem Koffer nach Spuren von Sprengstoff. Und ich beschwerte mich. Immer werde ich rausgegriffen. Warum eigentlich? Der Mann sagte, das sei reiner Zufall. An mir sei gar nichts Besonderes, wirklich nicht. Ganz anders wäre es, wenn ich dunkle Haut und einen Bart hätte, dann könnte ich jedes Mal mitkommen. "Die nehmen wir immer", sagte er. Er meinte das nett, ein bisschen wie: Sie gehören gar nicht in das Raster unserer Vorurteile.
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Shared Decision

End the culture of fear in healthcare

Navjoyt Ladher, The BMJ

A key finding of the independent report into deaths at Gosport War Memorial Hospital, where around 600 people received fatal and medically unjustified doses of opioids, was a hospital culture of uncritical deference to doctors and a fear of raising concerns. In an essay this week Philip Darbyshire and David Thompson issue an urgent call for the report to serve as a tipping point in ending professional hierarchies in clinical practice (doi:10.1136/bmj.k4270). Subservience and deference, endemic in health systems, are harming patients, they say, with professionals fearing retribution, disapproval, career limiting consequences, and worse if they dare to question or challenge colleagues.

How do we begin to dismantle the deeply embedded hierarchies of status and profession? Darbyshire and Thompson find answers in the existing evidence base for strong leadership to create safe, open, questioning healthcare organisations, where patients and families are included in decisions, and bad behaviour is not tolerated, no matter the rank. “We do not need more research,” they argue, “we need more leaders with the courage and creativity to implement what we already know.”

Courageous and creative leadership is essential to tackle issues discussed elsewhere in The BMJ, be that taking action on climate change (doi:10.1136/bmj.k4410), providing healthcare to forced migrants (doi:10.1136/bmj.k4200), having honest conversations about what intensive care can achieve (doi:10.1136/bmj.k4135), or dealing with the drivers of chronic diseases, such as diabetes. On this last point, a feature this week looks at the emerging specialty of lifestyle medicine (doi:10.1136/bmj.k4442). Practitioners use behavioural approaches to encourage change in diet, physical activity, sleep, stress management, and substance use. It offers a promising and sustainable approach to treating and preventing disease and is increasingly becoming part of the medical student’s curriculum. Critics say, however, that it needs to prove it can truly make a difference to patients’ lives, particularly in the context of wider social determinants of health.

The importance of preventive approaches in health is reflected in the inclusion of “prevention and lifestyle” as one of six new categories in The BMJ Awards next year (doi:10.1136/bmj.k4434). The awards, now in their 11th year, celebrate excellence in UK healthcare. Do enter, or nominate a colleague, if you have a project worthy of recognition (thebmjawards.bmj.com).

Follow BMJ Editor Fiona Godlee on Twitter @fgodlee and the BMJ @bmj_latest

Der Fürst

Gegensätzliche Meinungen

Doping im Fussball

Doping bringt nichts im Fußball! Diesen Eindruck versucht die Fußball-Branche seit Jahren zu erwecken. Jetzt hat auch noch der Mann mit den „sehenden Händen“ diese Position eingenommen. Weshalb sich die Frage aufdrängt, wo Dr. Hans-Wilhelm Müller-Wohlfahrthingeschaut hat in den vergangenen vierzig Jahren. Oder wo er nicht hingeschaut hat, wenn seine Hände fühlten, was mit den Muskeln seiner Profis los war. Um dem berühmten Arzt gerecht zu werden, muss man die kolportierte These eingrenzen. Müller-Wohlfahrt hat in einem Interview mit der „Zeit“ lediglich Binsenweisheiten von sich gegeben: Aufputschmittel leerten den „Akku“, im nächsten Spiel folge ein „Leistungsabfall“. Und Muskelberge raubten den Spielern „Elastizität“ sowie „Leichtigkeit“.
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Wie Netzwerke die Demokratie zerstören ...

Patientenversorgung unter Druck

Patientenversorgung unter Druck by Prof Dr Dr Ernst Hanisch on Scribd

Das Jahrhundert des Patienten

Eine effiziente Gesundheitsversorgung braucht gut informierte Ärzte und Patienten. Das Gesundheitssystem, welches uns das 20. Jahrhundert hinterlassen hat, erfüllt beide Bedürfnisse nicht. Viele Ärzte und noch mehr Patienten verstehen die verfügbaren medizinischen Daten und Forschungsergebnisse nicht. Sieben „Sünden“ sind mitverantwortlich für diesen Wissensmangel: profitorientierte Finanzierung, irreführende Berichterstattung in medizinischen Zeitschriften, einseitige Patientenbroschüren, irreführende Berichterstattung in den Medien, Interessenkonflikte, defensive Medizin und Lehrpläne an den medizinischen Fakultäten, die Ärzten die Interpretation statistischer Evidenz nur unzureichend vermitteln. Mehr

Give a voice to the voiceless

Kamran Abbasi, The BMJ

Rudolf Virchow’s investigation of a typhus epidemic in 1848 identified a root cause: “The power of the aristocracy, propped up by the church.” Big business is today’s aristocracy, politicians and the state today’s church. In society’s pursuit of wealth and profit, it is poor people who carry the greatest burden of disease, whose deaths are most likely when fire engulfs a tower block, the levees break in New Orleans, or a Titanic sinks.

After last week’s fire in London’s Grenfell Tower Martin McKee recalls Virchow to urge us not to ignore the political and commercial determinants of public health (doi:10.1136/bmj.j2966). Inadequate safety measures, despite warnings from residents, contributed to and probably caused 79 people to be dead or missing. This was a political failure leading to avoidable deaths and, says McKee, “it is impossible to achieve a comprehensive understanding of events such as Grenfell Tower without confronting the political determinants of health and challenging the forces that shape them.”

One solution might be to put an end to high rise living. An area might be regenerated by demolishing a “sink estate” that includes high rise buildings and replacing it with luxury apartments and low rise, affordable housing. But this would be a form of “social cleansing,” explains Anna Minton (doi:10.1136/bmj.j2981). The volume of new affordable housing is invariably too small, with a net loss of 8000 social homes in London in the past decade. Indeed, most residents “love” their tower blocks, but their experience is sullied by forces outside their control, from broken lifts to lack of security. The issue is less with the tower blocks themselves and more closely related to socioeconomic factors. “At a time of huge worry and uncertainty,” writes Minton, “threats to demolish people’s homes cannot be helping.”

Inequality and the vulnerabilities of poor people find an echo in our research section. Bochen Cao and colleagues (doi:10.1136/bmj.j2765) grouped countries by Human Development Index and examined the effect of variation in cancer death rates on longevity. Countries with the greatest resources benefited most in life expectancy as a direct result of improving cancer mortality. In an accompanying commentary (doi:10.1136/bmj.j2920), Mary Louise Tørring acknowledges the inequalities at play, and proposes priority funding for poor countries and for women, but wonders whether these new findings “might also prompt us to think more about cancer as a natural ceiling on human longevity rather than as a rising epidemic.”

A key message here, from a devastating fire in a London tower block to patchy global progress in longevity, is that health professionals have a responsibility to ensure that the weak are not silenced, ignored, or discounted. We must, in the words of McKee, with a nod to Virchow, give voice to the voiceless.
Follow BMJ Editor Fiona Godlee on Twitter @fgodlee and the BMJ @bmj_latest

Bloodlands - In Erinnerung und Trauer um die vielen Opfer der Sowjetunion, die dem Vernichtungsfeldzug Hitlers zum Opfer fielen

Labor omnia vincit – Die Arbeit besiegt alles

ZEIT ONLINE: Labor omnia vincit – Die Arbeit besiegt alles –
haben Sie sich tätowieren lassen. Was bedeutet Arbeit für Sie? 

Porombka: Diese Tätowierung beruht auf einem Stempel,
den der Ameisenforscher Auguste Forel in alle seine Bücher
hat reinmachen lassen. Auch ich stemple damit meine Bücher.
Und diesen Stempel habe ich mir dann auch auf den Arm machen lassen.
Das Ameisenmotiv ist so wichtig, weil die Arbeit der Ameisen
eine ist, wo ganz viele kleine Lebewesen kleine Stücke
zusammenbauen und an etwas Größerem bauen, von dem
sie nicht wissen, dass sie daran bauen. Ein emergentes
Phänomen also. Das finde ich total faszinierend. Forel hat
seine ganzen Bücher als kleine Ameisen verstanden, die an
etwas Größerem arbeiten. So ist es ja auch mit Twitter als
Kulturphänomen oder Artikeln, die Sie schreiben.
Wir schreiben alle an einem großen Text und das ist die Arbeit. 

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Population growth explained with IKEA boxes

Explaining population growth requires simplification, but not oversimplification.
In this TED video, Hans Rosling explains why ending poverty – over the coming decades – is crucial to stop population growth. Only by raising the living standards of the poorest, in an environmentally-friendly way, will population growth stop at 9 billion people in 2050.

Don’t Panic – The Facts About Population

This is a free documentary for a fact-based worldview. The visualizations & stories in this film were originally developed by Gapminder. The data-sources are listed here.
It was first broadcasted on BBC on 7th of November 2013.
Director & Producer: Dan Hillman. Executive Producer: Archie Baron. ©Wingspan Productions for BBC, 2013.

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