Your weekly BMJ digest – 06/5/17

Another week, another BMJ, but there is one thing you can rely on. During my many painful hours reading the BMJ, I’ve noticed a common thread – the BMJ is in love with Sweden. Whether it’s citing papers by the Swedish duo of Kecklund and Axelsson (see “Killer Night Shifts”) or name-dropping the Karolinska Institute whenever possible, the BMJ loves a bit of the blue and yellow. So much so, that the editorial article ends with the Bob the Builderesque inspirational quote “if Sweden can do it, so can we all.” For more on this sterile medical love affair read below…

Cover Story – The Swedes bare all: Ever wanted to know what your doctor has written about your creaky hip/dodgy discharge/disheartening BMI? Well, in Sweden you are now be able to. The Swedes have installed “Journalen,” an electronic medical record, which patients can access, in order to read their full medical summary. It is an effort to empower patients and keep them informed about their own health. Needless to say it is a big move and required legal change to implement. But 20 years since its inception in Uppsala the patient-accessible electronic medical record has hit the big-time and officially gone national with Stockholm finally signing on. No doubt there’ll be many research articles on its success/failure to follow and with its affinity for all things Swedish (who doesn’t love listening to a bit of ABBA whilst scoffing those little meatballs at Ikea?), I’m sure the BMJ will publish those articles at a later date.

Not satisfied giving the Swedish patient record its cover story, the BMJ has followed that article with another Swedish article, this time about the Karolinska Institute. It interviews Melvin Samson, a mover-and-shaker and gastroenterologist, who hops around medical institutions trying to improve them. His schemes improved the Radboud Centre in the Netherlands and now with massive reforms proposed in the Karolinska University Hospital (changing from a departmental/speciality format to a “patient pathway” instead), he’s trying to “put patients first.” There are, however, some damming things against this. Firstly only 3% of the Karolinska doctors have confidence in him, with a painful 59% saying they don’t have confidence (!) and secondly the reorganisation has been driven, to a certain extent, by making things most cost-effective. “Putting patients first” eh?

All that glitters is not gold: In a fascinating in-depth article co-authored by a Yale Medical Student (kudos Tyler Greenway), an analysis of the US drug market reveals some uncomfortable truths. The seminal US medical docu-drama, Scrubs, has provided essential education for UK clinicians as to the interplay between the pharmaceutical industry and US doctors. Drug companies have a lot more leeway in the US to woo their doctors with pens, gifts and even cold, naked money, but this article reveals that the drugs most aggressively promoted by drug reps in the US, don’t tend to make the lists of top-prescribed or top-selling medications in the US.

Perhaps more importantly, using a 5 dimensional analysis of the “therapeutic value” of medications, the researchers found that the most heavily promoted drugs were less likely to offer benefit when compared to top prescribed drugs. So if Zach Braff’s instructional monologues are beginning to fade, this article reminds us to remain informed and maintain a “healthy scepticism” when anyone (let alone a drug rep) tries to sell you anything too hard.

Here comes a smidge of science – Enjoy that bread roll: In a semiquantitative food questionnaire study of >100,000 individuals over a 24 year period, it was found that there was no significant increase in deaths from coronary heart disease in those people who freely ate gluten. Of course, the semiquantitative studies have their own limitations, not least the relatively subjective, unverifiable nature of responses.

Best of the Rest – Brexit and British Health: One of the key EU charters protecting public health and social rights may be lost in the fallout from Brexit’s “Great Repeal Bill,” with potentially devastating consequences. If the EU Charter of Fundamental Rights is not transcribed into British Law after Brexit, then safeguards may be lost, which protect public health concerns against manipulation by big industry. Last year the Charter helped maintain a judicial verdict to institute plain packaging for cigarettes despite clamour from the tobacco industry. It may be a brave new (scary and sickly) world post-Brexit if such legal defences vanish.

Pressure is no defence against negligence: We all know times are hard in the NHS but a latest RSM conference reveals that that would be no defence against negligence. Legal experts report that if a doctor were called up for negligence, the context of workplace pressure, overload and financial or time constraint would be unlikely to serve as an excuse. Most of us know anecdotal accounts of doctors being put in uncomfortable positions e.g. being asked to “act up” to fill rota gaps, but this article reminds us of the cold, hard legal position on what happens if things were to go wrong.

Chuckle of the week: With all the mess in the US this week, not least the start of the repeal of the Affordable Care Act, the best ironic, sobbing laugh in the BMJ comes from the deadpan interview with Mohammed Al-Ubaydli, Chief Exec of “Patients Know Best,” a British patient medical electronic record service. He says: 

“Swedish democracy is the kind where, when the government realises something is good it passes a law ensuring everyone does it. American democracy is the opposite.”