Caroline White

Suspected research fraud: difficulties of getting at the truth.

When research misconduct is suspected and the researcher is working outside the jurisdiction of official research bodies, there is nowhere for editors to turn. If they want to investigate their concerns, they are invariably forced to go it alone—a lengthy, costly, and difficult process

Assisted dying: law and practice around the world

Several countries in Europe and in North and South America already allow doctors to help patients end their lives. Caroline White, Owen Dyer, and Aser García Rada report

What do you think is a non-disease?

Editor—The BMJ ’s decision to extend participatory democracy to the question of disease is important not so much for the results but because it happened at all. To a previous generation the idea of asking consumers to decide on these matters would have been incomprehensible. Doctors decided which conditions were legitimate and which should be consigned to the outer darkness. In the debate about the nature of neurasthenia at the end of the 19th century all protagonists were in the medical profession and their debates were published in journals. The views of a few well educated and well heeled patients may be inferred from diaries and fiction, but their voices were largely unheard and unheeded. Now of course medical authority is in retreat everywhere and the final arbiter of “non-disease” is fast becoming the patient. All this is well and good, so why the outrage of so many respondents? I suspect it comes from a failure to recognise the different concepts of illness and disease. Taking chronic fatigue syndrome as an example from the debate, few could now question that it is indeed an illness. It has a nosological status and is clearly associated with suffering, ill health, and disability. The patient’s voice must be and is paramount. But is it a disease—that is, has a specific pathological process been identified to account for the above? Chronic fatigue syndrome is not yet a disease because no unambiguous evidence has yet been presented that has commanded widespread acceptance by the scientific community, which remains the arbiter. Of course, the syndrome may plausibly make the transition from illness to disease like many other illnesses have done. Or it may not. The traffic is not entirely one way in which illness entities inevitably receive the stamp of scientific approval, usually after a period of being falsely labelled as psychological. Previously apparently sound entities have lost their disease status under the cold light of scientific scrutiny. The concept of labelling also generated a lot of heat in this debate. People behave according to the labels that are ascribed to them, a process seen as largely negative. Some respondents rightly echo this, citing examples in which the act of labelling distress as something medical (pathological) carries with it a host of adverse consequences. w1-w8 But more commonly the act of giving a name to symptoms and disability brings relief. The acknowledgement by the medical profession that a patient’s condition has a name and is a legitimate illness is immensely reassuring and enabling. It also ends the battle of diagnosis—“If you have to prove you are ill you can’t get well.” Giving a condition a name is an intervention in itself with costs and benefits. Crudely handled, medicalisation can perpetuate disability and exclusion. But used constructively and appropriately it is the first step towards recovery.

Was there ever a golden age for junior doctors

As junior doctors prepare for a new contract after fighting the government’s attempt to make them work more unsociable hours without extra pay, Caroline White asked seven doctors how the job today compares with being a junior doctor in the past

Brain circuitry model for mental illness will transform management, NIH mental health director says.

The field of mental health is on the cusp of a revolution, which is set to transform the diagnosis and treatment of mental illness and reverse the lack of major progress made in curbing associated ill health and death over the past 100 years, the director of the US National Institute of Mental Health, has claimed. “We are at an extraordinary moment when the entire scientific foundation for mental health is shifting, with the 20th century discipline of psychiatry becoming the 21st century discipline of clinical neuroscience,” Thomas Insel said before a meeting on the challenges facing mental health research at the Royal Society in London on 31 August. But those looking for magic bullets will be disappointed. “There …

Plagiarism detection service to be launched in June.

Editors of scientific journals will soon have a new weapon at their disposal in the fight against research misconduct, delegates at the annual meeting of the Committee on Publication Ethics, held in London last week, were told. Scheduled for launch in June, researchers and editorial staff will be able to access CrossCheck, a plagiarism detection service, offered by the independent publishers’ membership association CrossRef. CrossRef is a collaborative reference linking service that functions as a sort of digital switchboard for articles from several hundred scholarly and professional publishers. Each item has …

Stronger grip on overheads and increased productivity could save NHS hospitals £5bn a year

A stronger grip on overheads, particularly workforce costs, and increased productivity could save NHS hospitals up to £5bn (€6.8bn;

Ranjit Chandra: how reputation bamboozled the scientific community.

7.7bn) every year by 2020, finds an interim review of operational efficiency in the health service in England, published on Thursday 11 June.1 The review was carried out by the life peer Patrick Carter, chair of the NHS Procurement and Efficiency Board, at the behest of the health secretary for England, Jeremy Hunt.2 The review’s findings were based on the detailed spending of 22 hospital trusts in England, selected to represent the range and geography of secondary care organisations across the country. The review concluded that there was ample scope for substantial savings to be made in four key areas—workforce; hospital pharmacy and medicines; estates management; and procurement—which could help the NHS reach its target of saving £22bn by 2020. Workforce was a …

London hospital says it will continue to offer HIV tests to all accident and emergency patients after trial.

The BMJ has just retracted a paper published in 1989. Caroline White reports on the longstanding concerns about Chandra’s work and the difficulties in getting to the truth

UK hip fracture audit shows wide variation in standards of care

A London hospital has begun offering bloodless HIV tests to every adult patient attending its accident and emergency department, in a bid to curb onward transmission of the infection in the capital, where rates are among the highest in the United Kingdom. Figures from the Health Protection Agency, published at the end of last year, indicate that a quarter (26%) of the estimated 86 500 people infected with HIV in the UK are unaware that they are infected. By 2012 the number of diagnosed and undiagnosed cases in the UK is expected to reach 100 000. Since the end of January Chelsea and Westminster Hospital has been routinely offering an HIV test to emergency care patients aged between 16 and 67 who are able to be tested. HIV tests are normally routinely offered in the NHS only to pregnant women …