Real versus rubbish evidence based medicine. A meeting of EBM heroes.

Find the original blogpost here

January 21, 2014 | jeremyhowick | 0 Comments
by Jeremy Howick, Oxford Centre for Evidence Based Medicine

Rethinking Evidence-Based Medicine: from rubbish to real

Trish Greenhalgh, an EBM critic, recently challenged Carl Heneghan on Twitter to promote real EBM, as opposed to the rubbish version. In response Carl proposed a meeting, for which I had the great pleasure (and stress!) of facilitating. There were quite a few EBM bigwigs, and as @mgtmccartney noted, the room was full of heroes such as Druin Birch, Jon Brassey, Martin Burton, Hasok Chang, Iona Heath, Richard Lehman, Mike Kelly, Neal Maskrey, Margaret McCartney, Rory Milne, and Des Spence. Details have been storified on Twitter so I won’t repeat them here.

To me (and not necessarily others in the group) the meeting revealed serious problems:

1. Too much evidence is flawed (out of date, financially conflicted, and suffering from publication bias).
2. This flawed evidence is used (often via guidelines) as a stick to beat clinicians. If your doctor doesn’t follow the guideline (even if you and your doctor don’t think it is best) the doctor risks being accused of malpractice and having their picture on the cover of the newspaper. For example the entire population is being ‘statinized’ in spite of little evidence for benefit (apart from those who have had heart attacks). Using guidelines as sticks for beating clinicians takes away patient choice, prevents critical thought, and hinders doctors’ ability to care for patients.
3. Evidence (good and bad) is presented in a way that doctors and patients do not understand. Tiny effects aremisleadingly represented as (seemingly larger) relative effect sizes. This leads to vast overuse of drugs such as statins.

To add insult to injury, producing this flawed evidence costs billions of dollars and millions of hours to produce.

But all clouds – even the big ones revealed at this meeting – have silver linings. Besides the problems, the meeting and its reaction demonstrated that there are many energetic people committed to real EBM because they care deeply about patients.

If you would like to help promote real and not rubbish EBM watch this space, The meeting was only intended to be a small first step and more will follow. (And if you haven’t signed up to the alltrials campaign do it now.)

Human Development Capabilities Approach Annual Conference: Athens 2-5 September 2014

Call For Papers

---

HDCA 2014 Annual Conference
Human Development in Times of Crisis: Renegotiating social justice

---

Important deadlines:

• Submission of proposals: March 15th 2014
• Announcement of acceptance/rejection: May 15th 2014
• Registration with early–bird-fee: July 10th 2014
• Submission full papers/posters to be included on the conf. CD: July 31st 2014
• Final deadline for conference registration (with regular rates): August 20th 2014

How to submit your proposal
Please submit your proposed poster, paper or panel using the appropriate form HERE !

Download the Call for Papers with full instructions here.

Special Topics of Interest:
The HDCA conference aims to bring together people from all over the world from different disciplines and fields interested in the field of human development and the capabilities approach. Papers on the 2014 conference may explore amongst others, the following topics:

Topic	Description
Policy analysis	Critical social policy, Social crisis, common good. "Late" capitalism, social problems, participation. Social inequality, poverty, social exclusion. Welfare production, social organisations, social services. Disadvantage, suffering, human security. Social movements, social protest, dynamics of civic society. Children – social beings and social becomings. Programs of enhancing capabilities.
Theoretical developments of the capability approach	Theoretical developments and research methodology. Social justice, equality, social inclusion. Human flourishing, well-being, components of a good life. Gender equality, feminist perspectives. Bildung, education, agency. Environmental and ecological justice, sustainable human development.
European challenges	European development, social quality, social cohesion. Migration, transnational mobility, refugees. Unemployment, marginalisation. Social prejudice, discrimination, conflict. Heterogeneity, diversity, disability. Fragmentation of Europe: democracy and austerity.

Oxford - Ethox Centre Visiting Fellowship 2014

CAROLINE MILES VISITING SCHOLARSHIP

THE ETHOX CENTRE

UNIVERSITY OF OXFORD

The Caroline Miles Visiting Scholarship is funded by the Ethox Foundation and is awarded annually to a post-doctoral or early career researcher to visit the Ethox Centre, University of Oxford.

The value of the scholarship is up to £2000.

Visiting Scholars will spend up to a month working at the Ethox Centre in Oxford, pursuing a research project on a topic relating to one of the Ethox Centre’s four main research programmes: global health ethics; clinical ethics; public health ethics; research ethics. Scholars will be expected to make a presentation on their research toward the end of their stay.

Deadline: 14th April 2014

For more information on how to apply visit: www.ethox.org.uk

Contact:

Dr Angeliki Kerasidou

Director of Caroline Miles Scholarship Scheme angeliki.kerasidou@ethox.ox.ac.uk

MSc + PhD Fellowships Global health and social justice Deadline 31 Jan 2014

King's College London 

MSc / PhD in Global Health & Social Justice

Applications for this programme entry 2014 are now open.
MSc + PhD  Fellowships (ESRC & AHRC) deadline January 31st 2014  

Who is the programme for?

The growing movement for global health seeks to address inequalities in health, disease, disability and medical care internationally. This innovative MSc / Phd programme is designed for those seeking high-level skills in the critical analysis of the drivers of global health inequalities, the politics, practices and ethics of the global health movement and the efficacy of alternative approaches.

The MSc in Global Health and Social Justice is ideal for health professionals, policy makers and shapers, those who work in governmental and non-governmental organizations, and anyone wishing to develop a more rigorous understanding of the field. It builds capacity for critically assessing the practices required to address global health from the perspective of social justice.

The PhD programme in Global Health and Social Justice is for outstanding candidates who seek to push forward the boundaries of knowledge in regard to the empirical or ethical aspects of global health and health justice.  Single as well multi-disciplinary approaches are welcomed.  Philosophical research can include the philosophy of human rights, health and social/global justice, theories of justice, health inequalities, causation and justice, and so forth.

Why does it matter?

The appalling inequities in mortality, disease, disability, and medical care between and within countries as well as global regions result from a complex mix of social, economic and political factors. Medical and health care advances are often extending the healthy lives of the wealthy few, yet millions sicken and die for want of basic health and social facilities, often hampered by ineffective and non-responsive political systems.  The increasing acknowledgement of social determinants of health move the scope of analysis and action much beyond medicine and healthcare policy.

From the World Health Organization to multiple NGOs, global pharmaceutical companies and the new generation of philanthropists, the global health movement is growing. It is challenged by a variety of grass roots movements that start from different premises and advocate very different practices of intervention. Improving global health requires a new generation of individuals who understand the many complex dimensions of health, healthcare, and global institutions and processes as well as who can reason ethically about the many difficult moral dilemmas present.

What is unique about this programme?

- An emphasis on social/global justice and the development of key critical skills for analysis, research, policy development and the ethical assessment of health and disease inequalities.

- Taught by internationally recognised experts within a world-leading Department of Social Science, Health and Medicine, drawing on the unrivaled strength of King’s College London across disciplines including sociology, anthropology, cultural geography, gerontology, political philosophy, ethics and political science.

- Provides the opportunity for advanced social science analysis of key issues, such as psychiatry and mental health, ageing, war and trauma, pharmaceuticals, pandemics and biosecurity, and the political economy of health.

-Builds on the Department’s close collaboration with the King’s Centre for Global Health and the King’s Regional Institutes, particularly Brazil, China and India.

- Taught in the heart of London, at the Strand Campus on the banks of the Thames, with immediate access to organizations and agencies relevant to global health and to London’s key cultural activities.

Funding opportunities?  

ESRC Funding  (31st January 2014 deadline)  MSc / MSc + PhD

THE King’s Interdisciplinary Social Science Doctoral Training Centre (KISS-DTC) is awarding a number of ESRC-funded postgraduate research studentships to support doctoral research and training in the social sciences at King’s, for students starting from September 2014.

The deadline for the next round (for funding to commence Sept/Oct 2014) of studentships is 17:00 GMT 31 January 2014. Please note that this deadline is absolute.

Studentships for the 2014-15 academic year are available for +3 doctoral studentships, and for 1+3 Masters and PhD studentships. For more information on eligibility and how to apply, please visit the relevant page.

Successful UK nationals or residents of 3 or more years will receive full funding.
Successful EU nationals will have fees covered, and may receive additional stipends.

AHRC Funding (31st January 2014 deadline)  PhD 3+

The London Arts and Humanities Partnership (LAHP) is pleased to invite applications from outstanding candidates for AHRC/LAHP Doctoral Training Awards for 2014-15 entry.

Up to 80 studentships are available for postgraduate research students studying Arts & Humanities subjects at King's College London. This funding includes work in the fields of history, philosophy, ethics, political science and international relations. Full details can be found on the KCL Graduate School Website;

http://www.kcl.ac.uk/study/pg/funding/sources/ahrc.aspx

Successful UK nationals or residents of 3 or more years will receive full funding.
Successful EU nationals will have fees covered, and may receive additional stipends.

Wellcome Trust  Ethics & Society PhD Studentship

Next deadline 2 April 2014

http://www.wellcome.ac.uk/Funding/Society-and-ethics/funding-schemes/Doctoral-Studentships/index.htm 

King's Funding Database

The College's Graduate Funding Database also has more details of funding schemes which you may be able to apply for.

http://www.kcl.ac.uk/graduate/funding/database/

http://www.kcl.ac.uk/study/pg/school/funding.aspx

For other funding opportunities and general queries related to studentships and doctoral places, please see the KCL graduate school website:http://www.kcl.ac.uk/study/pg/school/index.aspx

Alternative Funding guide
http://www.kcl.ac.uk/study/pg/funding/sources/alt.aspx

Funding graduate studies in the UK
http://www.prospects.ac.uk/funding_postgraduate_study.htm

How do I find out more?

For more information contact sridhar.venkatapuram@kcl.ac.uk

http://www.kcl.ac.uk/sspp/departments/sshm/study/globalhealth.aspx

Programme from Medellin Conference on Social Justice, Human Rights and Health Equity 27 -29 November 2013

I spoke at a conference last week in Medellin, Colombia where I learned a lot about the intellectual and political perspectives on health justice.  I am putting up the programme here so that more people can become aware of the distinguished researchers and topics of concern in the region.  It should also be noted that this was a conference organized by the Faculty of Public Health, which has a strong commitment to social justice.

The original progamme and information about the conference can be found here.


50th Anniversary of Facultad Nactional de Salud Publica Hector Abad Gomez
Medellin, Colombia
Social Justice, Human Rights and Health Equity  27 -29 November 2013

Programming Congress

Published on Friday, 10 May 2013 15:21 | Written by Administrator | Views: 3397

DAY 1 Wednesday, 27 November

Key issues: HUMAN RIGHTS AND EQUITY IN A GLOBAL PERSPECTIVE OF JUSTICE 

8:00 am-9: 00am	Opening
9:00 am-9: 45am	Inaugural Conference. Subject, dignity, and social justice society from an ethical reflection  Jorge Iván González, Universidad Nacional de Colombia
9:45 a.m. to 10:30 a.m.	The public health regarding the conditions of justice, equity and human rights in Latin America. Historical Perspective. Ana Maria Carrillo Forge, National Autonomous University of Mexico
10:30 a.m. to 11:00 a.m.	Break
11:00 a.m. to 11:45 a.m.	Economics, equity and global justice. Joan Benach Rovira, University Pompeu Fabra, Barcelona, ​​Spain.
11:45 a.m. to 12:30 p.m.	Human rights, global justice and health. Alvaro Franco, University of Antioquia, Colombia
12:30 p.m. to 2:00 pm	Break
2:00 pm-3: 45 pm	2:00 pm-3: 45 pm	2:00 pm-3: 45 pm	2:00 pm-3: 45 pm	2:00 pm-3: 45 pm	2:00 pm-3: 45 pm
Room 1	Room 2	Room 3	Room 4	Room 5	Room 6
2nd Pan American Congress of Health and Environment: Justice and equity in environmental health	Deepening Panel: Human Rights and equality in a global justice perspective	Round table: Disputes over the right to health (View more ..)	Round table: social justice and equity in mental health	Round table: International Health.The Primary Health Care, a comprehensive strategy in conflict with market reforms in health ( Learn more )	Round table: Healthy Cities as a contribution to social justice
3:45 pm-4: 3:00 p.m.	Break
4:15 pm-6: 00 pm	4:15 pm-6: 00 pm	4:15 pm-6: 00 pm	4:15 pm-6: 00 pm	4:15 pm-6: 00 pm	4:15 pm-6: 00 pm
Room 1	Room 2	Room 3	Room 4	Room 5	Room 6
2nd Pan American Congress of Health and Environment: Justice and equity in environmental health (research and experimentation)	Presentation of research and experiences related to the topic of the panel of deepening	Presentation of research and experience related to the subject table	Presentation of research and experience related to the subject table	Continued: Round table in International Health ( Learn more )	Continued: Round table Healthy Cities

DAY 2 Thursday, 28 November

Key issues: JUSTICE, RIGHT TO HEALTH AND CITIZENSHIP

8:00 am-8: 30am	Synthesis frame first day and second day
8:30 am-9: 30am	The debate on global justice and its relation to human rights and equity. Francisco Cortés, Universidad de Antioquia, Colombia
9:30 a.m. to 10:30 a.m.	Justice based on achievement: implications for social rights. Sridhar Venkatapuram, King's College London, England
10:30 a.m. to 11:00 a.m.	Break
11:00 a.m. to 11:45 a.m.	Citizenship and the right to health in Latin America: the tension between market reforms in health and fundamental rights. Alcides Silva de Miranda, Brazilian Center for Health Studies (CEBES), Brazil
11:45 a.m. to 12:30 p.m.	The key legal justice: poverty, social rights and the right to health. The scope of protection under international law. Paola Bergallo, Universidad de San Andrés, Argentina
12:30 p.m. to 2:00 pm	Break
2:00 pm-3: 45 pm	2:00 pm-3: 45 pm	2:00 pm-3: 45 pm	2:00 pm-3: 45 pm	2:00 pm-3: 45 pm
Room 1	Room 2	Room 3	Room 4	Room 5
2nd Pan American Congress of Health and Environment: Justice and equity in environmental health	Deepening Panel: Justice, the right to health and citizenship	Round table: The right to health at work (Learn more ...)	Round table: Inequities in health (View more ..)	Round table: International Health. The Primary Health Care, a comprehensive strategy in conflict with market reforms in health
3:45 pm-4: 3:00 p.m.	Break
4:15 pm-6: 00 pm	4:15 pm-6: 00 pm	4:15 pm-6: 00 pm	4:15 pm-6: 00 pm	4:15 pm-6: 00 pm
Room 1	Room 2	Room 3	Room 4	Room 5
2nd Pan American Congress of Health and Environment: Justice and equity in environmental health (research and experimentation)	Presentation of research and experiences related to the topic of the panel of deepening	Presentation of research and experience related to the subject table	Presentation of research and experience related to the subject table	Round table below: International Health

DAY 3 Friday November 29

Key issues: SOCIAL DETERMINANTS AND DETERMINATION: IMPLICATIONS FOR PUBLIC HEALTH FROM THE SOCIAL JUSTICE

8:00 am-8: 30am	Synthesis second day and third day framing
8:30 am-9: 30am	Conference: Social determinants of health: what is the proposal for social justice? Carissa Etienne, Director Pan American Health Organization
9:30 a.m. to 10:30 a.m.	The social determinants of health: a view from social justice and human rights. Jaime Breilh, Universidad Andina Simón Bolívar, Ecuador
10:30 a.m. to 11:00 a.m.	Break
11:00 a.m. to 11:45 a.m.	The theoretical problem of equity in health. Mario Hernandez, National University of Colombia.
11:45 a.m. to 12:30 p.m.	Social justice, human rights and health equity: implications for public health. Fernando Penaranda, University of Antioquia, Colombia
12:30 p.m. to 2:00 pm	Break
2:00 pm-3: 45 pm	2:00 pm-3: 45 pm	2:00 pm-3: 45 pm	2:00 pm-3: 45 pm	2:00 pm-3: 45 pm
Room 1	Room 2	Room 3	Room 4	Room 5
2nd Pan American Congress of Health and Environment: Justice and equity in environmental health	Panel depth: determinants and social determination, implications for public health from the social justice	Round table: The right to health sector reforms in Latin America	Round table: The importance of the history of public health (View more ..)	Round table: International Health. The Primary Health Care, a comprehensive strategy in conflict with market reforms in health
3:45 pm-4: 3:00 p.m.	Break
4:15 pm - 6:00 pm	Plenary Congress closing statement and closing

The most important infographic in global health

Find the original source on wired.com here

This is the most important infographic and image in global health right now.

I usually do not write commentary on this blog, preferring to just reblog.  However, this image is hugely important.  Other people have found this image, including Bill Gates's twitter feed.  Which is unlikely to have been sent by him, and largely misses the importance of this image.

The value of DALYs, which this infographic is based on, is that it seeks to measure the loss of life years across all human beings (humanity) due to premature death and morbidity.  It has many controversial aspects that are still open for debate, and it is often used in cost-effective analysis which is also questionable.  However, the really exciting thing about DALYs, and the important aspect of the work of the Institute of Health Metrics at the University of Washington, is that they make concrete the amorphous notion of suffering of the global poor/third world/ global health.  If want to know the GDP of a country, there are measurements that all feed into one number.  If you want to know a nation's debt, there is a number.  But if you wanted to know what a country's health looks like, or the health of all human beings in the world, there was no number, no picture.

This is the first image that I have seen that truly makes concrete how much of human lives are lost because of premature mortality and morbidity.  It also identifies the causes.  And, now, we can start a more informed global public discussion about what are the causes, how much will healthcare solve this problem, and how much do we have to go beyond healthcare and health systems to reduce this loss of human life years.  Once you understand that a preventable loss of a year of life is the preventable loss of one human being's ability to live a life they would like, the question of justice comes to the forefront.

Other people just see a list of diseases and lack of healthcare.  That is a real shame.

Want to Save Lives? You Need a Map of What’s Doing Us In

• BY LEE SIMMONS
• 11.15.13
• 9:30 AM

If sorrow were a landscape, here’s how it would look from a cruising altitude of 30,000 feet. This graphic maps the global cost of early mortality—some 1.7 billionyears of human life forfeited annually—sorted by cause of death. That’s 1.7 billion years of harvests and weddings, of factory work and music lessons and novels and new ideas that were supposed to happen and now won’t.

Infographic by Thomas Porostocky  |  Source: Institute for Health Metrics and Evaluation

And get this: Worldwide, about 40 percent of that toll results from disorders (shown in yellow above) that could be avoided with basic medications, clean water, and neonatal care. As you read this, 3,000 young kids are dying from diarrhea that a few zinc tablets might have stopped. Cost: 38 cents per life.

You might wish you hadn’t read that. But it’s the kind of insight that policymakers and NGOs need in order to focus health resources where they can do the most good. That’s why the Institute for Health Metrics and Evaluation at the Univer­sity of Washington created the massive database on which this graphic is based. Known as the Global Burden of Disease, it quantifies the incidence and impact of every conceiv­able illness and injury. Want to see your own odds of dying from gunshot or animal attack? You can go to the GBD Compare website and find out.

But IHME doesn’t just tally up death rates, it estimates the years of life lost (YLLs) from all those deaths: A fatal pneumonia infection at age 3 erases many more future birthdays than a heart attack at 80. Adding in years lived with disability, the database provides the most comprehensive measure we have of the burden of disease, in terms of lost human potential. It’s not a pretty picture.

Luckily, policymakers are paying attention. Well-targeted campaigns are reducing mortality from infectious diseases and birth complications throughout the world (as shown by the light shading in the picture above). While more than a million people still die of malaria each year, mostly children in sub-Saharan Africa, that number is down more than 20 percent since 2005.

These are just a few of the insights offered by GBD Compare. The interactive
visualization tool lets you drill down on that global map to compare regions and countries, spot trends, or slice the data by demographic groups. And because the data is structured hierarchically, you can set the resolution to zoom in for more detail or zoom out for big-picture comparisons. The basic inter­face is easy to use, but there’s a helpful video tutorial if you want to dig deeper into the toolbox.

Here are are few screenshots from the website itself. Don’t be thrown by the different color scheme; the “tree map” layout is basically the same as in the artist’s rendering above. The labels are a bit cryptic here, but if you visit the site you can run your cursor over the map to see full descriptive info for every tile.

A Dream Deferred: The Right to Food in America

Original link to Huffington post can be found here

A Dream Deferred: The Right to Food in America

Posted: 10/30/2013 5:03 pm

Follow

Hunger, Poverty , Farm Bill, Martin Luther King Jr., Food For Thought, Food Insecurity,Food Stamps, Hunger In America, Right To Food, Snap, Politics News

This year our nation commemorated the fiftieth anniversary of the March on Washington and Dr. Martin Luther King Jr.'s "I Have a Dream" speech, giving us all occasion to reflect on his civil rights aspirations and the extent to which they have been fulfilled. But the persistence of hunger in America today brings to mind Dr. King's other dream -- that of ending poverty and realizing the full spectrum of human rights, including the right to food.

Dr. King understood that social justice cannot be achieved without economic justice. In March 1965 he declared: "Let us march on poverty until no American parent has to skip a meal so that their children may eat." In the months before his assassination, Dr. King spearheaded nationwide efforts to launch a multiracial Poor People's Campaign. "We are coming to Washington," he said. "We are coming to demand that the government address itself to the problem of poverty."

Although he did not live to see the Campaign, those of us who believed in his dream carried it forward. In May 1968 thousands of people occupied the National Mall and demanded economic justice in the form of fair wages, decent housing, quality health care and education, and access to adequate food. Nearly fifty years later, this dream remains deferred for far too many Americans. Most starkly, we continue to treat access to food as a privilege, instead of as a fundamental human right.

The world over, freedom from hunger and access to sufficient, nutritious food are recognized as human rights. These ideas are not foreign to the United States; they were inspired by our government's commitment to ensuring "freedom from want" in the wake of the Great Depression. Now, more than ever, we must reclaim these values and ensure the right to food for all Americans.

Last month, the USDA reported that 49 million Americans live in "food insecure" households, meaning they cannot afford adequate food for themselves or their families. In other words, nearly one in six individuals in the richest country in the world is struggling to put food on the table. Hunger in the United States is not the result of a shortage of food or resources -- it is the direct result of poverty perpetuated through policies that fail to prioritize Americans' fundamental needs.

On the heels of the USDA report, the House voted to cut $40 billion over the next ten years from the Supplemental Nutrition Assistance Program (SNAP) -- the nation's largest anti-poverty program. Under the House version of the farm bill, 3.8 million individuals would lose their SNAP benefits in 2014 alone, and an estimated 210,000 children would be kicked off of free school lunch programs. On November 1, SNAP recipients will see an automatic decline in their benefits when a temporary boost to the program (voted in as part of the 2009 Recovery Act) ends.

The impact of these assaults on our nutrition assistance programs will be felt over a generation and possibly beyond. Children who do not receive adequate nutrition -- including prenatally -- are at risk of serious health and developmental problems. Hungry children struggle to learn in school and, according to a report by Feeding America, are far more likely to experience behavioral problems, increasing the chance that they will drop out of school and decreasing their lifetime earning potential. By failing to adequately feed our children, we are setting them up to fail.

This is a moral failing. It is also a violation of human rights.

As the House and Senate enter negotiations over the farm bill, we must call upon them to strengthen -- not undermine -- our food safety net. A recent study by the International Human Rights Clinic at NYU School of Law found that many food insecure households do not receive SNAP benefits because the program's eligibility requirements are drawn too narrowly. For households that do qualify, the benefits are simply insufficient to meet their food-related needs. On average, families on SNAP receive under $1.50 per person per meal.

We need to fortify SNAP, ensuring that it reaches all food insecure households and enables families to afford sufficient, nutritious food. In addition, we need to adopt and implement a national strategy to tackle the root causes of hunger in America today. At minimum, we must ensure a living wage so that individuals and families can provide for themselves.

Five years from now, when we commemorate the fiftieth anniversary of the Poor People's Campaign, we will inevitably ask ourselves: How far have we come in fulfilling Dr. King's other dream?

Let us act now to end hunger and ensure the right to food for all.

Rev. Jesse L. Jackson Sr., a former aide to the Rev. Dr. Martin Luther King Jr., is the president and founder of the RainbowPUSH Coalition.

Smita Narula is a human rights lawyer and professor and co-author of the studyNourishing Change: Fulfilling the Right to Food in the United States.