Opium and mortality

@HealthMed Opium is widely used internationally. A study from Iran just published in the British Medical Journal now reports almost doubling of mortality rates in regular users of opium.

Here are my comments to the Science Media Centre on this study:

"The key message in this prospective study on opiates is of interest to pharmacologists, health professionals and members of the public: use of recreational opium, whether raw or modified, smoked or swallowed, appears associated with increased risk of death from a wide range of diseases, including circulatory and respiratory disorders, and cancer.

"However the results need to be interpreted with caution. This work is from north-east Iran and may not be typical for other ethnically or genetically different individuals. The authors note that they cannot be sure whether the relationship is causative. And oddly, risks from opiates did not appear to be amplified in people with high blood pressure, smokers or diabetics, raising some questions about the accuracy of clinical data collection."

Although some commentators have linked findings of this study to use of medically prescribed or over the counter opiates, there are too many confounders for that to be a reasonable extrapolation from the BMJ study. Nonetheless the general principle remains that medicines should only be used when clinically indicated.

See more about the study and related comments on the New Zealand Science Media Centre site.

Health Policy and Technology launched by FPM and Elsevier

@HealthMed The Fellowship of Postgraduate Medicine, in partnership with international publisher Elsevier, has launched the first issue of a major new international journal - Health Policy and Technology.

The first issue includes a paper on the pioneering new Centre for Health Technology Assessment of Devices and Diagnostics within the UK’s National Institute for Health and Clinical Excellence (NICE), and papers on e-health from the USA, India and Europe. 

There is also the first of a series of interviews in print, online and as podcasts, with international leaders in the field of health policy and technology, beginning with Sir Michael Rawlins, Chairman of NICE.

The next policy maker to be featured in this series (June 2012 issue of HPT) will be Professor Gonzalo Calvo, former chair of the European Medicines Agency Cardiovascular Working Party, and Chair of the European Association of Clinical Pharmacology and Therapeutics, which represents the national clinical pharmacology societies from the 29 established and accession countries in Europe and their ~4000 clinical pharmacologist members.

Background to new journal and to the FPM.

From medieval pilgrims to 20th Century medicine

Medieval ward round in Siena Fresco

@HealthMed Opposite the cathedral in Siena is one of the oldest hospitals in Europe - Santa Maria della Scala.
Founded possibly as early as the latter part of the 9th Century, with its earliest record said to be 29th March, 1090, it remained in use as a hospital until the early 1990s, its success arising from its key location on the pilgrimage route to Rome.
It was set up to 'set up to care for pilgrims, assist the poor and provide for abandoned children'.
Frescoes on ward walls and ceilings areas provided interest for bed-fast patients. For current visitors they illustrate fashions in poor and wealthy, a major role for the hospital in feeding, educating (and arranging marriages) for the poor, and selected examples of early medical practice. These include examining a water sample, triage of the surgical patient (a young man with a serious, still bleeding, transverse wound on the right thigh), use of hydropathy (water therapy), and preparation for bad news - e.g. a ladder by which a series of babes are climbing to heaven. Patient consultations are attended by ward round retinues of varying size and seniority.
A plaque illustrates some of the sources of funding for the hospital - gifts of money, either in anticipation of a cure, or in thanks for treatment administered.
An early 20th century photograph shows very crowded rows of beds in the longest frescoed ward.

See article for more on Santa Maria della Scala.

Judges agree short-list for 2012 Hippocrates Awards for Poetry and Medicine

2012 judges Martha Kearney, Marilyn Hacker & Rod Flower FRS

@HealthMed In London on 4th April, after a lively discussion at the FPM, judges broadcaster Martha Kearney, Paris-based US poet Marilyn Hacker and medical researcher Professor Rod Flower FRS  agreed the short-list for the 2012 Hippocrates Awards for Poetry and Medicine. 

Judging was anonymous. In addition, to avoid runs of poems by the same poet, where there was more than one entry by the same poet, judges were not given poems in alphabetical order by surname of poet.
The 46 awarded and commended entries will be published in the 2012 Hippocrates Awards Anthology, to be released at the 2012 Hippocrates Awards in London, on Saturday 12th May.

The NHS-related short list includes one poet from Scotland and two from England. The Open international short-list includes one poet from the USA and two from the UK. Themes ranged from identity and immunity to psychiatry and alienation, and from global health to medicine in archaeology, and the role of women in health (see full details of short-listed names, biographies and judges comments below).

The judges also agreed commendations for 20 entries in the NHS category and 20 in the Open International category - 2 from Australia, 1 from New Zealand, 7 from the USA and 10 from the UK. Commended entries considered themes from birth to imaging, cancer, health and disease in art, history of medicine and illness in the family.

Awards will be announced by the judges on Saturday 12th May in London at an International Symposium on Poetry and Medicine at the Henry Wellcome rooms, with speakers and readers from the USA, France, Denmark, Russia, Cyprus, Greece and the UK.

Useful links

Key dates for the Hippocrates Initiative for Poetry and Medicine

Register for the 12th May Awards Symposium

Download programme for the 12th May Symposium

Open International and NHS-related short-listed and commended entries 

NHS-related short-list by entry title

Allogeneic   Andy Jackson
Claybury    Nick MacKinnon
Mr Blatný perseveres   Jane Kirwan

Top 20 commended NHS-related entries

I must speak for this man - Edward John Anderson
At the clinic - Neil Ferguson
Into the tunnel - Alex Josephy
A nurse's châtelaine - Alex Josephy
Sara's wig - Frances-Anne King
Anatomy - Jane Kirwan
Delivery - Jane Kirwan
Heal thyself - Jane Kirwan
Not raging - Jane Kirwan
Eighteen - Denise Kitchiner
These are the stories doctors tell - Jonathan Knight
A question for neuroscientists - Valerie Laws
Rorschach - Andrew Thomas Martin
Intensive care, Friday afternoon - Kev O'Donnell
Still birth - Janet Smith
The bones - Sarah Stringer
Shrink - Tricia Torrington
Whitby - Carol Whitfield
Syphilis II: Treponema pallidum - Alison Wood
The little mercury I have taken - Chris Woods

Open International short-list by entry title

Los Subiros - Shelley McAlister
The Edwin Smith papyrus - Kelly Grovier
Women’s Work - Mary Bush

Top 20 Commended Open International entries

A lobsterman looks at the sea - Richard Berlin
The lonely walk - Timothy Edward Brewis
Recent past events - Rafael Campo
Artifact - Amanda Carver
R-O-M-J-X - Martyn Crucefix
Heartburn - Claudia Daventry
Bone says  - Julie Dunlop
Post-traumatic stress disorder - Elizabeth Anne Gleeson
Ana and I - Natalie Ann Holborow
To an anatomical Venus - Matthew Howard
In the ward with my son - Leah Kaminsky
Careful - Kathleen M Kelley
Ablation - Connie Levesque
Birth - Renee Liang
Forensic pathology - Kona Macphee
District nurse - Alice Malin
Next of kin - Vicky Paine
Rembrandt - Lynn Roberts
Tomorrow will be a day beloved of your father & of you - Rosie Shepperd
Day off - Caroline Wilkinson

Further details on short-listed and commended entries for the 2012 Hippocrates Prize

A former nurse, a dentist, and an emerging US poet, are among six finalists for this year’s Hippocrates Prize for Poetry and Medicine - one of the highest value poetry awards in the world for a single poem. Themes ranged from medicine in archaeology to the role of women in new life science, and from health in the developing world to frailty and memory.

Now in its third year, the short-listed entries for the 2012 Hippocrates Prize for Poetry and Medicine have been selected by judges broadcaster Martha Kearney, distinguished US poet Marilyn Hacker and medical scientist Professor Rod Flower FRS, from over 1000 entries from 32 countries.

Rising US poet Mary Bush, academic and writer Kelly Grovier, who has published two poetry collections, and published poet and writer-in-healthcare Shelley McAlister have made the shortlist for the Open Category.

The prize, which has a £15,000 award fund, is split into two strands – an open category and an NHS category with both carrying a first prize of £5,000.

In the NHS section, medical librarian Andy Jackson is competing with retired dentist Jane Kirwan and former nurse Nick MacKinnon, for the major £5000 award.

The winners will be announced at an International Symposium on Poetry and Medicine at the University of Warwick on May 7th, which is being supported by the Fellowship of Postgraduate Medicine.

The judges also agreed commendations for 20 entries in the NHS category and 20 in the Open International category - 2 from Australia, 1 from New Zealand, 7 from the USA and 10 from the UK. Commended entries considered themes from birth to imaging, cancer, health and disease in art, history of medicine and illness.

Martha Kearney said: ‘Who would have thought that such beautiful poetry could be inspired by lab instruments, tissue engineering or MRI scans? It has been fascinating to sift through such an interesting range of work right at the very nexus of science and art.’

Rod Flower added: 'Like literary X-rays, these poems penetrate into the emotional structure of humankind’s age-old struggle against disease, whether it be at the hospital, the patient's bedside or in the science laboratory'.

Marilyn Hacker said: 'The best of these poems reminded the reader of poetry's capacity to delight and instruct. They find their strength in merging knowledge, craft and feeling: they affirm poetry's ability to arise from and to address crucial issues of human life, both individual and collective'.

The awards symposium will consider the relationship between poetry and medicine, with topics including poetry as therapy, using poetry in health professional training, the impact of health and disease on the professional poet and the history of poetry and medicine.

Speakers on the day will come from the around the UK, the USA, Cyprus, Denmark, France, Greece, and Russia. MEP Eleni Theocharous will speak and attendees will also be treated to a reading by Jo Shapcott, the recent winner of the Queen’s Gold Medal for Poetry.

The Hippocrates Initiative – winner of the 2011 Times Higher Education Award for Innovation and Excellence in the Arts – is an interdisciplinary venture that investigates the synergy between the medicine, the arts, and health.

To attend the Symposium see http://go.warwick.ac.uk/cpt/poetry/symp/

Notes to editors
Photos of all of the finalists, along with extracts of their poems are available on request, and all finalists have agreed to be contacted by press. For more information, please contact hippocrates.poetry@gmail.com

Awards: In each category there will be: 1st prize £5,000, 2^nd prize £1,000, 3^rd prize of £500, and 20 commendations each of £50.  

Entries are judged anonymously. To avoid the judges seeing clustered runs of entries by the same poet, judges are given the anonymous entries ordered alphabetically by title.

Short lists for the 2012 Hippocrates Prize for Poetry and Medicine

Short list for Open Awards 

Mary Bush: Women’s Work

Mary Bush recently (2011) earned a Ph.D. in Creative Writing/Poetry from the University of North Texas while continuing to work in my long-term career as a project manager in the Information Technology industry. I write poetry for pleasure, and I have always been interested in the overlap of art and science—whether writing “scientific” poetry or “elegant” software. My husband and I have three adult children, one of whom is autistic, and his unique use of language fascinates and inspires me. We live in a ramshackle old house in a small town in North Texas, where my husband plays loud guitar and I write poems.

She said: ‘I was inspired to write this poem by reading about the tissue engineering work of Dr. Doris Taylor (http://www.nytimes.com/2008/01/14/health/14heart.html). I was taken first by the fact that a woman was a leader and spokesperson for this cutting-edge scientific work and secondly by the notion of using a detergent or shampoo as part of the engineering process, as in a commercial context, detergent and shampoo are stereotypically considered "women's products." Everything about tissue engineering seemed beautiful to me, from the ethereal nature of the scaffolds to the idea of re-use and rebirth implicit in the process.’

Kelly Grovier: The Edwin Smith Papyrus

Kelly Grovier is the author of two collections of poetry with Carcanet Press: A lens in the palm (2008) and The Sleepwalker at Sea (2011). He is a regular contributor on arts to The Times Literary Supplement and co-founder of the scholarly journal European Romantic Review. In 2008, his popular history of London’s infamous Newgate Prison, entitled The Gaol (John Murray publishers), was a BBC Radio 4 Book of the Week. He is a lecturer in the Department of English and Creative Writing at Aberystwyth University and co-founder and co-director of the interdisciplinary David Jones Centre.

About the poem he said: ‘I’ve always been drawn to poems about fragments and ruin. So I found especially exciting the subject of ancient surgical papyri: those endlessly deteriorating tissues ironically intended to reverse the deterioration of tissues. “All composition is decomposition”, so the eighteenth-century traveller Walking Stewart once wrote. In the case of the so-called Edwin Smith papyrus (the oldest treatise on trauma we have, written around 1500 BCE), the allure was only amplified by hints of the interweaving of science and superstition, medicine and myth, and enticing allegations of possible forgery on the part of Smith himself, who acquired it in Egypt in 1862. In the poem I try to imagine the word and the world, the writer and the written, pixels and stars, in a ceaseless cycle of visions and division.’

Shelley McAlister: Los Subiros

Shelley McAlister grew up on the west coast of America and came to the UK in 1977. She writes short fiction and poetry and has previously been a writer in residence in healthcare on the Isle of Wight where she lives. She was commended in the 2010 Hippocrates Prize and has poems in a variety of publications including Magma, Iota and The Rialto. Her first poetry collection, Sailing Under False Colours, was published by Arrowhead Press in 2004.

Inspiration for the poem

As a lecturer in health and social care, I often read about inequalities in health. On this occasion I had a dream about a hospital on top of a mountain where the poorest people had no access to healthcare. I am fascinated by carriers of all kinds so once I had this setting clear in my mind, I knew that this was a poem about the bringers. 

Short list for Open Awards 

Jane Kirwan: Mr Blatný Perseveres

Jane Kirwan qualified as a dentist in 1970, retiring in 2005, now divides her time between London and the Czech Republic where Ivan Blatný is still admired as a poet. Her mother and sister have worked as psychiatrists. She has had two poetry collections published by Rockingham Press and more recently a prose-poem memoir with her partner, a Czech dissident and former political prisoner. In 2002 she won an Arts Council Writers Award. She is currently working with Wendy French on a project about the NHS. 

Andy Jackson: Allogeneic

Andy Jackson is from Manchester but lives in Fife, Scotland, where he is Medical Librarian at Ninewells Teaching Hospital in Dundee. His poems have appeared in Magma, Blackbox Manifold, Trespass and Gutter. He won the National Galleries of Scotland competition in 2008 and the inaugural Baker Prize in 2012. Debut collection The Assassination Museum was published by Red Squirrel Press in 2010 and he is editor of Split Screen : Poetry Inspired by Film & Television, also published by Red Squirrel in 2012. Currently working with WN Herbert on an historical anthology of poems about the city of Dundee.

The poem Allogeneic is partly informed by experience as a patient having bloods taken as part of a research programme into cholesterol levels conducted by the Tayside Medical Science Centre and partly by the eternally wonderful Hancock’s Half Hour episode The Blood Donor.

Nick MacKinnon: Claybury

Nick MacKinnon was an auxiliary nurse on Duncuan psychogeriatric ward of the Argyll and Bute Hospital in the early 1980s. The subject of his poem is Claybury Asylum where his mother Rosan worked as an SRN in the 1970s. Claybury's water tower is still the chief landmark in Roding Valley, but the buildings are now the gated housing estate Repton Park. The poem aspires to be a history of psychiatry from Victorian place of safety to our Care in the Community, from the point of view of the tower.

The Hippocrates Prize judges

Rod Flower is Professor of Biochemical Pharmacology at the WIlliam Harvey Research Institute[21] in London. His main scientific research interests concern inflammation and anti-inflammatory drug mechanisms. He was formerly President of the British Pharmacological Society and is a Fellow of the Academy of Medical Sciences.

Marilyn Hacker's book of poetry Presentation Piece (1974) won the National Book Award. In 2009, she won the PEN Award for Poetry in Translation for King of a Hundred Horsemen by Marie Étienne. In 2010, she received the PEN/Voelcker Award for Poetry.

Martha Kearney is the main presenter for BBC Radio 4’s lunchtime news programme ‘The World at One’. She previously worked for Channel 4, presented the BBC’s Woman’s Hour, Today and PM and was political editor for Newsnight. She has been commended for her national and international reporting, including for work on child poverty. She has been a judge for the Webb Essay Prize and the Guardian First Book Award, and has chaired the judging panel for the Orange Prize for Fiction.

Hippocrates Prize Organisers
Donald Singer is Professor of Clinical Pharmacology and Therapeutics, University of Warwick, and President of the Fellowship of Postgraduate Medicine. His interests include research on discovery of new therapies, and public understanding of drugs, health and disease.

Michael Hulse is a poet and translator of German literature, and teaches creative writing and comparative literature at the University of Warwick. He is also editor of The Warwick Review. His latest publications are: The Secret History (poems, Arc) and The Notebooks of Malte Laurids Brigge (translation of Rilke's novel, Penguin Classics). With Donald Singer he co-founded in 2009 the International Hippocrates Prize for Poetry and Medicine.

Sorcha Gunne is a Post-doctoral Teaching Fellow in the Department of English and Comparative Literary Studies. Prior to this appointment,she was an Early Career Fellow at the Institute of Advanced Study. Her research specialism is World Literatures in English, particularly twentieth-century and contemporary writing.

The 2012 Hippocrates prize is supported by

The Fellowship of Postgraduate Medicine, a national medical society founded in 1918 and publisher of the Postgraduate Medical Journal and Health Policy and Technology.

The Cardiovascular Research Trust, a charity founded in 1996, which promotes research and education for the prevention and treatment of disorders of the heart and circulation. 

Bulgakov, illness and creativity

Mikhail Bulgakov

@HealthMed The Russian playwright and novelist Mikhail Bulgakov is reported to have died in 1940 with hypertension and nephrosclerosis, said also to be the cause of his father's death. A recurring theme in the stage play by John Hodge - 'Collaborators', currently at the National Theatre in London, and winner 15th April 2012 of Olivier Award for best new play, is development of a tinge in Bulgakov's skin, obvious to his physician and friends; whether due to kidney disease - uraemic pigmentation, or some other cause such as liver disease is not made clear. A wishful twist in the play is the return to normal of all readings - blood pressure and lab tests, resulting from the 'simple' step of being seen in a hospital for the elite: an echo of reported changes in industrial output occurring merely because a Moscow bureaucrat of the time says this should happen.
A plausible medical background? Other than low salt diet, leeching and purging, little treatment was available for high blood pressure at that time. And kidney failure is a recognized complication of uncontrolled hypertension. However, his high blood pressure could also have been the consequence of progressive kidney disease, with genetic causes such as polycystic kidney disease an alternative diagnosis  - in the absence of confirmation of diagnoses in father and son by histology. A non-genetic cause in father and son could have been post-infective glomerular disease (such as Bright's disease) - Bulgakov gave up a career as a doctor because of an illness. This could have caused the onset of kidney disease, which, depending on the cause, may take up to several decades to progress to kidney failure.
This medical background raises the question: did long-term illness influence Bulgakov's literary creativity? There are two obvious potential effects: knowledge, especially as a doctor, of premature death giving the drive to create as much as possible; and effect of the disease itself on thoughts and imaginings. Of note, in the late stage, kidney disease is well-known typically to cause slowing of mental processes. There are apocryphal links between Tolstoi's novel 'War and Peace'.  However I experienced a real example as a junior doctor in London when a women was admitted to hospital in end-stage kidney disease. She was obtunded by her illness, however within a day or so of starting haemodialysis had recovered her previous passion for reading and was able to make accelerating progress through the book, obvious during successive ward rounds.
Modern science has revealed that cytokines, pathological factors involved in a wide range of medical problems, including inflammatory kidney disease, have important effects to influence mood and other aspects of brain activity, to the extent that trials are in prospect targeting cytokines as a way to treat depression. And of note Bulgakov wrote The Master and Margarita during the latter part of his last illness. Many researchers have been interested in the link between creativity and depression - and several obvious reasons for Bulgakov to be depressed in Moscow at that time, independent of his own health. For individual creative people, very challenging to differentiate between direct or indirect cause, and coincidence, both for creativity and its loss...

Pocket Prescriber Update

@HealthMed Pocket Prescriber 2012 was published on 30th March as a book and in e-format, aimed at providing core information to junior doctors, nurse and pharmacist prescribers and medical students and other health professional students interested in drugs and prescribing.
As in previous editions, there is a listing of ~500 of the most commonly used medicines, informed by advice from  experts in the wide range of therapeutic disciplines reflecting current medical practice. We have also included national guidelines aimed at improving safety and effectiveness in prescribing, and advice on management of medical emergencies, supported by guidelines from national and international professional societies, NICE guidelines and Formulary updates.

Over 100,000 copies of the Pocket Prescriber have entered national and international circulation since the first edition was published in 2004, Since 2010, the Pocket Prescriber has progressed to being an annually updated source of prescribing advice.

MHRA alert on mislabelled high strength codeine in UK co-codamol batch

@HealthMed Co-codamol contains two types of painkiller. Paracetamol and the opiate drug codeine. The UK Medicines regulator, the MHRA, has warned that around 39,000 packets of these combination tablets have been issued to wholesalers and pharmacies, with the opiate codeine present in 4 times the strength on the label: 30mg instead of 8mg per tablet. The strength of the paracetamol in the tablets said to be unaffected. Lower dose codeine forms of co-codamol (in the UK 8mg or 12.8mg per tablet) are available over the counter in pharmacies. The higher dose codeine 30mg per tablet form of co-codamol is a prescription only medicine. This dose may be quite appropriately be prescribed by a doctor, after taking into account a patient's medical history and current drug treatment.
However codeine in high dose in at risk groups of patients is more likely to cause serious adverse effects such as drowsiness, confusion, and reduced respiratory drive and blood pressure. People at particular risk include the elderly, those with liver or kidney or lung disease, and people already on medicines known to cause these adverse effects. 
Codeine is a prodrug: it has to be converted in the body to its active forms (mainly to morphine) before it can be effective in relieving pain. Therefore people who are genetically able to activate codeine very rapidly are more likely to experience adverse effects when exposed to higher than expected doses of codeine.
High doses of codeine can also cause constipation as a troublesome adverse effect.
These 30mg strength codeine forms of co-codamol tablets have on them the mark "CCD30" on one side with "CP" on the second side.
As recommended by the MHRA, anyone concerned that they may have been incorrectly given the high strength co-codamol should contact their GP or pharmacist promptly. The reported batch number is LL11701, expiry date September 2014.

See also:
Reuters report
Daily Express report
New England J Med report on codeine intoxication associated with ultrarapid CYP2D6 metabolism

Tuberculosis, Bel Ami and the Belle Epoque

Guy de Maupassant

@HealthMed Maupassant's 1885 book Bel Ami concerns the rise to wealth and influence of ex-soldier Georges Duroy, son of a poor rural family. Themes which still have a topical international resonance include the power of the press, foreign wars, corruption in business and government, and stock market insider trading. The anti-hero's success is largely due to the power of the wives of the rich, through their husbands, or direct involvement in political intrigue. A major subplot in Bel Ami is the impact of tuberculosis - estimated to cause the death of between 1 in 4, and 1 in 7 of the population in the mid 19th Century. In Bel Ami, Forestier, a wealthy publisher, develops rapid serious lung involvement, coughing blood, becoming breathless, and fevered. His early death provides a key opportunity for Duroy to enter formally into society.

Belle Epoque France was the outcome of cultural and economic flourishing during the latter part of 19th Century. An obvious question is what people at that time thought about tuberculosis. They knew that is was a serious and often deadly disease: Forestier's rapid death is anticipated as a matter of fact by Clothilde, a faithful companion of Duroy. An important academic view was that the 'soil'' - individual susceptibility - played a major role in the likelihood of developing consumption. There are several apparent similarities between those perceptions and public reaction to the epidemic of HIV-AIDS which emerged in the early 1980s. Tuberculosis was known as consumption because of its wasting effect. The term in translation dates back at least to Hippocrates in 460BCE: the Ancient Greeks used the term phthisis (wasting away) to describe the commonest disease of their time.  This was echoed by the description 'slim disease' for a wasting disorder which emerged in rural Uganda in the early 1980s, strongly associated with infection with the HTLV-III, and thus recognized to be a feature of HIV-AIDS. A major cause of weight loss in HIV-AIDS is associated opportunistic infections such as tuberculosis - a clear illustration of the importance of the impact of impaired host defence on development of a disease.

 

At the time of publishing Bel Ami, Maupassant was ill with syphilis. Not a socially acceptable disease to reflect in a literary work - although ample opportunity for this to be acquired by Maupassant's  anti-hero Duroy and passed on to his high society conquests. The concept of the risk of progressing from a 'night with Venus to a lifetime with Mercury' emerged shortly after the 1494 siege of Naples. In an epic poem of 1530, the Veronese doctor poet Girolamo Fracastoro refers to use of mercury as a possible cure for the disease. And its late effects were well known to Shakespeare, with examples in his play 'Timon of Athens'. One of Fracastoro's many contributions to science and medicine was the idea that certain diseases are spread by particles. In the 1600s, early inventors of microscopy went on to confirm the existence of minute particles. Antoni van Leewenhoek was the first to report single-cell micro-organisms, in 1676 correspondence to the Royal Society, which, after initial scepticism, then confirming his findings, made him a member in 1680. 

A dramatic change in medical thinking and knowledge about tuberculosis occurred in the early 1880s. In 1881, French doctor Louis Landouzy gave a series of influentual lectures on causes of consumption, including speculation that routes of transmission could included infected dust, milk and meat. And in 1882, the Prussian pathologist Robert Koch was the first to describe the causative tubercle bacillus, supported by his formulation in 1884 with Friedrich Loeffler of 4 postulates about the evidence needed to confirm disease causation by microbes. This direct work on the germ theory of disease had been anticipated 350 years before by Frascatoro. Koch's investigations and discoveries in relation to tuberculosis lead to his receipt of the 1905 Nobel Prize in Physiology and Medicine.

The timing of publication in 1885 of Maupassant's novel Bel Ami is therefore of special interest, following 3 years after Koch's discovery. There is no explicit recognition in Bel Ami of the resulting logic for isolating patients with what later became called 'open' tuberculosis - when the TB germs are free to travel from the lungs through the air to nearby contacts. However the move of Forestier to a remote house may have served both to give him a quiet place to convalesce or die, and tacitly to isolate him from at risk friends.

Modern parallels to the public response to tuberculosis in the Belle Epoque range from reactions such as fear, concern and denial for mystery illnesses with no cause known (e.g. pre-HIV 'slim disease'), the response of the public to those affected by HIV-AIDS, before the emergence of effective treatment; and responses to the many types of cancer without known cause, and other  reasons for premature illness and mortality, for example - sudden cardiac death syndromes in young athletes and older adults, despite many advances in diagnosis and treatment.

Online launch by Elsevier of FPM journal - Health Policy and Technology

@HealthMed Health Policy and Technology was launched online on 14th March by the international publisher Elsevier on behalf of the Fellowship of Postgraduate of Medicine (see Editorial on Launch). The print version of the journal will be published later in March.
The first issue of the journal features editorials, reviews and original research by an international range of contributors from USA, Norway, Holland, UK and India. 
Key themes of papers in the issue include diagnostics, technology for drug discovery, e-Health, and health technology assessment, and health policy.
There is also the first in a series of interviews with senior health service, research and industry professionals, and policy makers, starting with Clinical Pharmacologist Sir Michael Rawlins, Chairman of the UK's National Institute for Health and Clinical Excellence.

Helpful links
Podcast of interview with Sir Michael Rawlins, Chair of NICE
HPT website
Background to FPM and the launch of HPT
Fellowship of Postgraduate of Medicine website

Why a national No Smoking Day?

@HealthMed See the interview on the impact of no smoking initiatives by the University of Warwick's Knowledge Centre to coincide with the UK's National No Smoking Day.

Below is a summary of key points for smokers wanting to quit

No Smoking Day (March 14th) is an excellent time for UK smokers to think about stopping and to get started on the best ways to stop. Around 1 million people across the UK use No Smoking Day as the start to quitting smoking for good. 

World No Tobacco Day? UK smokers have two major calendar dates as prompts to stop, No Smoking Day on March 14th, a UK initiative, and World No Tobacco Day (annually on 31st May), organized by the World Health Organization.

Why stop? As well as causing well-known problems such as premature skin ageing and impotence, smoking is the leading preventable cause of death in the UK, causing around one in five deaths, and killing one in two lifetime smokers. Smoking causes increased risk of serious illness and of premature death from heart and lung disease and a wide range of cancers. And these risks not only affect smokers: they are transferred by passive smoking to adult friends and family, children and babies, and people who just happen to be near to smokers.

How quickly does quitting smoking help? Very. A recent report from Glasgow has shown a large decrease in the number of premature births and the underweight babies with reduced smoking by pregnant mothers. An for example in the first 10 months after the smoking ban in public places in Scotland, there were 1 in 7 fewer admissions to hospital for acute coronary disease among smokers, and a 1 in 5 reduction in former smokers. There was also a large early impact of reducing passive smoking, with ~1 in 5 fewer coronary events both in people who had never smoked and in ex-smokers.

How can drugs help? Drugs such as nicotine replacement treatments are helpful when smokers first start to quit. And nicotine replacement treatments and other drugs such as bupropion can help people who have stopped to stay quit of smoking. Drugs work best when combined with the kind of support available from the NHS Stop Smoking Service. Local NHS Stop Smoking staff can advise smokers on which medicines can help.

Who can help? Depending on personal preference NHS Stop Smoking support can send mailed information, text messages, emails and provide online help. Other helpful advice is available from the British Heart Foundation ‘WeQuit’, which has over 20,000 volunteers ready to help smokers who want to stop. And several helpful smartphone apps are now available.

Helpful links

More on why and how to quit smoking
WeQuit  
NHS Local Stop Smoking Services
My Last Cigarette smartphone app
Smoking, medicines and hip fracture risk