The BMJ’s own patient journey

At present globally, the BMJ is the only medical journal that has taken these steps. With opening up their plans and acting on it publicly they took a heading from which they never could have backed off again. When we saw the impressive list of things that the BMJ is doing, witnessed some of the prior meetings, plans and efforts that preceded the adoption of their new strategy we wanted to encourage this mission. The journal is well aware that its embarking on a journey, Sure its going to get criticized, and challenged, and will stumble and learn from experience.

After speaking to some of the patients involved who completely agreed with our insights on the effort BMJ has put into this, we wanted to step ahead. Encouraging them with the Patients Included Award 2014 and the badge was therefore appropriate. For us, this is just the beginning, we really would like to stimulate change in the rest of the medical publishing world too.

Sure, it is not suitable for every type of research and also for many, the steps taken above may been seen as too big. But I believe, along with many others, that patients are the experts in having “lived experience“ of disease, so why not involve them?

The challenge will be how to ensure that all patients have representative participation, not just a vocal minority. And its important to clearly define what is meant by co-creation of content and patient partnership; and how to evaluate its impact.

So as we move to have Patients Included, first at conferences, and now in one of the largest medical journals in the world we hope that it will bring the same added value to medical publishing as it does to conferences.

More about this on https://www.linkedin.com/today/post/article/20140618060741-19886490-brit...

Ill health has become far to profitable and far too commonplace.

I absolutely approve of the BMJs initiatives towards genuine lay and patient involvement in the process of review. It is increasingly clear through the withholding of data on RCTs that the public is getting raw deal, and it is clear to that certain individuals are abusing the level of their 'eminence' to behave like radical fanatics stamping out the otherwise rightful expression of dissent.
The fat/cholesterol hypothesis is based upon a complete absence of evidence and examples of well-informed lay people and patients can be witnessed in blog and comment forums, some of them hosted by well-informed and experienced medical professionals, debating this matter and exchanging opinions can be witnessed about the web.
What's more this exchange is more than simply an exchange, it is fast growing instrument of teaching and learning, because often the blog and the comments beneath equate to more than the sum of the component parts. The thread beneath makes for added value. People share sources, and in outing their ideas they invite a kind of informal crowd-sourcing.
Moreover, the trade in ideas in such forums isn't always the passing on of insights from the blogging professional to interested follower, I do know that interested followers may submit ideas or links that invoke interest in the leading blogger, that may then lead to cognitive advances. It can be interesting to see the opinion of even a cardiologist trend over time as if under the influence of certain of his or her followers.
Closer to the BMJ the rapid responses (73 in number at the time of writing) published in re: the adverse effects of statins indicate how informed and responsive even pay people and patients can be. I browsed all 73 comments and gave at least 75% of them the thumbs up on the basis that many originated from well informed statins sceptics, some of whom had experienced intolerable and unacceptable adverse reactions, others were statin and cholesterol sceptic, and some supportive comments came from the 'faithful' number but who are offended by the emergent trend of eminent (if secretive) statin enthusiasts to express almost totalitarian intolerance in the face of the otherwise democratic expression of dissent.
The harsh reality is that exist a minority of lay people who are now fer better informed upon some certain health matters than are the majority members of the medical profession, and often, as could be quite reasonable to anticipate, certain patients are better informed upon their specific health matters that might be their GP (family physician). My experience of contact with members of the medical profession is that they generally exercise high levels of conservatism, they feel strong pressure to conform, persist in thinking NICE is promoting excellence and best practice in all areas, and cannot grasp some guidance is having them trend away from best practice, perhaps trending to something bordering on malpractice. The proposal to halve the QRISK2 threshold in re guidelines for lipid modification would be case in point, and it is generating opposition from within the ranks.
Meanwhile, in the blogosphere, and within sources and contacts the web grants easy access to a key and core bunch s laypeople are now assured the fat/cholesterol hypothesis must be laid to rest, while becoming increasingly assured of what its potential (and evidence supported) supported successor might look like. Of course, as with any hypothesis, it will need to placed upon an even firmer evidential footing. But this is crowd-sourcing at its best.
In submitting her rapid response Amy Price gets my full support for making the very pertinent point that being on both sides of the patient and diagnosis cum treatment divide lends for very insightful perspectives. My own curiosity in health matters arose several years ago and began with my diagnosis of T2DM and a growing is weak suspicion that may be the the advice health professionals issued could be improved. It has taken a while but I am absolutely convinced early diagnosis of T2DM or syndrome X (as equating to pre-diabetes) could opne the door for casue and naturally oriented guidance and interventions that could lead to a reversal of the diagnosis. This would not need drug based interventions, and some of the proposed interventions might raise an eyebrow amongst conservative probationers beholden of conventional wisdom,but indeed proposals would nonetheless be well thought out.
Few GPs have realised that a high proportion of their time is spent addressing health conditions that arise in modern and urban environments more than they do elsewhere or than did in former times. This is an indication the cause(s) prevail or are more intensive in this times and places. Much of a GPs time is pent addressing health issues that are man-made and arise from environmental factors prevailing in the urbanised world. The factors bear upon human endocrinology, and even upon our pets, putting added strain upon the detoxicant business of 'methylation', and adding to background levels of oxidative stress. The number of conditions that can be associated with one of the big indicators of this trend, homocysteine, runs to 100 or so.
The emerging model for the preservation of wellness in general, and the emerging model in relation to the real etiology of CVD point the way to more naturally oriented treatments and interventions, and more naturally oriented policy upon primary prevention. The emergent models understand matters well enough that at last the patients best interests can be brought forwards. Practitioners and s[specialists could cease to cover for their inadequacy with recourse to the prescription pad, and they coul increasingly exercise the new model of understanding where know the relationship of cause and effect implies the very expedient pathway of discouraging patient contact with 'cause'.
Sadly few GPs perceive the one thing they most agree upon, the fat/cholesterol hypothesis, is more cause than benefit.
The power of the lay mind is proven, with Anthony Colpo, author of a book, 'The Great Cholesterol Con', and Barry Groves, author of thoroughly researched book on the consequences of chronic hyperinsulinemia allied to chronic lipoxidative stress associating with dietary excesses of PUFAs, 'Trick and Treat, each lending gravitas and evidence to the idea that the lay mind can be progressive in its ideas, and can come up with evidence backed treaties that fly in the face of conventional wisdom.
More patients venturing to the great resource that is the BMJ, more exchange and debate in which they are involved, and a more transparent process of review that seeks and values patient contributions IS the way forwards. Hopefully this will be an initiative that will reverse the trend, and patients interests can again top the agenda above the financial agenda of the great corporate influence.
Natural interventions could prevent Alzheimers, of that I'm sure, and patients really have no more need of oligomer disruptors than they need HMG-CoA reductase inhibitors, and frankly the reality is that patient need HMG-CoA reductase inhibitors like a hole in the head. And I suppose the memory, cognitive, and responses degrading side-effects of HMG-CoA reductase inhibitors amount to that, a hole in the head.
Perhaps with increased patient involvement many a GP will be shamed into getting up to speed on certain matters. And of course they have my full support and respect for being so darned good at much of what they do. Nonetheless it is excellence we after.
Ill health has become far to profitable and far too commonplace

Christopher Palmer has no affiliations. His occupation is truck driver. Chris became interested in health science and health politics at the beginning of 2009. He has spent the last three years researching the fat/cholesterol hypothesis and despite the day-job considers himself a full time and freelancing researcher.
Chris 's interests now major of the methylation/homocysteine/oxycholesterol etiology for atherogenicity and CVD, and finds that it can aswer questions of 'convergence' better than does the fat/cholesterol hypothesis. Chris is a trending champion of cause oriented clinical excellence, as opposed to pharmacologically based practice.
Chris hopes to see much needed reinvestment in cause and naturally oriented best practice in medicine in his remaining lifetime.
Contact by email to cjp.321.321@gmial.com

Some links to support propositions placed:
if not cholesterol then what?
Des Spence: 'NICE is busted'
Dr John Briffa blogging on Clowns and Jokers with at least one comment of pure genius beneath.