🧵 THREAD on critiquing lifestyle medicine from

article from @dnunan79 @dnblane @mgtmccartney just published in @BJGPjournal: bjgp.org/content/71/706…

🗣️ "... we focus on the unintended consequences of uncritical endorsement and application of lifestyle medicine including the infiltration of pseudoscience, profiteering, and the potential for widening health inequalities by a continued focus on the ‘individual’."

🗣️ "We have two main concerns here:

1⃣ the opportunity taken by some to link alternative medicine practices to lifestyle medicine

2⃣ the association of some ‘lifestyle medicine practitioners’ with commercial opportunities" Image

🗣️ "‘Lifestyle medicine’ needs a clear consensus on what constitutes evidence based practice, with organisational
standards and leadership commitment to the removal of bad science, and of financial and ideological conflicts."

🗣️ "The concept of individual ‘choices’ and ‘changes’, and by proxy ‘control’, plays a central role in many working definitions of lifestyle medicine. We are concerned about the potential for widening health inequalities when conceptualised and delivered in this way." Image

🗣️ "...the growth in private services are unlikely to yield benefits for people at highest risk of premature mortality from non-communicable diseases.

Those in greatest need of support with health behaviour change are least likely to receive it." Image

🗣️ "Lifestyle medicine’s continued emphasis on the individual as the change agent most likely results in the people at lowest risk having the greatest amount of intervention, while people carrying the greatest risk are not receiving the support they need."

I have been to a lifestyle medicine course and it was good @PLMcourse but I was worried lifestyle medicine would reinforce inverse care law.

It's the people we can least reach that have the worst health outcomes - least access to the resources to change their 'lifestyle'.

Is health is fully meritocratic? thelancet.com/journals/lance…

🗣️ "First, meritocracy expresses a certain idea of freedom; our opportunities should not be fixed
by the circumstances of our birth.

Second, “it gestures to the hope that what we achieve reflects what we deserve”"

There will be backlash to this article: why?

People have built careers/businesses on 'lifestyle medicine': educational, consulting via books, courses, podcasts etc.

It's not about right/wrong - we need better policies on STRUCTURAL DRIVERS AND 'lifestyle change'.
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More from @DipeshGopal

21 Mar
🧵 THREAD on BIAS in MEDICINE #MedTwitter #FOAMed



➡️ is integral to how we see people/make diagnoses: can't be removed

➡️ affects research questions that get asked, who gets funded, what gets published and in which journal

@FutureHealthJ: rcpjournals.org/content/future…

Bias training:

➡️ increases bias awareness

➡️ doesn't decrease biases (no evidence base)

➡️ bias training ignores communication, provides no debiasing interventions, doesn't measure motivation

➡️ doesn't address structural problems

Read: ncbi.nlm.nih.gov/pmc/articles/P…

Shoutout to the amazing team:





And Prof @damienridge who shaped the manuscript.

Hundreds of papers, hours of lectures/books, many drafts to get here.

Thank you 🙏🏽
Read 26 tweets
20 Mar
🧵 on #COVID19 in Pregnancy / Breastfeeding


Prof @thangaratinam:

Pregnant women at increased risk of severe COVID (ITU admission), thus earlier delivery

Risk factors: obesity, advancing maternal age, non-white ethnic origin #GlobalPregCov

🔗: bmj.com/content/372/bm…

Animation here:

Read more about the research here: birmingham.ac.uk/research/who-c…


Prof Paul Heath @StGeorgesUni

Efficacy in slide in general population:

Pfizer/Moderna/AstraZeneca/Gamaleya from clinical studies.

Novovax, Janssen, Sinovac, Bharat Biotech from press release.

Read 12 tweets
19 Mar
🧵 THREAD on "good men" #NotAllMen #MeToo

🗣️ What is the pass we give ourselves when we call ourselves "good men"?

Full video from @wayfarerstudios @justinbaldoni:

feat. @TonyPorterACTM @acalltomen @jameyjaz
🗣️ The language used to objectify women is problematic.

Full video from @wayfarerstudios @justinbaldoni:

featuring @TonyPorterACTM @acalltomen
🗣️ What should men do? (watch from 56 mins)

Believe women
Don't use assumptions
Interject in the locker/boardroom

Be intentional about educating boys/young men

Set an example

Look inwards

Full video from @wayfarerstudios @justinbaldoni:
Read 4 tweets
3 Mar


THREAD on @BMJLeader study: bmjleader.bmj.com/content/early/…

➡️ Gender and racial CONFERENCE PANEL KEYNOTE SPEAKER representation at Royal College conferences 2015-2019

➡️ Publicly available data: 20 of the 70 conferences

At 60% (n=12) of conferences in our sample, there
was a predominance of male speakers.

Median percentage of female speakers: 35 - 46%.

In 15% (n=3) of conferences, there were an equal number of male and female keynote speakers.

No #manels detected! 🤯 @medicalwomenuk

At 20% (n=4) of conferences examined, none of the keynote speakers were from ethnic minorities.

Median % ethnic minority speakers 9 - 18%.
No increase from 2015 to 2019.

@crageshri @RammyaMathew @Dr2NisreenAlwan @DrRakN @DrJessPotter
Read 10 tweets
25 Feb
🧵THREAD about public/healthcare funding


🗣️ "We must not resort to infighting...instead of placing the focus of our rage where it deserves to be placed – at the feet of those who have been managing the NHS in recent years."

It's not only mismanagement. It's consistent underfunding.

When you look at the govt's own figures, it looks like public spending is increasing: gov.uk/government/sta…

Note the y-axis is £ billions but not accounting for inflation (nothing about real terms).

When you look in detail it looks like health spending is increasing and social care is constant.

Note the y-axis is £ billions but now IS accounting for inflation.
Read 12 tweets
4 Jan

🧵 THREAD about probably one of the BEST discussions about social value of work, economic wealth and fairness in a while.

40 mins with @amolrajan, @PJTheEconomist @elerianm @KGerlich777 Louise Casey

@davidgraeber 🗣️ "The more your job helps others, the less you get paid"

Reminded me of @euan_lawson for @BJGPjournal quoting Michael Sandel on meritocracy: bjgp.org/content/70/701…

🗣️ "In an unequal society, those who land on top want to believe their success is morally justified. In a meritocratic society, this means the winners must believe...

🗣️ "...they have earned their success through their own talent and hard work.… at a time when racism and sexism are out of favor (discredited though not eliminated), credentialism is the last acceptable prejudice."
Read 10 tweets

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