BMJ GROUP AWARDS

ЖЖReview the shortlists for all categories at http://bit.ly/aUWoE5 Sir George Alleyne ЖЖListen to the awards launch podcast at bmj.com/podcasts A highly respected figure in global health, George Alleyne has played LIFETIME ACHIEVEMENT AWARD a large part in tackling HIV and non-communicable disease and Whose legacy will readers is an energetic promoter of health equality across the world. Currently the chancellor of the University celebrate this year? of the West Indies, Sir George is also the former director of the Pan Annabel Ferriman introduces this year’s award and American Health Organization. Adrian O’Dowd reveals the shortlisted candidates Born in Barbados, he graduated in medicine from the University When Belgian senator Marleen Temmerman called on women in Belgium of the West Indies in 1957 and to refuse to have sex with their partners until the country’s politicians continued his postgraduate ended eight months of wrangling and formed a government, few people studies in the United Kingdom and effect on national economies. in the UK had heard of her. But readers of the BMJ were in the know and the United States. During more Sir George has served on various unsurprised. than a decade of original research, committees including the For Professor Temmerman, an obstetrician and gynaecologist, had he produced 144 publications in scientific and technical advisory won the BMJ Group’s Lifetime Achievement Award last April. In that case, scientific journals, which qualified committee of the World Health it was not for suggesting a “crossed leg strike” to end political deadlock him at just 40 years of age to be Organization Tropical Research (a solution advocated by the women of Greece in Aristophanes’ play appointed professor of medicine Programme and the Institute of Lysistrata) but for her services to women’s health in Belgium and Kenya. in 1972 at the University of the Medicine committee on scientific She was an impressive winner and stunned the audience with her West Indies, where he was made investigation in developing passionate acceptance speech. chancellor in 2003. countries. Now it is time for readers of the BMJ to choose another health champion Through many speeches, by voting for one of this year’s shortlist. The award is for someone He has played a large addresses, and presentations, who, through a working lifetime, has made a unique and substantial role in tackling HIV and he has helped focus attention contribution to improving healthcare. It is the only award where readers of non-communicable on issues such as equity in the journal and members of the public are able to vote. From a total of 88 entries, the science broadcaster Geoff Watts, and I disease and is an health, health and development, (AF), as champion of the award, whittled down the nominees to a shortlist energetic promoter of problems in healthcare in the of 10, which was presented to the judging panel in early February. health equality Caribbean, and international The judging panel consisted of Fiona Godlee, editor in chief of the BMJ; cooperation in health. Maureen Bisognano, president and chief executive officer of the Institute Sir George joined the Pan Sir George retired in 2003 of Healthcare Improvement, Cambridge, Massachusetts; Iain Chalmers, American Health Organization but remains as chancellor of the one of the founders of the Cochrane Collaboration and editor of the James in 1981 as chief of research University of the West Indies and Lind Library; Andy Haines, professor of public health and primary care promotion and coordination and serves on the Task Force on Health and former dean of the London School of Hygiene and Tropical Medicine; subsequently held several posts Care in the Caribbean. and Michael Marmot, professor of epidemiology and public health at before serving as its director from His influence is still strong University College London and president of the BMA. 1995 to 2003—the first Caribbean and has helped to persuade the In choosing their shortlist of three, the judges considered not only person to hold this title. United Nations to hold a high level the nominees’ academic achievements but also their contribution to He was appointed by the United meeting on non-communicable the improvement of international health. Voting is open and will close Nations Secretary General in 2003 diseases in September with on 9 April. Please go to bmj.com to register your vote. The winner will be to serve as his special envoy for the aim of mobilising a serious announced at the awards dinner in London on 18 May. HIV/AIDS in the Caribbean region, response to the pandemic of these The first winner, preceding Professor Temmerman, was Judith Mackay, a post he held until last year. diseases sweeping through the director of Asian Consultancy on Tobacco Control and senior adviser to the Knowing many of the heads of developing world. World Lung Foundation, whose life has been spent combating the tobacco state in the Caribbean region, he He has also received numerous industry. We are sure that this year’s winner will be as worthy of the title. has also encouraged joint working awards, including the Pelican Annabel Ferriman is news editor, BMJ [email protected] on non-communicable diseases, Award from the University of the Cite this as: BMJ 2011;342:d1062 realising the need for action across West Indies, the Centenary Medal governments and not just health in Jamaica, and degrees honoris departments to achieve effective causa from various universities • Vote on bmj.com results. including the University of the In 2003, he was appointed West Indies. by the Caribbean Community In 1990, Sir George was made Secretariat as the head of a new Knight Bachelor by the Queen for commission to examine health his services to medicine and in issues confronting the region, 2001 was awarded the Order of including HIV/AIDS, and their the Caribbean Community.

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Professor Sir Richard Peto Dr John Wennberg Richard Peto, epidemiologist and A true patient champion, John statistician, has contributed much Wennberg is known as the to the decrease in neoplastic, world’s leading medical care vascular, and respiratory mortality epidemiologist and has spent from smoking, both in the UK and decades helping to transform our elsewhere. understanding of what goes on Currently codirector of the Clinical in healthcare systems and the Trial Service Unit and Epidemiological reasons for health inequalities. Studies Unit (CTSU) at the University of Dr Wennberg, the Peggy Y Oxford, Professor Peto demonstrated Thomson professor emeritus in (in collaboration with Richard Doll) the evaluative clinical sciences at the extraordinary extent to which Dartmouth Medical School in the the hazards of persistent cigarette US, has spent more than 40 years smoking exceed those from the studying and documenting large aggregate of all other known causes During the 1980s they introduced variations in healthcare delivery variation in healthcare and how to of cancer. large simple trials, meta-analyses across the US and concluding tackle it. He also showed that for those of trials, and correction of that the amount of medical care a For individual patients, it who manage to stop smoking before epidemiological studies for regression patient receives is determined by showed that in populations in age 30 or 40, the eventual long term dilution bias, which showed that the where they live. which there were high rates of benefits of cessation are far greater real importance of blood pressure and activity, some people might be than had previously been thought blood cholesterol concentrations had A true patient champion, receiving treatments that other and thus has effectively argued the been underestimated. Dr John Wennberg is clinicians and patients would importance of cessation in the UK A substantial part of Professor known as the world’s regard as unnecessary and of no and many other countries. This has Peto’s epidemiological work has leading medical care additional value, and that patients had, and continues to have, a direct been, and still is, in China (where epidemiologist would not want if they were fully influence on public policy and adult he led a study that interviewed the informed about the risks and mortality in many countries. families of one million people who He has been a professor in the benefits of the treatment choices. After gaining a BA in natural had died during the 1980s, assessing department of community and This led him and Albert Mulley sciences from the University of their smoking habits), India (using family medicine since 1980 and to co-found the Foundation Cambridge in 1965 and an MSc similar methods), and Russia (where in the department of medicine for Informed Medical Decision in statistics from the University of his large studies with David Zaridze since 1989. Dr Wennberg is a Making in 1989, a non-profit London in 1967, Professor Peto confirming the massive mortality from graduate of Stanford University corporation providing objective began to work on chronic disease alcohol have recently helped lead to and the McGill University Faculty scientific information to patients epidemiology with Professor Doll and effective controls). of Medicine. His postgraduate about their treatment choices to Charles Fletcher. During the 1970s, Professor training was in internal medicine promote patient involvement in In 1976, 1994, and 2004, Peto introduced the logrank test and nephrology at Johns medical care decisions. Professors Doll and Peto published for analyses of trials and for meta- Hopkins University, but he In 1988, he founded the Center the 20 year, 40 year, and 50 year analyses of trials, particularly those of became interested in applying for the Evaluative Clinical Services follow-ups of the study of smoking cancer treatments. epidemiological principles to the and with his colleagues there, he and death among British doctors, The Early Breast Cancer Trialists’ healthcare system while pursuing produced the Dartmouth Atlas of and in 1981 they published their Collaborative Group, which he his master’s degree in public Health Care—a series of reports quantitative report, The Causes of founded in 1985 and still leads, brings health at Johns Hopkins. on how healthcare is used and Cancer, which gained worldwide together worldwide randomised With colleague Alan Gittelsohn, distributed in the US. He stepped attention. evidence and has contributed much Dr Wennberg developed a strategy down as director of the centre, to evaluating and consolidating the for studying the population based now known as the Dartmouth The greatest absolute improvements in treatment that rates of allocation and use of Institute for Health Policy and mortality reductions have have helped decrease UK breast health resources, which found Clinical Practice, in 2007. come, however, from his cancer mortality since the 1980s. large variations among local and Dr Wennberg is a member of studies of the avoidable This decrease is now steep in many regional healthcare markets, the Institute of Medicine of the causes of chronic disease, countries but is steepest in the UK. much of which seemed to relate to National Academy of Science particularly smoking The greatest absolute mortality distribution of supply of resources and the Johns Hopkins University reductions have come, however, from and differences in local medical Society of Scholars. Also in 1981, Professor Peto’s close his studies of the avoidable causes of opinion. He has received numerous collaboration with Rory Collins on large chronic disease, particularly smoking. Since his pioneering work, awards, including the Institute of scale randomised evidence began, Professor Peto has won many research in many countries has Medicine’s 2008 Gustav O and since 1985 they have codirected awards, is one of the world’s most shown wide variations in rates Lienhard Award, and the CTSU, which conducts large studies of widely cited medical researchers, and of clinical activity. This work has Association for Health Services the causes and treatment of disease was knighted in 1999 for services to been vital because it has informed Research’s Distinguished worldwide. epidemiology and cancer prevention. policy makers about unwarranted Investigator Award.

BMJ | 26 FEBRUARY 2011 | VOLUME 342 469 TECHNOLOGY

 You can now use your smart phones to access doc2doc.bmj.com, BMJ Group’s global clinical online community A SMARTER WAY TO PRACTISE The popularity of smartphones now outstrips that of the personal computer, but is their use by doctors a desirable trend? Tom Nolan reports

t’s hard to get away from smartphones: the fessionals, found that ¡Š% own a smartphone. a package of Œ› reference tools including the Brit- latest models are widely discussed on televi- When asked how they use their phone at work ish National Formulary , Clinical Evidence, and sion and in newspapers and are generally on during a typical shift, ¡¡% of respondents said fi ve Oxford handbooks. This gives users instant show through the growing number of users. they use them to communicate with other col- access to information without the need for com- Now they’re also on the wards, being used as leagues, œ£% said they access information on the puter access, internet connection, or books. Ipocket textbooks, email clients, and, of course, internet or intranet, while ¤‹% use work related “If you ask yourself the question, ‘What do I as mobile phones. But are they improving the software apps. Although the fi ndings may not need to know in order to do the right thing here?’ standards of care and, if so, should all doctors be be truly representative of the profession—most and look it up, you’ll fi nd an appropriate answer,” using them? Or are they just a useful gadget for respondents were junior doctors within fi ve years says Mark Stacey, associate dean at the School those with an inclination towards touch screens? of qualifi cation who responded to email requests of Postgraduate Medical and Dental Education There is no agreed defi nition of a smartphone. and online adverts—they indicate just how impor- at Cardiff University, who has been running the They can be thought of as a combination of a tant smartphones have already become to many project. “The people who have engaged with the mobile phone, personal digital assistant (PDA), doctors’ working lives. “I use it for work because project have loved it, using the device on a daily and mobile computer. Like a computer, they run of the way it synchronises my calendars, appoint- basis to ensure accurate prescribing and appro- on an operating system, such as Microsoft’s Win- ments, and rotas,” says Paul McGovern, an ortho- priate investigations and treatment.” dows Mobile or Google’s Android. Applications paedics registrar at Basildon Hospital. “I also use The fi ndings from this project have not yet been such as email clients, web browsers, and down- it for looking things up in trauma meetings or on published, but an earlier study by Dr Stacey’s loadable “apps” run on the operating system. the wards.” group suggests that junior doctors’ attitudes to the The market for apps, small self contained use of smartphones are variable. ¤ The researchers programmes, is huge. Revenues from apps in Smartphones for all? gave ŠŒ£ foundation year Œ and Š trainees a PDA the fi rst half of Š‹Œ‹ were estimated at $Š.Šbn Given that some doctors already fi nd that smart- that included Œ¡ electronic textbooks. Looking (£Œ.’bn; €Œ.•bn),Œ while in January Š‹ŒŒ Apple phones improve their effi ciency and productivity, at use of the devices over ŒŠ months, they found announced the ten billionth download from its could hospitals and health services do the same that users fell into three groups: ’‹% engaged app store (the honour by supplying medical with the project, fi nding the device a useful learn- went to Paper Glider, “People purchasing or staff with smartphones ing tool; Šœ% were unconvinced of the benefi ts; a game that involves handing out smartphone for use at work? In and ¤œ% disconnected, preferring to seek advice flicking paper aero- many places this is from colleagues instead. planes across a virtual devices need to think very already happening. “Those who didn’t engage had a variety of rea- offi ce). carefully about maintaining Physicians at Doyles- sons: because they felt they couldn’t use it or they The market for apps town Hospital, Penn- preferred to use other devices or other sources,” aimed at doctors is also the confi dentiality of any sylvania, use iPhones Dr Stacey says. However, he says it is important to growing rapidly. Apps patient data they store on it” to access electronic challenge perceptions about the usefulness and range from mobile ref- patient records, medi- value of such devices. In his latest study some FŠ erence tools such as Doctor’s Toolbag and the cal reference applications, and email.Š In the UK, doctors did not take up the off er to participate ini- Oxford Handbook of Clinical Medicine to the more than œ‹‹ medical students at Leeds Uni- tially but were enthusiastic once the device was iStethoscope (box). versity were issued with iPhones last year so that demonstrated face to face. “We have witnessed they can access online textbooks. The phones a snowball eff ect where it is recommended to Smartphone use among doctors have to be returned when students graduate. peers,” he says. Smartphones are a popular choice of phone Another initiative, the iDoc project run by the Top-down initiatives may not be the best way among doctors. A survey of Œ›œ UK doctors by Wales Deanery, has off ered smartphones to all to realise the potential of smartphones within d’, a non-profi t organisation that aims to increase foundation year Œ doctors since October Š‹‹£. healthcare, according to James Sherwin-Smith, the use of mobile technology by healthcare pro- Doctors are given a free smartphone that includes chief executive offi cer of d’. “Junior doctors are

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APPS THAT COULD CHANGE THE WORLD OF MEDICINE AirStrip OB Mobile MIM MobiUS VitalHub iStethoscope This app allows obstetricians This radiology image viewing MobiUS aims to turn your VitalHub collects patient data The iStethoscope claims to view cardiotocograms app was first launched for the smartphone into a portable from different sources and to turn your iPhone into a when, as the company’s iPhone in 2008. However, it ultrasound machine. An brings them together in an stethoscope, allowing you to website generously puts it, was removed from Apple’s ultrasound probe attaches to a iPhone app. This gives users listen to your heartbeat, see “the demands of their day App Store after regulatory Windows Mobile smartphone secure access to patient your heart waveform, or listen necessitate their periodic problems with the Food and via a USB port allowing the user records, test results, vital signs, to other quiet sounds around absence.” AirStripOB allows the Drug Administration. Over two to perform fetal, cardiac, blood and medical literature. It also you. With some colourful and user to view the cardiotocogram years later, after tests to ensure vessel, and other ultrasound gives notifications of abnormal mixed reviews on the iTunes in real time or review earlier that images could be interpreted imaging. Images can then be results of laboratory tests. It App Store it might not be recordings and gives access to under various lighting and sent by email for later review was developed by Mount Sinai the finished product, but at patient data such as age, parity, screen conditions, the app has or a second opinion. MobiUS Hospital in Toronto, Canada. 59p it won’t break the bank. and recent examinations. become the first diagnostic is expected to be available in www.vitalhub.com www.peterjbentley.com/ Other AirStrip apps include radiology app to be approved by the US from mid-2011 at an istethoscopepro.html an electrocardiogram viewer the FDA and is back on the App estimated price of $8000. and vital signs monitor. www. Store. www.mimsoftware.com/ www.mobisante.com airstriptech.com products/iphone

a very mobile workforce. Trusts often struggle to NHSmail data from a remote device tion of medical devices. Wireless keep up with paperwork such as promptly issuing when it is reported lost or stolen. If you networks are thought to be of low a P’œ form [at the end of employment] or com- have other patient data on the device risk and need not be restricted. œ pleting Criminal Record Bureau checks, let alone you need a plan to deal with that.” handing out a mobile phone every six months.” There are other problems that Smartphone as a medical device However, doctors who wish to take advantage of can easily be overlooked. As As smartphones become faster and smartphones in their work can be put off by hav- useful as they may be for clini- more fl exible, their application within ing to do this at their own expense. d’ aims to cal work, the distraction value medicine is widening. This has led some build a mobile phone network for health profes- of smartphones is arguably people to ask whether smartphones sionals and use the bargaining power of this group far greater. With instant access should be classed as a medical device and to reduce the costs to their members. Another to personal email, social networking sites such therefore subject to regulation, for instance by the solution may be for schools or employers to subsi- as Facebook and Twitter, and addictive games US Food and Drug Administration. • dise the cost of clinical apps or provide their own. such as Angry Birds and Bejeweled (each has Their portability means that they can be used been downloaded over œ‹ million times), there is almost anywhere. “Smartphones can make A smart idea? a great temptation to use smartphones while at diagnostics personal and accessible— making Perhaps the biggest concern regarding the use of work for non-work related activity. Doctors tap- it true point of care,” says Sailesh Chutani, chief smartphones in healthcare is that of confi denti- ping away on their handheld devices can also executive offi cer of Mobisante, whose smartphone ality. “People purchasing or handing out smart- create a negative impression on the ward, where ultrasound device will be launched this year. “This phone devices need to think very carefully about teamwork is so essential. could help migrate healthcare delivery from the maintaining the confi dentiality of any patient Other barriers must also be overcome, such as more expensive settings such as hospitals and spe- data they store on it,” says Paul Jones, chief tech- poor network coverage within hospitals, and the cialised personnel, to less expensive settings such nology offi cer at Connecting for Health. “People perception that mobile phones are banned in the as clinics or small practices managed by mid-level need to take personal responsibility for what they workplace. For many years mobile phones were healthcare professionals. Such a migration will are putting on these banned from hospitals over concerns that their increase access while improving outcomes and devices. It is easy to signals interfered with hospital equipment. In reducing costs.” As such, they may be of particu- lose a phone, and you Š‹‹£, the Department of Health reviewed inci- lar use in developing countries or rural settings. should plan for what dents involving mobile phone interference on Smartphones have already become an every- you are going to do medical devices. ’ The report advised that patients day part of many doctors’ working lives. As tech- when it is lost. With should be allowed “the widest possible use of nology and apps improve, they look set to off er NHSmail we’ve got mobile phones in hospitals” where that would even greater benefi ts in terms of access to infor- the facility to remove not pose a threat to safety, privacy, and the opera- mation and advice at the point of care and may also become commonly used medical devices THE RISE OF THE SMARTPHONE in their own right. If security, logistical, and cost Smartphones date back to 1993, when IBM launched the Simon, a touch issues can be overcome smartphones may one day screen phone with integrated email, fax, calendar, and notepad. Simon was become essential to every doctor’s job—and then ahead of its time: it wasn’t until nearly 10 years later that smartphones began there really will be no getting away from them. to establish themselves as a mainstream alternative to mobile phones, with Tom Nolan is a general practice trainee , King’s College brands such as BlackBerry, Palm, and Ericsson releasing popular devices at the Hospital, London, UK [email protected] beginning of this century. It took the launch of the Apple iPhone in 2007 for the Competing interests: None declared smartphone market to explode, and it is now growing faster than ever. In the Provenance and peer review: Commissioned; not externally final quarter of 2010 over 100 million were sold worldwide, outselling personal peer reviewed. computers for the first time. 7 References are in the version on bmj.com Cite this as: BMJ 2011;342:d1124

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