Ch\u00e8res et chers coll\u00e8gues,<\/p>\n
Un nouvel ab\u00e9c\u00e9daire pour saluer l\u2019arriv\u00e9e du printemps, que nous f\u00eatons aussi en musique<\/a>.<\/p>\n Attractivit\u00e9<\/p>\n La perte d\u2019attractivit\u00e9 des m\u00e9tiers de sant\u00e9 devient pr\u00e9occupante au Royaume-Uni (voir ici<\/a> ou l\u00e0<\/a>, pour les m\u00e9decins, et l\u00e0<\/a> pour les infirmi\u00e8res), ou au Qu\u00e9bec (voir ici<\/a>), par exemple.<\/p>\n Bertolus (Chlo\u00e9)<\/p>\n Un beau portrait de notre coll\u00e8gue dans Lib\u00e9ration<\/em><\/a>.<\/p>\n Bibliom\u00e9trie<\/p>\n \u00ab\u00a0In this report, we draw attention to the information that is lost when data about researchers and their institutions are squeezed into a simplified metric or league table. We look at four familiar types of analysis that can obscure real research performance when misused and we describe four alternative visualizations that unpack the richer information that lies beneath each headline indicator and that support sound, responsible research management.\u00a0\u00bb<\/em>C\u2019est ainsi que commence le rapport<\/a>\u00a0\u00ab\u00a0Profiles, not metrics\u00a0\u00bb<\/em>de Jonathan Adams, Marie McVeigh, David Pendlebury et Martin Szomszor, pour le Web of Science Group. Il incite \u00e0 utiliser de meilleurs outils pour \u00e9valuer les chercheurs et les institutions \u00e0 partir de leurs publications.<\/p>\n Bonheur<\/p>\n La croissance \u00e9conomique ne fait pas toujours le bonheur, selon The Economist<\/em><\/a>. Cet article se fonde sur le World Happiness Report<\/a>\u00a0<\/em>publi\u00e9 le 20 mars dernier. La France n\u2019est pas parmi les nations les plus malheureuses (class\u00e9e 25e<\/sup>sur 156).<\/p>\n Budget<\/p>\n Science<\/em><\/a> nous apprend que la Maison-Blanche veut faire des coupes sombres dans le budget des agences scientifiques, notamment les National Institutes of Health<\/em>(- 13 %). Le Congr\u00e8s devrait s\u2019opposer \u00e0 ces r\u00e9ductions budg\u00e9taires.<\/p>\n Code de conduite<\/p>\n Le gouvernement britannique a \u00e9dict\u00e9 un code de conduite<\/a> \u00e0 propos des donn\u00e9es de sant\u00e9, justifi\u00e9 ainsi\u00a0: \u00ab\u00a0The code is designed to recognise that, while data-driven health and care technologies will undoubtedly deliver huge benefits to patients, clinicians, carers, service users and the system as a whole, it is our duty as NHS England and central government to capitalise on these opportunities responsibly. If we do not think about issues such as transparency, accountability, liability, explicability, fairness, justice and bias, it is also possible that the increasing use of data-driven technologies, including AI, within the health and care system could cause unintended harm.\u00a0\u00bb<\/em><\/p>\n Compagnonnage<\/p>\n Dans le Figaro<\/em><\/a>, une tribune d\u2019un collectif de chirurgiens d\u00e9fenseurs du mod\u00e8le fran\u00e7ais de formation des jeunes m\u00e9decins, \u00ab\u00a0la formation m\u00e9dicale entre pairs, qui doit demeurer un pilier central de la m\u00e9decine\u00a0\u00bb.<\/p>\n D\u00e9fenseur des droits<\/p>\n Le rapport d\u2019activit\u00e9 du D\u00e9fenseur des droits insiste sur les difficult\u00e9s engendr\u00e9es par \u00ab\u00a0l\u2019\u00e9vanescence\u00a0\u00bb des pouvoirs publics dans certains endroits du pays\u00a0: \u00ab\u00a0En 2018, le D\u00e9fenseur des droits a constat\u00e9 une fois encore, aussi bien au niveau local par l\u2019interm\u00e9diaire de ses 501 d\u00e9l\u00e9gu\u00e9s, qu\u2019au niveau national par les services centraux de l\u2019institution, les effets n\u00e9fastes de l\u2019\u00e9vanescence croissante des services publics sur les personnes pour lesquelles ils constituent souvent le principal recours. Cette situation s\u2019amplifie ann\u00e9e apr\u00e8s ann\u00e9e et n\u2019\u00e9pargne plus personne, y compris les usag\u00e8res et usagers jusque-l\u00e0 aptes \u00e0 y faire face, et touche l\u2019ensemble des strates de la soci\u00e9t\u00e9.\u00a0\u00bb (page 16 et suivantes du rapport<\/a>)<\/p>\n Dickens (Charles)<\/p>\n The Times Literary Supplement<\/em><\/a> nous apprend que, selon une lettre d\u00e9couverte r\u00e9cemment, l\u2019\u00e9crivain anglais a maniganc\u00e9 un internement abusif de sa femme.<\/p>\n Donn\u00e9es de sant\u00e9<\/p>\n Le syndicat des d\u00e9partements d\u2019informatique m\u00e9dicale s\u2019inqui\u00e8te de la nouvelle r\u00e8glementation, qui risque de donner un trop large acc\u00e8s aux donn\u00e9es de sant\u00e9 produites par les h\u00f4pitaux (voir ici<\/a>).<\/p>\n La m\u00eame crainte est exprim\u00e9e dans le BMJ<\/em><\/a> \u00e0 propos des applications m\u00e9dicales.<\/p>\n Doudna (Jennifer)<\/p>\n The New York Review of Books<\/em><\/a>\u00a0s\u2019est entretenue avec Jennifer Doudna, qui a jou\u00e9 un r\u00f4le d\u00e9cisif, avec la fran\u00e7aise Emmanuelle Charpentier, dans la d\u00e9couverte du syst\u00e8me CRISPR- Cas9 et son utilisation pour modifier l\u2019ADN. Elle y parle de la joie de la d\u00e9couverte\u00a0et des enjeux \u00e9thique de la sienne.<\/p>\n eClinicalWorks<\/p>\n Tel est le nom d\u2019un logiciel tr\u00e8s utilis\u00e9 aux \u00c9tats-Unis pour l\u2019informatisation des dossiers m\u00e9dicaux. L\u2019histoire d\u2019une catastrophe \u00e0 m\u00e9diter racont\u00e9e ici<\/a>\u00a0: \u00ab\u00a0The software in question was an electronic health records system, or EHR, made by eClinicalWorks (eCW), one of the leading sellers of record-keeping software for physicians in America, currently used by 850,000 health professionals in the U.S. It didn\u2019t take long for Foster to assemble a dossier of troubling reports \u2014 Better Business Bureau complaints, issues flagged on an eCW user board, and legal cases filed around the country \u2014 suggesting the company\u2019s technology didn\u2019t work quite the way it said it did. [\u2026] <\/em><\/p>\n But 10 years after President Barack Obama signed a law to accelerate the digitization of medical records \u2014 with the federal government, so far, sinking $36 billion into the effort \u2014 America has little to show for its investment. KHN and Fortune spoke with more than 100 physicians, patients, IT experts and administrators, health policy leaders, attorneys, top government officials and representatives at more than a half-dozen EHR vendors, including the CEOs of two of the companies. The interviews reveal a tragic missed opportunity: Rather than an electronic ecosystem of information, the nation\u2019s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can\u2019t stand and has enriched and empowered the $13-billion-a-year industry that sells it.<\/em><\/p>\n By one measure, certainly, the effort has achieved what it set out to do: Today, 96 percent of hospitals have adopted EHRs, up from just 9 percent in 2008. But on most other counts, the newly installed technology has fallen well short. Physicians complain about clumsy, unintuitive systems and the number of hours spent clicking, typing and trying to navigate them \u2014 which is more than the hours they spend with patients. Unlike, say, with the global network of ATMs, the proprietary EHR systems made by more than 700 vendors routinely don\u2019t talk to one another, meaning that doctors still resort to transferring medical data via fax and CD-ROM. Patients, meanwhile, still struggle to access their own records \u2014 and, sometimes, just plain can\u2019t.<\/em><\/p>\n Instead of reducing costs, many say, EHRs, which were originally optimized for billing rather than for patient care, have instead made it easier to engage in \u201cupcoding\u201d or bill inflation (though some say the systems also make such fraud easier to catch). [\u2026]<\/em><\/p>\n In a study published last year in the journal Health Affairs, Ratwani and colleagues studied medication errors at three pediatric hospitals from 2012 to 2017. They discovered that 3,243 of them were owing in part to EHR \u201cusability issues.\u201d Roughly 1 in 5 of these could have resulted in patient harm, the researchers found. \u201cPoor interface design and poor implementations can lead to errors and sometimes death, and that is just unbelievably bad as well as completely fixable,\u201d he said. \u201cWe should not have patients harmed this way.\u201d<\/em><\/p>\n Using eye-tracking technology, Ratwani has demonstrated on video just how easy it is to make mistakes when performing basic tasks on the nation\u2019s two leading EHR systems. When emergency room doctors went to order Tylenol, for example, they saw a drop-down menu listing 86 options, many of which were irrelevant for the specified patient.\u00a0\u00bb<\/em><\/p>\n Edition<\/p>\n Les universit\u00e9s se rebellent de plus en plus contre les tarifs exorbitants des abonnements aux revues scientifiques. D\u2019autres solutions se d\u00e9veloppent, selon The Atlantic\u00a0<\/em><\/a>: \u00ab\u00a0 Alternatives have started to emerge. There are illegal ones, such as the website Sci-Hub, that allow users to pirate journal articles. (Elsevier sued Sci-Hub and won $15 million in 2017.) But the strongest push for a new, aboveboard system has come from the open-access movement.<\/em><\/p>\n Open access means a journal article is free to read, but researchers pay the journal a fee to cover the cost of publishing. For publishers, it means changing their business model from charging readers to charging authors. In 2001, scientists founded the Public Library of Science to publish open-access journals. The idea caught on, and even traditional publishers, including Elsevier, have since introduced open-access journals under their umbrella. But the most prestigious journals, such as Nature and Science, remain behind a paywall.<\/em><\/p>\n The agencies that fund scientific research are growing enthusiastic about open access. In the United States, government agencies such as the National Institutes of Health and the National Science Foundation require grantees to deposit their papers in a public repository within 12 months of publication. Last fall, 11 European agencies that collectively fund $8.8 billion in research put forward a far more radical proposal, Plan S. By 2020, the scientists they fund would be able to publish only in journals that are free to read upon publication. (\u201cThe S in Plan S can stand for \u2018science, speed, solution, shock,\u2019\u201d its leading proponent told Nature.) The Bill & Melinda Gates Foundation later signed on to Plan S as well.\u00a0\u00bb<\/em><\/p>\n Food and Drug Administration<\/em><\/p>\n Scott Gottlieb, qui dirigeait la FDA depuis 2017, a d\u00e9missionn\u00e9, officiellement pour raisons personnelles. Il \u00e9tait devenu la b\u00eate noire du lobby des cigarettiers en raison de sa lutte vigoureuse contre la cigarette traditionnelle et la e-cigarette (voir ici<\/a>).<\/p>\n Greffe h\u00e9patique<\/p>\n Dans le BMJ<\/em><\/a> une patiente de 37 ans raconte comment \u00e0 trois reprises une greffe h\u00e9patique lui a sauv\u00e9 la vie.<\/p>\n Dans le Monde<\/em><\/a>, une tribune de membres du Centre h\u00e9pato-biliaire de l\u2019h\u00f4pital Paul Brousse pour proposer des solutions face \u00e0 la p\u00e9nurie de greffons h\u00e9patiques. Voici leur conclusion\u00a0: \u00ab\u00a0Les r\u00e9sultats r\u00e9cents des transplantations h\u00e9patiques adultes \u00e0 partir d\u2019un h\u00e9mi-foie issu d\u2019un don du vivant et la possibilit\u00e9 d\u2019augmenter le nombre de greffons h\u00e9patiques transplant\u00e9s par l\u2019utilisation de machines de perfusion devraient conduire l\u2019Agence de la biom\u00e9decine \u00e0 encourager et financer ces solutions. L\u2019\u00e9nergie que nous d\u00e9ployons pour proposer des solutions \u00e0 nos malades repose sur le rapport singulier qui existe entre l\u2019\u00e9quipe soignante et ses patients en attente d\u2019une greffe h\u00e9patique. Utilisons cette \u00e9nergie ! En 2017, 170 personnes sont d\u00e9c\u00e9d\u00e9es sur la liste d\u2019attente de transplantation h\u00e9patique.\u00a0\u00bb<\/em><\/p>\n Holmes (Elizabeth)<\/p>\n L\u2019imposture de la soci\u00e9t\u00e9 Theranos va se terminer devant le juge. The Guardian<\/em><\/a> explique la fascination exerc\u00e9e par une jeune entrepreneuse qui promettait de changer le monde\u00a0: \u00ab\u00a0Elizabeth Holmes did not change the world, as she once promised, but she certainly captured its attention. <\/em>The story of the founder of the now defunct blood-testing company Theranos is everywhere. There is a bestselling book, a popular podcast and a new documentary, The Inventor: Out for Blood in Silicon Valley, directed by the Oscar winner Alex Gibney, which premiered in the US on Monday.<\/em>Why are we so obsessed with Holmes? Elementary, my dear reader: she is a mesmerisingly modern morality tale. A photogenic 19-year-old Stanford dropout starts a revolutionary blood-testing company, which police are now investigating as a possible multibillion-dollar scam. Powerful men such as Henry Kissinger give her their backing. Holmes is named the US\u2019s youngest self-made female billionaire before the authorities come knocking and a criminal case is mounted. \u00bb<\/em><\/p>\n Industrie<\/p>\n Faut-il s\u2019inspirer des m\u00e9thodes industrielles pour am\u00e9liorer les pratiques m\u00e9dicales\u00a0? Peut-\u00eatre, mais pas sans r\u00e9flexion. C\u2019est le sens de l\u2019article de Carl Macrae paru dans le BMJ<\/em><\/a>\u00a0<\/em>: \u00ab\u00a0Exhortations to learn from other industries have been common in the world of healthcare improvement since the inception of the discipline. <\/em>These are not always helpful. Recounting oversimplified improvement examples from other industries (often aviation) can provoke considerable frustration and scepticism among clinicians exposed to the unique challenges and everyday complexities of trying to improve healthcare. Patients are not aeroplanes, and hospitals are not production lines. Nonetheless, many successful efforts to improve the quality and safety of healthcare have taken inspiration from other industries. [\u2026]<\/em><\/p>\n Translating and adapting improvement techniques to healthcare is hard and has had varied results. Some interventions, such as those aimed at reducing infections related to central venous catheters, have proved popular and successful; others, such as incident reporting systems, have met with frustration and failure. Initial enthusiasm for oversimplified, large scale attempts to apply a new improvement technique often quickly gives way to confusion, complication, and criticism. [\u2026]<\/em><\/p>\n Learning from other industries is neither simple nor straightforward but it remains an important part of improving the quality and safety of healthcare. Adapting quality improvement tools from elsewhere requires a deep understanding of the mechanisms and systems that underpin an improvement technique in one industry; closely examining the context, practices, and challenges inherent in a particular setting in healthcare; and then carefully adapting and reinventing the improvement technique to work in healthcare. At the core, the process of learning from other industries is really a process of learning more about our own. \u00bb<\/em><\/p>\n Intelligence artificielle<\/p>\n Pour Eric Topol, dont le livre Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again<\/em>est comment\u00e9 dans The Economist<\/em><\/a>, l\u2019intelligence artificielle va rendre la m\u00e9decine plus humaine\u00a0: \u00ab\u00a0Dr Topol\u2019s vision of medicine\u2019s future is optimistic. <\/em>He thinks ai will be particularly useful for repetitive, error-prone tasks, such as sifting images, scrutinising heart traces for abnormalities or transcribing doctors\u2019 words into patient records. It will be able to harness masses of data to work out optimal treatments (for both conditions and individuals), and improve workflows in hospitals. In short, ai is set to save time, lives and money.<\/em><\/p>\n Much of this is hypothetical\u2014but ai is already outperforming people in a variety of narrow jobs for which it has been trained. Eventually it may be able to diagnose and treat a wider range of diseases. Even then, Dr Topol thinks, humans would oversee the algorithms, rather than being replaced by them. [\u2026]<\/em><\/p>\n The Hippocratic Oath holds that there is an art to medicine as well as a science, and that \u201cwarmth, sympathy and understanding may outweigh the surgeon\u2019s knife or the chemist\u2019s drug\u201d. That is not just a platitude: the patients of sympathetic physicians have been shown to fare better. As Dr Topol says, it is hard to imagine that a robot could really replace a human doctor. Yet as demand for health care outstrips the supply of human carers, the future may involve consultations on smartphones and measurements monitored by chatbots. The considerately warmed stethoscope, placed gently on a patient\u2019s back, may become a relic of the past.<\/em><\/p>\n In the end technology may even be able to solve the empathy deficit.\u00a0\u00bb<\/em><\/p>\n L\u2019optimisme de ce confr\u00e8re pourrait \u00eatre temp\u00e9r\u00e9 par les risques de biais dans l\u2019utilisation de l\u2019intelligence artificielle et du deep learning<\/em>, car les algorithmes peuvent \u00eatre orient\u00e9s vers les fins que poursuivent leurs concepteurs et rec\u00e8lent des faiblesses telles qu\u2019ils peuvent \u00eatre attaqu\u00e9s et tromp\u00e9s (voir ici<\/a> dans Le Monde <\/em>comment un r\u00e9seau de neurones confond un chat et un chien, et l\u00e0<\/a> dans Science<\/em>\u00a0: \u00ab\u00a0With public and academic attention increasingly focused on the new role of machine learning in the health information economy, an unusual and no-longer-esoteric category of vulnerabilities in machinelearning systems could prove important. <\/em>These vulnerabilities allow a small, carefully designed change in how inputs are presented to a system to completely alter its output, causing it to confidently arrive at manifestly wrong conclusions. These advanced techniques to subvert otherwise-reliable machine-learning systems\u2014so-called adversarial attacks\u2014have, to date, been of interest primarily to computer science researchers. However, the landscape of often-competing interests within health care, and billions of dollars at stake in systems\u2019 outputs, implies considerable problems. We outline motivations that various players in the health care system may have to use adversarial attacks and begin a discussion of what to do about them. Far from discouraging continued innovation with medical machine learning, we call for active engagement of medical, technical, legal, and ethical experts in pursuit of efficient, broadly available, and effective health care that machine learning will enable.\u00a0\u00bb<\/em>)<\/p>\n Julia (Luc)<\/p>\n Si quelqu\u2019un peut parler d\u2019intelligence artificielle, c\u2019est bien Eric Julia, ing\u00e9nieur fran\u00e7ais \u00e0 l\u2019origine par exemple du logiciel de reconnaissance vocale Siri. Il vient de publier aux \u00e9ditions First L\u2019Intelligence artificielle n\u2019existe pas<\/em>. Le Monde<\/em><\/a> a bross\u00e9 son portrait. Ici<\/a> et l\u00e0<\/a> deux entretiens o\u00f9 il d\u00e9veloppe les principales id\u00e9es de son livre.<\/p>\n Krueger (Alan)<\/p>\n Cet \u00e9conomiste de renom a disparu le 16 mars dernier, en mettant fin \u00e0 ses jours. The Economist<\/em><\/a> nous rappelle sa contribution \u00e0 l\u2019\u00e9conomie, qu\u2019il a illumin\u00e9e de son talent, en s\u2019inspirant des travaux m\u00e9dicaux et en allant v\u00e9rifier sur le terrain les pr\u00e9jug\u00e9s de ses coll\u00e8gues \u00e9conomistes\u00a0: \u00ab\u00a0From the outset he was interested in understanding why workers earned what they did.<\/em>But he recognised that the question could not be answered satisfactorily without rigorous and careful study of data. Mr Krueger subscribed to the <\/em>New England Journal of Medicine, and admired the way each article began by discussing the paper\u2019s research design. Economics badly lagged behind medicine and the physical sciences in the use of careful empirical work, not least because of the difficulty of running experiments on messy real-world interactions. In the late 1980s, however, some economists were honing methods to study \u201cnatural experiments\u201d, in which a more or less random, localised event allowed researchers to compare the experiences of affected and unaffected groups, in something of the way that a laboratory scientist might compare treatment and control groups. [\u2026]<\/em><\/p>\n And, often in partnership with Daniel Kahneman, a Nobel laureate who pioneered the application of psychology to economics, Mr Krueger dug into the measurement of subjective well-being, hoping to find better ways of capturing shifts in what matters most in life. The goal of economic progress is after all to help people lead more satisfying lives, and to foster its pursuit, governments and scholars need reliable data. It was a message he preached throughout his career. His professional example inspired scores of young scholars, whose work is a monument to his memory. Both economics and American public life are much poorer for his death.\u00a0\u00bb<\/em><\/p>\n Long\u00e9vit\u00e9<\/p>\n Alors que The New York Times<\/em><\/a> s\u2019interroge sur l\u2019\u00e2ge auquel un chirurgien doit s\u2019arr\u00eater d\u2019op\u00e9rer, le Quotidien du m\u00e9decin<\/em><\/a> consacre un article \u00e0 Christian Chenay, qui exerce toujours son m\u00e9tier de g\u00e9n\u00e9raliste \u00e0 97 ans.<\/p>\n \u00ab\u00a0Ma sant\u00e9 2022\u00a0\u00bb<\/p>\n Cette r\u00e9forme annonc\u00e9e en septembre dernier fait l\u2019objet d\u00e9sormais d\u2019un projet de loi \u00ab\u00a0relatif \u00e0 l\u2019organisation et \u00e0 la transformation du syst\u00e8me de sant\u00e9\u00a0\u00bb (voir ici<\/a>). Le d\u00e9bat parlementaire va bon train, d\u2019autant plus que la plupart des grandes d\u00e9cisions se feront par ordonnance.<\/p>\n La nouvelle loi instaure la cr\u00e9ation du Health Data Hub, destin\u00e9 \u00e0 faciliter l\u2019acc\u00e8s aux donn\u00e9es de sant\u00e9. Voir ici<\/a>ce qu\u2019en dit celui qui va avoir la responsabilit\u00e9 de le mettre en place, monsieur Jean-Marc Aubert, par ailleurs auteur d\u2019un rapport<\/a> sur le financement et la r\u00e9gulation du syst\u00e8me de sant\u00e9, qui a inspir\u00e9 certaines mesures de la loi en discussion.<\/p>\n Medusavirus<\/p>\n Fascin\u00e9 par le mythe de la M\u00e9duse, Masaharu Takemura, virologue japonais \u00e0 l\u2019Universit\u00e9 des sciences de Tokyo, a appel\u00e9 Medisavirus un nouveau virus g\u00e9ant qu\u2019il a d\u00e9couvert avec son \u00e9quipe, comme nous le raconteThe Atlantic<\/em><\/a>.<\/p>\n Novlangue<\/p>\n Les amateurs de novlangue et d\u2019abstractions aiment beaucoup l\u2019Anap et se d\u00e9lecteront \u00e0 la lecture de son r\u00e9cent opuscule<\/a> intitul\u00e9 \u00ab\u00a0Fluidifier les parcours patients et les synergies entre acteurs – D\u00e9marches et outils\u00a0\u00bb.<\/p>\n Open space<\/em><\/p>\n Bilan globalement n\u00e9gatif, selon deux chercheurs de la Harvard Business School <\/em>(voir ici<\/a>).<\/p>\n Petit \u00ab\u00a0p\u00a0\u00bb<\/p>\n De nouvelles voix s\u2019\u00e9l\u00e8vent pour que le \u00ab\u00a0p\u00a0\u00bb < 0,05 et l\u2019expression \u00ab\u00a0statistiquement significatif\u00a0\u00bb soient remis\u00e9es (voir ici<\/a> sur le site de Retraction Watch).<\/p>\n Extrait de l\u2019entretien avec Nicole Lazar, professeur de statistiques \u00e0 l\u2019Universit\u00e9 de Georgie : \u00ab\u00a0Eliminating statistical significance does not mean that <\/em>\u201canything goes.\u201d\u00a0 <\/em>The expectation is that the FDA would develop new standards that don\u2019t depend\u00a0 on a single metric, but rather take into account the full set of measured results.<\/em><\/p>\n Furthermore, as we have seen in many other contexts, relying on statistical significance alone often results in weak science.\u00a0 While the FDA has taken a conservative stance about the evidence needed to declare a new drug effective, which is understandable, that comes with a cost.\u00a0 Namely, drugs that might be effective according to better measures of evidence are potentially rejected.\u00a0\u00bb<\/em><\/p>\n Un compromis serait peut-\u00eatre de retenir \u00ab\u00a0p\u00a0\u00bb < 0,005 (voir ici<\/a> cette position exprim\u00e9e par L. Monnier et coll.)<\/p>\n Pacemakers auto-rechargeables<\/p>\n Et si on utilisait les mouvements cardiaques pour recharger les pacemakers et \u00e9viter les changements de batterie. C\u2019est ce qu\u2019ont r\u00e9ussi pour l\u2019instant chez l\u2019animal Zhang Hao et Yang Bin, deux chercheurs chinois (voir ici<\/a>).<\/p>\n Pr\u00e9vention<\/p>\n La pr\u00e9vention est l\u2019affaire de la puissance politique, selon la r\u00e9dactrice en chef du BMJ<\/em><\/a>. Questions, r\u00e9ponses<\/p>\n Dans le cadre du Grand D\u00e9bat, le pr\u00e9sident de la R\u00e9publique a invit\u00e9 le 18 mars pr\u00e8s de soixante-dix intellectuels pour une discussion marathon de plus de huit heures. Le domaine de la sant\u00e9 et celui de la recherche ont \u00e9t\u00e9 abord\u00e9s succinctement. Le r\u00e9sum\u00e9 de ces \u00e9changes est consultable sur le site de France Culture<\/a> (en particulier de 21h29 \u00e0 21h51, et de 22h25 \u00e0 22h39).<\/p>\n L\u2019intervention de Serge Haroche, prix Nobel de physique 2012 et professeur honoraire au Coll\u00e8ge de France, a \u00e9t\u00e9 particuli\u00e8rement remarqu\u00e9e. On peut l\u2019entendre ici<\/a>\u00a0(de 4h08 \u00e0 4h14 apr\u00e8s le d\u00e9but de l\u2019enregistrement).<\/p>\n Rougeole<\/p>\n A cause en particulier des actions des anti-vaccins, qui n\u2019h\u00e9sitent pas aux \u00c9tats-Unis \u00e0 s\u2019attaquer violemment au comit\u00e9 devant dresser la liste des vaccins obligatoires (voir ici<\/a>), la rougeole redevient fr\u00e9quente (voir ici<\/a>). La mise en quarantaine obligatoire dans certaines situations a des cons\u00e9quences dramatiques au plan social, surtout en l\u2019absence de couverture en cas d\u2019arr\u00eat maladie (voir ici<\/a>).<\/p>\n Soda<\/p>\n Le BMJ<\/em><\/a> nous r\u00e9v\u00e8le la similitude entre les m\u00e9thodes utilis\u00e9es pour promouvoir le tabac et les boissons sucr\u00e9es\u00a0: \u00ab Marketing of sugary drinks to children by multinational corporations, and the need to regulate it, have been public concerns since the 1970s. <\/em>In 1974 the Better Business Bureau created the Children\u2019s Advertising Review Unit to promote \u201cresponsible\u201d children\u2019s advertising through industry self policing. In 2006, in response to calls for government regulation, industry created its Children\u2019s Food and Beverage Advertising Initiative (CFBAI). CFBAI members pledge \u201cto shift the mix of advertising primarily directed to children (\u2018child-directed advertising\u2019) to encourage healthier dietary choices,\u201d to \u201cdevote 100% of their child-directed advertising to better-for-you foods, or to not engage in such advertising,\u201d and to \u201climit the use of third-party licensed characters, celebrities and movie tie-ins.\u201d<\/em><\/p>\n Comparisons have been made between the tobacco and soft drink industries, including similarities in aggressive activities to oppose taxation and marketing restrictions, leading some to ask, \u201cIs sugar the new tobacco?\u201d Internal tobacco industry documents show that many of today\u2019s leading children\u2019s drink brands were once owned and developed by tobacco companies.\u00a0\u00bb<\/em><\/p>\n Starobinski (Jean)<\/p>\n Le 4 mars disparaissait \u00e0 Morges en Suisse le th\u00e9oricien de la litt\u00e9rature, \u00e9crivain et m\u00e9decin Jean Starobinski \u00e0 l\u2019\u00e2ge de 98 ans. Il laisse une \u0153uvre consid\u00e9rable (voir sa n\u00e9crologie ici<\/a>). On peut l\u2019entendre gr\u00e2ce \u00e0 France Culture<\/a> nous parler de la nostalgie avec \u00e9rudition et sensibilit\u00e9.<\/p>\n T\u00e9l\u00e9consultations<\/p>\n Pour d\u00e9sengorger les urgences, le Centre hospitalier intercommunal de Cr\u00e9teil propose des t\u00e9l\u00e9consultations, avec un certain succ\u00e8s, selon une tribune des initiateurs de ce service publi\u00e9e par les \u00c9chos<\/em><\/a>.<\/p>\n T\u00e9tanos<\/p>\n Un enfant am\u00e9ricain non vaccin\u00e9 a contract\u00e9 le t\u00e9tanos aux \u00c9tats-Unis. Il a surv\u00e9cu apr\u00e8s deux mois de soins et 800\u00a0000 dollars de frais m\u00e9dicaux, comme le rapporte The Washington Post<\/em><\/a>.<\/p>\n Ubersisation<\/p>\n The Atlantic<\/em><\/a> essaie de tirer un bilan provisoire de l\u2019uberisation des services, qui a transform\u00e9 des pans entiers de l\u2019\u00e9conomie.<\/p>\n Vaiva (Guillaume)<\/p>\n Un entretien<\/a> avec le psychiatre lillois sur le dispositif VigilanS de pr\u00e9vention du suicide.<\/p>\n Venezuela<\/p>\n The Lancet<\/em><\/a> comme Le Monde<\/em><\/a> montrent \u00e0 quel point la situation calamiteuse du Venezuela a des cons\u00e9quences tragiques sur l\u2019\u00e9tat de sant\u00e9 de la population. Extrait de l\u2019article du Monde<\/em>\u00a0: \u00ab\u00a0<\/em>“Le syst\u00e8me s\u2019est effondr\u00e9, plus rien ne marche”,affirme le docteur Alejandro Risquez. P\u00e9diatre et \u00e9pid\u00e9miologiste reconnu, il est une des voix critiques du syst\u00e8me depuis plusieurs ann\u00e9es. Il a particip\u00e9 plusieurs fois aux r\u00e9unions avec les repr\u00e9sentants des Nations unies pour dresser le diagnostic annuel des services de sant\u00e9 v\u00e9n\u00e9zu\u00e9liens. <\/em>“A partir de 2015, les officiels du r\u00e9gime ont commenc\u00e9 \u00e0 ne plus divulguer leurs chiffres, affirme-t-il. L\u2019ann\u00e9e suivante, ils n\u2019ont donn\u00e9 que le taux de mortalit\u00e9 infantile. Il baissait chez nos voisins, chez nous il augmentait de 30 %.”<\/p>\n Pendant les premi\u00e8res ann\u00e9es du r\u00e9gime chaviste, de nombreux sp\u00e9cialistes ont reconnu que les programmes gouvernementaux comme les missions Barrio Adentro, touchant les zones les plus pauvres du pays, ont permis des avanc\u00e9es en mati\u00e8re de sant\u00e9 publique. Avec les accords sign\u00e9s par Fidel Castro au d\u00e9but des ann\u00e9es 2000, environ 35 000 m\u00e9decins ou aide-soignants cubains se sont install\u00e9s dans les quartiers. Les missions Barrio Adentro II sont ensuite venues en aide aux cliniques et aux petits dispensaires, ou aux centres de diagnostic.<\/em><\/p>\n “Jusqu\u2019au mitan des ann\u00e9es 2010, une \u00e9poque o\u00f9 les dollars entraient, tout allait apparemment pour le mieux, explique le m\u00e9decin. Mais la corruption s\u2019est enracin\u00e9e. Au minist\u00e8re, les militaires ont pris les commandes. Les projets ont commenc\u00e9 \u00e0 capoter. Des sommes colossales ont \u00e9t\u00e9 investies dans les h\u00f4pitaux, de 2008 \u00e0 2013, mais rien n\u2019a march\u00e9.”\u00a0\u00bb<\/em><\/p>\n V\u00e9rit\u00e9<\/p>\n Une excellente \u00e9mission de France Culture<\/a> sur la\u00a0\u00ab\u00a0post-v\u00e9rit\u00e9\u00a0\u00bb, ou les \u00ab\u00a0faits alternatifs\u00a0\u00bb, avec le rappel de la distinction due \u00e0 Leibniz entre la v\u00e9rit\u00e9 de fait et la v\u00e9rit\u00e9 de raison. Avec Myriam Revault d’Allonnes et Ran Hal\u00e9vi, invit\u00e9s d\u2019Alain Finkelkraut.<\/p>\n Dans le domaine scientifique ainsi, il faut une strat\u00e9gie pour lutter contre la d\u00e9sinformation (voir ici<\/a>).<\/p>\n Wonner (Martine)<\/p>\n La d\u00e9put\u00e9e a men\u00e9 une mission \u00ab\u00a0flash\u00a0\u00bb sur le financement de la psychiatrie. Elle fait d\u2019amers constats dans sa communication<\/a>. Elle a cette formule qui r\u00e9sume bien la situation\u00a0: \u00ab\u00a0La psychiatrie <\/em>“hospitali\u00e8re<\/em>“souffre aujourd\u2019hui \u00e0 la fois d\u2019un sous-financement et d\u2019un mal-financement, qui ne permettent pas l\u2019ad\u00e9quation de l\u2019offre aux besoins.\u00a0\u00bb<\/em>Elle semble avoir \u00e9t\u00e9 entendue par le pr\u00e9sident de la R\u00e9publique, qui, lors d\u2019un d\u00e9placement en Gironde le 28 f\u00e9vrier dernier dans le cadre du Grand D\u00e9bat, a annonc\u00e9 \u00ab une initiative de grande ampleur \u00bb pour la psychiatrie, ajoutant : \u00ab on va r\u00e9investir, relancer des appels \u00e0 projets. Je veux aussi qu\u2019on puisse redonner une perspective \u00e0 la p\u00e9dopsychiatrie et \u00e0 la psychiatrie dans notre pays. \u00bb Il a constat\u00e9 que \u00ab le monde de la psychiatrie est aujourd\u2019hui en grande difficult\u00e9 \u00bb (voir ici<\/a>). On aimerait que toutes ces d\u00e9clarations, notamment en ce qui concerne l\u2019investissement et les moyens, se traduisent dans les faits.<\/p>\n En Australie l\u2019investissement dans ce domaine est massif (voir ici<\/a>).<\/p>\n World wide web<\/p>\n Pour les 30 ans du web, son cr\u00e9ateur, l\u2019anglais Tim Berners-Lee, a \u00e9tabli un bilan sur le site de la Web Foundation\u00a0<\/em><\/a>: \u00ab\u00a0I broadly see three sources of dysfunction affecting today\u2019s web:<\/em><\/p>\n Et fait des pr\u00e9conisations : \u00ab Governments must translate laws and regulations for the digital age. They must ensure markets remain competitive, innovative and open. And they have a responsibility to protect people\u2019s rights and freedoms online. We need open web champions within government \u2014 civil servants and elected officials who will take action when private sector interests threaten the public good and who will stand up to protect the open web.<\/em><\/p>\n Companies must do more to ensure their pursuit of short-term profit is not at the expense of human rights, democracy, scientific fact or public safety. Platforms and products must be designed with privacy, diversity and security in mind. This year, we\u2019ve seen a number of tech employees stand up and demand better business practices. We need to encourage that spirit. \u00bb<\/em><\/p>\n Le Monde<\/em><\/a> a rappel\u00e9 les d\u00e9buts de cette r\u00e9volution en France, au temps du minitel.<\/p>\n XX<\/p>\n Le cerveau f\u00e9minin est r\u00e9put\u00e9 diff\u00e9rent du cerveau masculin.Dans The Guardian<\/a><\/em>, Gina Rippon pretend le contraire : \u00ab Rippon has analysed the data on sex differences in the brain. She admits that she, like many others, initially sought out these differences. But she couldn\u2019t find any beyond the negligible, and other research was also starting to question the very existence of such differences. For example, once any differences in brain size were accounted for, \u201cwell-known\u201d sex differences in key structures disappeared. Which is when the penny dropped: perhaps it was time to abandon the age-old search for the differences between brains from men and brains from women. Are there any significant differences based on sex alone? The answer, she says, is no.<\/em>\u00bb<\/em><\/p>\n Books<\/a>\u00a0<\/em>affirme que le premier \u00e9crivain connu \u00e9tait une femme\u00a0:\u00ab N\u00e9e vers 2285 avant notre \u00e8re en M\u00e9sopotamie, la princesse Enheduanna \u00e9tait une pr\u00eatresse et une po\u00e9tesse. Elle est l\u2019auteure d\u2019un ensemble d\u2019hymnes religieux, pour la plupart \u00e9crits dans le but de f\u00e9d\u00e9rer les peuples conquis par son p\u00e8re, le roi d\u2019Akkad, Sargon Ier. Son \u0153uvre la plus connue est un cycle de trois po\u00e8mes d\u00e9di\u00e9 \u00e0 la d\u00e9esse Innana. \u00bb<\/em><\/p>\n Y<\/p>\n La g\u00e9n\u00e9ration Y n\u2019existe pas selon Vincent Cocquebert, interview\u00e9 par le Monde<\/em><\/a>\u00a0: \u00ab\u00a0On parle des millennials comme on parlerait de la famille Suricate. On applique \u00e0 la jeunesse les codes narratifs du documentaire animalier. On les d\u00e9crit, par exemple, comme accros au porno, alors que nombre d\u2019entre eux ont un rapport tr\u00e8s pudibond \u00e0 la sexualit\u00e9.<\/em><\/p>\n Pour bien comprendre ce qui se joue l\u00e0, il faut revenir \u00e0 la gen\u00e8se du concept. La premi\u00e8re r\u00e9f\u00e9rence \u00e0 cette tranche d\u2019\u00e2ge appara\u00eet en 1993, dans un \u00e9dito non sign\u00e9 du magazine am\u00e9ricain <\/em>Advertising Age, sous le nom de <\/em>\u00ab g\u00e9n\u00e9ration Y \u00bb. L\u2019objectif de cette publication marketing \u00e0 pr\u00e9tention sociologisante n\u2019est pas de d\u00e9crire la jeunesse telle qu\u2019elle est, mais de cr\u00e9er le portrait-robot d\u00e9sirable d\u2019un n\u00e9oconsommateur \u00e9thique, qui aime les marques, l\u2019engagement et croit au message publicitaire.\u00a0\u00bb<\/em><\/p>\n Zuboff (Shoshana)<\/p>\n \u00ab\u00a0Enter, as a critical guide, Shoshana Zuboff, who has emerged as the leading explicator of surveillance capitalism. A Harvard Business School professor emerita with decades of experience studying issues of labor and power in the digital economy, Zuboff in 2015 published a paper, \u201cBig Other: Surveillance Capitalism and the Prospects of an Information Civilization,\u201d which has since become an essential source for anyone looking to reckon seriously with what she described as a distinct, emerging economic logic. Now she has followed up that paper with a doorstop of a book, an intensively researched, engagingly written chronicle of surveillance capitalism\u2019s origins and its deleterious prospects for our society.\u00a0\u00bb<\/em><\/p>\n C\u2019est ainsi que The New York Times<\/em><\/a> commente le dernier livre de Shoshana Zuboff, en concluant\u00a0: \u00ab\u00a0Light on prescriptivist notions, Zuboff does propose a \u201cright to sanctuary,\u201d based on universalist, if ever more threatened, humanitarian principles, like the right to asylum. But she\u2019s after something bigger, providing a scaffolding of critical thinking from which to examine the great crises of the digital age. Through her we learn that our friends to the north were indeed correct: Facebook is the problem (along with Google, Microsoft, Amazon, et al.). This is the rare book that we should trust to lead us down the long hard road of understanding.\u00a0\u00bb<\/em><\/p>\n Ce m\u00eame livre est recens\u00e9 par la Los Angeles Review of Books<\/em><\/a>, <\/em>qui \u00e9crit notamment\u00a0: \u00ab\u00a0Zuboff\u2019s fierce indictment of the big internet firms goes beyond the usual condemnations of privacy violations and monopolistic practices. To her, such criticisms are sideshows, distractions that blind us to a graver danger: By reengineering the economy and society to their own benefit, Google and Facebook are perverting capitalism in a way that undermines personal freedom and corrodes democracy. \u00bb<\/em><\/p>\n Amiti\u00e9s et bon courage.<\/p>\n","protected":false},"excerpt":{"rendered":" Ch\u00e8res et chers coll\u00e8gues, Un nouvel ab\u00e9c\u00e9daire pour saluer l\u2019arriv\u00e9e du printemps, que nous f\u00eatons aussi en musique. Attractivit\u00e9 La perte d\u2019attractivit\u00e9 des m\u00e9tiers de sant\u00e9 devient pr\u00e9occupante au Royaume-Uni (voir ici ou l\u00e0, pour les m\u00e9decins, et l\u00e0 pour … Continuer la lecture
\nNous en avons l\u2019illustration en France avec la complaisance des pouvoirs publics envers l\u2019alcool, que d\u00e9noncent plusieurs personnalit\u00e9s du monde de la m\u00e9decine dans une tribune<\/a> intitul\u00e9e \u00ab\u00a0La d\u00e9mission gouvernementale face \u00e0 l\u2019alcool est scandaleuse \u00bb.<\/p>\n\n