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International medical graduates I agree with Natarajan and Ravikumar that overseas doctors have been treated very shabbily. 1 One of the surprising features of the whole affair has been the lack of outcry from UK and EU doctors in protest. The British Medical Association's response has been muted to say the least. But is this so surprising? In medicine, as in life, there are winners as well as losers and the simple truth is that UK and EU doctors are the winners here. Their jobs will be protected. They will not have to prove that they are better than overseas doctors to get a job; they will merely have to be available and be able to do the job. 2 But UK and EU doctors should not become too smug. It is likely that, over the coming years, the large increase in the number of UK medical graduates will make medical unemployment a reality in this country. 3 What will they do then? They could go abroad; but in light of the UK's treatment of overseas doctors they should not count on too warm a welcome. Who will speak up for them? We would do well to remember the words of Martin Niemoller, a German pastor: 'First they came for the Jews and I did not speak out-because I was not a Jew. Then they came for the communists and I did not speak out-because I was not a communist. Then they came for the trade unionists and I did not speak out-because I was not a trade unionist. Then they came for me-and there was no one left to speak out for me'.
International medical graduates I agree with Natarajan and Ravikumar that overseas doctors have been treated very shabbily. 1 One of the surprising features of the whole affair has been the lack of outcry from UK and EU doctors in protest. The British Medical Association's response has been muted to say the least. But is this so surprising? In medicine, as in life, there are winners as well as losers and the simple truth is that UK and EU doctors are the winners here. Their jobs will be protected. They will not have to prove that they are better than overseas doctors to get a job; they will merely have to be available and be able to do the job. 2 But UK and EU doctors should not become too smug. It is likely that, over the coming years, the large increase in the number of UK medical graduates will make medical unemployment a reality in this country. 3 What will they do then? They could go abroad; but in light of the UK's treatment of overseas doctors they should not count on too warm a welcome. Who will speak up for them? We would do well to remember the words of Martin Niemoller, a German pastor: 'First they came for the Jews and I did not speak out-because I was not a Jew. Then they came for the communists and I did not speak out-because I was not a communist. Then they came for the trade unionists and I did not speak out-because I was not a trade unionist. Then they came for me-and there was no one left to speak out for me'.
Ezzati et al. (May 2006 JRSM 1) misplace their confidence by a wide margin in claiming to have reached the first 'unbiased' estimates of state and national levels and trends of obesity in the USA. To do so, they claim to have calculated rates of self-reporting biases using data from the NHANES (National Health and Nutrition Examination Survey) and Behavioral Risk Factor Surveillance System (BRFSS) surveys of the US Center for Disease Control and Prevention, which were assumed to be representative of the USA population on the basis of the original sampling design. In reality the assumption is questionable, the response rates being about 80% for NHANES and 45% for BRFSS. If nothing else, such a discrepancy sets a distance between what the two surveys may represent, also considering that the surveys represent different samples. In a crucial decision, Ezzati et al. excluded subjects who did not participate in both surveys-an exclusion that inevitably invalidates any claim that the bias estimates reached could be representative of the USA population or of individual state populations. Such elementary flaws lead to ask how scarce resources could be approved for such a wanting study design.
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