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June issue of PLoS Medicine: sex, incentives, and safety

Unfortunately, none of the PLoS Medicine editors could make it out to the healing fields of the annual music and mud extravaganza that is Glastonbury Festival last week, but we have still been able to explore some fascinating, and perhaps controversial, aspects of healthcare. This month, Corita Grudzen and Peter Kerndt discuss working practices in the adult film industry. They propose that regulation is now necessary to enforce much-needed health and safety standards for actors who perform in adult films.

Systematic interventions aimed at improving health outcomes may often seem sensible on paper, but how often do they deliver? In the UK, new contracts for family practitioners were introduced in 2004, bringing in “pay for performance”, in which an element of the practitioner’s income depends on meeting specific quality targets. Do incentives such as this result in better outcomes for patients? Christopher Millett and colleagues wanted to examine just that, and they focused specifically on treatment targets for diabetes in Wandsworth, an ethnically diverse part of South London. Encouragingly, pay-for-performance contracts did seem linked to improvements in overall quality of care. However, improvements in outcomes such as blood sugar management and blood pressure were not experienced equally by all ethnic groups, posing a familiar challenge: how can we deliver quality healthcare for all? A Perspective discusses this problem and emphasises the importance of setting local, and flexible, program goals.

Of course, incentives can act both ways: they can result in “desirable” behaviour, but are also capable of promoting courses of action that the public might see as undesirable. For example, we know that trials comparing one drug against another are more likely to produce results favouring the sponsor’s drug, but it’s not obvious why. Lisa Bero and colleagues wanted to find out to what extent different factors are linked to the overall trial result. Funding source emerges as the single biggest factor linked to outcome, even when other variables are controlled for. Should the trials that really matter to doctors and patients be funded through government sources, or overseen by public bodies?

Public funding for healthcare research is, clearly, finite; and finite resources entail prioritisation. In an eloquent essay, Emmanuel Lagarde sets out the case for a much-ignored, but hugely important global health challenge: why we need to scale up research into road safety, and particularly in Africa. Whilst mortality rates from road traffic accidents seem to be falling in the developed world, rates are rising in developing countries. Certainly, we need to deliver research that is relevant to health burdens of the real world: Ben Goldacre can keep his yurt-based gong therapy, just for the moment at least.

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