Medicine and Science from The BMJ

Sue Farrington is chair of the Patient Information Forum, a member organisation which promotes best practice in anyone who produces information for patients. In this podcast, she discusses what makes good patient information, why doctors should be pleased when patients arrive at an appointment with a long list of questions, and why patients are savvy about believing "doctor google". https://www.pifonline.org.uk/

15s30m is a social movement to reduce frustration & increase joy - the idea is to spend 15 seconds of your time now, and save someone else 30 minutes down the line. To talk about their movement we're joined by the founders, Rachel Pilling, consultant ophthalmologist, and Dan Wadsworth, transformation manager - both from Bradford Teaching Hospitals NHS Trust. They explain why this is quality improvement, but doesn't require a lot of theory or permission to put in place, and why empowering staff to make small changes increases joy and reduces frustration. Follow them on twitter - https://twitter.com/15s30m See some of their missions on youtube - https://www.youtube.com/channel/UCg6ECK8oq_-pYMTgAR6pt7w

Mendelian randomisation - it’s a technique that uses the chance distribution of genes in a population, combined with big data sets, to investigate causative relationships. But there are a lot of questions we have in The BMJ about how the technique works - the association between genes and apparently non-biologically mediated behaviours, how much the strict rule of not claiming causation based on observational data has actually been overturned, and general confusion about how the non-methodologists amongst us can read these studies. Neil Davies and George Davey Smith from University of Bristol, and Michael Holmes from the University of Oxford, join us to explain how the technique works, where it can be applied, and what readers should look out for when they're trying to assess the quality of a mendelian randomisation study. Read their full research methods and reporting paper: https://www.bmj.com/content/362/bmj.k601

It’s been quite a year for the NHS - it just turned 70, had a winter crisis like never before, got over junior doctor strikes, but then was hit by a series of scandals about breast screening, and now opiate prescriptions. At the same time, we’ve seen demonstrations in favour of the service and even widespread public backing for more money. So how do all of these things mix into the way in which the British public view the NHS? In this podcast, Ben Page - chief exec of Ipsos MORI, the polling company, joins us to discuss the fluctuations in public opinion. Read the provocation: https://www.bmj.com/content/361/bmj.k2663 More NHS at 70 coverage: https://www.bmj.com/nhs-at-70

This week influential Editor-in-Chief of JAMA Internal Medicine Dr Rita Redberg joins Ray for a wide ranging conversation on all things health. A Professor at the University of California San Francisco and high profile contributor to The Washington Post and New York Times, Rita is also a practising cardiologist who loves to see patients. She says that ‘being a doctor is really a privilege’. Together, Ray and Rita canvas many topics including shared decision making between doctors and patients, the tricky territory of medical device approvals, the controversy surrounding both statins and CT scans, and the implications of not including enough women in clinical trials.

Doctors and the farming industry are often blamed for overuse of antibiotics that spurs the growing problem of antimicrobial resistance - but the professions are using different methods to combat resistance and reduce overuse. In this roundtable, we bring medics and vets together to discuss the problem - where antibiotic resistance arises, how resistance genes propagate through the environment and between countries, and what non-drug approaches can be used to reduce the need for antibiotics. Sandy Trees, Vet Record editor in chief, and retired veterinary surgeon Stuart Reid, principal of the Royal Veterinary College Jenny Bellini, cattle and dairy vet, Friars Moor Livestock Health in Dorset Peter Hawkey, professor of clinical and public health bacteriology, University of Birmingham Tim McHugh, professor of medical microbiology at University College London Emmanuel Wey, consultant in infection, Royal Free Hospital, London

Getting feedback from people who use NHS services is essential to assessing their value - and improving their quality. Hospitals and general practices widely post information about patient's satisfaction with their services on their websites, but approach tells us little about how feedback changes things on the ground . In this podcast, James Munro, former doctor and academic and current CEO of Care Opinion, explains how their online platform works, how Trusts are using it as a quality improvement tool, and how health systems can capitalise on the learning potential of this large scale data collection. This is part of the series of interviews with people who are making partnership between health professional and patients work in the real world. Listen to Katherine Cowen, from the James Lind Alliance, talk about how to broker an agreement about research priorities. https://soundcloud.com/bmjpodcasts/katherine-cowan-reaching-a-priority

Wendy Burn is a consultant old age psychiatrist, and new president of the Royal College of Psychiatrists. Her work on dementia has given her an affinity for the neurobiological basis of psychiatry - and her tenure at the college is seeing a move to wards this neurobiological model in the teaching of the profession. In this interview she talks about her work, how the profession is changing, and why she thinks Kanye can be a model for mental health.

Ray Moynihan is a senior research assistant at Bond University, a journalist, champion of rolling back too much medicine, and host of a new series “The Recommended Dose” from Cochrane Australia. In the series, Ray has talked to some of the people who shape the medical evidence that underpin healthcare around the world - the series aim is to elucidating their worldview, and how their thinking shapes their work. Over the next couple of months, we’ll be co-publishing the series - so keep an ear out for those interviews in your podcast feed.

At evidence live this year, one of the sessions was about the work of Evidence Aid - and their attempt to bring high quality evidence to the frontline of a humanitarian crisis. In that situation, it’s very difficult to know what will work - a conflict, or even immediately post-conflict situation is characterised by chaos - and merely doing something is vital. But though each situation is unique, sharing what’s worked elsewhere can be key to maximising the help given to vulnerable people.

At Evidence Live this year, the focus of the conference was on communication of evidence - both academically, and to the public. And part of that is the role that investigative journalism has to play in that. At the BMJ we’ve used investigative journalistic techniques to try and expose wrong doing on the part of government and industry - always in collaboration with clinicians and researchers. To explain a bit more about the world of journalism and campaigning, we're joined by to Shelley Jofre - from the BBC, Jet Schouten - from Radar, Kath Sansom - who started the online sling the mesh campaign & Deb Cohen, former investigations editor at The BMJ.

Don Berwick, president emeritus of the Institute of Healthcare Improvement, and former Administrator of the Centers for Medicare and Medicaid Services. In this conversation he discusses how he went from being a paediatrician to running Medicare for Obama, how we can create headroom in stressed systems, and breaking the rules to make things better for patients and staff. Quality improvement series:

When tackling societal problems - like the opioid epidemic in the US - there are two ways of approaching it. One is to reduce demand - by organising treatment programmes, or reducing the underlying reasons why people may become addicted in the first place - but that’s hard. So governments often turn to the other route - reducing supply - and that’s what the US government did in 2014 when it rescheduled oxycodone combination products from schedule 3 to schedual 2 - essentially making it harder for people to obtain a prescription. Now reducing that legal supply, without in hand reducing the demand, led to fears that those people with an opioid addiction would just turn to illicit routes to obtain their drugs - and new research published on bmj.com has attempted to find out if that happened. We're joined by 3 of the authors, James Martin, associate professor of criminology at Swinburne University; Judith Aldridge, professor of criminology at the University of Manchester; and Jack Cunliffe, lecturer in quantitative methods and criminology at the University of Kent. Read the full research: https://www.bmj.com/content/361/bmj.k2480

Series two of The Recommended Dose kicks off with polymath and poet, Dr John Ioannidis. Recognised by The Atlantic as one the most influential scientists alive today, he’s a global authority on genetics, medical research and the nature of scientific inquiry itself – among many other things. A professor at Stanford University, John has authored close to 1,000 academic papers and served on the editorial boards of 30 of the world's top journals. He is best known for seriously challenging the status quo. His trailblazing 2005 paper 'Why Most Published Research Findings Are False' has been viewed over 2.5 million times and is the most cited article in the history of PLoS Medicine. In it, he argues that most medical research is biased, overblown or simply wrong. Here, he talks to Ray about the far-reaching implications of these findings for people both inside and outside the world of health. While most closely associated with exploring cutting-edge conundrums across science, genomics and even economics, John is also something of a humanist. He’d be right at home with the philosophers of ancient Greece, seeking as he does to find answers to the big questions of the day in science and medicine, as well as in nature and narratives. A voracious reader himself, John has a lifelong love of ‘swimming in books’ and has penned seven literary works of his own in Greek – two of which have been nominated for prestigious literary prizes. And fittingly, he finds inspiration for his myriad of multi-disciplinary pursuits on Antipaxi, one of Greece’s most beautiful and secluded islands. He shares some of his distinctive logic, reason - and even a little of his poetry - on this very special episode of The Recommended Dose, produced by Cochrane Australia and co-published with the BMJ. You'll find our show notes and a full transcript of the show at http://australia.cochrane.org/trd

There’s a lot going on in the world at the moment - Ebola’s back, Puerto Rico is without power and the official estimations of death following the hurricane are being challenged. The WHO’s just met to decide what to do about it all, as well as sorting out universal healthcare, access to medicines, eradicating polio, etc etc. To make sense of that a little, we grabbed Ashish Jha - Director of the Harvard Global Health Institute to shed some light into how decisions about global health are made, and why he tries to see the world as it actually is - not how he wishes it would be. Reading list: Mortality in Puerto Rico after Hurricane Maria https://www.nejm.org/doi/full/10.1056/NEJMsa1803972 https://www.bmj.com/universal-health-coverage

We at The BMJ care about food, and if our listener stats are to be believed, so do you. In this podcast we talk to a few of the authors of a new series, published next week on bmj.com, which tries to provide some insight into the current state of nutritional science - where the controversies lie, where there’s broad agreement, and the journey of our understanding of nutrition. The open access fees for those articles has been paid for by Swiss Re - a wholesale provider of reinsurance, insurance and other insurance-based forms of risk transfer - they have not had any input into the editorial process, which has gone through the same peer review as any of our other analysis articles. Swiss Re are also co-hosting a conference where we’ll be bringing together a lot of these researchers - and which will be live streamed next week - you’ll be able to access that for free on bmj.com For more on the conference: http://institute.swissre.com/events/food_for_thought_bmj.html

In December 2017, the NEJM’s national corespondent, Lisa Rosenbaum, published an article “The Less-Is-More Crusade — Are We Overmedicalizing or Oversimplifying?” The article aimed a broadside against those who are campaigning against the overuse of medicine, and the over diagnosis of treatment. This week in the BMJ we’ve published a rebuttal to that article, and in this podcast we talk to Steve Woloshin and Lisa Schwartz - both professors at the Dartmouth Institute for Health Policy and Clinical Practice. Steve and Lisa’s article carefully deconstructs some of the ideas advanced by Rosenbaum, but in this podcast we discuss how much separate camps are forming in this debate - and how to have a constructive dialogue across that divide. Read Steve and Lisa's essay https://www.bmj.com/content/361/bmj.k2035 Iona Heath's essay - The role of fear in overdiagnosis https://www.bmj.com/content/349/bmj.g6123 Stacy Carter's interview about moral shocks https://soundcloud.com/bmjpodcasts/preventing-overdiagnosis-2017-stacy-carter-on-the-culture-of-overmedicalisation

Each time you order a test for a child, do you think the population that makes up the baseline against which the results are measured? It turns out that that historically those reference intervals have been based on adults - but children, especially neonates and adolescents, are undergoing physiological changes that mean those reference intervals may not be appropriate. To get around this Khosrow Adeli, head and professor of clinical biochemistry at the Hospital for Sick Children, and the University of Toronto, and colleagues have undertaken a mission to recruit children and young people into a study of their test results. Read the full practice article: https://www.bmj.com/content/361/bmj.k1950

Patients who are depressed and prescribed antidepressants may report weight gain, but there has been limited research into the association between the two. However new observational research published on bmj.com aims to identify that association. Rafael Gafoor, a psychiatrist and researcher at Kings College London, and one of the authors of that research joins us to talk about the potential mechanism of action - is it a physiological response to the drug, is it to do with the underlying reason for the prescription; how they studied the association; and what this might mean for individual prescriptions. You can read the full research on bmj.com; https://www.bmj.com/content/361/bmj.k1951

Complexity science offers ways to change our collective mindset about healthcare systems, enabling us to improve performance that is otherwise stagnant, argues Jeffrey Braithwaite, professor of health systems research and president elect of the International Society for Quality in Health Care. Read the full analysis: https://www.bmj.com/content/361/bmj.k2014 Quality improvement series: https://www.bmj.com/quality-improvement The BMJ in partnership with and funded by The Health Foundation are launching a joint series of papers exploring how to improve the quality of healthcare delivery. The series aims to discuss the evidence for systematic quality improvement, provide knowledge and support to clinicians and ultimately to help improve care for patients.

There’s been a lot of attention given to the new antirviral drugs which target Hepatitis C - partly because of the burden of infection of the disease, and the lack of a treatment that can be made easily accessible to around the world, and partly because of the incredible cost of a course of treatment. But a new article on BMJ talks about the uncertainly of that treatment - do we know that the drugs actually clear a HepC infection, and that this will lead to a corresponding decrease in mortality and morbidity? Janus Jakobsen from the Copenhagen Clinical Trial Unit joins us to discuss what the literature proves. Read the full article: https://www.bmj.com/content/361/bmj.k1382

Worldwide, the rate of type II diabetes is estimated to be around 1 in 11 people - about 9%. For the Pima people of Arizona, 38% of the adult population have the condition - but across the border in Mexico, the rate drops down to 7%. The difference between the groups is their life experience - one side displaced, the other on their traditional lands - and their experience is being replicated elsewhere. Lauren Carruth, assistant professor at The American University, joins us to talk about the Pima people, where else displacement is changing patterns of non-communicable disease, and what this might tell us about economic migrations effect on health. Read the full editorial: https://www.bmj.com/content/361/bmj.k1795

We’re in an era of big data - and hospitals and GPs are generating an inordinate amount of it that has potential to improve everyone’s health. But only if it’s used properly. New research published on www.bmj.com this week describes another set of information, about that data, that the authors believe could be just as important as the data itself. Griffin weber, and Isaac Kohane, from the Department of Biomedical informatics at Harvard medical school join us to discuss. Read the full research: https://www.bmj.com/content/361/bmj.k1479

The array of options available to pharmaceutical companies, to advertise their drugs, is incredibly broad - and the amount that they spend is increasing, with some reports saying it’s up 60% in the last five years. In most countries, there are pretty strict rules to limit the ways in which Pharma can spend their advertising dollars - but the WHO guidelines which have informed many of those rules are now 30 years out of date. A new analysis on bmj.com “Ethical drug marketing criteria for the 21st century“ proposes some ways in which those guidelines should be updated, we're joined two of the authors - Lisa Parker and Lisa Bero - from the Charles Perkins centre at the faculty of pharmacy at the university of Sydney to discuss. Read the full analysis: https://www.bmj.com/content/361/bmj.k1809

For many people, cancer is now survivable and has become a long term condition, and depression and anxiety are more common in cancer survivors than in the general population. Despite this, 73% of patients don't receive effective psychiatric treatment. Alexandra Pitman, consultant liaison psychiatrist at St George’s University Hospitals NHS Foundation Trust, and Andrew Hodgkiss, consultant liaison psychiatrist, at the Institute of Psychiatry, Psychology & Neuroscience join us to dispel some of the concern clinicians may have about the complexities of diagnosing depression in cancer - what is biopsychosocial, what is the organic result of the cancer or treatment - and some of the concern about treatment interactions. Read the two education articles: https://www.bmj.com/content/361/bmj.k1415 https://www.bmj.com/content/361/bmj.k1488

Smokers want to vape, it can help them quit, and it’s less harmful than smoking, say Paul Aveyard professor of behavioural medicine at the University of Oxford. But Kenneth C Johnson, adjunct professor at the University of Ottawa, argues that smokers who vape are generally less likely to quit and is concerned about youth vaping as a gateway to smoking, dual use, and potential harms from long term use. Read the debate: https://www.bmj.com/content/361/bmj.k1759

Harry Burns was a surgeon, who gave up his career in that discipline to become a public health doctor. Eventually that lead to him being the last Chief Medical Officer of Scotland, and now he’s professor of global public health at the University of Strathclyde. Scotland has always had a separate NHS, but since devolution, the parliament there has had much more autonomy in running the country - and Harry has seemed to manage to convince them that improving health means improving the social determinants of health. In this conversation we talk about that link, how his philosophy has affected policy up there, some of the experiments which are going on in the country, and what he thinks is the most exciting change. Read the editorial on GDP and wellness: https://www.bmj.com/content/360/bmj.k1239

We talk about financial conflicts of interest a lot atThe BMJ - and have take taken the decision that our educational content should be without them. We also talk a lot about non-financial conflicts of interest, but the choppy waters of those are much more difficult to navigate. In this podcast, we discuss whether we should, or if we could even could, make people’s intellectual positions transparent. Arguing that it’s important to tackle this issue, are Wendy Lipworth and Ian Kerridge from Sydney health Ethics at the University of Sydney - and arguing that it’s not as easy as we think is Marc Rodwin, from Suffolk University Law School in Boston. Read the full head to head: https://www.bmj.com/content/361/bmj.k1240

In 2016, from an estimated pre-war population of 22 million, the United Nations (UN) identified 13.5 million Syrians requiring humanitarian assistance, of which more than 6 million are internally displaced within Syria, and around 5 million are refugees outside of Syria. In this podcast, Aula Abarra, consultant in infectious disease from London, joins us to discuss what's happening now in Eastern Ghouta, and area of Damascus, where civilians are being held under siege, where humanitarian aid is unable to reach. Read the full editorial: https://www.bmj.com/content/360/bmj.k1368

The first digital banking in the UK was launched in 1983, Skype turns 15 this year, but 2017 finally saw panic over the impact that online consultations may have on general practices. In this podcast Martin Marshall, professor of healthcare improvement at University College London joins us to discuss whether video conference actually is a disruptor, or whether it’s actually the whole business model of general practice that needs to change. Read the full analysis: https://www.bmj.com/content/360/bmj.k1195

When a new drug reaches market, the race is on to find more indications for its use - exploratory trials are set up, and positive results can lead to the off label prescriptions (eg Pregabalin for lower back pain. However, these initial indications are rarely confirmed with further, better quality, evidence. Jonathan Kimmelman is an associate professor at MCgill University in Canada, thinks it's time to explore less, and confirm more - and joins us to explain why. Read the full analysis: http://www.bmj.com/content/360/bmj.k959

Ravi Gupta, is a resident in internal medicine at Johns Hopkins in Baltimore - and as he said has seen the influence of sudden price hikes on his patients - between 2010 and 2015 more than 300 drugs in the U.S. have seen sudden increases of over %100. Ravi and his co-authors have suggested, and tested the feasibility of, a possible answer to those price hikes - a small tweak that should protect patients from the possibility that they’ll suddenly be unable to afford their essential medication. Read the full research: http://www.bmj.com/content/360/bmj.k831

”An additional person died every seven minutes during the first 49 days of 2018 compared with what had been usual in the previous five years. Why? In this podcast, Danny Dorling, Halford Mackinder professor of geography at the university of Oxford, talks about the spike in mortality, what that means for overall life expectancy in the UK (spoiler, it’s not great) and what he thinks could be fuelling the change. Read the full editorial http://www.bmj.com/content/360/bmj.k1090 For more information, this article by Dorling and Hiam has further analysis: https://theconversation.com/rapid-rise-in-mortality-in-england-and-wales-in-early-2018-an-investigation-is-needed-93311

That’s Jo Shapiro is a surgeon and manager in Brigham and Women’s hospital, she’s also director of the Center for Professionalism and Peer Support, and has written an editorial for The BMJ on tackling unprofessional behaviour. In this discussion, she and I talked about what she thinks (beyond the illegal) are the most damaging behaviours seen around a hospital, what needs to be done to set up an environment that allows the victims of unprofessional behaviour to speak out about senior members of staff, and how she goes about confronting perpetrators about their behaviour. Read the full editorial: http://www.bmj.com/content/360/bmj.k1025

Our latest debate asks, should doctors recommend acupuncture for pain? Asbjørn Hróbjartsson from the Center for Evidence-based Medicine at University of Southern Denmark argues no - evidence show's it's no worse than placebo. Mike Cummings, medical director of the British Medical Acupuncture Society argues yes - that there is evidence of efficacy, and trials haven't been designed to accurately measure that. We also hear from Kumari Manickasamy, a GP in north London, and someone who used acupuncture to control her pain during pregnancy despite knowing the lack of evidence. Read the debate and commentary: http://www.bmj.com/content/360/bmj.k970 http://www.bmj.com/content/360/bmj.k990

In this year's Nuffield Summit round table we're asking, how can the NHS become a good employer? At the moment, there is a recruitment and retention crisis across the workforce, doctors and nurses are leaving the NHS in droves, rota gaps are prevalent. A recent BMA survey showed that the majority of junior doctors are now planning to take a career break. So against this backdrop, what can the NHS do to nurture it's employees, and make medicine an exciting proposition for the millennial, and subsequent, generations. Taking part are: Fiona Godlee (Chair), editor-in-chief, The BMJ Candace Imison, director of policy, The Nuffield Trust Bob Klaber, consultant paediatrician and associate medical director, Imperial College Healthcare NHS Trust Claire Lemer, consultant in general paediatrics and service transformation, Guys and St Thomas’s NHS Foundation Trust Nishma Manek, GP trainee in London, national medical director’s clinical fellow Clifford Mann, consultant in Emergency Medicine, Taunton and Somerset NHS Foundation Trust, national clinical advisor for NHS England’s Accident and Emergency Improvement Plan

Its now widely agreed that one of the key ways of reducing the current high level of "waste " in biomedical research is to focus it more squarely on addressing the questions that matter to patients - and the people and medical staff that care for them. In this interview, Tessa Richards - the BMJ's patient partnership editor, talks to Katherine Cowan, independent consultant and a senior advisor the the James Lind Alliance, which has pioneered patient involvement with their research priority setting partnerships. In this conversation they talk about how these work, the challenge of navigating between different groups with what are often very different views and agendas, and why she thinks healthy debate on divergent views is no bad thing

Up to $500m a year could be put to better use by stopping ineffective and potentially harmful supplementation programmes in poorer countries, argues John Mason, professor emeritus at Tulane University School of Public Health and Tropical Medicine. However Keith West, professor of infant and child nutrition at Johns Hopkins Bloomberg School of Public Health disagrees, saying that such programmes have been proved to save millions of lives and should be withdrawn only when robust evidence permits. Read the full head to head debate: http://www.bmj.com/content/360/bmj.k927

International travel is increasingly common. Between 10% and 42% of travellers to any destination, and 15%-70% of travellers to tropical settings experience ill health, either while abroad or on returning home, Malaria is the commonest specific diagnosis, accounting for 5%-29% of all individuals presenting to specialist clinic, followed by dengue, enteric fever, and rickettsial infections . In this podcast Doug Fink specialist registrar, and Victoria Johnston consultant, in infectious diseases at The Hospital for Tropical Diseases join us to discuss diagnosis, and treatment - and why the clinically most interesting diagnosis is rarely the right one. Read the full practice article: http://www.bmj.com/content/360/bmj.j5773

In a new analysis John McArthur and Krista Rasmussen, from the Global Economy and Development Program at the Brookings Institution, and Gavin Yamey from Duke University, have set out to analyse the potential for lives saved by the goals set in the Sustainable Development Goals In this conversation I talked to Gavin and John about the numbers, which countries have to accelerate their development to meet those goals - and we also address some of the criticisms of the SDGs - that they’re too wide ranging, that they lack a political dimension, and that they are unrealistic. Read the full analysis and more on the SDGs: http://www.bmj.com/content/360/bmj.k373 http://www.bmj.com/content/sustainable-development-goals

A study published by The BMJ today reports a possible association between intake of highly processed (“ultra-processed”) food in the diet and cancer. Ultra-processed foods include packaged baked goods and snacks, fizzy drinks, sugary cereals, ready meals and reconstituted meat products - often containing high levels of sugar, fat, and salt, but lacking in vitamins and fibre. They are thought to account for up to 50% of total daily energy intake in several developed countries. Mathilde Touvier, senior researcher in nutritional epidemiology and Bernard Srour, pharmacist and PhD Candidate, both at INSERM, join us to discuss what ultra processed foods actually are, why it is they could be leading to cancer, and what their cohort study tells us about that potential risk. Read the full open access research: http://www.bmj.com/content/360/bmj.k322

Sabine Netters is an oncologist in The Netherlands - where assisted dying is legal. There doctors actually administer the drugs to help their patients die (unlike proposed legislation in the UK). In this moving interview, Sabine explains what was going through her head, the first time she helped her patient die - and how in the subsequent years, the emotional toll hasn't lessened. She explains why she believes that in certain circumstances, euthanasia can be the ultimate caring act. Read her essay: http://www.bmj.com/content/360/bmj.k116

Bobbie Farsides is professor of clinical and biomedical ethics at Brighton and Sussex Medical School. She’s been described as one of the few people that is acceptable to “both sides” of the assisted dying debate. This week she joins us to talk about the way in which the debate on euthanasia has played out in the UK - and hear why she thinks it’s now time for all individual doctors to make up their own mind, and not let either camp own the argument for them. Read her commentary on the debate: http://www.bmj.com/content/360/bmj.k544

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person. It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture. Yet medical participation in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001. Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees. The 2016 release of previously classified portions of guidelines from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers. In this podcast, Zackary Berger, associate professor at Johns Hopkins School of Medicine, joins us to discuss what those guidelines have revealed. Read the full analysis: http://www.bmj.com/content/360/bmj.k449

The number of people officially recorded as sleeping on the streets of England rose from 1768 in 2010 to 4751 in autumn 2017.1 Charities estimate the true figure to be more than double this. Danny Dorling, Halford Mackinder professor of geography at the University of Oxford joins us to explain what's fuelling that rise, why the true extent of the problem is far larger, and what steps need to be taken to tackle the epidemic. Read the editorial: http://www.bmj.com/content/360/bmj.k214

We have evidence on which to act, and inaction costs lives, argues Simon Capewell, Professor of Public Health and Policy, at the University of Liverpool. But Aileen Clarke, professor of public health and health services research at Warwick Medical School, says our understanding of the human behaviour that leads to unhealthy choices is still lacking Read the head to head http://www.bmj.com/content/360/bmj.k292

We know that smoking 20 cigarettes a day increases your risk of CHD and stroke - but what happens if you cut down to 1, do you have 1/20th of that risk? Allan Hackshaw, professor of epidemiology at UCL joins us to discuss a new systematic review and meta analysis published on bmj.com, examining the risk of smoking just one or two cigarettes a day. Read the full review: http://www.bmj.com/content/360/bmj.j5855

Virginia Murray, public health consultant in global disaster risk reduction at Public Health England, was instrumental in putting together the Sendai Framework for Disaster Risk Reduction - an international agreement which aims to move the world from reacting to disasters, to proactively preventing them. In this podcast, she explains what they learned in the process, and why science had to become storytelling, in order to make politicians pay attention. Read the editorial on creating a set of indicators for disaster preparedness. http://www.bmj.com/content/359/bmj.j5279

The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice. In this audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. Kate Addlington, associate editor and trainee psychiatrist is joined by Cat Chatfield, quality editor and GP. They discuss acute respiratory distress syndrome: http://www.bmj.com/content/359/bmj.j5055 Why it’s important to have early diagnosis of psychotic symptoms, and the evidence for improved outcomes: http://www.bmj.com/content/357/bmj.j4578 And finally, why it’s important to consider hearing-loss on the ward: http://www.bmj.com/content/360/bmj.k21

Many older adults have difficulty understanding speech in acute healthcare settings owing to hearing loss, but the effect on patient care is often overlooked. Jan Blustein professor of health policy and medicine at New York University, and who has also experienced the affects of hearing loss, joins us to explain what that's like, and gives some tips on making it easier to communicate. Read the full analysis: http://www.bmj.com/content/360/bmj.k21 Full transcript of the interview: https://docs.google.com/document/d/1Rp7zvRlnTG5KRVLgmR-PFt-0fVRLBqINU5EmOrT5RDU/edit?usp=sharing