Medicine and Science from The BMJ

The World Health Organization, the Roll Back Malaria Partnership, and the United Nations, all have a vision of a malaria-free world. The world has already committed to malaria eradication, albeit without a target date. Bruno Moonen, deputy director for malaria at the Bill and Melinda Gates Foundation, thinks that for malaria, eradication is the only equitable and sustainable solution. Where as Clive Shiff, associate professor at the Johns Hopkins Bloomberg School of Public Health, thinks this is a top-down strategy, dependent on massive concentrated funding until finished - funding which could be more effectively spent elsewhere. In this podcast they debate whether malaria should be eliminated, or eradicated, and how that might work. Read the full debate: http://www.bmj.com/content/356/bmj.j916

Scott Murray, professor of primary palliative care at the University of Edinburgh, has written, and talked in this podcast before, about the benefits of early palliative care - and today he’s back to explain how illness trajectory, and the pattern of decline at the end of life, affects 4 main areas of wellness - physical, social, psychological and spiritual or existential. Read his full analysis article: http://www.bmj.com/content/356/bmj.j878

In 2015, community acquired pneumonia (CAP) accounted for 15% of deaths in children under 5 years old globally and 922 000 deaths globally in children of all ages. In this podcast Iram Haq, a registrar and clinical research associate in paediatric respiratory medicine, joins us to discuss the definition of pneumonia, how to assess for the infection, and what treatments are effective. Read the full clinical update: http://www.bmj.com/content/356/bmj.j686

The UK government published its report Childhood Obesity: a Plan for Action, in August 2016. A new analysis article takes them to task for the inadequacy of that response to a growing problem. Neena Modi is a professor of neonatal medicine, at Imperial College London, and president of the Royal College of Paediatrics and Child Health, and joins us to discuss what that report should have contained. Read the full analysis: http://www.bmj.com/content/356/bmj.j762

A new rapid recommendation had concluded that LIPUS makes no different to patients experience of bone healing, and therefore shouldn't be used. In this podcast, we talk to three of those panel members - Rudolf Poolman, orthopaedic surgeon from The Netherlands, Stefan Schandelmaier, a methodologist from McMaster University, and Maureen Smith, a patient representative. Read the full recommendation: http://www.bmj.com/content/356/bmj.j576

All doctors, irrespective of their specialty or the setting in which they work, will care for patients who die. Around half of all deaths occur in hospitals. Evidence suggests that the quality of communication around this process is poorer in hospitals than in other settings, according to responses from relatives who have experienced bereavement. Over half of NHS complaints concern care of the dying. In this podcast, Katherine Sleeman, clinician scientist and honorary consultant in palliative medicine at King's College London, and Jane Harris, counselling and psychotherapy practitioner, and bereaved mother and daughter join us to discuss what support the carers and relatives of a dying patient need, and give practical advice on how to become better at having those difficult conversations. Read the full essentials article: http://www.bmj.com/content/356/bmj.j367

Persistent physical symptoms are common and include those symptoms that last at least three months and are insufficiently explained by a medical condition after adequate examination and investigation. Observational studies in primary care report that women, especially those aged 35-45 years, more commonly present with these symptoms. In this podcast, Madelon den Boeft, a GP and, Nikki Claassen-van Dessel, a GP trainee, both in The Netherlands, join us to explain why listening to a patient is important, and making sure that regular follow up is essential. Read the full uncertainties article: http://www.bmj.com/content/356/bmj.j268

Vivek Murthy, the US surgeon general, has highlighted prescription opioid misuse as a serious public health problem. In this podcast, Richard Hurley speaks to him about what he thinks needs to be done to tackle the issue. http://www.bmj.com/content/356/bmj.j715

Evidence shows using electronic health records can increase efficiency, and reduce preventable medical errors - but only if they are used properly. However, in the US, the president of the American Medical Association calls them almost unusable. In this debate, Richard Hurley is joined by George Gellert, Regional Medical Informatics Officer at CHRISTUS Santa Rosa Health System and Edward Melnick, Assistant Professor of Emergency Medicine at Yale, who debate whether US doctors should be using electronic medical records. Read the related article: http://www.bmj.com/content/356/bmj.j242.

The use of novel psychoactive substances is increasing, however there is little information about what these are, and how they work. Dr Derek Tracy, consultant psychiatrist at Oxleas NHS Foundation Trust, and David Wood, consultant physician and toxicologist at Guy's and St Thomas' NHS Foundation Trust join us to explain that doctors already know how to deal with these, if they think about them in terms of traditional drug use. Read the two related articles: http://www.bmj.com/content/356/bmj.i6814 http://www.bmj.com/content/356/bmj.i6848

http://evidencelive.org/manifesto/ The BMJ, and the Centre for Evidence Based Medicine in Oxford have long collaborated to document the problems with the creation and use of Evidence based medicine - and together we host evidence gatherers, synthesisers and users in the conference Evidence Live. We know what the problems are - but what would positive change, when it comes to the creation and use of medical evidence look like? To find out we’re doing a series of discussions at various places around the world - where we’re talking to people who have a particular insight into one area of the evidence ecosystem. Ultimately we’re collating this into what we’re calling the evidence manifesto. In this discussion we went to the The Farr Institute which is a of 21 academic institutions and health partners in the UK - whose mission is to deliver high-quality, cutting-edge research using ‘big data”.

Should gluten-free foods be available on prescription? A gluten free diet is the main treatment for celiac disease, and gluten-free food has been available on prescription from the NHS. However, as finances become tighter, in some areas patients no longer have that option. Prescriptions of gluten free food is the same as a prescription for a drug, argues David Sanders, professor of gastroenterology from Royal Hallamshire Hospital, but James Cave lambasts a costly system that frustrates patients and doctors alike. Gemma Gleed is the mother of a child with coeliac disease, who has had her prescriptions cancelled. Read the debate: http://www.bmj.com/content/356/bmj.i6810

Surrogate endpoints are commonly used in clinical trials to get quicker results, however Michael Baum, emeritus professor at University College London, worries that by not focusing on real outcomes - length of life, and quality of life - that these are being used to justify expensive treatments which may not benefit patients. Read the full analysis: http://www.bmj.com/content/355/bmj.i6286

State regulation is necessary for safety, says Simon Capewell, professor of public health and policy at the University of Liverpool. Richard Lilford, professor of public health at the University of Warwick, argues that restricting adults’ choice can undermine such aims. Read the debate: http://www.bmj.com/content/355/bmj.i6341

In this year's Christmas BMJ 2016 podcasts, we’ve been discussing morality, compassion, truth. In this final one, it's time for war. After the second world war, there was an attempt to bring a moral sense to conflict - and Julian Sheather, specialist adviser on ethics and human rights to the BMA, and author of the christmas editorial “medicine under fire” is worried about the retrenchment of those ideals. http://www.bmj.com/content/355/bmj.i6464 Peter Wever is a doctor in The Netherlands, and has been uncovering the story of the number 10 stationary hospital, in st-omer in northern france - a British army hospital that was targeted and destroyed during the first world war. http://www.bmj.com/content/355/bmj.i6509

In response to the turmoil of 2016, with political campaigns being run on, and won on, misinformation - many commentators are disparing that we’ve become a post-truth society. And what is truth anyway? Tracy Brown, director of Sense about Science, the charity set up to champion evidence in everyday life, is less pessimistic about the public's appetite for evidence. http://www.bmj.com/content/355/bmj.i6467 Anders Huitfeldt, a postdoctoral scholar at Stanford University School of Medicine, and has been trying to puzzle out “Is caviar a risk factor for being a millionaire?” http://www.bmj.com/content/355/bmj.i6536

Underneath all of our civilisation and science, we’re still primates - and the connection between patient and doctor can be reinforced by simply taking a hand. Robin Youngson, cofounder of hearts in healthcare, and Mitzi Blennerhassett, who has written extensively on patient engagement, have co-authored an editorial calling for the humanisation of medicine, and we talk to them about the power of touch. Read the editorial: www.bmj.com/content/355/bmj.i6262 Andrew Steptoe is the British Heart Foundation professor of psychology, at University College London. He and colleagues have been using a large cohort study to measure the link between overall happiness and health. Read the full research: www.bmj.com/content/355/bmj.i6267

In an ideal world, policies would be evidence based - but governments are made of humans, who have positions and ideologies and moral bases. In this podcast Anthony Painter, from the RSA will be talking about why universal basic income may work, but who’s proponents cross ideological barriers, and writer and philosopher AC Grayling explains how economic arguments become moral crusades. A universal basic income: the answer to poverty, insecurity, and health inequality? http://www.bmj.com/content/355/bmj.i6473 Morality and non-medical drug use http://www.bmj.com/content/355/bmj.i5850

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 new monthly audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. In our second audio edition, GPs Sophie Cook and Helen Macdonald, surgical trainee Jessamy Baganel, and internalist and methodologist Reed Siemieniuk, talk about the evidence for vitamin D supplements. http://www.bmj.com/content/355/bmj.i6201 The new Rapid Recommendation series in the BMJ http://www.bmj.com/content/354/bmj.i5085 Communication with patients who have learning difficulties, or others who have experienced torture. http://www.bmj.com/content/355/bmj.i5296 http://www.bmj.com/content/355/bmj.i5019 And safety netting of people with low, but not no, risk of cancer. Can safety-netting improve cancer detection in patients with vague symptoms?

Renal transplantation improves quantity and quality of life compared with chronic dialysis. A UK general practice with 8000 patients will have around four patients with a functioning renal transplant, one patient on the transplant waiting list, and several under consideration for transplantation. Many medical problems in renal transplant recipients will be managed by non-specialist clinicians, and this article provides advice for the non-specialist on managing renal transplant patients. In this podcast, Tom Nieto, and Paul Cockwell from the Renal Services unit in the, College of Medical and Dental Sciences at the University of Birmingham, join us to discuss how non-specialists can spot problems early, and when it’s appropriate to talk about the potential for transplantation. Read their full clinical update: http://www.bmj.com/content/355/bmj.i6158

Glasgow GP, writer, broadcaster, and The BMJ's weekly columnist Margaret McCartney joins us to talk about her new book "The State of Medicine: Keeping the Promise of the NHS". Read all of Margaret's columns: goo.gl/iKmmie

Despite high quality systematic reviews reporting ineffectiveness, many guideline groups continue to recommend vitamin D supplementation (with or without calcium) for fall or fracture prevention. Recently Public Health England recommended that everyone needs vitamin D equivalent to an average daily intake of 10 μg (400 IU) to protect bone and muscle health, In this podcast, Andrew Grey, associate professor of medicine at the University of Aukland joins us to discuss what the evidence says for who should, and who shouldn't take vitamin D supplimentation. Read the full uncertainties article: http://www.bmj.com/content/355/bmj.i6201

Allocation concealment - blinding which arm of a trial a patient is randomised to - is being questioned in an analysis published on thebmj.com. David Torgerson, director of the York Trials Unit at the university of York and colleagues have been looking at the way in which trials do this randomisation, and how they subsequently report it - and have found both lacking. Read the full analysis: http://www.bmj.com/content/355/bmj.i5663

Concussion is a clinical diagnosis made after a head injury with consequent associated signs, symptoms, and neurological or cognitive impairment (infographic - http://bmj.co/conrecG). In the absence of strong evidence, most recommendations on the management and recovery from concussion are based on international expert consensus. In this podcast John Brooks, academic clinical fellow in general practice, and Simon Kemp, chief medical officer for the Rugby Football Union take us through the process of guiding a patient through recovery and back into everyday life, including sport. Read the full 10 minute consultation: http://www.bmj.com/content/355/bmj.i5629

Between 13 & 33% of the adult population have regular difficulty in getting to sleep, or staying asleep. It's important to recognise the difference between acute and chronic insomnia, as treatment strategies differ. David Cunnington, director of the Melbourne Sleep Disorders Centre, joins us to explain what non-drug interventions are available to help those with chronic insomnia. Read the full clinical review: http://www.bmj.com/content/355/bmj.i5819

Despite considerable investment and innovation, chemotherapy drugs have had little effect on survival in adults with metastatic cancer. In this podcast, Navjoyt Ladher, clinical editor for The BMJ, talks to Peter Wise, former consultant physician and senior lecturer Imperial College School of Medicine, and author of a recent analysis on TheBMJ.com Read the full analysis: http://www.bmj.com/content/355/bmj.i5792

In the UK, junk food advertising is banned on children’s TV - but manufactures are still able to target children in other ways. A recent report from the WHO "Tackling food marketing to children in a digital world", takes a look at the issue. In this podcast we're joined by João Breda, programme manager for nutrition physical activity and obesity at the regional office for Europe of the World Health Organisation, and Mimi Tatlow-Golden, lecturer in childhood studies and developmental psychology at the open university, and the lead author on the report. Read the full report: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/publications/2016/tackling-food-marketing-to-children-in-a-digital-world-trans-disciplinary-perspectives-2016

To avoid waste of research, no new studies should be done without a systematic review of existing evidence. That argument has been made for 20 years, yet the lack of reference to a systematic review before designing new studies is still a problem. Hand Lund, professor at the University of Southern Denmark joins us to explain why research before researching is still an issue. Read the full analysis: http://www.bmj.com/content/355/bmj.i5440

In patients with symptomatic severe aortic stenosis but at lower risk of perioperative death, how do minimally invasive techniques compare with open surgery? Prompted by a recent trial, an expert panel produced these recommendations based on three linked rapid systematic reviews. In this podcast we talk to Michael Shapiro who was a patient representative on that panel about what matters to patients, and how he found taking part in creating the recommendation. Read the recommendation in full: http://www.bmj.com/content/354/bmj.i5085

Catherine Calderwood has been chief medical officer for Scotland since March 2015 - her first CMO report, which she titled “Realistic Medicine” has created a stir beyond the borders of Scotland. The BMJ, sat down with Catherine at a the Preventing Overdiagnosis conference to find out what she intended with that report. Read more: http://www.bmj.com/content/355/bmj.i5455

Middle East respiratory syndrome (MERS) is an acute viral respiratory tract infection caused by the novel betacoronavirus. Cases have been limited to the Arabian Peninsula and its surrounding countries, and to travellers from the Middle East or their contacts. The clinical spectrum of infection varies from no symptoms or mild respiratory symptoms to severe, rapidly progressive pneumonia, acute respiratory distress syndrome, septic shock, or multiorgan failure resulting in death. In this podcast Sarah Shalhoub, infectious diseases consultant at King Fahad Armed Forces Hospital, in Saudi Arabia joins us to discuss the history of the disease, clinical presentation, and what can be done to support those infected. Read the full clinical update: http://www.bmj.com/content/355/bmj.i5281

Elizabeth Pisani, visiting senior research fellow at King's College London, collects data on sex workers and injecting drug users in low and middle income countries. For years she has been sharing her data, and joins us to explain why she went from being protective of her research to to making it freely available - and talk about some of the practicalities of keeping participants anonymous. Read the full analysis: http://www.bmj.com/content/355/bmj.i5295

Independent contractor status creates unnecessary stress, argues Azeem Majeed, GP partner and professor of primary care at Imperial College London. Laurence Buckman, GP partner and former head of the BMA GP committee, values his autonomy and distance from a non-benign employer. Read the full head to head: http://www.bmj.com/content/355/bmj.i5064 We also hear from former columnist and current partner in a federated practice, Des Spence, who thinks that the days of small GP surgeries are numbered. Independent or employed? There is a third way. . . http://www.bmj.com/content/355/bmj.i5329

The Preventing Overdiagnosis conference is part of The BMJ's campaign against Too Much Medicine. Helen Macdonald clinical editor for The BMJ was at the conference, and talked to some of the key speakers there about what they believe the key issues are, and what's being done to roll back the harms of too much medicine. http://www.bmj.com/too-much-medicine http://www.preventingoverdiagnosis.net/

Globally each year more than 30 000 people become living kidney donors. Living kidney donation is constantly evolving, with new ways of pooling donors and recipients to maximise opportunity. With increased numbers, there is increasing information regarding the long term outcomes associated with donation. Pippa Bailey, clinical lecturer in renal medicine at the University of Bristol, and Aisling Courtney, consultant nephrologist at Belfast City Hospital join us to explain who can donate, to whom, and the possible impact of donation on the donor’s health. Read the full update: http://www.bmj.com/content/354/bmj.i4746

In a clinical trial, we usually think of risk in terms of the new active compound - will it have unwanted effects. However, two analyses in The BMJ are concerned about the risk associated with the control arm. Robin Emsley is a professor of psychiatry at Stellenbosch University in South Africa, he and colleagues have written about the risk associated with forgoing treatment in patients with schizophrenia. Read the full analysis: http://www.bmj.com/content/354/bmj.i4728 Jonathan Mendel, lecturer in human geography at the University of Dundee, and Ben Goldacre, senior clinical research fellow at the University of Oxford, have examined the ethical approval given to trials, and are concerned that identified risks are not adequately communicated to patients. Read the full analysis: http://www.bmj.com/content/354/bmj.i4626

Alastair Matheson, independant consultant and former ghostwriter, describes how the pharmaceutical publications industry seeks to legitimise ghostwriting by changing its definition while deflecting attention from wider marketing practices in academic publishing. Read his full analysis: http://www.bmj.com/content/354/bmj.i4578

Oversimplification and lack of evidence stigmatise people with mental illness and impede prevention efforts, says Simon Wessley, professor of psychiatry at King's College London, in an editorial published on thebmj.com. Read the full editorial: http://www.bmj.com/content/354/bmj.i4869

Lily was diagnosed at 14 years old with stage four Hodgkin's lymphoma and received six rounds of chemotherapy and two weeks of radiotherapy. She survived but now lives with the long term effects of that therapy - and joins us to discuss how it has impacted her quality of life. We're also joined by Saif Ahmad and Thankamma Ajithkumar, oncologists from Cambridge University Hospitals NHS Foundation Trust, who give advice for generalists on late effects of anticancer chemotherapy that may affect quality of life. Read the full clinical review: http://www.bmj.com/content/354/bmj.i4567

The United Nation's Millennium Development Goals, and the subsequent Sustainable Development Goals, define premature mortality as being a death under the age of 70. As demographic change means more people are living longer than this, Peter Lloyd-Sherlock, professor of social policy and international development at the University of East Anglia, argues that this will lead to discrimination against older people. Read the full analysis: http://www.bmj.com/content/354/bmj.i4514

"I say to all Australian doctors - young, old, the political and the apolitical - that on this depends not just our ethical credibility as a profession, but our shared humanity. " Following the leaked emails published in The Guardian newspaper, alleging abuse of asylum seekers detained by the Australian government on the Pacific island of Nauru, David Berger joins us again to say it is time that doctors take a stand and march to protest against this treatment. Read his full editorial: http://www.bmj.com/content/354/bmj.i4606 Listen to the head to head debating if doctors should boycott working at the detention centres: https://soundcloud.com/bmjpodcasts/should-doctors-boycott-working-in-australias-immigration-detention-centres

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 new monthly audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. In our first audio edition, GPs Sophie Cook and Helen Macdonald, psychiatry trainee Kate Adlington, and HIV and sexual health trainee Deborah Kirkham talk about communication skills – ICE - obtaining a patient’s ideas, concerns and expectations about their health. http://www.bmj.com/content/354/bmj.i3729 They also examine the lack of evidence for cardiovascular examination. http://www.bmj.com/content/354/bmj.i3309 And finally, they talk about how 50% of patients with treatment resistant hypertension may actually be treatment non-adherent, and what that could mean for other conditions. http://www.bmj.com/content/354/bmj.i3268

The European Medicines Agency (EMA) has embraced a new model of drug testing and marketing called “adaptive pathways”, allowing new drugs for “unmet medical needs” to be launched on the market faster, on the basis of fewer data. While industry claims this is necessary, an analysis on thebmj.com looks at the assumptions underlying the new pathway, and raises concerns about the negative impact on patient safety and the cost of healthcare. To discuss, we're joined by Courtney Davis, senior lecturer at King’s College London, Peter Gøtzsche, director of the Nordic Cochrane Centre and Joel Lexchin, a professor at York University in Toronto. Read the full analysis: http://www.bmj.com/content/354/bmj.i4437

Andrew Elder, a professor at the University of Edinburgh talks about likelihood ratios in diagnostic testing, and how they’re helpful in thinking about how context changes the predictive value of a test. This is part of a wider discussion on the evidence behind clinical examination of the cardiovascular system https://soundcloud.com/bmjpodcasts/evidence-for-examination Read the full clinical review: http://www.bmj.com/content/354/bmj.i3309

You may have spent hours practicing for your examination exams, but how evidence based are the techniques taught? Andrew Elder, a professor at the University of Edinburgh, and author of the clinical review “How valuable is physical examination of the cardiovascular system?” joins us to discuss. Read the full review: http://www.bmj.com/content/354/bmj.i3309 Andrew also discussed likelihood ratios; which are useful in understanding the relative use of tests in different clinical scenarios: https://soundcloud.com/bmjpodcasts/likelyhood-ratios-in-diagnostic-tests

It is estimated that 50% of patients who have what appears to be treatment resistant hypertension are actually not taking their drugs as prescribed. Indranil Dasgupta, a consultant nephrologist at the Heart of England NHS Foundation Trust joins us to discuss what factors may influence non-adherence, and how to encourage patients to divulge that information. Read the full article: http://www.bmj.com/content/354/bmj.i3268

“How long have I got, doc” is a TV medical drama cliche - but like all cliches has it’s feet in real life - and it’s medicine’s attempt to answer these questions that the authors of an analysis article on TheBMJ.com are questioning. Kirsty Boyd is a consultant in palliative care in NHS lothian, a trainer and a researcher with the University of Edinburgh. Scott Murray is a GP, and St Columba's Hospice Chair of Primary Palliative Care, also at the University of edinburgh. They argue that it’s time to rethink how we talk about prognosis, and what conversations to have as patients become more unwell. Read the full analysis: http://www.bmj.com/content/354/bmj.i3802

Ivan Oransky, co-founder of Retraction Watch and global editorial director at MedPage Today, discusses which areas of science are most affected by research fraud, and what motivates individuals to risk their careers by fabricating data.

With the emergence of sofobuvir, a new direct acting antiviral, treatment for Hepatitis C infection is currently undergoing it's greatest change since the discovery of the virus 25 years ago. However Gilead, who manufacture the treatment, are under fire for the cost of the druge - around $90 000 for a course of treatment. Victor Roy, doctoral researcher at the University of Cambridge, discusses how the new drug was discovered and came to market, and what happened to the profits from sale. Read the full analysis: http://www.bmj.com/content/354/bmj.i3718

Failures in implementation of data sharing projects have eroded public trust. In the wake of NHS England’s decision to close down its care.data programme, Tjeerd-Pieter van Staa professor of health e-research at the University of Manchester, examines what lessons must be learnt, and what we can do better next time. Read the full analysis: http://www.bmj.com/content/354/bmj.i3636