Medicine and Science from The BMJ

The incidence and prevalence of Crohn’s disease is increasing worldwide, and a clinical review on thebmj.com provides a practical approach to the diagnosis, management, and long term care of patients with Crohn’s disease. To help us understand what it’s like to have this condition, we're joined by Sarah, who was diagnosed with Crohn’s 13 years ago when she was 18. Read the full clinical review: http://www.bmj.com/content/349/bmj.g6670

A clinical review on thebmj.com looks at Meniere’s disease. One of the review's authors, Jonny Harcourt, a consultant otologist at Charing Cross Hospital in London, takes us through the pathogenic process and clinical presentation of the disease, its clinical course and prognosis, and what clinical features help to discriminate the condition from other diagnoses. He also discusses the evidence for treatment. In a second interview Corine from The Netherlands discusses her experience of having the disease, and offers her tips to others with the condition. https://soundcloud.com/bmjpodcasts/menieres-disease-patient Read the full review: http://www.bmj.com/content/349/bmj.g6544

A clinical review on thebmj.com looks at Meniere's disease. Corine from The Netherlands discusses her experience of having the disease and explains how the symptoms of vertigo and tinnitus have affected her everyday life. She also offers her top tips on coping with the disease to others with the condition. In a second podcast, Jonny Harcourt, a consultant otologist at Charing Cross Hospital in London and one of the authors of the review, takes us through the clinical course and prognosis of the disease. https://soundcloud.com/bmjpodcasts/menieres-disease Read the full review: http://www.bmj.com/content/349/bmj.g6544

Large trials show that hydroxyethyl starch increases the risk of death, kidney injury, and bleeding. So why does the European Medicines Agency still allow its use? Helen Macdonald, analysis editor for The BMJ, discusses the issue with Christiane Hartog, a lecturer in intensive care medicine at Jena University Hospital in Germany, and one of the authors of an analysis paper on thebmj.com Read the full analysis paper: www.bmj.com/content/349/bmj.g5981

Surgeon, writer, and researcher, Atul Gawande is best known for the development of surgical checklists, but the death of his father has inspired him to write his latest book exploring medical and societal attitudes to death. We joined him for breakfast during his whistle stop tour of the UK recording this year's BBC Reith Lectures, to discuss Being Mortal.

In a GMC survey last year, the UK’s surgical trainees came bottom of the list when it came to satisfaction about their training. Today, Craig McIlhenny, Director of the faculty of surgical training at the Royal college of surgeons of Edinburgh has released a report with a series of recommendations to improve standards of training, and he hopes, help it come inline with the European Working Time Directive Read his full report http://goo.gl/kH55lW

Fatoumata Nafo-Traoré is the executive director of the Roll Back Malaria Partnership, and has just returned from Sierra Leone and Guinea. In this podcast, she describes the effect of the west African ebola outbreak on the prevention and treatment of malaria, and other diseases, in affected regions. In an earlier podcast, Dr Nafo examined recent successes in the global effort to control malaria.

Fatoumata Nafo-Traoré is the executive director of the Roll Back Malaria Partnership. In this podcast, she updates us on recent successes in the global effort to control the disease. A second podcast examines the effect of the current ebola outbreak on the prevention and treatment of malaria, and other diseases, in affected regions.

A thrice failed antidepressant is at the centre of a new marketing campaign to win approval for what could become the world’s first blockbuster sex pill for women. Frustrated by the drug’s repeated rejection, proponents have orchestrated a fierce attack, accusing the regulator of unfairness, and enlisting support from several well connected women’s organisations in the US. Critics counter that the campaign is exceedingly misleading, that it targets a desire disorder that does not exist, and that approval could see widespread overprescribing of a drug with marginal benefits and real safety concerns. Ray Moynihan has investigated for The BMJ, and talks to Rebecca Coombes about the way this publicity campaign has been orchestrated. Read the full feature: http://www.bmj.com/content/349/bmj.g6246

Our whole society views risk in medicine wrongly, argue Jerome Hoffman and Hemal Kanzaria from the University of California Los Angeles. In this podcast they slay some strongly held myths about medicine's ability to heal, and say that one of our big beliefs, that death is not inevitable, is leading to overtreatment. Read their full analysis of the situation: http://www.bmj.com/content/349/bmj.g5702 For more information about overdiagnosis and overtreatment, visit www.bmj.com/too-much-medicine

Allyson Pollock, professor of global health, and Peter Roderick, a barrister and senior research fellow, both at Queen Mary University of London, argue that, through various mechanisms in the 2012 Health and Social Care Act, the NHS in England could be turned into a small core service. For full healthcare coverage, will we have to turn to commercial medicine? Read their analysis article: http://www.bmj.com/content/349/bmj.g5603 The NHS Reinstatement Bill Campaign: http://www.nhsbill2015.org/

Cerebral palsy is a clinical diagnosis, which describes a wide spectrum of neurological disability – all as a result of some sort of trauma to the developing brain, either pre or post natally. Neil Wimalasundera, a consultant in paediatric neurodisability at Great Ormond Street Hospital, and one of the authors of The BMJ clinical review discusses how to diagnose and manage cerebral palsy in children. Read the full clinical review: http://www.bmj.com/content/349/bmj.g5474

Jocalyn Clarke, executive editor at icdd,b, argues the solutions proposed to improve global health are too focused on the medical, and fail to tackle the underlying socioeconomic factors which will undermine those efforts. Read her full analysis of the situation: http://www.bmj.com/content/349/bmj.g5457

In April 2006 one of the largest hospitals in the Netherlands hit the national headlines with the exposure of “scandalously” poor results for cardiac surgery. Melvin Samsom, CEO of the hospital, explains how the high death rates galvanised quality improvement and innovative change, transforming it into a model for patient participation. Read more about the transformation at: http://www.bmj.com/content/349/bmj.g5765

Kawasaki Disease presents as fever and rash, which makes diagnosis difficult. In this podcast, Anthony Harnden, professor of primary care at the University of Oxford, describes what to watch out for to ensure you don’t miss the diagnosis. Read the full article: http://www.bmj.com/content/349/bmj.g5336

Is medicine trying to learn too much from aviation? Kevin Fong, consultant anaesthetist at UCLH is currently working with Kent, Surrey and Sussex air ambulance. At Risky Business he talked to The BMJ about why he thinks medicine is trying to learn too much from aviation.

Screening tests were central to many of the discussions taking place at the Preventing Overdiagnosis conference (preventingoverdiagnosis.net) To sum up some of the problems with screening we’re joined by Carl Heneghan, director of the Centre for Evidence Based Medicine at the University of Oxford, and John Broderson, associate professor in the Research Unit and Section of General Practice at the University of Copenhagen. For more on over diagnosis, visit www.bmj.com/too-much-medicine

A recent clinical review in The BMJ discusses diagnosis and management of prolactinomas and non-functioning pituitary adenomas. One management option is surgery to remove the tumour, often this can done trans-sphenoidally. Though major complications of this type of surgery are low (~1%), there are still effects that can be distressing to patients, and should be discussed. In this interview the patient wished to remain anonymous, so we have re-recorded her words. She describes the way in which attempts to reassure her about the surgery made he under-estimate the risks involved. Read the full review: http://www.bmj.com/content/349/bmj.g5390

Stephen Martin, an associate professor at the University of Massachusetts Medical School, thinks we're overtreating otherwise healthy patients who have mild hypertension. In this podcast he sets out his argument, and explains why prescribing drugs to these people may actually be doing more harm than good. Read the full analysis article: http://www.bmj.com/cgi/doi/10.1136/bmj.g5432

Demand for better access to primary care is ever rising, but is email the answer? In this podcast, Elinor Gunning, a clinical teaching fellow in London says that patients want it and that careful planning can mitigate worries about safety and security. Emma Richards, trainee academic GP, is not so sure and thinks clearer guidance and resourcing are needed first. Read the head to head online: http://www.bmj.com/content/349/bmj.g5338

David Heymann, professor of infectious disease epidemiology, and head and senior fellow, at the Chatham House Centre on Global Health Security was sent to investigate the first outbreaks of Ebola in 1976. In this podcast he gives a longer term perspective on the disease, and talks about the importance and challenges of introducing novel treatments. For more information on ebola virus disease, including working in a front line clinic, visit bmj.com/ebola David Heymann's analysis article, Prevention is better than cure for emerging infectious diseases: http://www.bmj.com/content/348/bmj.g1499

A new rational testing article, published on thebmj.com, looks at how to diagnose an immediate food allergy. Mabel Chew, The BMJ's practice editor, is joined by Cathal Steele from the Belfast Trust Regional Immunology Service - they discuss which tests are appropriate, and the common pitfalls in diagnosis. Read the full article: http://www.bmj.com/content/349/bmj.g3695

Management of spasticity requires a balanced approach, weighing the benefits of treatment against the usefulness of the spasticity. Current interventions to treat spasticity lack a robust evidence base, and guidelines often depend on expert recommendations. A new clinical review published on thebmj.com discusses the assessment and treatment of spasticity in adults. In this podcast we're joined by one of the authors of that review, Siva Nair, from the Department of Neurology at The Royal Hallamshire Hospital, and by a patient with spasticity, Ian, who is chairman of the Hereditary Spastic Paraplegia (HSP) Support Group. Read the clinical review: http://www.bmj.com/content/349/bmj.g4737 For more information on HSP visit http://hspgroup.org/

Global endorsement as a WHO essential medicine is big step. But Corrado Barbui, from the Department of Public Health and Community Medicine at the University of Verona, has found that the quality of applications for antidepressants and antipsychotics is poor and calls on applicants and WHO to raise standards. Read the analysis article: http://www.bmj.com/content/349/bmj.g4798

Pre-diabetes is an umbrella term and the most widely used phrase to describe a blood concentration of glucose or glycated haemoglobin (HbA1c) that lies above normal but below that defined for diabetes. John S Yudkin, emeritus professor of diabetes at University College London, thinks this is over-medicalisation and will only increase the burden on individuals and the health system. Read the full analysis article: http://www.bmj.com/content/349/bmj.g4485

Research fraud, the deliberate falsification of research data, undermines science and can lead to horrible outcomes, as exemplified by Andrew Wakefield and the MMR/Autism scandal. A new Head to Head in The BMJ sets out the case for and against making research fraud a crime. Arguing yes is Prof. Zulfiqar Bhutta, from the Hospital for Sick Children in Toronto, who says that criminal sanctions are necessary to deter growing deliberate research misconduct, which can ultimately harm patients. Prof. Julian Crane, from the University of Otago Wellington, disagrees: he doubts that sanctions will have any deterrent effect and worries that criminalisation would undermine trust. Read the full debate: http://www.bmj.com/content/349/bmj.g4532

HIV testing is now being routinely offered in increasingly diverse health settings, including primary care. In this podcast we talk to HIV consultant Mike Rayment, from Chelsea and Westminster NHS Foundation Trust, and Paul, a patient diagnosed with HIV infection 4 years ago. They discuss how to go about offering testing, and what matters to patients when they receive the diagnosis. Read the clinical review discussed: http://www.bmj.com/content/349/bmj.g4275

Devi Sridhar, population health researcher and lecturer, joins us to discuss why an independent organisation to co-ordinate international health concerns is absolutely necessary. Read more in her analysis article, Global rules for global health: Why we need an independent, impartial WHO

Whichever country hoists aloft the World Cup trophy on 13 July, the real winner will be the alcohol industry. In this podcast Jonathan Gornall explains why FIFA promotes the interests of the alcohol industry, and the extraordinary demands countries comply with in order to host the World Cup. World Cup 2014: festival of football or alcohol? http://www.bmj.com/content/348/bmj.g3772

Drugs to encourage weight loss have a chequered past, with many of them having been withdrawn from the market due to increased morbidity and mortality. In this podcast Raj Padwal, associate professor of medicine at the University of Alberta, takes us through the remaining therapy Orlistat, and discusses the potential for two new therapies, Phentermine-ER topiramate, and Lorcaserin, which are being licensed in some countries Read the full article: http://www.bmj.com/content/348/bmj.g3526

Two articles on bmj.com look at helicobacter pylori; a systematic review and meta-analysis examines if eradication treatment reduces rates of gastric cancer, and an uncertainties article asks who we should be testing and treating for the infection. Two of the authors of those articles, Alex Ford from the Leeds Gastroenterology Institute, and Paul Moayyedi from the Gastroenterology Division of McMaster University, join us to discuss the bacterium. Read the full articles www.bmj.com/content/348/bmj.g3174 www.bmj.com/content/348/bmj.g3320

New NICE guidance says that smokers should be encouraged to cut down on the number of cigarettes they smoke, as well as trying to quit. In a head to head, published on bmj.com, Paul Aveyard, professor of behavioural medicine at the University of Oxford, says that reducing smoking is a worthwhile step towards cessation, but Gerard Hastings, professor of social marketing at Stirling and Open Universities, argues that the lifelong nicotine replacement therapy being recommended in support may benefit industry more than public health. Read the full head to head: http://www.bmj.com/content/348/bmj.g2787

UTIs are often diagnosed in secondary care, but often that diagnosis isn't accurate. In this podcast Gavin Barlow from the Department of infection and tropical medicine at Hull & East Yorkshire Hospitals NHS Trust joins us to discuss when and how to test for the infection​. Read the full clinical review Investigation of suspected urinary tract infection in older people http://www.bmj.com/content/348/bmj.g3861

The BMJ has been investigating the “cosy relationship” between the alcohol industry and the British government. In a series of articles Under the influence, journalist Jonathan Gornall has been looking into UK government’s consultation into introducing a minimum unit price for alcohol in England and Wales, and also at the wider responsibility deal between government and industry which is meant to champion public health. In his latest article, he looks at the billion unit pledge, and how it's actually being used as a marketing tool to attract new drinkers. Read all of the articles discussed on www.bmj.com/alcohol

A new analysis article on bmj.com discusses the story of a surgical colon cancer trial, that was started 30 years ago and then abandoned, and the data lost. In this podcast Helen Macdonald talks to Tom Treasure from Imperial College London, who has unearthed the data and now published the research. Also joining the discussion is Peter Doshi, one of the instigators of the RIAT initiative set up to encourage this kind of work to correct the scientific record. Read the full article: http://www.bmj.com/content/348/bmj.g2085

Digital technology introduces new concerns for confidentiality and information security. In this podcast Bradley Crotty and Arash Mostaghimi, both from Harvard Medical School, outline the regulations governing confidentiality and medical privacy and provide practical advice on how to safeguard patient information Read their article for more details: http://www.bmj.com/content/348/bmj.g2943

The International Olympic Committee (IOC) and other international sports federations have recently introduced policies which require a medical investigation of women athletes known or suspected to have hyperandrogenism. Women who are found to have naturally high testosterone levels and tissue sensitivity are banned from competition unless they have surgical or pharmaceutical interventions to lower their testosterone levels. But a recent analysis published on bmj.com says that these tests and procedures are at best not medically necessary, and at worst totally unethical. In this podcast we're joined by two of the authors, Rebecca Jordan-Young, professor women’s gender and sexuality studies at Barnard College, and Katrina Karkazis, bioethicist at Stanford centre for biomedical ethics. Read the full analysis article online: http://www.bmj.com/content/348/bmj.g2926

Michael Farrell, professor and director of the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney, talks to Mabel Chew, The BMJ's practice editor, about prescription of cannabinoids. They discuss the latest evidence on nausea and appetite, when cannabinoids may be effective for chronic pain, and which common problems to watch out for. Read the full article: http://www.bmj.com/content/348/bmj.g2737

Glycated Haemoglobin (HbA1c) is used to measure glucose control in patients with diabetes, but can now be used as an alternative test to glucose concentration for diagnosing type 2 diabetes or identifying people at high risk of developing the disease. in this podcast Eric Kilpatrick, from the Department of Clinical Biochemistry at Hull York Medical School, and Stephen Atkin, from Weill Cornell Medical College Qatar, describe when testing HbA1c may be appropriate for diagnosis, and what comorbidities would rule it out. Read the full rational testing article: http://www.bmj.com/content/348/bmj.g2867

First seizure covers a wide range of manifestations, but picking up the minor events can prevent a patient from experiencing a major event, so early diagnosis is key. Heather Angus-Leppan, consultant neurologist and epilepsy lead at the Royal Free Hospital in London, talks to Navjoyt Ladher about how to manage the first seizure in an adult. Read the full clinical review at: http://www.bmj.com/content/348/bmj.g2470

Tamiflu (oseltamivir) is a neuraminidase inhibitor, developed by Roche, for the treatment of seasonal and pandemic influenza. Yet for the first time a comprehensive review of the data, by independent researchers, has shown that the claims for Tamiflu’s effectiveness have been overestimated, and that harms have been underreported. Here is the audio of a recent press conference where researchers and the BMJ's editors describe the findings of that research, and the systematic regulatory failures those findings expose. Taking part were: Fiona Godlee - BMJ editor in chief Carl Heneghan - Director of Oxford University's Centre for Evidence Based Medicine Peter Doshi - Assistant Professor of Pharmaceutical Health Services Research Elizabeth Loder - The BMJ clinical epidemiology editor David Tovey - Editor in chief, Cochrane Library Ben Goldacre - Founder of the AllTrials campaign

Mabel Chew talks to Tamara Pringsheim, from the University of Calgary, about the use of triptans for acute treatment of migraine. When, how, and what contraindications a physician should be aware of. Read the full article: http://www.bmj.com/content/348/bmj.g2285

The NHS has been collecting data on patients’ experience of care for over 10 years but few providers are systematically using the information to improve services. Angela Coulter joins us to discuss the new Friends and Family test, and why it will fail to change services until it asks the right questions. read the full paper: http://www.bmj.com/content/348/bmj.g2225

Meticillin resistant Staphylococcus aureus (MRSA) remains one of the foremost hospital acquired pathogens. Patients colonised or infected with MRSA provide a reservoir within hospitals, although infection prevention and control measures minimise the risk of transmission. Although there is broad agreement on the control measures required for patients colonised or infected with MRSA, there is considerable controversy over who, when and how to screen for the bacteria. John Coia, a consultant microbiologist at Glasgow Royal Infirmary, discusses when screening may be appropriate, how it should be carried out, and the best strategy for decolonisation. Read the full article: http://www.bmj.com/content/348/bmj.g1697

Read the full analysis of ParkinsonNet: http://www.bmj.com/content/348/bmj.g1838 Patients with Parkinson’s disease need long term support to manage their condition. In this podcast Bastiaan Bloem, medical director at the Parkinsons Institute in Nijmegen, and Marko van der Vegt, a Parkinsons patient, describe the benefits of ParkinsonNet; a model of integrated care provided by a network of specialists and suggest it has promise for other long term conditions

Subdural haematoma is more common in elderly patients, yet the condition is easy to miss in this group. John Young, a consultant geriatrician at Bradford Teaching Hospitals NHS Foundation Trust, describes what clinical signs to look out for, and what tests can confirm a diagnosis of subdural haematoma.

Each year at the Nuffield Trust Health Policy Summit, The BMJ hosts a breakfast roundtable. It has been one year since the Health and Social Care Bill for England was enacted, and the reconfiguration of the NHS continues, so this year we asked our panel to give the bill an end of year report. Taking part were: John Richards – Southampton Clinical Commissioning Group Nigel Edwards - CEO Nuffield Trust Jennifer Dixon - CEO Health Foundation Terence Stephenson - president Academy of Medical Royal Colleges Maureen Baker - Chair RCGP Hugh Taylor - Chairman Guys and St Thomas' Foundation Trust Nick Hicks - CEO COBIC Ltd Jeremy Taylor - National Voices Tim Ferris - VP for population health management, Partners Healthcare, MA Nick Timmins - Senior Associate Nuffield Trust

Read the open access research: http://www.bmj.com/cgi/doi/10.1136/bmj.g1458 Australia was one of the first countries to introduce HPV vaccination, and due to it's cervical cancer screening programme, is one of the first to be able to measure the effectiveness of the vaccine. In this podcast, 3 of the authors of a new paper on bmj.com discuss their findings and talk about implications for cervical cancer screening in Australia.

Most doctors are familiar with patients who describe chronic pain all over the body, which is associated with a range of other symptoms including poor sleep, fatigue, and depression. This complex of symptoms is sometimes referred to as fibromyalgia. Management of patients with this condition is often complex and challenging. The diagnosis of fibromyalgia has long been controversial, with some experts questioning whether it exists as a separate entity In this podcast Anisur Rahman, professor of rheumatology at University College London, joins us to discuss diagnosis and management of the condition. Read the full clinical review article: http://goo.gl/MYryTJ

Complete implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) recommends policies in China that would prevent almost 13m smoking related deaths by 2050, suggests a paper published on bmj.com. China is home to about one third of the world’s smokers and reducing smoking in China could have an enormous public health impact, even on a global scale. To discuss their research, we are joined by three of the paper's authors, David Levy from Georgetown University, Teh-Wei Hu from University of California at Berkeley, and Andrew Moran from Columbia University Medical Center. Read the full open access research: http://www.bmj.com/cgi/doi/10.1136/bmj.g1134