Medicine and Science from The BMJ

NB: In our interview about statins, Abramson quotes the figure of an 18% relative increase in risk of adverse effects of statins. This figure should be couched in uncertainty, and a correction has been posted on bmj.com to reflect that - http://www.bmj.com/content/348/bmj.g3329 -------------------------------------------------------------------- It may soon be recommended that statins are prescribed to patients with a low risk of cardiovascular disease. John Abramson from the Department of Health Care Policy at Harvard Medical School explains why the risks associated with taking the drug may have been underplayed. Also this week, interviews with Steve Field, the new chief inspector of hospitals, and Richard Vautry, deputy chairman of the BMA's GP committee, recorded at the National Association of Primary Care's annual Best Practice conference. See also: Should people at low risk of cardiovascular disease take a statin? http://www.bmj.com/content/347/bmj.f6123

The BMJ, BMJ Open, Heart, Thorax, and Tobacco control – all journals in BMJ’s stable, have announced they will no longer carry research funded in part, or in whole, by the tobacco industry. Fiona Godlee, BMJ Editor in chief, explains what that means, and Allen Brandt, professor of the history of science at Harvard University, gives us a potted history of the way in which the tobacco industry has manipulated science. Also this week, Sebastian Brandner, professor of neuropathology at UCL, explains his research into the population prevalence of the prion which causes vCJD. See also Prevalent abnormal prion protein in human appendixes after bovine spongiform encephalopathy epizootic http://www.bmj.com/content/347/bmj.f5675 Journal policy on research funded by the tobacco industry http://www.bmj.com/content/347/bmj.f5193

There are many overlapping classifications for bowel polyps. Geir Hoff, professor of gastroenterology at the University of Oslo, explains why he fears screening for one type has lead to overtreatment of another. Also, Sophie Wilne, consultant paediatric oncologist at Nottingham University Hospitals NHS Trust, discusses the clinical signs of brain tumours in children and young adults, and what treatment should follow. See also: Identifying brain tumours in children and young adults www.bmj.com/content/347/bmj.f5844 New polyps, old tricks: controversy about removing benign bowel lesions www.bmj.com/content/347/bmj.f5843

As Clare Gerada's stint as RCGP chair comes to a close, she gives BMJ news reporter Gareth Iacobucci a typically honest exit interview. And David Loxterkamp, a primary care physician in Belfast, Maine, tells us why he thinks metrics are obscuring humanism in medical care. See also: Clare Gerada: “It’s like the wild west in healthcare” http://goo.gl/SiWZ5y Humanism in the time of metrics—an essay by David Loxterkamp http://goo.gl/FRD0xC

A study on bmj.com raises raises concerns over possible “subjective bias owing to racial discrimination” in the MRCGP - the Royal College of General Practitioner''s postgraduate exams required to become a registered GP in the UK. Aneez Esmail, professor of primary care at the University of Manchester and the paper's lead author, explains the background to the study and its findings. Read the accompanying editorial and news story, which includes a response from RCGP chairwoman Claire Gerada. See also: Academic performance of ethnic minority candidates and discrimination in the MRCGP examinations between 2010 and 2012: analysis of data http://www.bmj.com/content/347/bmj.f5662 BMJ author hits out at attempts to dismiss findings of possible racial bias in RCGP exam http://www.bmj.com/content/347/bmj.f5871

Professor Sir Mike Richards, previously National Cancer Director at the Department of Health, and former head of the Academic Division of Oncology at King's College London, is the new chief inspector of hospitals in England. In his new role he will have the power to enter hospitals, both in planned and unplanned inspections, to highlight problems before they develop into another scandal of the kind that happened in Mid-Staffordshire. He talks about his new role to Nigel Hawkes. See also: “We know where to probe,” says Mike Richards, the new chief inspector of hospitals http://www.bmj.com/content/347/bmj.f5557

UN Refugee Agency High Commissioner António Guterres described the Syrian crisis this week as the great tragedy of the century, a "disgraceful humanitarian calamity with suffering and displacement unparalleled in recent history." Every 15 seconds a Syrian seeks refuge in neighbouring countries. UNHCR spokesperson Andrej Mahecic describes a typical refugee's journey from the stricken country and how their health needs are addressed when they reach refugee camps and host communities in Jordan, Lebanon, and Turkey. See also: http://www.bmj.com/content/347/bmj.f5413

NICE has published now guidelines on the treatment of children with autism. Mabel Chew BMJ practice editor talks to Tim Kendall, director of the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists, who helped draw up the guidelines. Mabel also talks to Declan P O’Regan, consultant radiologist at the MRC Clinical Sciences Centre in London, and an author of our rational imaging article on investigating stable chest pain See also: http://www.bmj.com/content/347/bmj.f3940 http://www.bmj.com/content/347/bmj.f4865

What do clinicians need to know about the developing role of HPV in cervical cancer prevention? BMJ clinical reviews editor Sophie Cook speaks to Henry Kitchener, professor of gynaecological oncology, and Emma Crosbie, senior lecturer and honorary consultant in gynaecological oncology, both at the University of Manchester. Read the full clinical review: http://www.bmj.com/content/347/bmj.f4781

inda Gask, professor of primary care psychiatry at the University of Manchester, explains why a personality disorder diagnosis is not as hopeless as many patients and doctors fear. Also Carol Brayne, professor of public health at the University of Cambridge, discusses how to make the most of the UK government’s push to diagnose dementia, even though the evidence is limited. See also: http://www.bmj.com/content/347/bmj.f5276 http://www.bmj.com/content/347/bmj.f5125 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61570-6/fulltext

For our first podcast of 2010, we’ll be asking various medical professionals what they’d like to see happen to healthcare in the next decade. Also, Chris Grundy tells us how effective 20 mph zones really are at preventing accidents.

This week, research published on bmj.com shows that overweight and obese teenagers can be taught to eat more sensibly by using a device called a mandometer. Professor Julian Shield, who led the study, talks about the results. Also this week, the response to one of the articles in the latest Christmas BMJ was enormous. Duncan Jarvies talks to Nathan Grills, the author of the article, about the storm in a sleigh.

Haiti this week suffered its worst earthquake in 200 years. Marc Dubois, general director of aid charity MSF UK, talks about how his organisation is responding to the disaster and how doctors can help. Also, BMJ clinical editor Elizabeth Loder interviews Benjamin Wolozin about the link between cardiovascular disease and dementia. Krishna Moorthy talks to Helen Morant about what medicine can learn from aviation.

This week the Faculty of Public Health has released its manifesto tor a healthier Britain. Duncan Jarvies speaks to the faculty’s president, Professor Alan Maryon-Davis, about the manifesto’s recommendations. Also new online this week, we have a clinical review on depression in adolescents. We talk to one of the authors, Professor Anita Thapar, about one aspect of it - prevention - and the promising research that is under way.

Several articles on bmj.com deal with clubfoot disorder. Kirsten Patrick gives us a quick history of the condition, and talks to Andrew Hogg - a GP trainee - about a film he made in South Africa to help Zulu parents understand it. Also this week, Trish Groves tells Duncan Jarvies about the importance of sharing data - and the possible problems that may arise. Deborah Cohen takes us through the news.

Urinary tract infections are commonly seen in primary care, particularly in women, yet there are gaps in the evidence about their treatment. Trish Groves talks to Paul Little about a group of papers that compare management approaches for the condition, look at their cost effectiveness, and analyse patients’ reactions to them. Duncan Jarvies takes us through the news.

This week new research was published on the use of the SSRI (selective serotonin re-uptake inhibitor) antidepressants, in combination with the drug tamoxifen. For some time there have been concerns about prescribing them together, and a new study finally quantifies that, David Juurlink explains how. Also this week, a child’s early years will affect the rest of their life, in terms of medical as well as social and educational outcomes. Clyde Hertzman talks about what governments are, and should be, doing to help build a solid foundation. Juliet Walker and Birte Twisselmann takes us through the week’s news.

In this week’s podcast Sam Lister, health editor of the Times, explains the political fight that’s emerging around provision of free home health care for elderly people. Duncan Jarvies talks to Iain Chalmers, from the the James Lind Initiative, about the importance of making information about clinical trials available to the public. Sabreena Malik takes us through this week’s news.

Estimates of HIV are just that, estimates – but in order to research the progression of the virus, and the effectiveness of intervention strategies, those estimates have to be as accurate as possible. Professor Prabhat Jha joins us to explain the novel way in which he and his team have collected data in India to provide a more accurate picture about the spread of the virus. Also this week, as spending cuts are planned across public services, the financial strain on the UK health service is increasing. One way in which some money can be saved is through disinvestment; ceasing treatments which have been superseded, or shown ineffective. Peter Littlejohns, the clinical and public health director of the National Institute for Health and Clinical Excellence (NICE), joins us to explain what NICE is doing in that arena. Annabel Ferriman takes us through the news.

This week’s hot topic is chronic fatigue syndrome. The journal Science published a paper in October 2009, which suggested a possible link between a new virus (xenotrophic murine leukaemia virus-like virus) and the syndrome. Duncan Jarvies is looking at the evidence behind this link, and finding out more about the history and treatment of the condition. Richard Hurley takes us through what caught his eye on bmj.com week.

This week, Duncan Jarvies talks to Stacy Lindau and Natalia Garilova about their new sex life expectancy measure, and what it could mean for patients and public health. Zosia Kmietowicz talks to Douglas Gwatidzo and Rutendo Bonde about the health care system in Zimbabwe, and how the situation there has changed since its nadir in 2008. David Payne takes us through this week’s news.

If you visited Trafalgar Square in central London today you’d see Admiral Nelson gazing down from his column. What you won’t see is a statue to celebrate the work of Edward Jenner – although once there was one. Gareth Williams, a professor of medicine at the University of Bristol, is backing a campaign to have Jenner’s statue reinstated. Mabel Chew talks to him about the life and times of the father of vaccination.

This week the BMJ published research into the use of sunbeds. Cancer Research UK surveyed teenagers across the country to find out how often they top up their tan. Duncan Jarvies talks to Catherine Thomson, from Cancer Research UK, and Madeleine Brindley, a journalist who’s often campaigned on the dangers of solariums, about the results. Also this week, recent revelations from a group of stem cell scientists shone a light on some of the problems with peer review. Modern science often holds it sacrosanct, but in a feature in this week’s BMJ, Mark Henderson - science editor of the Times newspaper - highlights various ways in which it might not work. Trish Groves, the BMJ’s research editor, talks to Liz Wager, an independent researcher into peer review, about the process and the ways in which it might be improved.

This week Duncan Jarvies discusses with London GP Chris Ford how to talk to patients about their cannabis use. Rebecca Coombes talks to Jim Swire, a retired GP whose daughter Flora died in the Lockerbie bombing. Dr Swire has written an article for the BMJ about the role of Abdelbaset Al-Megrahi’s doctors in his early release.

This week Ike Iheanacho investigates the role of herbal remedies in modern medicine. He speaks to Dr Linda Anderson, Principal Pharmaceutical Assessor at the Medicines and Healthcare products Regulatory Agency (MHRA), and Michael Mcintyre, chair of the European Herbal Practitioners Association. Sabreena Malik and David Payne take us through the week’s news.

This week’s podcast is based on the BMJ series Competent Novice.Junior doctors play an important part in verifying sudden deaths in hospital and communicating with the family of the deceased. Unexpected, and often premature, deaths can be challenging to manage. In this podcast Mabel Chew talks to Paul Frost, a consultant in intensive care medicine at the University of Wales. Paul gives practical step by step advice on dealing with sudden death, illustraded by a case study of a 19 year old stab victim who has died in the accident and emergency department. Also this week, Annabel Ferriman takes us through the news.

A traumatic death can be very difficult for friends and family to deal with. A clinician’s instinct may be to protect them from seeing the extent of the damage to the body. However this may not be best in the long run. Duncan Jarvies talks to Alison Chapple about her research into people’s experiences of viewing a body after a traumatic death. Also this week, the National Patient Safety Agency regularly issue alerts about clinical problems that can be averted. Mabel Chew talks to the NPSA about its latest alert featuring digital tourniquets. Birte Twisselmann takes us through the news.

This week David Payne talks to Emily Friedman, a health policy and ethics analyst, about Cambodia – a country with a difficult past that is now rebuilding its healthcare system to try to meet some of the particular needs of its population.

In this week’s podcast Duncan Jarvies talks to Theresa Marteau about screening for diabetes; can patients be given too much information? Also Anne Buvé discusses the likelihood of HIV transmission in serodiscordant couples when the infected partner is receiving antiretroviral treatment. Annabel Ferriman takes us through the news.

This week we’ re looking at the legacy of large sports events - with the 2012 Olympic games costing £9bn, and that cost being justified by saying how great an impact the games will have on the health of the nation. We talk to Gerry McCartney about his systematic review of the evidence for those claims. Antibiotic resistance is a major problem, and we increasingly have to turn to second line drugs as bacteria become immune. We have just published a systematic review on bmj.com that looks at the link between prescribed antibiotics in primary care and antimicrobial resistance. Coauthor Alastair Hay tells us about his findings. Annabel Ferriman, takes us through the news.

In this week’s podcast we examine the link between toothbrushing and cardiovascular disease – Richard Watts talks about his research in Scotland. Also this week the Department of Health issued a statement that has made some people wonder about the future of NICE. Fiona Godlee discusses the statement with health economist James Raftery. Finally this week, Evan Harris may have recently lost his seat in parliament, but one thing that’ll keep him busy is his new job as a columnist for the BMJ. Trevor Jackson talks to him about his first column on Wakefield and MMR.

What is the association between IQ and attempted suicide? David Batty talks to us about his research in Sweden. Also this week, Steven Kawczak, associate director of the Cleveland Clinic’s Center for Continuing Education, outlines the clinic’s new CME partnership with the BMJ and BMJ Learning. And finally, Richard Budgett, chief medical officer of the London 2012 Olympics, speaks about how scientists are hoping to beat the cheats. He also discusses a recent BMJ research paper about the limited health and economic benefits that big sporting events have on their host nations. The recent Legacy of the games podcast includes an interview with the lead author of that paper.

This week research published on bmj.com looks at the association between the smoking ban and a drop in acute myocardial infarctions. Anna Gilmore, director of the Tobacco Control Centre at the University of Bath, talks to us about her findings. We also hear from the London Health Observatory about how much money the drop has saved the NHS.

Since mobile phones have been around there has been public concern about their safety - fears over radiation exposure causing cancer have been particularly trenchant. This week Paul Elliott and his colleagues published research looking for an increase in the incidence of childhood cancers around mobile phone base stations. Paul joins us in the studio. NCEPOD (the National Confidential Enquiry into Patient Outcome and Death) have published a report on parenteral nutrition. Kayte McCann talks to gastroenterologist Jim Stewart about the findings. Finally, bevacizumab (traded as Avastin) has been used for off-label treatment of age related macular degeneration for some time. The BMJ published research looking at the effectiveness of this monoclonal antibody compared with what was formerly the standard NHS treatment. Adnan Tufail, one of the study’s authors, joins us in the studio.

This week saw the British Medial Association’s Annual Representatives Meeting. Deborah Cohen and Helen Morant tell us what was going on in Brighton. Also this week we have the second part of Sophie Arie’s special report on Haiti.

Later this month sees the 17th International AIDS Conference in Vienna. One of the topics that will be discussed there is harm reduction, and the political will to embrace it.In this podcast, we look at the effects of long term opiate substitution programmes in Muirhouse, Edinburgh. Local GP Roy Robertson discusses the research he conducted there. We also travel to Kiev in Ukraine, where Richard Hurley talks to NGOs and injecting drug users about local harm reduction programmes.

The new coalition government’s white paper on health – encompassing the future of the NHS - was published this week. Chris Ham, chief executive of the health policy think-tank the King’s Fund and professor of health policy and management at the University of Birmingham, and Edward Davies, editor of BMJ Careers, discuss their immediate impressions with Ashley McKimm. Also this week a paper on www.bmj.com looks at suicide, and how the method of an attempted suicide relates to a later successful attempt. Professor Bo Runeson from the Karolinska Institutet in Sweden joins us on the phone to discuss his research.

This week the print BMJ has a cluster of articles on suicide – one of which talks about the efficacy of physical barriers to prevent suicide from bridges. In the podcast, we’ll hear from Kevin Hines the survivor of such an attempt, and Alys Cole-King, a psychiatrist who wants to break down the stigma of suicide. We’ll also hear from Gordon Smith, one of the authors of a study looking at a link between the time when a mother gives birth – whether it’s in the normal working week, or out of hours - and the risk of neonatal death. Finally Richard Hurley tells us about AIDS 2010, the 25 000 delegate conference in Vienna.

The new coalition government’s plans for the NHS in England put GPs firmly in the driving seat - how do their secondary care colleagues feel about that? Jacky Davis, co-chair of the NHS Consultants’ Association and a founder member of the “Keep our NHS Public” campaign, shares her views with Duncan Jarvies. Duncan also talks to Professor Julian Le Grand from the London School of Economics about how market pressures can help make health care more efficient and what GP fundholding taught us. To see all BMJ Group’s articles about the NHS white paper for England, including discussion threads, podcasts, blogs, and learning modules, visit doc2doc.bmj.com/whitepaper

In June 2010 the drug company Novo Nordisk announced that its only conventional human biphasic insulin, human Mixtard 30, would no longer be available in the UK from January 2011, a decision that affects an estimated 90,000 patients Drug and Theraputics Bulletin (DTB), one of the BMJ’s sister journals, is campaigning against that decision. DTB editor Ike Ihenacho talks about the campaign. Mabel Chew talks to the authors of a rational testing article on what to do about mildly abnormal serum amine transferase levels, what to suspect, and how to diagnose. Finally, we have a musical interlude.

In this week’s podcast we discover the link between the weather and the risk of heart attacks - Krishnan Bhaskaran tells us about his research. Also, criticism and response are crucial parts of the scientific process, but how well do authors of research papers respond to critics of their work? Peter Gøtzsche and Tony Delamothe discuss their work looking at that in the BMJ.

Jill Morrison talks about how people on long term incapacity benefit because of mental health problems could be identified by their GPs three years before they stop working. BMJ Deputy editor Trish Groves explains more about the journal’s new policy of asking authors of eligible research articles to pay a publication fee. And, finally, why does the modern eunuch remain invisible?

This week, to steal a line from the latest BMJ editor’s choice, we’ll be talking shit. The millennium development goal on sanitation is way off track; Lyla Mehta, a sociologist from the Institute of Development Studies, tells us why, and Kamal Kar, a development consultant from India, explains how his grass roots initiative changes the way people view sanitation. Also, National confidential enquiry into patient outcome and death reported on cosmetic surgery this week. Dr Alex Goodwin, anaesthetist and clinical coordinator of the report, tells us about the problems they had collecting data, and some of the implications of their findings.

In this week’s podcast we find out from Sean Tunis about the future of comparative effectiveness research in the USA, and how the new institute created to champion it will differ from the UK’s National Institute of Clinical Excellence. Also, Claudia Cooper talks about her research that could support carers in the decisions they have to make for dementia sufferers.

A person’s right to refuse treatment is based on their capacity to make a rational decision – but what is the situation when someone is admitted after a suicide attempt? Can you be simultaneously rational and suicidal? Anthony David from the Institute of Psychiatry gives us his views. A second interview deals with Barrett’s oesophagus, which is on the increase. The same is true for adenocarcinoma of the oesophagus, which can arise from the condition. We talked to Rebecca Fitzgerald from the Hutchison/MRC Research Centre how developments in treatment, and a new method of sampling, could make a national screening test a possibility.

In a series of articles, this spotlight focuses on recognising and managing the end of life, having the difficult conversations with patients about their death, and the importance of taking into account the spiritual aspects of death. In this podcast Duncan Jarvies talks to the authors of 2 of those articles. Professor Jane Maher, oncologist and CMO of Macmillan Cancer Support, talks about the importance of end of life care. Dr Mike Knapton, GP and CMO of the British Heart Foundation, talks about their move into palliation.

This week we’re joined by Martin McKee, professor of European public health at the Loncon School of Hygiene and Tropical Medicine. He’s also research director of the European observatory on health systems and policies, a group that promotes evidence based healthcare policies in Europe. We’ll be discussing the effect the squeeze in funding is having on health care in Europe, and the various strategies different countries are using to save money.

Last week saw Safety 2010, the international conference on preventable accidents. We hear from some of the speakers there why safety comes second when it comes to global health. Also this week, female sexual dysfunction - fact or fiction. In advance of a BMJ debate on the topic, we get to the heart of the issue.

Last week BMJ Careers published “The new lost tribe,” describing the cohort of surgical trainees moving from ST2 to ST3. In this podcast Edward Davies, BMJ Careers editor, and Tom Dolphin, a member of the BMA junior doctors’ committee, describe how competition for training places is affecting career progression.

This week Beate Wieseler from IQWiG (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) tells us how they uncovered data on the antidepressant reboxetine. Also Angela Thomas and Julia Anderson, haematologists from the Comprehensive Care Haemophilia and Thrombosis Centre, Royal Infirmary of Edinburgh, explain how to investigate a child who bruises easily.