Medicine and Science from The BMJ

Controversy rages over the relative benefits or harms of screening for breast cancer, with evidence suggesting that in younger women at least it does more harm than good. Now a new paper on bmj.com reports the results of 25 years of follow up of women who have taken part in a breast cancer screening trial in Canada, and suggests that annual screening does not cut breast cancer deaths. Anthony Miller, Professor Emeritus at the Dalla Lana School of Public Health, University of Toronto, lead author on the paper, and director of the trial, joins us to discuss the results.

Read the full article online: http://www.bmj.com/content/348/bmj.g401 When you prescribe a drug, do you ever stop to wonder if it's suitable for vegetarians? Kinesh Patel and Kate Tatham from Imperial College London have found that 74 of the 100 drugs most commonly prescribed by GPs in the UK contain ingredients which may have been derived from animals.

Read the full article: http://www.bmj.com/content/348/bmj.g129 Erectile dysfunction is a common problem, and novel treatments mean that patient’s options have widened. In this podcast Asif Muneer, consultant urological surgeon and andrologist at University College Hospital in London, explains the aetiology, treatment, and prognosis for the condition.

Two articles on bmj.com look at high risk devices for rare conditions, and how the US Food and Drug Administration regulates them. Joining us to discuss the problems are Rita Redberg, professor of medicine at the University of California San Francisco, and Aaron Kesselheim, assistant professor of medicine at the Harvard School of Public health. Read the articles Presumed safe no more: lessons from the Wingspan saga on regulation of devices http://www.bmj.com/content/348/bmj.g93 Assessment of US pathway for approving medical devices for rare conditions http://www.bmj.com/content/348/bmj.g217

Read the article: http://www.bmj.com/content/348/bmj.f7003 The 2013 World Health Organization guidelines continue to recommend rapid fluid resuscitation for children with shock, despite evidence from the FEAST trial that this can increase mortality. Katheryn Maitland, professor of tropical paediatric infectious disease at Imperial College London, who led the FEAST trial, joins us to discuss it.

Read the head to head: http://www.bmj.com/content/348/bmj.g171 The BMJ no longer publishes research funded by tobacco companies. Richard Smith says that research funded by drug companies is also flawed and published to encourage sales, but Trish Groves says that the industries are fundamentally different and that moves are afoot to increase integrity Join the authors live on Twitter to debate the issue on 21 January, 1200-1230 GMT at #pharmaban.

When searching for clues to reach a diagnosis, neurologists often empathise with the detective who is trying to solve a case, write Peter Kempster and Andrew Lees in BMJ sister journal Practical Neurology bit.ly/1dqReQq. In this podcast, journal editor Phil Smith and Andrew Lees, director of the Queen Square Brain Bank in London, discuss how neurologists draw upon detective skills. They also talk about neurologists who have turned these skills to crime fiction writing, and the use of narrative in clinical case histories. The expert witnesses called upon are: - Oliver Sacks, best selling author and professor of neurology at NYU School of Medicine - Peter Gautier Smith, now retired from consulting at Queen Square and author of 31 detective novels - Chris Goetz, who worked at Rush University Medical Centre with Harold Klawans, crime fiction writer and authority on Parkinson’s disease Listen to the full interviews here: Andrew Lees bit.ly/1cPaoxM Peter Gautier-Smith bit.ly/1d5HhKj Harold Klawans bit.ly/19cXR Oliver Sacks bit.ly/1hBsbgz

It is generally agreed that sex is useful when getting pregnant, but is it necessary? Professors Amy Herring, and Carolyn Halpern from the University of North Carolina explain how they found virgin births in the US for their Christmas BMJ paper. Also Gareth Jones, emeritus professor of anaesthesia at Cambridge University, recalls his early life in the City Lodge Hospital – formerly Cardiff Union Workhouse Finally, does being right always make you happy? Bruce Aroll, professor of primary care at the University of Auckland wanted to know, and so designed a pilot study. See also: Like a virgin (mother): analysis of data from a longitudinal, US population representative sample survey (http://www.bmj.com/content/347/bmj.f7102) Being right or being happy: pilot study (http://www.bmj.com/content/347/bmj.f7398) Growing up over the shop (http://www.bmj.com/content/347/bmj.f6922)

James Bond, legendary secret agent, marksman, womaniser, smoker, but perhaps most famously, drinker. Neil Guha and Patrick Davies from Nottingham University Hospitals NHS Trust, and Graham Johnson from the Royal Derby Hospital, have documented Commander Bond's drinking in a Christmas BMJ paper, and join us to discuss its findings. Also this week, Doctors of the World, The BMJ's Christmas charity, has a role beyond emergency response to humanitarian crises, helping undocumented migrants in the UK access healthcare. Richard Hurley visits its clinic in the east end of London to find out out more. See also Were James Bond’s drinks shaken because of alcohol induced tremor? http://www.bmj.com/content/347/bmj.f7255

This year The BMJ has chosen Doctors of the World as it's Christmas appeal. This week we hear about the charity's international work. Deputy magazine editor Richard Hurley talks to some of the doctors who are working in Syria and the camps surrounding the stricken country. Also this week, a clinical review on BMJ.com looks at polymyalgia rheumatica. Clinical reviews editor Sophie Cook asks Sarah Mackie, from the Leeds Institute of Rheumatic and Musculoskeletal Medicine, how she explains this difficult condition to patients. After the typhoon: how volunteer doctors are bringing medical care to those most in need http://www.bmj.com/content/347/bmj.f7193 Polymyalgia rheumatica http://www.bmj.com/content/347/bmj.f6937

Professor Sir John Oldham, from the Institute of Global Health Innovation at Imperial College London, talks about reforming reform, and why he worries that research agendas are more influenced by career aspirations than patient care. Tom Kenny, director of external relations at the Evaluation, Trials, and Studies Coordinating Centre at the National Institute for Health Research, explains how the NIHR is trying to put patients at the centre of the research it funds. Finally doctors' health - Michael Peters from the BMA's Doctors for Doctors Unit, explains why life's everyday struggles are hard for doctors to cope with. See also: Reform reform: an essay by John Oldham http://www.bmj.com/content/347/bmj.f6716 Doctors’ health: taking the lifecycle approach http://www.bmj.com/content/347/bmj.f7086

The latest NCEPOD (National Confidential Enquiry into Patient Outcome and Death) report examines the management of aneurysmal subarachnoid haemorrhage, in England's National Health Service. Two of the report's clinical co-ordinators, Mike Gough, a vascular surgeon at Leeds General Hospital, and Alex Goodwin, anaesthetist at the Royal United Hospital in Bath, join us to discuss the reports findings and recommendations. Read the full report: http://www.ncepod.org.uk/sah.htm

The population timebomb: The idea that an ageing population is making it harder and harder to fund pensions, social care, and healthcare, as the number of older people grows in proportion to the working population. Jeroen Spijker, senior research fellow at the School of Social and Political Science in the University of Edinburgh, explains why he thinks the risk has been overblown. Also, Michael Kidd, current president of WONCA – the world organisation of family doctors - talks about the pressures on primary care, and how he would like to attract the best medical talent to the specialty. http://www.bmj.com/content/347/bmj.f6598

A modelling study on bmj.com suggests that a 20% tax on sugar sweetened drinks would reduce the number of obese adults in the UK by 1.3%, and by 0.9 for those who are overweight. The health gains are fairly similar across all income groups. Oliver Mytton, one of the study's authors, describes why a 20% figure was chosen and how the modelling was done. Also, liver function tests follow a different normal range during pregnancy. Catherine Williamson, professor of women’s health at King's College London, explains why. Read the articles: Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK - http://www.bmj.com/content/347/bmj.f6189 Abnormal liver function tests in pregnancy - http://www.bmj.com/content/347/bmj.f6055

Professor Michael Marmot has spearheaded WHO Europe’s Health 2020 report, which looks at the disparity in the social determinants of health across the region. He joins us to explain why he’s hopeful for change. Also, Spencer Ellis, consultant rheumatologist at Lister Hospital in Stevenage, explains when and why to order antinuclear antibody (ANA) tests.

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.