Medicine and Science from The BMJ

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.

In this week’s podcast Jayati Das-Munshi, from the Institute of Psychiatry, London, talks about her study into the mental health effects of ethnic density. Also, hyper/hypo - antonyms that can sound almost identical. Adam Frankel and Phillip Vecchio from the Princess Alexandra Hospital in Woolloongabba, Australia, explain their their plan to do away with these troublesome prefixes.

China’s New Rural Cooperative Medical Scheme, aims to provide health insurance to 800 million rural citizens. We’ll be finding out from Scott Rozelle, from Stanford University and Qingye Meng from Peking University, the background to the formation of the scheme, and its place in the wider Chinese medical system.

A BMJ investigation this week raises concerns about the ability of the US Food and Drug Administration to monitor the safety of medical devices through post-approval surveillance. We ask: is the FDA giving device manufacturers an easy regulatory ride? Also, the National Institute for Health and Clinical Excellence (NICE) is set to lose the power to restrict the use of any drug that exceeds its £30k cost per quality adjusted life year ceiling. Alan Maynard, professor of health economics at the University of York, discusses what this will mean.

This week the podcast’s all about risk, as we bring you two reports from Risky Business, the conference where speakers from a wide range of hazardous industries came together to share ideas. Pat Crosskerry tells Rebecca Coombes how his work shows thinking more analytically, and less intuitively, could help doctors make better diagnostic decisions, and save lives. We also look at the contentious subject of medical litigation, and ask if it improves patient safety.

This week Dulcie McBride, a consultant in public health at University College London, joins us to talk about the UK’s practice variation in referring to secondary care. Also Simon Wright, head of health at Save the Children, the BMJ’s Christmas charity, talks to Rebecca Coombes about how the money you donate helps health care in some of the world’s poorest countries.

This week we’re joined by Jack Wennberg, author of the Dartmoth Atlas of Healthcare. He and Fiona Godlee discuss his work, and what the UK can learn from the US. Also this week what do you buy a MAMIL (Middle Aged Man in Lycra) for Christmas?

In this week’s cracker of a show… Firstly, could how you park your car indicate your choice of specialty? Secondly, how a team of scientists managed to solve the mystery of the missing French monarch. And are doctors in ITU more likely to be oliguric, and at greater risk of acute kidney injury than their patients? We read a modern fable, which has an important message for the management of complex clinical collaborations. And finally, how much beauty is there in beauty sleep?

In the final BMJ podcast of 2010, David Payne asks the Independent’s Jeremy Laurance about the year past, and BMJ authors how they feel going into the one ahead. Also, Adama Traore tells us about the work Save the Children are doing in Sierra Leone. The charity has been instrumental in implementing free healthcare for women and children there, and we hear about their success.

This week we find out the best way to treat a Mesobuthus tamulus (indian red scorpion) sting. We also discuss the current state of healthcare in Iraq; and how Andrew Wakefield’s article linking the MMR vaccine and autism was not bad science, but deliberate fraud.

In this week’s podcast we hear from Tom Jefferson of the Cochrane Collaboration about the problem of publication bias – and a tool that could help researchers dowse for hidden data. Also, Brian Deer discusses his features and explains why it’s been so long from the original publication of Wakefield’s work in the Lancet to the revelations just published in the BMJ. And David Payne talks to us about the new BMJ iPad app.

Andrew Lansley said this week his NHS reforms are needed because the UK’s health outcomes are amongst the poorest in Europe. However John Appleby, chief economist at the King’s Fund, tells us why the comparisons are flawed. We also hear from Turkey’s minister of health, Recep Akdağ, on the strides his country has made in providing healthcare.

In this week’s podcast Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge, wonders if a nudge is enough to change our health behaviours. Also this week, Aziz Sheikh, from the E-medicine Group at The University of Edinburgh, explains how telemedicine is going to be an integral part of future healthcare.

In this week’s podcast Andrew Farmer from the National Institute of Health Research, Health Technology Assessment programme (NIHR HTA), tackles uncertainty. Also, Andrew Clark from the University of Hull tells us that the case for administering oxygen isn’t air tight.

This week we find out about diabetes. Mabel Chew, our Sydney based associate editor, discovers why it’s important not to miss the diagnosis of type I diabetes in children. And we learn about a new therapeutic agent for type II diabetes: glucagon-like peptide-1 analogues.

In this week’s podcast we find out from Susan Brien and Paul Ronksley about the cardioprotective effects of alcohol. Also, Annabel Ferriman tells us about the nominees for the BMJ Group lifetime achievement award.

Between March 2010 and March 2011 the cost of maize and wheat doubled. This is just the latest in a series of price hikes in food staples. In an editorial this week, Joachim Von Braun sets out some of the problems that this price rise is going to cause. David Nabarro, UN special representative of the secretary-general on food security and nutrition, describes why and how we should control the price rise.

In this week’s podcast, Johan Sundstrom explains how blood pressure in adolescents effects mortality in adults. And John Appleby, chief economist of the King’s Fund, talks waiting times.

This month marks the 30th anniversary of the first diagnosed case of AIDS. Bertrand Audoin, from the International AIDS Society, brings us up to date with the latest developments in the fight against the disease. Also this week, Francesco Capuccio from Warwick University explains the importance of sleep as a “health commodity” and the problems with its sacrifice, in our increasingly busy lives.

This week the British government has tabled an amendment to remove maximum pricing from the Health and Social Care Bill. We convened a round table discussion to find out what other elements of the bill need re-examining. Joining us in the studio at BMA house were: John Black - president of the Royal College of Surgeons. Clare Gerada - chair of the Royal College of General Practitioners Michelle Drage - chief executive of the London Wide LMCs Nigel Edwards – acting chief executive of the NHS Confederation Anna Dixon - director of policy at the King’s Fund

As the world’s attention turns to Fukushima, we hear from Ryuki Kassai, Director of Community and Family Medicine at Fukushima Medical University, about the situation on the ground there. He tells us about the difficulties they currently face, and the uncertainty of the next few days and weeks. Also this week, Paul Mackin of Newcastle University discusses the use and efficacy of atypical antipsychotic

Jamie Love, Knowledge Ecology International, and Hans Hogerzeil, director of essential medicines and pharmaceutical policies at the World Health Organization (WHO), discuss the ongoing EU trade negotiations with India. They set out their concerns that it may lead to an interruption in the supply of new generic drugs to the developing world.

At BMA house, we convened a group of world experts in shared decision making. Inspired by the Salzburg Global Summit meeting we discussed the background, practical challenges, and how to engage patients with their health The participants were: Fiona Godlee , editor in chief, BMJ Angela Coulter , director of global initiatives, Foundation for Informed Medical Decision Making Albert Mulley , co-founder, Foundation for Informed Medical Decision Making, and director, Dartmouth Center for Health Care Delivery Science Glyn Elwyn, research professor with an interest in shared decision making, Cardiff University Muir Gray , chair of the Information Standard, Department of Health, and co-editor (with Gerd Gigerenzer of the new book Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020 Marion Collict, national programme manager, shared decision making, NHS (UK’s National Health System) Alf Collins , consultant in pain medicine, Taunton and Somerset NHS Foundation Trust, and national clinical lead for Co-Creating Health Margaret McCartney , writer and GP Anu Dhir , junior surgical trainee and co-signatory of the Salzburg Statement Gerd Gigerenzer , director, Center for Adaptive Behaviour and Cognition, Max Planck Institute for Human Behaviour Lisa Schwartz , professor of medicine, Dartmouth Medical School, author (with Steve Woloshin (see below)) of Know Your Chances available free online. Steve Woloshin , professor of medicine, Dartmouth Medical School “e-Patient Dave” deBronkart , co-chair, Society for Participatory Medicine Tessa Richards , analysis editor, BMJ Sue Ziebland , research director of the Health Experiences Research Group and a reader in qualitative health research, Department of Primary Health Care, University of Oxford

At BMA house, we convened a group of world experts in shared decision making. Inspired by the Salzburg Global Summit meeting we discussed the background, practical challenges, and how to engage patients with their health The participants were: Fiona Godlee , editor in chief, BMJ Angela Coulter , director of global initiatives, Foundation for Informed Medical Decision Making Albert Mulley , co-founder, Foundation for Informed Medical Decision Making, and director, Dartmouth Center for Health Care Delivery Science Glyn Elwyn, research professor with an interest in shared decision making, Cardiff University Muir Gray , chair of the Information Standard, Department of Health, and co-editor (with Gerd Gigerenzer of the new book Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020 Marion Collict, national programme manager, shared decision making, NHS (UK’s National Health System) Alf Collins , consultant in pain medicine, Taunton and Somerset NHS Foundation Trust, and national clinical lead for Co-Creating Health Margaret McCartney , writer and GP Anu Dhir , junior surgical trainee and co-signatory of the Salzburg Statement Gerd Gigerenzer , director, Center for Adaptive Behaviour and Cognition, Max Planck Institute for Human Behaviour Lisa Schwartz , professor of medicine, Dartmouth Medical School, author (with Steve Woloshin (see below)) of Know Your Chances available free online. Steve Woloshin , professor of medicine, Dartmouth Medical School “e-Patient Dave” deBronkart , co-chair, Society for Participatory Medicine Tessa Richards , analysis editor, BMJ Sue Ziebland , research director of the Health Experiences Research Group and a reader in qualitative health research, Department of Primary Health Care, University of Oxford

At BMA house, we convened a group of world experts in shared decision making. Inspired by the Salzburg Global Summit meeting we discussed the background, practical challenges, and how to engage patients with their health The participants were: Fiona Godlee , editor in chief, BMJ Angela Coulter , director of global initiatives, Foundation for Informed Medical Decision Making Albert Mulley , co-founder, Foundation for Informed Medical Decision Making, and director, Dartmouth Center for Health Care Delivery Science Glyn Elwyn, research professor with an interest in shared decision making, Cardiff University Muir Gray , chair of the Information Standard, Department of Health, and co-editor (with Gerd Gigerenzer of the new book Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020 Marion Collict, national programme manager, shared decision making, NHS (UK’s National Health System) Alf Collins , consultant in pain medicine, Taunton and Somerset NHS Foundation Trust, and national clinical lead for Co-Creating Health Margaret McCartney , writer and GP Anu Dhir , junior surgical trainee and co-signatory of the Salzburg Statement Gerd Gigerenzer , director, Center for Adaptive Behaviour and Cognition, Max Planck Institute for Human Behaviour Lisa Schwartz , professor of medicine, Dartmouth Medical School, author (with Steve Woloshin (see below)) of Know Your Chances available free online. Steve Woloshin , professor of medicine, Dartmouth Medical School “e-Patient Dave” deBronkart , co-chair, Society for Participatory Medicine Tessa Richards , analysis editor, BMJ Sue Ziebland , research director of the Health Experiences Research Group and a reader in qualitative health research, Department of Primary Health Care, University of Oxford

This week’s podcast is a summary of the shared decision making round table - looking at it’s history, practicalities of implementation and how to get patients involved. The full round table can be found on bmj.com/podcasts.

Should we screen for prostate cancer? A study published on bmj.com suggests that it doesn’t improve survival rates, and could lead to over treatment. Gabriel Sandblom, of the Karolinska Institute, tells us about his research. Also, James Ritter, emeritus professor of pharmacology at King’s College London, explains the As in the ABCD of hypertension treatment.

Information abounds in our burgeoning knowledge economy, but how much is useful - let alone essential? Martin Dawes from the University of British Colombia tells us about the hierachy of evidence. Also this week, data journalist and author of Information is Beautiful, David McCandless, talks to us about the power and the pitfalls of graphically representing data.

Regulation of genetic testing kits is difficult, so how do we start to control this growing market? Christine Hauskeller, from the ESRC Centre for Genomics in Society at the University of Exeter, discusses her idea for an international standard which will help consumers make the right choices. Also this week, management of type 2 diabetes could be improved using an “artificial pancreas”. Roman Hovorka, principal research associate at the Institute of Metabolic Science, University of Cambridge, describes his new intelligent system for insulin delivery.

The problems associated with arsenic in drinking water have been known for some time, but new research published in the BMJ helps quantify that risk with respect to cardiovascular disease. Yu Chen, New York University School of Medicine, joins us to discuss her research. Also this week, requests for travel information for pregnant women are on the increase, but the available information is patchy. Lucy Chappell, a lecturer at Kings College London School of Medicine and one of the authors of a new clinical review on the subject, joins us in the studio to talk about the evidence and how to assess risk.

What are the health impacts of cold homes and fuel poverty? Michael Marmot, professor of epidemiology and public health at University College London, talks about findings of the report he co- authored for environmental charity Friends of the Earth. BMJ editor in chief Fiona Godlee and deputy editor Trish Groves talk about the BMJ Group’s evidence to the UK parliamentary science and technology select committee inquiry into peer review.

Richard Peto, renowned epidemiologist at Oxford University, won the BMJ Group lifetime achievement award this week. We hear from him about his work, and some of impact it has had. Also this week, Martin Thornhill, from the University of Sheffield, talks about his research, which shows the effect of a change to NICE guidance on antibiotic prophylaxis for endocarditis.

In this week’s podcast Babatunde Osotimehin, executive director of the UN population fund, joins us in the studio to talk about climate change and reproductive rights. Also, Barry Taylor from the University of Otago in New Zealand, describes his research into the link between sleep, BMI, and body fat in children.

In this week’s podcast Trish Groves talks to Marzio Babille, UNICEF representative in Chad, about the country with the lowest immunisation rates in the world. Sophie Cook finds out from Davor Jurkovic, from University College Hospital London, about clinical signs of ectopic pregnancy that may be easy to miss.

How can doctors and police sharing information help stop violent crime? Jonathan Shepherd, from Cardiff University, explains the Cardiff Violence Prevention Programme - and his research into its effectiveness. Also this week, as a new antiplatelet agent is being considered by the National Institute for Health and Clinical Excellence (NICE), Albert Ferro, from King’s College London, takes us through this class of drugs, their effectiveness, and their indications.

In this week’s podcast, we look at the ups and downs of postural hypotension. Also, beansprouts have been fingered as the cause of the recent E coli outbreak in Germany, David Payne investigates this microbiological detective story.