Medicine and Science from The BMJ

Hugh Montgomery, director of the University College London Institute for Human Health & Performance, talks about the space where climate, health, and international security meet. Christabel Owens, head of mental health research at the Devon Partnership NHS Trust, explains why warning signs for suicidal thoughts may not be visible to those best placed to spot them.

In 2001 Portugal abolished all criminal penalties for personal possession of drugs – effectively decriminalising their use. Health journalist Nigel Hawkes talks to João Goulão, Portugal’s drug tsar, to find out how effective this policy change has been. Also, the General Medical Council is introducing revalidation for doctors. Part of that revalidation will require input from a doctor’s colleagues and patients. We hear from John Campbell, Peninsula College of Medicine and Dentistry, about possible independent factors that could affect the scores.

One way of tackling obesity is by attending a weight loss club, such as WeightWatchers . There are many such schemes available on the NHS, but which one is the most effective? We find out the results of an RCT that aims to find out. Also this week, ethnographic studies aren’t just limited to lost tribes. We find out what observation of receptionists in general practice surgeries uncovered.

Tessa Richards (BMJ’s analysis editor) and Duncan Jarvies (BMJ’s multimedia producer) talk to Veena Rao (adviser at Karnataka Nutrition Mission, India) about the issue of undernutrion in the country. And David Payne (BMJ’s web editor) gives us a run-down of the new bmj.com.

Mariana Lazo, from Johns Hopkins Bloomberg School of Public Health, tells us how non-alcoholic fatty liver disease has affected all cause mortality in the US. Also, Ley Sander, from University College London, discusses the problem of sudden death in epilepsy.

This week’s podcast is from UKSEM, the big sports and exercise medicine conference in London. Daniel Lieberman, an evolutionary biologist from Harvard, explains how we have evolved to run. Steven Blair, University of South Carolina, explains how physical inactivity is having serious effects on our health. Finally Karim Khan, BJSM’s editor, tells us how much exercise gives you the most bang for your buck. If you’re interested in sports medicine, then have a listen to the BJSM podcast, where your can find more interviews with world leaders in sports medicine - http://podcasts.bmj.com/bjsm

To mark World AIDS Day, the WHO has issued a report outlining policy successes and failures in the diagnosis and treatment of HIV/AIDS. Yves Souteyrand, the co-ordinator of the report, joins us to discuss its findings and how to combat the disease in the future. Alan White, professor of men's health at Leeds Metropolitan University and the author of a new European report into men's health, explains why we need to look at men differently. Finally, renowned surgeon Atul Gawande launches the BMJ's 2011 Christmas appeal, in aid of charity Lifebox, by describing how a cheap reliable pulse oximeter costing £160 should be available in all operating theatres. You can donate at www.lifebox.org/donations

How much does it cost sub-Saharan countries to train all the doctors who end up working in the UK, US, Canada, and Australia? Edward Mills from the University of Ottawa explains his economic analysis of healthcare migration. Also Hungarian health minister Miklós Szócska talks about his country's challenges and plans when it comes to improving health outcomes, currently among the worst in Europe.

Vanessa Whitburn, editor of BBC Radio 4’s The Archers, talks morbidity and mortality in Ambridge. James Raftery, University of Southampton, updates the Forrest Report – whose evidence prompted the breast cancer screening programme in the UK.

Somehow we've come to the end of another year. The Independent's health editor Jeremy Laurance talks us through the big health stories from 2011. And Greg Scott discusses his Christmas paper on the phrase "obs stable", and what it's revealed these two words have actually come to mean to hospital doctors.

The problem of missing data is well known, especially in cases where drug companies conceal evidence. However pharmaceutical industry misconduct is not the only cause, and a cluster of papers in this week's BMJ show how aspects of the culture of medical science contribute to the problem. Elizabeth Loder, BMJ's clinical editor, talks to Harlan Krumholz (Harold H Hines Jr professor of medicine at Yale University) and Joseph Ross (assistant professor of medicine, also at Yale) about missing data from US publicly funded trials. Lisa Bero (professor at the Department of Clinical Pharmacy, University of California) describes how adding missing data to meta-analyses of drug trials can change the results, and Richard Riley (senior lecturer in medical statistics at Birmingham University) explains why individual participant meta-analyses aren't as balanced as we may think.

Antoine Declos, Université de Lyon, explains the performance curve of surgeons as they become more experienced. Peter Wilmshurst, Royal Shrewsbury Hospital, and veteran whistleblower explains why it may be harder to expose the truth in a lab, than on the ward.

Simon Hatcher, associate professor of psychiatry at the University of Aukland, sets out the use of newer antidepressants for the treatment of depression in adults. Deborah Cohen, BMJ's investigations editor, updates us on the Tamiflu saga, and how Roche is still holding onto its full patient data.

Mabel Chew talks to epileptologists Martin Brodie from the Western Infirmary Glasgow and Patrick Kwan from the University of Melbourne, about the newer drug treatments for the condition. Also, Kate Smolina from Oxford University's Department of Public Health explains what constitutes the drop in deaths from acute myocardial infarction.

The Indian government has invested £1.2bn to kick start rural healthcare in its most populous northern state, Uttar Pradesh. Much of that money has now disappeared, and the programme is blighted by corruption and murder. Harriet Vickers hears the details. Also this week, the UK's Department for International Development has to make decisions on sometimes scant evidence. We find out how DFID is trying to improve research into aid programmes.

Journalist Karen McColl interviews Wendell Potter, US health industry lobbying guru turned critic. Mark Ashbridge, an associate professor at Dalhousie University, explains how cannabis intoxication is an increasingly important factor in motor vehicle collisions.

This week we look at older women's health, Gita Mishra from the School of Population Health, University of Queensland, explains the trajectories of perimenopausal symptoms. Martha Hickey, professor of obstetrics and gynaecology at the University of Melbourne, and Jane Elliott a senior lecturer at the University of Adelaide, give Mabel Chew practical tips on prescribing HRT. Finally Steinar Tretli, research director of the Cancer Registry of Norway, explains the results of their research into how HRT and mammography combine to increase apparent rates of breast cancer.

With the future of the Health and Social Care bill more certain, how will the health service react to the legislative changes? At this year's Nuffield Trust Health Policy Summit, the BMJ's editor Fiona Godlee hosted a round table to discuss this question. Taking part were: David Bennett, Chairman and CEO, Monitor Paul Corrigan, Management consultant, Southside Penny Dash, McKinseys Nigel Edwards, Kings Fund Clare Gerada, RCGP Gareth Goodier, CEO, Cambridge University Hospitals NHS Foundation Trust, Cambridge Alastair McLellan, Editor, Health Services Journal James Morrow, GP, Sawston, Cambridge Judith Smith, Nuffield Trust Simon Stevens, CEO, Global Health, United Health Group, USA Helen Thomas, Medical Director, Sentinel Commissioning, Plymouth For more from the summit, and to watch some of the keynote speeches, go to the Nuffield Trust site.

Dan Chisholm, a health economist with the World Health Organisation talks to Harriet Vickers about a cluster of articles which examines the more cost effective way to tackle non-communicable diseases in sub-Saharan Africa and South East Asia.

Is elective ventilation an acceptable way to increase organs available for transplant? Duncan Jarvies discusses the ethics with Dominic Wilkinson (associate professor of neonatal medicine and bioethics, and consultant neonatologist, at the University of Adelaide). And Harriet Vickers talks to Iona Heath (president of the Royal College of General Practitioners) and David Haslam (president of the British Medical Association) about how the NHS reforms fundamentally threaten medical professionalism.

A new peer led parenting group is having success in South London, we visit a session to find out why. Also Jane Driver, an associate professor at Brigham and Women’s Hospital in Boston, explains how Alzheimer's disease and cancer maybe opposite sides of the same coin.

Indhu Prabakar, a subspecialty registrar in sexual and reproductive health at Abacus Services for Sexual and Reproductive Healthcare in Liverpool, goes through the options for emergency contraception. Tim Coleman, a professor of primary care at the UK Centre for Tobacco Control Studies, University of Nottingham, explains his research on methods to help smokers quit.

Eithne MacMahon, consultant and honorary senior lecturer at the Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, explains how to test and treat a pregnant woman exposed to a child with a rash. Sverre Bergh, a researcher at the Centre for Old Age Psychiatric Research, Sanderud Hospital in Norway, discusses the results of his research into stopping SSRIs in dementia patients in Norway.

Hopes are high that the 2012 Olympics and Paralympics will have a lasting sports and exercise legacy, but the work done to ensure the health of the millions of attendees could also have an important impact. Harriet Vickers talks to Brian McCloskey, the Health Protection Agency’s national Olympics and Paralympics lead, about how infectious diseases will be monitored and controlled during the games, and ensuring the knowledge and structures developed are captured. And Ziad Memish, deputy public health minister for Saudi Arabia’s Department of Health, discusses the innovations and interventions his country has pioneered for public health at the Hajj, paving the way for other mass gatherings.

This week we’re concentrating on the problem of an overactive bladder, the subject of a cluster of articles in this week’s BMJ. Practice editor Mabel Chew is joined by Linda Cardozo, professor of urogynaecology, and Dudley Robinson, consultant urogynaecologist, both from King’s College Hospital, London.

The focus of this week’s programme is health promotion and behaviour change. Joining Karim Khan, BJSM editor, and Domhnall McAuley, BMJ primary care editor, is Mike Evans, associate professor of family medicine at the University of Toronto and founder of the Health Design Lab. Dan Heath, senior fellow at Duke University’s Center for the Advancement of Social Entrepreneurship, and co-author of a book “Switch – how to change things when change is hard” also joins the panel. The Health Design Lab’s viral video 23 and 1/2 hours: What is the single best thing we can do for our health? has been watched over 2.5m times, and is freely available on youtube

SPARX is a new cognitive behavioural therapy based computer game for young people with depression. Sally Merry, an associate professor of child and adolescent psychiatry at the University of Auckland, joins us to explain how it was created. Also this week Christine Jenkins, thoracic physician at Concord Hospital in Sydney, gives Mabel Chew a masterclass in spirometry.

BMJ deputy editor Trish Groves talks to Bianca Hemmingsen, a PhD student at Copenhagen University Hospital, about research comparing metformin and insulin with insulin alone, for the treatment of type 2 diabetes. Also, Dan Lasserson, a senior clinical researcher at the University of Oxford, tells BMJ practice editor Mabel Chew how late onset type 1 diabetes can be easily missed.

BMJ features editor Rebecca Coombes finds out more about a new pneumococcal vaccine being rolled out in Ghana. And David Payne meets Kenneth Kizer, the US doctor who transformed the failing Veteran’s Health Administration and took on the tobacco industry in California.

Paul Offit, the author of the yes side of our head to head article "Should childhood vaccination be mandatory", joins us to discuss his book Deadly Choices: How the anti-vaccine movement threatens us all, and explains why he thinks it is wrong to refuse to accept patients who haven't been vaccinated. Also, in the month when UK prime minister David Cameron said dementia care is a “national crisis” and that he is making it one of his personal priorities, Marcel Olde Rikkert, professor in geriatrics at Radboud University Nijmegen Medical Centre in the Netherlands, discusses his research which looks at the relative effectiveness of dementia follow up care by either dedicated memory clinics or general practitioners.

It's the first time doctors have been polled for strike action since 1975, and we've heard a lot about the moral arguments of doing so, but what about the practicalities? Edward Davies, BMJ Careers editor, talked to Mark Porter, chair of the BMA's consultant committee, about how he thinks doctors can balance industrial action and patient safety. Also this week, Richard Hurley finds out why Sam Shuster, emeritus professor of dermatology at the University of Newcastle, thinks drug testing for athletes is illogical and immoral.

In this weeks podcast BMJ features editor Rebecca Coombes reports from Risky Business, the patient safety conference held in London last week. She talks to Loretta Evans, a mother who lost her son because of medical negligence, and about her fight to receive an apology from the hospital. Dr Liliane Field, medicolegal adviser at the Medical Protection Society, talks about the importance of a genuine apology, and what doctors should do if they feel prevented from doing so.

Keith Fox, president of the British Cardiovascular Society, and Rory Collins, co-director of the University of Oxford's Clinical Trial Service Unit and Epidemiological Studies Unit, discuss the safety of statins, and how clever prescribing can overcome worries about myopathy. Also this week, Tony Delamothe, BMJ deputy editor, explains why the sudden interest in atrial fibrillation is making him queasy.

This week we look at herpes simplex encephalitis, an easily missed central nervous system infection which can have serious consequences. Our practice editor Mabel Chew discusses the features of the illness with Tom Solomon, professor of neurological science at Walton Centre NHS Foundation Trust, Liverpool. And podcast producer Duncan Jarvies gets advice on diagnosis from Adam Zeman, professor of cognitive and behavioural neurology at Peninsular Medical School.

For the last year a group commissioned by the UK government has been looking at whether making all published research freely available is attainable or not. BMJ editor Fiona Godlee speaks to Dame Janet Finch, the group's chair, about its conclusions. We also bring you highlights from a BMJ hosted round table on what the landscape of research publishing could, and should, look like in the future.

With changes to the NHS such as cuts, competition and tendering, secondary care will need to adapt. Joining BMJ features editor Rebecca Coombes to discuss how, are: Yi Mien Koh, chief executive of Whittington Health, London Jan Filochowski, chief executive of West Hertfordshire Hospitals NHS Trust Fergus Gleeson, divisional director of Critical Care, Theatres, Diagnostics and Pharmacy at Oxford University Hospitals Nigel Edwards, senior fellow at the King’s Fund Derek Greatorex, chair of the South Devon and Torbay Clinical Commissioning Group Kate Hall, policy advisor, Monitor, London This is the full version of the roundtable. See the podcast above for highlights.

The healthcare landscape in the England is shifting, with cuts, competition and tendering some of the major changes. Secondary care must adapt to these, but how? Joining BMJ features editor Rebecca Coombes to discuss the issues are: Yi Mien Koh, chief executive of Whittington Health, London Jan Filochowski, chief executive of West Hertfordshire Hospitals NHS Trust Fergus Gleeson, divisional director of Critical Care, Theatres, Diagnostics and Pharmacy at Oxford University Hospitals Nigel Edwards, senior fellow at the King’s Fund Derek Greatorex, chair of the South Devon and Torbay Clinical Commissioning Group And BMJ practice editor Mabel Chew talks to Ruth Reed (specialty registrar in child and adolescent psychiatry, Warneford Hospital, Oxford) and Mina Fazel (postdoctoral research fellow, Warneford Hospital Oxford) about why post-traumatic stress disorder is easily missed, and what clinicians should look out for.

Barack Obama saw his Affordable Care Act remain law last week, as the US Supreme Court ruled it is constitutional. Ed Davies (BMJ US news and features editor) talks to Janice Hopkins Tanne (freelance journalist based in New York) about the ruling’s implications. And what are the options for tackling childhood obesity? Li Ming Wen (research and evaluation manager at Sydney University) believes intervention needs to be early, and has demonstrated that giving new mothers simple nutrition messages reduces their child’s BMI at age two. BMJ assistant editor Helen MacDonald speaks to him.

It seems the race to implement telehealth is on – the UK government’s response to its Whole System Demonstrator pilot has been very positive. But has it been over-hyped? We find out from Jennifer Dixon, Director of the Nuffield Trust, which has evaluated the pilot. Also, alcohol: beneficial or detrimental? Evidence shows it depends on what aspects of health you look at. Research published on bmj.com this week adds to the picture by looking at the association between alcohol consumption and the risk of developing arthritis. Alicja Wolk, professor of nutritional epidemiology at the Karolinska Institutet, explains her study.

It has been almost exactly a year since Anders Breivik bombed government buildings in Oslo, and then carried out a mass shooting on the island of Utøya, where he killed 69 people, mostly teenagers. In that time there has been much discussion about his mental state. Vivienne Nathanson and Julian Sheather from the BMA join us to discuss the moral and ethical problems that a diagnosis of insanity bring to the case. Also this week, seven articles on bmj.com look at the science behind sports product adverts. We hear from Matthew Thompson, from the Centre for Evidence Based Medicine in Oxford, who criticises the quality of the evidence submitted to the European Food Safety Authority to back these claims

Daniel Hackam, associate professor at Western University in Canada, explains how shift patterns can have a detrimental effect on the vascular health of workers. Also this week Seena Fazel, Wellcome Trust senior research fellow in clinical science at the University of Oxford, queries the predictive value of the risk assessment tools routinely used to predict violent behaviour

A feature this week asks "Should patients be able to control their own records?". The website renalpatientview.org allows patients to do exactly that. Neil Turner, a professor of nephrology at Edinburgh Royal Infirmary, explains how he and colleagues developed the resource. Also Steven Woloshin and Lisa Schwartz, authors of the "Not So Stories" column have turned their statistical scrutiny onto a recent advert by Susan G. Komen for the Cure®, the breast cancer charity. They explain how the case for mammography has been massively oversold.

This week we’ll hear why Donald Light, professor of comparative health systems research at the University of Medicine and Dentistry of New Jersey, thinks the innovation crisis in the development of drugs is more marketing rhetoric than reality. Also this week, a research paper on bmj.com looks at how subclinical psychological distress affects mortality. Tom Russ, Alzheimer Scotland clinical research fellow at the University of Edinburgh and one of the paper's authors, explains what they found.

Marion Nestle is the Paulette Goddard Professor of Nutrition, Food Studies, and Public Health at New York University. She has written widely about food and nutrition, and is an iconoclast in the world of food politics. In this podcast she explains how economic forces have changed the food industry, and how that change is fuelling the obesity epidemic.

Over the decades public health has had many incarnations. Geof Rayner and Tim Lang (Center for Food Policy) argue that public health today needs an overhaul, and to focus on our co-existence with nature and relationships with each other. They explain why, and how. Many of the issues Dr Rayner and Professor Lang are concerned about are being taken up by the People's Health Movement. Member Jonny Currie explains what he wants the movement to achieve, and others involved talk about actions they are taking.

In 2008 the rates of suicide in the UK began to increase. Is it a coincidence that this was also when the financial crisis hit? Ben Barr, research fellow in the department of Public Health and Policy at the University of Liverpool, explains what his study found. Those who've attempted to kill themselves once are at high risk of doing so again, but interventions to prevent this have been hard to find. Merete Nordentoft, professor at the Mental Health Centre Copenhagen, University of Copenhagen, talks us through the results of her study examining a promising candidate.

It's increasingly obvious that acutely ill patients have received less than gold standard care. Deficiencies in training are often blamed. Paul Frost, consultant in intensive care medicine at the University Hospital of Wales, takes us through the admission of an acutely ill patient. Also this week, BRCA mutations and ionising radiation both increase the risk of developing cancer, but how do these risk factors combine? Anouk Pijpe, an epidemiologist at the Netherlands Cancer Institute, explains the results of her retrospective cohort study.

A BMJ head to head article this week asks: "Are the causes of obesity primarily environmental?" John Wilding, Head of the Department of Obesity and Endocrinology at the University of Liverpool, and Tim Frayling, professor of human genetics at the University of Exeter, argue their cases. Also this week, David Williams, a consultant obstetric physician at University College Hospital London, explains why pre-eclampsia is easily missed.

This week we concentrate on diabetes "The difference between insulin management in type 1 and type 2 diabetes is rather like the difference between driving a sports car and driving a lorry," says Edwin Gale, emeritus professor of diabetes at the University of Bristol. He tells us why this means the newer insulins that have benefits in the treatment of type 1 diabetes may not be as good for type 2. Sripal Bangalore, director of research at the New York University School of Medicine, discusses his research into the relative effectiveness of different types of stents in diabetes patients

Schemes which reduce emergency admissions sound like a good thing, but Martin Rowland, professor of health services research, Cambridge Centre for Health Services Research, University of Cambridge, explains how they can go off track. And Mabel Chew gets some advice on the prognosis of children with acute coughs from Matthew Thompson, a senior clinical scientist in the Department of Primary Care Health Sciences, Oxford University.