Medicine and Science from The BMJ

In every generation there are a few that know the secret; the counterintuitive effects of loop diuretics. In this podcast Steven Anisman, cardiologist at the Dartmouth Hitchcock Department of Cardiovascular Medicine, joins us to explain about the threshold effects of these drugs, and why that might change the way in which you think about prescribing them. Read the full article on treatment of oedema with loop diuretics, and contribute to the discussion: https://www.bmj.com/content/364/bmj.l359

Renza Scibilia and Chris Aldred have diabetes, and their introduction to the idea of complications arising from the condition were terrifying. Because of this early experience, and Chris's later development of complications, they have campaigned to make doctors really think about the way in which they talk about complications with patients. Challenging the use of "non-compliant" and other stigmatising language. Chris has also documented his experience of developing an ulcer, and having it successfully treated, on social media, to open up the conversation and make us all #talkaboutcomplications. Chris Aldred is @grumpy_pumper on twitter, and blogs at http://www.the-grumpy-pumper.com. Renza Scibilia is @RenzaS on twitter and blogs at https://diabetogenic.wordpress.com/

In 2014, Oliver Johnson was a 28 year old British doctor, working on health policy in Sierre Leone after finishing medical school. Also working in Freetown was Sinead Walsh, then the Irish Ambassador to the country. Then the biggest outbreak of Ebola on record happened in West Africa, starting in Guinea and quickly spreading to Liberia, Sierre Leone and Nigeria. Oliver and Sinead have co-authored a book about the change that wrought on their lives, how they stepped into roles coordinating the international response to the disease and running a treatment centre. They join us today to talk about their experiences there. For more information about Ebola, including the current outbreak in the Democratic Republic of Congo visit https://www.bmj.com/ebola. For Sinead and Oliver's book - Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline is available now. https://www.amazon.co.uk/dp/B07DFLFF9P/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1

If you've been keeping up to day with The BMJ - online on in print, you might have noticed that we've got a new type of article - NIHR Signals - and they are here to give busy clinicians a quick overview of practice changing research that has come out of the UK's National Institute for Health Research. Tara Lamont, director of the NIHR dissemination centre, joins us to talk a bit more about the research underpinning these articles. You can find the full list of articles: https://www.bmj.com/NIHR-signals

More doctors are choosing to retire early, doctors who take career breaks find it hard to return to practice, and doctors at all stages of their careers are frustrated by the lack of support given to training and development in today’s NHS. Each year the BMJ holds a roundtable discussion at the Nuffield Summit - where health leaders come together to talk about the NHS. We wanted to know what more the NHS can do to provide fulfilling careers for staff and to improve support for doctors who want to keep working and those seeking to return to practice. Taking part in the discussion were: Tom Moberly - UK editor for The BMJ Rahkee Shah - paediatric registrar Ronny Cheung - consultant general paedatrician Claire Lemer - consultant paediatrician Candace Imison - Director of Workforce Strategy at the Nuffield Trust James Morrow - GP partner

Diabetes is synonymous with sugar, but diabetes insipidus, "water diabetes", can't be forgotten. Between 2009 and 2016, 4 people died in hospital in England, when lifesaving treatment for the condition was not given. In this podcast, we hear some practical tips for non-specialists to aid diagnosis, and how patients should be managed during hospital admission. On the podcast are Miles Levy, consultant endocrinologist from Leicester Royal Infirmary Pat McBride, head of family services at the Pituitary Foundation John Wass, professor of endocrinology at Oxford University Malcolm Prentice, consultant endocrinologist at Croydon University Hospital. Read the full practice article: https://www.bmj.com/content/364/bmj.l321

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month. They start by talking about how difficult a task it is to find evidence that's definitely practice changing, what GPs can learn from Malawian children with nonsevere fast-breathing pneumonia, how radiation dosage varies substantially - and consultant radiologist Amy Davies what that means for patients. They also rail against add-on tests for fertility, and the lack of evidence underpinning their use - will the traffic light system suggested help patients make treatment choices. Carl's rant this week is based on a new study by Steve Woloshin and Lisa Schwartz which documented 20 years of medical marketing in the USA. Reading list: Pneumonia in Malawi - https://www.ncbi.nlm.nih.gov/pubmed/30419120 Variation in radiation dose - https://www.bmj.com/content/364/bmj.k4931 Traffic light fertility tests - https://www.bmj.com/content/364/bmj.l226 Medical marketing - https://jamanetwork.com/journals/jama/fullarticle/2720029

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Recent years have seen political and social progress for people who identify as LGBT+ (lesbian, gay, bisexual, and transgender; the “+” indicating inclusion of other minority sexual and gender identities). Yet international evidence shows ongoing health and social inequalities in this group, many of which emerge during adolescence and represent unique safeguarding risks. In this podcast, Kate Addlington, psychiatry trainee and associate editor at The BMJ is joined by Ginger Drage, expert patient educator at University College London, Jessica Salkind, academic clinical fellow in paediatrics & teaching lead for LGBT+, at Imperial College London and Rosanna Bevan, psychiatry trainee from East London Foundation Trust They discuss the the risks faced by LGBT+ young people, which include increased rates of self harm, suicide, and family rejection or abuse, and what steps clinicians can take to support and intervene if necessary. Read the full practice article: https://www.bmj.com/content/364/bmj.l245

Current evidence is sufficient to justify a national screening programme, argues Mark Lown clinical lecturer at the University of Southampton, but Patrick Moran, senior research fellow in health economics at Trinity College Dublin, thinks there are too many unanswered questions and evidence from randomised trials is needed to avoid overdiagnosis Read the full debate: https://www.bmj.com/content/364/bmj.l43

Patients who experience chronic rhinosinusitis may way for a considerable period of time before presenting, because they believe the condition to be trivial. In this podcast, Alam Hannan, ENT Consultant at the Royal Throat Nose and Ear Hospital in London, explains why that belief is not founded, and describes which treatments can be effective at providing relief.

The Royal College of Physicians will survey all its members in February on this most controversial question. It says that it will move from opposition to neutrality on assisted dying unless 60% vote otherwise. The BMJ explores several conflicting views. From Canada, palliative care doctor Sandy Buchman explains why he sees medical aid in dying as a compassionate treatment that fully respects patient autonomy. The Canadian Medical Association is neutral on the issue, and Jeff Blackmer, its vice president for international health, shares how that stance enabled it to represent all its members, including doctors with conscientious objections. But many are unconvinced to say the least. Rob George, a UK palliative care doctor and professor at King's College London, says assisted suicide has no place in medicine. Tony Baldwinson, from the UK campaign group Not Dead Yet, worries for disabled people were society to endorse doctors actively ending lives. And Zoe Fritz, a consultant physician in acute medicine at Addenbrooke’s Hospital, Cambridge, has a proposal that she says would protect the doctor-patient relationship. Read all our content at https://www.bmj.com/assisted-dying "Why I decided to provide assisted dying: it is truly patient centred care" by Sandy Buchman https://www.bmj.com/content/364/bmj.l412 "How the Canadian Medical Association found a third way to support all its members on assisted dying" by Jeff Blackmer https://www.bmj.com/content/364/bmj.l415 "Religious and non-religious people share objections to assisted suicide" by Mark Pickering https://blogs.bmj.com/bmj/2019/01/30/religious-and-non-religious-people-share-objections-to-assisted-suicide/ "The courts should judge applications for assisted suicide, sparing the doctor-patient relationship" by Zoe Fritz https://blogs.bmj.com/bmj/2019/01/30/the-courts-should-judge-applications-for-assisted-suicide-sparing-the-doctor-patient-relationship/

Jönköping has been at the centre of the healthcare quality improvement movement for years - but how did a forested region of Sweden, situated between it's main cities, come to embrace the philosophy of improvement so fervently? Goran Henriks, chief executive of learning and innovation at Qulturum in Jönköping joins us to explain. He also tells us about Esther, and why she figures so centrally in their planning.

In this EBM round-up, Carl Heneghan, Helen Macdonald and Duncan Jarvies are back to give you an update Dual vs single therapy for prevention of TIA or minor stroke - how does the advice that dual work better translate in the UK? Carl explains why Japan can teach us to get active and, how GPs can use that information to "drop a decade" in aging. Finally, Helen took some time to relax over Christmas - until she read a story in the Christmas edition about gender discrimination in medicine, and it reminded her of her time on the ward. Reading list: The BMJ Practice: Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke https://www.bmj.com/content/363/bmj.k4169 Delaying and reversing frailty: a systematic review of primary care interventions https://bjgp.org/content/early/2018/11/30/bjgp18X700241

We have had two articles published recently on bmj.com, looking at drug prevention of HIV; PeP - Post-exposure Prophylaxis and PreP - Pre-exposure Prophylaxis, neither prevent the virus from entering the body, but they do prevent the infection from taking hold. There are lots of questions that doctors have about these - what are the risk profiles of patients who should be offered the treatments? How can they be prescribed? What are the side effects? And if you're in England, where PreP is not yet available on the NHS, can doctors advise their patients to buy it online? Michael Brady, Sexual health and HIV consultant at Kings College Hospital and Medical Director of the Terrence Higgins Trust, joins us to help answer those questions. Further reading BMJ article on PeP https://www.bmj.com/content/363/bmj.k4928 BMJ article on PreP BASHH guidelines on PreP - https://www.bashhguidelines.org/media/1189/prep-2018.pdf https://iwantprepnow.co.uk http://www.aidsmap.com/

HbA1c concentration is used as the biomarker for long term glycaemic control, however if the lifespan of red blood cells is altered, that may lead to an over, or under estimation of that control. In this podcast Ravinder Sodi, consultant clinical biochemist at University Hospitals of Morecambe Bay NHS Foundation Trust, explains when to suspect HbA1c is not an accurate measure of glycemic control, and what alternative tests are available. Read the full article: https://www.bmj.com/content/363/bmj.k4723

Terence Stephenson is a consultant paediatrician who became been chair of the General Medical Council in 2015. His 4 year tenure has now come to an end, but during his time with the regulator the medical profession faced a number of challenges - the case of Hadiza Bawa Garba and a growing recruitment crisis in the NHS - the GMC is the gatekeeper for foreign doctors who who wish to work here. As the rules on EU doctors change, the GMC’s regulatory practice may have to change too. In this podcast, Abi Rimmer, a report and editor for The BMJ, went to Terrence’s office to talk to him about his career at the GMC, and his perspective on how the organisation has responded to those challenges. Read the related article: https://www.bmj.com/content/363/bmj.k5402

Susan Greenhalg is a research professor of chinese society in Harvard’s department of anthropology - not a natural fit for a medical journal you may think, but recently she has been looking at the influence of Coca Cola on obesity policy in China. She has written up her investigation in an article published on bmj.com this week, and joins us in the podcast to talk about why a communist country would embrace a message from an icon of capitalism, and what attitudes toward financial conflicts of interest exist in the country. Read the full feature: https://www.bmj.com/content/364/bmj.k5050 Accompanying editorial: https://www.bmj.com/content/364/bmj.l4

For many of you Christmas is over and, you’re back to work. Admin piled up over christmas? Feeling resentful for all those forms, and the weird codes they make you put in them? In this podcast I hope we can explain why that’s important, with 17th century death, the esoteria of reed codes, and why the WHO cares about spaceship accidents. Consumption, flux, and dropsy: counting deaths in 17th century London https://www.bmj.com/content/363/bmj.k5014 Christmas guide to clinical coding https://www.bmj.com/content/363/bmj.k5209

2018 will go down in history as a year of reckoning as the year that that some men’s behaviour came back to bite them. The continuing impact of #MeToo across the world has prompted another round of thinking about women’s experiences in medicine, which can be seen this year’s christmas journal In this podcast, Esther Choo and Eleni Lenos, join us to discuss their research into mother's experiences of being doctors - and how discrimination is still rife against them. Also Sarah Lowry, from the Royal College of Physicians brings us some other women's voices - this time from the RCP exhibition "This vexed Question: 500 years of women in medicine" Visit the exhibition: https://www.rcplondon.ac.uk/events/vexed-question-500-years-women-medicine Physician mothers’ experience of workplace discrimination: a qualitative analysis https://www.bmj.com/content/363/bmj.k4926 A lexicon for gender bias in academia and medicine https://www.bmj.com/content/363/bmj.k5218

the Christmas BMJ season is upon us - if you’re to go to our website now, you’ll see that it’s been a bumper year. In the podcast, we’re going to be bringing you a select few - we’ll be looking at motherhood. Trying to figure out what 17th Century causes of death were, and - as it’s christmas - in this pod we’ll be looking at food. We talk to Frances Mason and Amanda Farley, from the University of Birmingham, about their RCT examining the “Effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period" https://www.bmj.com/content/363/bmj.k4867 We also have Eric Robinson from the University of Liverpool explains how calorific restaurant food from his observational study, "(Over)eating out at major UK restaurant chains" https://www.bmj.com/content/363/bmj.k4982

In the second of our EBM round-ups, Carl Heneghan, Helen Macdonald and Duncan Jarvies are joined by Deborah Cohen, investigative journalist and scourge of device manufacturers. We're giving our verdict on the sensitivity and specificity of ketone testing for hyperemesis, and the advice to drinking more water to prevent recurrent UTIs in women. Deb joins us to talk about the massive, international, investigation into failing regulation for implantable devices - and shares some of the stories where these have harmed patients. Finally, Carl is excised about antivaxer ads on facebook - but Helen has seen some pro-vaccine ones which are poor science too. Reading list: Diagnostic markers for hyperemesis gravidarum https://www.ncbi.nlm.nih.gov/pubmed/24530975 Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2705079 The great implant scandle https://www.bbc.co.uk/iplayer/episode/b0btjr55/panorama-the-great-implant-scandal Facebook antivaccine ads https://www.independent.co.uk/news/uk/home-news/anti-vaccination-antivaxxers-uk-advert-banned-facebook-post-vaccines-kill-babies-a8620831.html

A new collection of articles published by The BMJ includes twelve country case studies, each an evaluation of multisectoral collaboration in action at scale on women’s, children’s, and adolescent’s health. Collectively these twelve studies inform an overarching synthesis and accompanying commentaries, drawing together lessons learned in achieving effective multisectoral collaboration. In this podcast, Wendy Graham, professor of obstetric epidemiology at the London School of Hygiene and Tropical Medicine, and Shyama Kuruvilla, senior strategic advisor to the World Health Organisation, join us to discuss what can be learned from those case studies. Read all the case studies: https://www.bmj.com/multisectoral-collaboration

Infant formula manufacturers were made pariah in the 70s, because of their marketing practices - this lead to “The Code”, adopted by the WHO, which set out clear guidelines about what those practices should be. Now an investigation on bmj.com by Chris Van Tulleken, honorary senior lecturer at University College London, examines the practices associated with the marketing of specialist milk formula for children with cow’s milk protein allergy, and asks whether doctors organisations should be receiving money from that industry. Read the full investigation: https://www.bmj.com/content/363/bmj.k5056

Nausea and vomiting in pregnancy affects around 70% of pregnancies. It is mild for around 40% of women, moderate for 46%, and severe for 14%. By contrast, hyperemesis gravidarum is a complication of pregnancy rather than a normal part of it and occurs in around 1.5% of pregnancies. The psychosocial burden of HG can be heavy for women and their families. In this podcast, Caitlin Dean Phd Candidate, Gillian Ostrowski, general practitioner, Rebecca C Painter, consultant obstetrician join us to explain what hyperemesis is like for those who experience it, and discuss what treatment options are available. Read the full article: https://www.bmj.com/content/363/bmj.k5000

Healthy self confidence has an important role in surgery, but what came first - the surgeon or the ego? In this conversation, Christopher Myers, Yemeng Lu-Myers, and Amir Ghaferi join us to talk about the (very few) surgeons who behave badly in theatre, and why that behaviour has persisted, and can be detrimental. Read their full analysis: https://www.bmj.com/content/363/bmj.k4537

Until recently, The BMJ had a campaign of patient partnership - now we have a patient and public partnership campaign. The reason for that change is that medicine has an effect beyond the individual being treated - and this podcast interview is a very good example of that. Anya De Iong, patient editor for The BMJ, talks to Christine Morgan - independent chair of the Greater Manchester Carers Strategic Group. Christine has a mission to bring the needs of carers into thinking and planning about the NHS - and explains how the needs of patients and carers may be similar, and different.

You’ll have read in a clinical trial “Most patients had an acceptable adverse-event profile.” Or that a drug “has a manageable and mostly reversible safety profile.” And that “the tolerability was good overall.” In this podcast, Bishal Gyawali (@oncology_bg) joins us to describe what events those terms were actually describing in cancer drug trials, and how they reduce the readers appreciation of the adverse effects of these novel drugs. Read the full analysis: https://www.bmj.com/content/363/bmj.k4383

Welcome to this, trial run, of a new kind of BMJ podcast - here we’re going to be focusing on all things EBM. Duncan Jarvies, Helen Macdonald and Carl Heneghan - and occasional guests- will be back every month to discuss what's been happening in the world of evidence. We'll bring you our Verdict on what you should start or stop doing, geek out about stats, and rant about the unevidence based world in which we live. This week we talk about: Vitamin D https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30265-1/fulltext Oxygen https://www.bmj.com/content/363/bmj.k4169 The UK parliament's report on clinical trial transparency https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/1480/1480.pdf

Clinical trials for regulatory approval are designed to test efficacy, but new drugs might have adverse reactions - reactions those trials aren’t designed to spot. To talk about those adverse reactions - how to spot them, how to report them and what to do about them, we're joined by Robin Ferner, from the West Midlands Centre for Adverse Drug Reactions. Read the full practice article: https://www.bmj.com/content/363/bmj.k4051

Machines that can learn and correct themselves already perform better than doctors at some tasks, but not all medicine is task based - but will AI doctors ever be able to have a therapeutic relationship with their patients? In this debate, Jörg Goldhahn, deputy head of the Institute for Translational Medicine at ETH Zurich thinks that the future belongs to robot doctors - but Vanessa Rampton, Branco Weiss fellow at McGill Institute for Health and Social Policy, says they'll never be able to emulate the empathy required. We're also joined by Michael Mittelman, executive director of the American Living Organ Donor Fund, who has had complex healthcare needs for his whole life - to explain what he feels about the prospect of his care delivered by machine. Read the full debate: https://www.bmj.com/content/363/bmj.k4669

As the accompanying editorial to this article says, "oxygen has long been a friend of the medical profession Even old friendships require reappraisal in the light of new information." And that’s what a new rapid reccomendation - Oxygen therapy for acutely ill medical patients - does. To discuss we're joined by two of the authors, Reed Simieniuk, general internist at McMaster University and Gordon Guyatt, distinguished professor at McMaster University. Read the full recommendation: https://www.bmj.com/content/363/bmj.k4169

Cardiovascular factors are associated with risk of stroke - and those factors can be mediated by lifestyle and by genetic make up. New research published by The BMJ sets out to explore how these risks combine, and we're joined on the podcast by two of the authors - Loes Rutten-Jacobs, senior postdoctoral researcher at the German Center for Neurodegenerative diseases, and Susanna Larsson, associate professor at the Karolinska Institutet. Read the full open access research: https://www.bmj.com/content/363/bmj.k4168

On the podcast, we’ve talked a lot about the limits of medicine - where treatment doesn’t work, or potentially harms. But in that conversation, we’ve mainly focused on specific treatments. Now a new analysis, broadens that to talk about patients being admitted to a whole ward - intensive care. The authors of that article contend that, often, patients or their families don’t fully understand the implication of that admission. To discuss, we're joined by Jamie Gross, consultant in intensive care medicine at London North West University Healthcare NHS Trust, and by Barry Williams, patient representative at the Intensive Care Society. Read the full analysis: https://www.bmj.com/content/363/bmj.k4135

The common cold is usually mild and self limiting - but they’re very annoying, especially the runny nose and bunged up feeling that form the nasal symptoms. A new practice article, published on BMJ.com looks at the available evidence for treatment of those nasal symptoms - both pharmacological and alternative. In this podcast we're joined by Mieke van Driel - GP in Australia and a professor of primary care at The University of Queensland, and An De Sutter - GP in Belgium and professor of family medicine at Ghent University. Read the full article, and play with the interactive infographic: https://www.bmj.com/content/363/bmj.k3786

What can we learn from the shameful story of vaginal mesh? That thousands of women have been irreversibly harmed; that implants were approved on the flimsiest of evidence; that surgeons weren’t adequately trained and patients weren’t properly informed; that the dash for mesh, fuelled by its manufacturers, stopped the development of alternatives; that surgeons failed to set up mesh registries that would have identified complications sooner; and that the National Institute for Health and Clinical Excellence and the UK regulators let them off the hook. The BMJ has a published an investigation into vaginal mesh, which charts some of the issues above. In this podcast The BMJ talked to three women who have had a vaginal mesh implanted, and all suffered the negative consequences that have prompted these investigations. We bring you these stories to underline how life altering the situation has been for these woman, and to highlight the need for fully informed consent before anyone else has a mesh implanted. What we must learn from mesh: https://www.bmj.com/content/363/bmj.k4254

There is very little guidance on withdrawing or tapering opioids in chronic pain (not caused by cancer). People can fear pain, withdrawal symptoms, a lack of social and healthcare support, and they may also distrust non-opioid methods of pain management. This can mean that patients receive repeat opioid prescriptions for extended periods of time. In this podcast, Harbinder Sandhu, health psychologist in pain management at Warwick Medical School, Andrea Furlan, associate professor of medicine at University of Toronto, and Sam Eldabe, consultant in pain medicine at The James Cook University Hospital join us to set out the evidence on tapering opioids - and give practical advice on how to support patients. We're also joined by Colin, who was prescribed opioids for a decade, before he decided to reduce his usage. What you need to know: For people with chronic pain and who do not have cancer, the benefits of long term opioids are outweighed by the issues of tolerance, dependence, and the requirement for higher doses Tapering is the gradual reduction of opioids with the aim of limiting withdrawal symptoms; it may target complete discontinuation of the opioid, or on occasion a reduction of the dose It is not clear how best to support people to taper their opioids; whether it is best done by interdisciplinary pain management programmes, buprenorphine substitution, or behavioural interventions Read the full uncertainties paper: https://www.bmj.com/content/362/bmj.k2990

Ted Kaptchuk, professor of medicine at Harvard Medical school - and leading placebo researcher, has just published an analysis on bmj.com describing the effect of open label placebo - placebos that patient's know are placebos, but still seem to have some clinical effect. Ted joins us to speculate about what's going on in the body, what this means for designing a more effective placebo, and asking whether it's time to start honestly prescribing placebos in the clinic. Read his full analysis: https://www.bmj.com/content/363/bmj.k3889

We want clinical trials to be thorough - but Vinay Prasad, assistant professor of medicine at Oregon Health Science University, argues that the problem of overdiagnosis may be as prevalent, in the way we measure disease in our research, as our practice. In this podcast he joins us to discuss the problem, and why he thinks what qualifies as disease in clinical trials may be getting so broad that outcomes are becoming less meaningful and harder to interpret. Read the full analysis: https://www.bmj.com/content/362/bmj.k3783

Brits have a reputation as Europe’s boozers - and for good reason, with alcohol consumption higher than much of the rest of the continent. That reputation is extended to our young people too - but is it still deserved? Joanna Inchley, senior research fellow at the University of St Andrews, explains new research on decreasing drinking - http://www.hbsc.org/ Also this week, as part of our coverage of the 70th anniversary of the founding of the NHS, we’ve been running a series of articles exploring this unique institution’s future. Neena Modi, professor of neonatal health, and Jonathan Clarke, clinical research fellow, from Imperial College London, passionately believe that the NHS needs to be publicly financed - and importantly, publicly provided. https://www.bmj.com/content/362/bmj.k3580

Last week we heard about how evidence in policy making is imperilled - but today we’re hearing about a plan to make evidence about health central to all aspects of government. Laura Webber, director of public health modelling at the UK Health Forum, Susie Morrow, chair of the Wandsworth Living Streets Group and Brian Ferguson, chief economist at Public Health England join us to discuss a “health in all policies” approach, with protected funding for preventive interventions. Read their full analysis: https://www.bmj.com/content/362/bmj.k3377

This week a very different kind of conversation on the Recommended Dose – one that considers the art of medicine more than the science. Iona Heath is a long-time family doctor who has worked in a London GP clinic for over 30 years, and at one time became President of the Royal College of General Practitioners. With an international profile, gained in part through her much-loved writing in the BMJ, Iona is unlike many of our previous guests. For a start, she loves words more than numbers, and literature more than clinical guidelines. Host Ray Moynihan caught up with Iona at a recent conference in Helsinki – where she'd just presented little data but much food for thought from the likes of novelists EM Forster and James Baldwin. Here, she shares more of her love of literature and thoughtful commitment to the best kind of patient care.

If you’re of a scientific persuasion, watching policy debates around Brexit, or climate change, or drug prohibition are likely to cause feelings of intense frustration about the dearth of evidence in those discussions. In this podcast we're joined by Chris Bonell, professor of public health sociology - in this podcast he airs those frustrations, and worries that the rise of populism is pushing evidence even further out of policy decision. Read the accompanying essay: https://www.bmj.com/content/362/bmj.k3827

More than ½ of patients leave hospital with changes to four or more of their long-term medications - but how appropriate are those changes? New research published on bmj.com looks at antihypertensive medication prescription changes to try and model that - and found that more than half of intensifications occurred in patients with previously well controlled outpatient blood pressure. To discuss what they found, we're joined by Timothy Anderson, primary care research fellow, and Michael Steinman, professor of medicine, both from UCSF. Read the open access research: https://www.bmj.com/content/362/bmj.k3503

We at The BMJ care about food, and if our listener stats are to be believed, so do you. In this podcast we’re looking at quality as an important driver of a good diet. At our recent food conference - Food For Thought - hosted in Zurich by Swiss Re we brought researchers in many fields of nutritional science together. We asked people with competing ideas to write articles to elucidate where there’s agreement, and where there is still contention. There was lots of disagreement - but one thing that was widely agreed on was that, quality of food matters. Quality is as, if not more, important than quantity. In this podcast we’ll be exploring what quality is, how industrial food production affects it, and how we conceptualise quality. Joining us are Martin White, Mathilde Touvier, Jean Adams, Nicola Guess and Alan Levinovitz. For the last podcast in the food series: https://soundcloud.com/bmjpodcasts/nutritional-science-why-studying-what-we-eat-is-so-difficult? For more on the Food for Thought series https://www.bmj.com/food-for-thought

The concept of overdiagnosis is pretty hard to get - especially if you’ve been educated in a paradigm where medicine has the answers, and it’s only every a positive intervention in someone’s life - the journey to understanding the flip side - that sometimes medicine can harm often takes what Stacey Carter director of Research for Social Change at Wollongong university described in an preventing overdiagnosis podcast last year as a “moral shock” - https://soundcloud.com/bmjpodcasts/preventing-overdiagnosis-2017-stacy-carter-on-the-culture-of-overmedicalisation This year, we asked some of the leaders in the field to describe what it was that opened their eyes to overdiagnosis and overtreatment - and recorded the session for you. You’ll hear from Fiona Godlee, editor in Chief of The BMJ, Steve Woloshin and Lisa Schwartz, directors of the Center for Medicine and Media at The Dartmouth Institute, John Brodersen - professor of general practice at the University of Copenhagen, and Barry Kramer - director of the Division of Cancer Prevention at the U.S. National cancer institute. The

This week saw the latest Preventing Overdiagnosis conference - this time in Copenhagen. The conference is a is a forum where researchers and practitioners can present examples of overdiagnosis - and we heard about the various ways which disease definitions are being subtly widened, and diagnostic thresholds lowered. In this podcast we talk to Allen Frances, psychiatrist and former chair of the Diagnostic and Statistical Manual of Mental Disorders. We also hear from friends of the podcast, Steve Woloshin and Lisa Schwartz about the way in which some disease awareness campaigns fuel inappropriate diagnosis. https://www.preventingoverdiagnosis.net/ https://www.bmj.com/too-much-medicine

The number of people estimated to be latently infected with TB - that is infected with TB, which has not yet manifested symptoms - is around 2 billion. That is 1 in 3 people on the planet are infected by the bacteria. The World Health Organization’s website notes that on average 5-10% of those infected with TB will develop active TB. That number is terrifying, but a new analysis published in the BMJ, suggests that the assumption that latent TB often has a very long incubation period of many years may be wrong - and that may change how we calculate the number of people affected, and our whole approach to tackling the disease. This podcast features Lalita Ramakrishnan, professor of immunology and infectious diseases at Cambridge University, Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania, and Marcel Behr, professor of medicine at McGill university. Together they discuss the analysis article "Revisiting the timetable of tuberculosis" - https://www.bmj.com/content/362/bmj.k2738

This week, a very special conversation with a maverick British medico who set up a tiny research centre in Oxford and watched it grow into a global collaboration of over 40,000 people across 130 countries. Three decades on, the Cochrane Collaboration now produces the world's most trusted health evidence that's used by patients, health professionals, researchers and policy makers around the world every day. Cochrane co-founder Iain Chalmers joins Ray to look back on the origins of the organisation and the extraordinary life of its namesake, Archie Cochrane. Iain also reflects on his work beyond the collaboration - from working in refugee camps in Gaza to teaching children in Uganda how to detect ‘bullshit’ health claims and more recently, establishing the James Lind Alliance. It's no surprise he's received the BMJ’s most prestigious award for a lifetime of achievement in healthcare, along with a knighthood from the Queen.

Dyspareunia is a common but poorly understood problem affecting around 7.5% of sexually active women. It is an important and neglected area of female health, associated with substantial morbidity and distress. Women may be seen by several clinicians before a diagnosis is reached, There are also specialist psychosexual clinics, where men and women can be referred for sexual problems. Little has been written on the holistic approach to care for women with dyspareunia, therefore, some of the advice here is based on expert experience. Joining us to talk about care are Leila Frodsham, consultant gynaecologist and lead for psychosexual medicine, and Nikki Lee, speciality trainee in obstetrics & gynaecology, both at King’s College London. We’re also joined by Poppy, who experienced dyspareunia and has undergone treatment. Read the full education article: https://www.bmj.com/content/361/bmj.k2341