Medicine and Science from The BMJ

Patient’s rights in research - moving beyond participation

At EBM live recently, we ran a workshop with researchers, patients and clinicians to talk about patient rights in research - should patients be setting the full research agenda? Should they be full participants and authors?
Helen Macdonald, BMJ’s UK research editor and co-host of our talk evidence podcast sat down to Paul Wicks, researcher and patient, and Emma Cartwright, The BMJ's What your patient is thinking editor, to reflect on what the workshop uncovered - and where we should be moving to next.
Read more about the BMJ's patient and public partnership: https://www.bmj.com/campaign/patient-partnership
Go to EBM live in Toronto in 2020
https://ebmlive.org/ebmlive-2020/

Cannabinoid Hyperemesis Syndrome

Cannabinoid hyperemesis syndrome is a relatively newly recognised condition - but, according to one study, can account for up to 6% of patients presenting to emergency departments.
The causal mechanism is as yet unclear - but currently the only known way to prevent the syndrome is for the patient to stop their cannabis use.
Yaniv Chocron, chief resident at Lausanne University Hospital, Lausanne, Switzerland talks us through spotting the condition, and what we think might be the mechanism of action.
Read the full easily missed article:
https://www.bmj.com/content/366/bmj.l4336

Fighting bad science in Austria

Cochrane Austria have been asking the public what they'd like to know about health. Not whether the latest drug is more efficacious, but whether glacier stone power cures hangovers.
Gerald Gartlehner, director of the Cochrane Austria Centre joins us to explain what they do, and how their evidence has been received.
Read more about the project (in German):
https://www.medizin-transparent.at/

Fertility awareness based methods for pregnancy prevention

Fertility awareness based methods of contraception are increasingly being used for pregnancy prevention. In the US, the proportion of contraceptive users who choose such methods has grown from 1% in 2008 to approximately 3% in 2014. 
Relative to other methods of pregnancy prevention, however, substantial misinformation exists around fertility awareness based methods of contraception, particularly about the effectiveness of specific methods and how to use them. 
Rachel Urrutia, assistant professor of Obstetrics and Gynecology at the, University of North Carolina,  and Chelsea Polis, senior research scientist at the Guttmacher Institute join us to describe the various fertility awareness based methods, and the evidence base behind all the options available.
Read the full clinical update
https://www.bmj.com/content/366/bmj.l4245

Talk Evidence - smoking, gloves and transparency

This month we have some more feedback from our listeners (2.20)
Carl says it's time to start smoking cessation (or stop the reduction in funding for smoking reduction) (11.40) and marvels at how pretty Richard Doll's seminal smoking paper is.
It's gloves off for infection control (22.20)
Andrew George, a non-executive director of the Health Research Authority joins us to talk about their consultation on research transparency, and explains how you can get involved (27.04)
And we talk about a new tool for rating the transparency of pharma companies (37.40)
Reading list:
Impact of the WHO Framework Convention on Tobacco Control on global cigarette consumption
https://www.bmj.com/content/365/bmj.l2287
Sixty seconds on . . . gloves off
https://www.bmj.com/content/366/bmj.l4498
HRA transparency consultation
https://www.hra.nhs.uk/about-us/consultations/make-it-public/our-vision-research-transparency/
Sharing of clinical trial data and results reporting practices among large pharmaceutical companies
https://www.bmj.com/content/366/bmj.l4217

I have never encountered an organisation as vicious in its treatment of whistleblowers as the NHS

Margaret Heffernan has thought a lot about whistleblowing, and why companies don't respond well to it. She wrote the "Book Wilful Blindness: Why We Ignore the Obvious at our Peril".
In this podcast she talks about how culture, and groupthink, leads to a culture where whistleblowers are ignored, and why the NHS needs to change the way it treats people who try and call out poor care.
This was recorded at Risky Business - https://www.riskybusiness.events/ where you can find our more about the conference and watch previous talks.

After Grenfell

It's been just over two years since a fire broke out in Grenfell tower, in west London, claiming the lives of 72 residents. 223 people survived, thanks to the work of the fire brigade and health care.
In this podcast we hear from Andrew Roe, assistant commissioner at London Fire Brigade, and Anu Mitra, consultant emergency physician at St Mary's hospital - they talk about the support which has been provided, and where more needs to be done to help frontline staff cope with the horrors of the job.
The interviews were recorded at Risky Business - https://www.riskybusiness.events/ - where you can find out more about the Risk in healthcare.

Talk Evidence - Z drugs, subclinical hypothyroidism and Drazen’s dozen

This week on the podcast, (2.02) a listener asks, when we suggest something to stop, should we suggest an alternative instead?
(8.24) Helen tells us to stop putting people on treatment for subclinical hypothyroidism, but what does that mean for people who are already receiving thyroxine?
(20.55) Carl has a black box warning about z drugs, and wonders what the alternative for sleep are.
(30.11) Finally the NEJM has published Jeff Drazen's dozen most influential papers - but not a systematic review amongst them. Cue the rant.
Reading list:
Rapid rec on subclinical hypothyroidism
https://www.bmj.com/content/365/bmj.l2006
Temporal trends in use of tests in UK primary care, 2000-15
https://www.bmj.com/content/363/bmj.k4666
Black box warning for z-drugs
https://www.bmj.com/content/365/bmj.l2165
Drazen's dozen
https://cdn.nejm.org/pdf/Drazens-Dozen.pdf

Did international accord on tobacco reduce smoking?

WHO Director-General Dr. Tedros recently said “Since it came into force 13 years ago, the Framework Convention on Tobacco Control remains one of the world’s most powerful tools for promoting public health,”.
But is it?
That’s what a to studies just published on bmj.com try and investigate - one of which pulls together all the data we have on smoking rates, from 1970 to 2015, and then a quasi-experimental study which tries to model what the effect of the FCTC has had.
Steven Hoffman, and Matthieu Poirier from the Global Strategy Lab at York University join us to explain what their research means, and why it’s time to double down on our attempts to reduce smoking.
Read the open access research:
https://www.bmj.com/content/365/bmj.l2287
https://www.bmj.com/content/365/bmj.l2231

Working as a team, and combating stress, in space

Nicole Stott is an engineer, aquanaut and one of the 220 astronauts to have lived and worked on the International Space Station.
In a confined space, under huge pressure, with no way out, it's important that teams maintain healthy dynamics, and individuals can manage their stress adequately, and in this podcast Nicole explains a little about living on the ISS and how she coped for 91 days.
Read more about the Space Art Foundation:
https://www.bmj.com/content/365/bmj.l4244
More from Risky Business
https://www.riskybusiness.events/