Medicine and Science from The BMJ

Assisted dying: should doctors help patients to die?

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/

Goran Henriks - How an 80 year old woman called Esther shaped Swedish Healthcare

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.

Talk evidence - TIAs, aging in Japan and women in medicine

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

HIV - everything you wanted to know about PeP and PreP

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 - when it might not be accurately measuring glycemic control

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 - looking back at chairing the GMC

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

How Coca-Cola shaped obesity science and policy in China

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

Coding at Christmas

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

Women in medicine at Christmas

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

Christmas Food 2018

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