Medicine and Science from The BMJ

Carers need a voice in the NHS

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.

Acceptable, tolerable, manageable - but not to patients. How drug trials report harms.

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

Talk evidence - Vitamin D, Oxygen and ethics

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

Adverse drug reactions

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

HAL will see you now

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

How much oxygen is too much oxygen?

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

How does lifestyle affect genetic risk of stroke?

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

Talking honestly about intensive care

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

Nasal symptoms of the common cold

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’s it like to live with a vaginal mesh?

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