Medicine and Science from The BMJ

Doctors and vets working together for antibiotic stewardship

Doctors and the farming industry are often blamed for overuse of antibiotics that spurs the growing problem of antimicrobial resistance - but the professions are using different methods to combat resistance and reduce overuse.
In this roundtable, we bring medics and vets together to discuss the problem - where antibiotic resistance arises, how resistance genes propagate through the environment and between countries, and what non-drug approaches can be used to reduce the need for antibiotics.
Sandy Trees, Vet Record editor in chief, and retired veterinary surgeon
Stuart Reid, principal of the Royal Veterinary College
Jenny Bellini, cattle and dairy vet, Friars Moor Livestock Health in Dorset
Peter Hawkey, professor of clinical and public health bacteriology, University of Birmingham
Tim McHugh, professor of medical microbiology at University College London
Emmanuel Wey, consultant in infection, Royal Free Hospital, London

James Munro cares about patients opinions.

Getting feedback from people who use NHS services is essential to
assessing their value - and improving their quality. Hospitals and general practices widely post information about patient's satisfaction with their services on their websites, but approach tells us little about how feedback changes things on the ground .
In this podcast, James Munro, former doctor and academic and current CEO of Care Opinion, explains how their online platform works, how Trusts are using it as a quality improvement tool, and how health systems can capitalise on the learning potential of this large scale data collection.
This is part of the series of interviews with people who are making partnership between health professional and patients work in the real world. Listen to Katherine Cowen, from the James Lind Alliance, talk about how to broker an agreement about research priorities. https://soundcloud.com/bmjpodcasts/katherine-cowan-reaching-a-priority

Prof. Wendy Burn - the changing focus of psychiatry.

Wendy Burn is a consultant old age psychiatrist, and new president of the Royal College of Psychiatrists. Her work on dementia has given her an affinity for the neurobiological basis of psychiatry - and her tenure at the college is seeing a move to wards this neurobiological model in the teaching of the profession.
In this interview she talks about her work, how the profession is changing, and why she thinks Kanye can be a model for mental health.

Your recommended dose of Ray Moynihan

Ray Moynihan is a senior research assistant at Bond University, a journalist, champion of rolling back too much medicine, and host of a new series “The Recommended Dose” from Cochrane Australia.
In the series, Ray has talked to some of the people who shape the medical evidence that underpin healthcare around the world - the series aim is to elucidating their worldview, and how their thinking shapes their work.
Over the next couple of months, we’ll be co-publishing the series - so keep an ear out for those interviews in your podcast feed.

Evidence in a humanitarian emergency

At evidence live this year, one of the sessions was about the work of Evidence Aid - and their attempt to bring high quality evidence to the frontline of a humanitarian crisis.
In that situation, it’s very difficult to know what will work - a conflict, or even immediately post-conflict situation is characterised by chaos - and merely doing something is vital. But though each situation is unique, sharing what’s worked elsewhere can be key to maximising the help given to vulnerable people.

When an investigative journalist calls

At Evidence Live this year, the focus of the conference was on communication of evidence - both academically, and to the public. And part of that is the role that investigative journalism has to play in that.
At the BMJ we’ve used investigative journalistic techniques to try and expose wrong doing on the part of government and industry - always in collaboration with clinicians and researchers.
To explain a bit more about the world of journalism and campaigning, we're joined by to Shelley Jofre - from the BBC, Jet Schouten - from Radar, Kath Sansom - who started the online sling the mesh campaign & Deb Cohen, former investigations editor at The BMJ.

Don Berwick - you can break the rules to help patients

Don Berwick, president emeritus of the Institute of Healthcare Improvement, and former Administrator of the Centers for Medicare and Medicaid Services.
In this conversation he discusses how he went from being a paediatrician to running Medicare for Obama, how we can create headroom in stressed systems, and breaking the rules to make things better for patients and staff.
Quality improvement series:

Darknet Opioids

When tackling societal problems - like the opioid epidemic in the US - there are two ways of approaching it. One is to reduce demand - by organising treatment programmes, or reducing the underlying reasons why people may become addicted in the first place - but that’s hard. So governments often turn to the other route - reducing supply - and that’s what the US government did in 2014 when it rescheduled oxycodone combination products from schedule 3 to schedual 2 - essentially making it harder for people to obtain a prescription.
Now reducing that legal supply, without in hand reducing the demand, led to fears that those people with an opioid addiction would just turn to illicit routes to obtain their drugs - and new research published on bmj.com has attempted to find out if that happened.
We're joined by 3 of the authors, James Martin, associate professor of criminology at Swinburne University; Judith Aldridge, professor of criminology at the University of Manchester; and Jack Cunliffe, lecturer in quantitative methods and criminology at the University of Kent.
Read the full research:
https://www.bmj.com/content/361/bmj.k2480

09 John Ioannidis

Series two of The Recommended Dose kicks off with polymath and poet, Dr John Ioannidis. Recognised by The Atlantic as one the most influential scientists alive today, he’s a global authority on genetics, medical research and the nature of scientific inquiry itself – among many other things.
A professor at Stanford University, John has authored close to 1,000 academic papers and served on the editorial boards of 30 of the world's top journals. He is best known for seriously challenging the status quo. His trailblazing 2005 paper 'Why Most Published Research Findings Are False' has been viewed over 2.5 million times and is the most cited article in the history of PLoS Medicine. In it, he argues that most medical research is biased, overblown or simply wrong. Here, he talks to Ray about the far-reaching implications of these findings for people both inside and outside the world of health.
While most closely associated with exploring cutting-edge conundrums across science, genomics and even economics, John is also something of a humanist. He’d be right at home with the philosophers of ancient Greece, seeking as he does to find answers to the big questions of the day in science and medicine, as well as in nature and narratives.
A voracious reader himself, John has a lifelong love of ‘swimming in books’ and has penned seven literary works of his own in Greek – two of which have been nominated for prestigious literary prizes. And fittingly, he finds inspiration for his myriad of multi-disciplinary pursuits on Antipaxi, one of Greece’s most beautiful and secluded islands.
He shares some of his distinctive logic, reason - and even a little of his poetry - on this very special episode of The Recommended Dose, produced by Cochrane Australia and co-published with the BMJ.
You'll find our show notes and a full transcript of the show at http://australia.cochrane.org/trd

Ashish Jha tries to see the world as it is.

There’s a lot going on in the world at the moment - Ebola’s back, Puerto Rico is without power and the official estimations of death following the hurricane are being challenged. The WHO’s just met to decide what to do about it all, as well as sorting out universal healthcare, access to medicines, eradicating polio, etc etc.
To make sense of that a little, we grabbed Ashish Jha - Director of the Harvard Global Health Institute to shed some light into how decisions about global health are made, and why he tries to see the world as it actually is - not how he wishes it would be.
Reading list:
Mortality in Puerto Rico after Hurricane Maria
https://www.nejm.org/doi/full/10.1056/NEJMsa1803972
https://www.bmj.com/universal-health-coverage