Medicine and Science from The BMJ

What forced migration can tell us about diabetes

Worldwide, the rate of type II diabetes is estimated to be around 1 in 11 people - about 9%. For the Pima people of Arizona, 38% of the adult population have the condition - but across the border in Mexico, the rate drops down to 7%.
The difference between the groups is their life experience - one side displaced, the other on their traditional lands - and their experience is being replicated elsewhere.
Lauren Carruth, assistant professor at The American University, joins us to talk about the Pima people, where else displacement is changing patterns of non-communicable disease, and what this might tell us about economic migrations effect on health.
Read the full editorial:
https://www.bmj.com/content/361/bmj.k1795

Big Metadata

We’re in an era of big data - and hospitals and GPs are generating an inordinate amount of it that has potential to improve everyone’s health. But only if it’s used properly. New research published on www.bmj.com this week describes another set of information, about that data, that the authors believe could be just as important as the data itself.
Griffin weber, and Isaac Kohane, from the Department of Biomedical informatics at Harvard medical school join us to discuss.
Read the full research:
https://www.bmj.com/content/361/bmj.k1479

WHO can tackle pharma advertising

The array of options available to pharmaceutical companies, to advertise their drugs, is incredibly broad - and the amount that they spend is increasing, with some reports saying it’s up 60% in the last five years. In most countries, there are pretty strict rules to limit the ways in which Pharma can spend their advertising dollars - but the WHO guidelines which have informed many of those rules are now 30 years out of date.
A new analysis on bmj.com “Ethical drug marketing criteria for the 21st century“ proposes some ways in which those guidelines should be updated, we're joined two of the authors - Lisa Parker and Lisa Bero - from the Charles Perkins centre at the faculty of pharmacy at the university of Sydney to discuss.
Read the full analysis:
https://www.bmj.com/content/361/bmj.k1809

The complexities of depression in cancer

For many people, cancer is now survivable and has become a long term condition, and depression and anxiety are more common in cancer survivors than in the general population. Despite this, 73% of patients don't receive effective psychiatric treatment.
Alexandra Pitman, consultant liaison psychiatrist at St George’s University Hospitals NHS Foundation Trust, and Andrew Hodgkiss, consultant liaison psychiatrist, at the Institute of Psychiatry, Psychology & Neuroscience join us to dispel some of the concern clinicians may have about the complexities of diagnosing depression in cancer - what is biopsychosocial, what is the organic result of the cancer or treatment - and some of the concern about treatment interactions.
Read the two education articles:
https://www.bmj.com/content/361/bmj.k1415
https://www.bmj.com/content/361/bmj.k1488

E-cigarettes - debating the evidence

Smokers want to vape, it can help them quit, and it’s less harmful than smoking, say Paul Aveyard professor of behavioural medicine at the University of Oxford.
But Kenneth C Johnson, adjunct professor at the University of Ottawa, argues that smokers who vape are generally less likely to quit and is concerned about youth vaping as a gateway to smoking, dual use, and potential harms from long term use.
Read the debate:
https://www.bmj.com/content/361/bmj.k1759

Harry Burns - the social determinants of Scotland

Harry Burns was a surgeon, who gave up his career in that discipline to become a public health doctor. Eventually that lead to him being the last Chief Medical Officer of Scotland, and now he’s professor of global public health at the University of Strathclyde.
Scotland has always had a separate NHS, but since devolution, the parliament there has had much more autonomy in running the country - and Harry has seemed to manage to convince them that improving health means improving the social determinants of health.
In this conversation we talk about that link, how his philosophy has affected policy up there, some of the experiments which are going on in the country, and what he thinks is the most exciting change.
Read the editorial on GDP and wellness:
https://www.bmj.com/content/360/bmj.k1239

Can we regulate intellectual interests like financial ones?

We talk about financial conflicts of interest a lot atThe BMJ - and have take taken the decision that our educational content should be without them.
We also talk a lot about non-financial conflicts of interest, but the choppy waters of those are much more difficult to navigate.
In this podcast, we discuss whether we should, or if we could even could, make people’s intellectual positions transparent.
Arguing that it’s important to tackle this issue, are Wendy Lipworth and Ian Kerridge from Sydney health Ethics at the University of Sydney - and arguing that it’s not as easy as we think is Marc Rodwin, from Suffolk University Law School in Boston.
Read the full head to head:
https://www.bmj.com/content/361/bmj.k1240

Civilians under siege in Eastern Ghouta

In 2016, from an estimated pre-war population of 22 million, the United Nations (UN) identified 13.5 million Syrians requiring humanitarian assistance, of which more than 6 million are internally displaced within Syria, and around 5 million are refugees outside of Syria.
In this podcast, Aula Abarra, consultant in infectious disease from London, joins us to discuss what's happening now in Eastern Ghouta, and area of Damascus, where civilians are being held under siege, where humanitarian aid is unable to reach.
Read the full editorial:
https://www.bmj.com/content/360/bmj.k1368

Online Consultations - general practice is primed for a fight

The first digital banking in the UK was launched in 1983, Skype turns 15 this year, but 2017 finally saw panic over the impact that online consultations may have on general practices.
In this podcast Martin Marshall, professor of healthcare improvement at University College London joins us to discuss whether video conference actually is a disruptor, or whether it’s actually the whole business model of general practice that needs to change.
Read the full analysis:
https://www.bmj.com/content/360/bmj.k1195

Evidence for off label prescribing - explore less, confirm more

When a new drug reaches market, the race is on to find more indications for its use - exploratory trials are set up, and positive results can lead to the off label prescriptions (eg Pregabalin for lower back pain. However, these initial indications are rarely confirmed with further, better quality, evidence.
Jonathan Kimmelman is an associate professor at MCgill University in Canada, thinks it's time to explore less, and confirm more - and joins us to explain why.
Read the full analysis:
http://www.bmj.com/content/360/bmj.k959