Medicine and Science from The BMJ

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

Nutritional science - why studying what we eat is so difficult.

We at The BMJ care about food, and if our listener stats are to be believed, so do you.
In this podcast we talk to a few of the authors of a new series, published next week on bmj.com, which tries to provide some insight into the current state of nutritional science - where the controversies lie, where there’s broad agreement, and the journey of our understanding of nutrition.
The open access fees for those articles has been paid for by Swiss Re - a wholesale provider of reinsurance, insurance and other insurance-based forms of risk transfer - they have not had any input into the editorial process, which has gone through the same peer review as any of our other analysis articles. Swiss Re are also co-hosting a conference where we’ll be bringing together a lot of these researchers - and which will be live streamed next week - you’ll be able to access that for free on bmj.com
For more on the conference:
http://institute.swissre.com/events/food_for_thought_bmj.html

The misunderstanding of overdiagnosis

In December 2017, the NEJM’s national corespondent, Lisa Rosenbaum, published an article “The Less-Is-More Crusade — Are We Overmedicalizing or Oversimplifying?”
The article aimed a broadside against those who are campaigning against the overuse of medicine, and the over diagnosis of treatment.
This week in the BMJ we’ve published a rebuttal to that article, and in this podcast we talk to Steve Woloshin and Lisa Schwartz - both professors at the Dartmouth Institute for Health Policy and Clinical Practice.
Steve and Lisa’s article carefully deconstructs some of the ideas advanced by Rosenbaum, but in this podcast we discuss how much separate camps are forming in this debate - and how to have a constructive dialogue across that divide.
Read Steve and Lisa's essay
https://www.bmj.com/content/361/bmj.k2035
Iona Heath's essay - The role of fear in overdiagnosis
https://www.bmj.com/content/349/bmj.g6123
Stacy Carter's interview about moral shocks
https://soundcloud.com/bmjpodcasts/preventing-overdiagnosis-2017-stacy-carter-on-the-culture-of-overmedicalisation

Biochem for kids

Each time you order a test for a child, do you think the population that makes up the baseline against which the results are measured? It turns out that that historically those reference intervals have been based on adults - but children, especially neonates and adolescents, are undergoing physiological changes that mean those reference intervals may not be appropriate.
To get around this Khosrow Adeli, head and professor of clinical biochemistry at the Hospital for Sick Children, and the University of Toronto, and colleagues have undertaken a mission to recruit children and young people into a study of their test results.
Read the full practice article:
https://www.bmj.com/content/361/bmj.k1950

Antidepressants and weight gain

Patients who are depressed and prescribed antidepressants may report weight gain, but there has been limited research into the association between the two. However new observational research published on bmj.com aims to identify that association.
Rafael Gafoor, a psychiatrist and researcher at Kings College London, and one of the authors of that research joins us to talk about the potential mechanism of action - is it a physiological response to the drug, is it to do with the underlying reason for the prescription; how they studied the association; and what this might mean for individual prescriptions.
You can read the full research on bmj.com;
https://www.bmj.com/content/361/bmj.k1951

Think of healthcare is an ecosystem, not a machine

Complexity science offers ways to change our collective mindset about healthcare systems, enabling us to improve performance that is otherwise stagnant, argues Jeffrey Braithwaite, professor of health systems research and president elect of the International Society for Quality in Health Care.
Read the full analysis:
https://www.bmj.com/content/361/bmj.k2014
Quality improvement series:
https://www.bmj.com/quality-improvement
The BMJ in partnership with and funded by The Health Foundation are launching a joint series of papers exploring how to improve the quality of healthcare delivery. The series aims to discuss the evidence for systematic quality improvement, provide knowledge and support to clinicians and ultimately to help improve care for patients.

New antivirals for Hepatitis C - what does the evidence prove?

There’s been a lot of attention given to the new antirviral drugs which target Hepatitis C - partly because of the burden of infection of the disease, and the lack of a treatment that can be made easily accessible to around the world, and partly because of the incredible cost of a course of treatment.
But a new article on BMJ talks about the uncertainly of that treatment - do we know that the drugs actually clear a HepC infection, and that this will lead to a corresponding decrease in mortality and morbidity?
Janus Jakobsen from the Copenhagen Clinical Trial Unit joins us to discuss what the literature proves.
Read the full article:
https://www.bmj.com/content/361/bmj.k1382

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