Medicine and Science from The BMJ

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

How to stop generic drug price hikes (or at least reduce them)

Ravi Gupta, is a resident in internal medicine at Johns Hopkins in Baltimore - and as he said has seen the influence of sudden price hikes on his patients - between 2010 and 2015 more than 300 drugs in the U.S. have seen sudden increases of over %100.
Ravi and his co-authors have suggested, and tested the feasibility of, a possible answer to those price hikes - a small tweak that should protect patients from the possibility that they’ll suddenly be unable to afford their essential medication.
Read the full research:
http://www.bmj.com/content/360/bmj.k831

Dorling on decreasing life expectancy - ”the DOH have lost their credibility”

”An additional person died every seven minutes during the first 49 days of 2018 compared with what had been usual in the previous five years. Why?
In this podcast, Danny Dorling, Halford Mackinder professor of geography at the university of Oxford, talks about the spike in mortality, what that means for overall life expectancy in the UK (spoiler, it’s not great) and what he thinks could be fuelling the change.
Read the full editorial
http://www.bmj.com/content/360/bmj.k1090
For more information, this article by Dorling and Hiam has further analysis:
https://theconversation.com/rapid-rise-in-mortality-in-england-and-wales-in-early-2018-an-investigation-is-needed-93311

Unprofessionalism - ”blaming other people, I put that at the top of the impact list”

That’s Jo Shapiro is a surgeon and manager in Brigham and Women’s hospital, she’s also director of the Center for Professionalism and Peer Support, and has written an editorial for The BMJ on tackling unprofessional behaviour.
In this discussion, she and I talked about what she thinks (beyond the illegal) are the most damaging behaviours seen around a hospital, what needs to be done to set up an environment that allows the victims of unprofessional behaviour to speak out about senior members of staff, and how she goes about confronting perpetrators about their behaviour.
Read the full editorial:
http://www.bmj.com/content/360/bmj.k1025

Should doctors prescribe acupuncture for pain?

Our latest debate asks, should doctors recommend acupuncture for pain? Asbjørn Hróbjartsson from the Center for Evidence-based Medicine at University of Southern Denmark argues no - evidence show's it's no worse than placebo. Mike Cummings, medical director of the British Medical Acupuncture Society argues yes - that there is evidence of efficacy, and trials haven't been designed to accurately measure that.
We also hear from Kumari Manickasamy, a GP in north London, and someone who used acupuncture to control her pain during pregnancy despite knowing the lack of evidence.
Read the debate and commentary:
http://www.bmj.com/content/360/bmj.k970
http://www.bmj.com/content/360/bmj.k990