Medicine and Science from The BMJ

How does it feel, to help your patient die?

Sabine Netters is an oncologist in The Netherlands - where assisted dying is legal. There doctors actually administer the drugs to help their patients die (unlike proposed legislation in the UK).
In this moving interview, Sabine explains what was going through her head, the first time she helped her patient die - and how in the subsequent years, the emotional toll hasn't lessened. She explains why she believes that in certain circumstances, euthanasia can be the ultimate caring act.
Read her essay:
http://www.bmj.com/content/360/bmj.k116

The tone of the debate around assisted dying

Bobbie Farsides is professor of clinical and biomedical ethics at Brighton and Sussex Medical School. She’s been described as one of the few people that is acceptable to “both sides” of the assisted dying debate.
This week she joins us to talk about the way in which the debate on euthanasia has played out in the UK - and hear why she thinks it’s now time for all individual doctors to make up their own mind, and not let either camp own the argument for them.
Read her commentary on the debate:
http://www.bmj.com/content/360/bmj.k544

Torture - What declassified guidelines tell us about medical complicity

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person.
It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture. Yet medical participation in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001. Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees.
The 2016 release of previously classified portions of guidelines from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers.
In this podcast, Zackary Berger, associate professor at Johns Hopkins School of Medicine, joins us to discuss what those guidelines have revealed.
Read the full analysis:
http://www.bmj.com/content/360/bmj.k449

We must not get to the stage of thinking that [homelessness] is normal

The number of people officially recorded as sleeping on the streets of England rose from 1768 in 2010 to 4751 in autumn 2017.1 Charities estimate the true figure to be more than double this.
Danny Dorling, Halford Mackinder professor of geography at the University of Oxford joins us to explain what's fuelling that rise, why the true extent of the problem is far larger, and what steps need to be taken to tackle the epidemic.
Read the editorial:
http://www.bmj.com/content/360/bmj.k214

Public health - time for pragmatism or knowledge production?

We have evidence on which to act, and inaction costs lives, argues Simon Capewell, Professor of Public Health and Policy, at the University of Liverpool. But Aileen Clarke, professor of public health and health services research at Warwick Medical School, says our understanding of the human behaviour that leads to unhealthy choices is still lacking
Read the head to head
http://www.bmj.com/content/360/bmj.k292

Smoking one a day can’t hurt, can it?

We know that smoking 20 cigarettes a day increases your risk of CHD and stroke - but what happens if you cut down to 1, do you have 1/20th of that risk?
Allan Hackshaw, professor of epidemiology at UCL joins us to discuss a new systematic review and meta analysis published on bmj.com, examining the risk of smoking just one or two cigarettes a day.
Read the full review:
http://www.bmj.com/content/360/bmj.j5855

Virginia Murray - the science of disaster risk reduction

Virginia Murray, public health consultant in global disaster risk reduction at Public Health England, was instrumental in putting together the Sendai Framework for Disaster Risk Reduction - an international agreement which aims to move the world from reacting to disasters, to proactively preventing them.
In this podcast, she explains what they learned in the process, and why science had to become storytelling, in order to make politicians pay attention.
Read the editorial on creating a set of indicators for disaster preparedness.
http://www.bmj.com/content/359/bmj.j5279

Education round-up - January 2018

The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice.
In this audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. Kate Addlington, associate editor and trainee psychiatrist is joined by Cat Chatfield, quality editor and GP.
They discuss acute respiratory distress syndrome:
http://www.bmj.com/content/359/bmj.j5055
Why it’s important to have early diagnosis of psychotic symptoms, and the evidence for improved outcomes:
http://www.bmj.com/content/357/bmj.j4578
And finally, why it’s important to consider hearing-loss on the ward:
http://www.bmj.com/content/360/bmj.k21

They can’t hear you - how hearing loss can affect care.

Many older adults have difficulty understanding speech in acute healthcare settings owing to hearing loss, but the effect on patient care is often overlooked.
Jan Blustein professor of health policy and medicine at New York University, and who has also experienced the affects of hearing loss, joins us to explain what that's like, and gives some tips on making it easier to communicate.
Read the full analysis:
http://www.bmj.com/content/360/bmj.k21
Full transcript of the interview:
https://docs.google.com/document/d/1Rp7zvRlnTG5KRVLgmR-PFt-0fVRLBqINU5EmOrT5RDU/edit?usp=sharing

MVA85A trial investigation - press conference.

Trial MVA85A - monkey trials for a booster vaccine for BCG, developed by researchers at Oxford University, is the subject of an investigation published on bmj.com.
Experts warn that today’s investigation is just one example of “a systematic failure” afflicting preclinical research and call for urgent action “to make animal research more fit for purpose as a valuable and reliable forerunner to clinical research in humans.”
The press conference is led by Dr Fiona Godlee, the editor-in-chief of the BMJ, who provides a background to the investigation. The panel members are:
Dr Deborah Cohen, author of the investigation and associate editor at the BMJ, talking about carrying out the investigation and the difficulty to obtain basic information
Professor Paul Garner from the Liverpool School of Tropical Medicine, addressing the ineffectiveness of the current TB vaccine and also talking about the backlash he experienced after publishing a systematic review concluding that the animal studies results had been overstated
Malcolm Macleod, from the University of Edinburgh, talking about the broader public health aspect
Merel Ritskes-Hoitinga from the Department for Health Evidence in The Netherlands, addressing the quality of animal studies and the need for systematic reviews
and Jonathan Kimmelman, from McGill University in Canada analysing the story from the perspective of biomedical ethics.