Medicine and Science from The BMJ

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

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