Medicine and Science from The BMJ

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

Nuffield Summit 2018 - HR in all policies, how the NHS can become a good employer

In this year's Nuffield Summit round table we're asking, how can the NHS become a good employer?
At the moment, there is a recruitment and retention crisis across the workforce, doctors and nurses are leaving the NHS in droves, rota gaps are prevalent. A recent BMA survey showed that the majority of junior doctors are now planning to take a career break.
So against this backdrop, what can the NHS do to nurture it's employees, and make medicine an exciting proposition for the millennial, and subsequent, generations.
Taking part are:
Fiona Godlee (Chair), editor-in-chief, The BMJ
Candace Imison, director of policy, The Nuffield Trust
Bob Klaber, consultant paediatrician and associate medical director, Imperial College Healthcare NHS Trust
Claire Lemer, consultant in general paediatrics and service transformation, Guys and St Thomas’s NHS Foundation Trust
Nishma Manek, GP trainee in London, national medical director’s clinical fellow
Clifford Mann, consultant in Emergency Medicine, Taunton and Somerset NHS Foundation Trust, national clinical advisor for NHS England’s Accident and Emergency Improvement Plan

Katherine Cowan - Reaching A Priority

Its now widely agreed that one of the key ways of reducing the current high level of "waste " in biomedical research is to focus it more squarely on addressing the questions that matter to patients - and the people and medical staff that care for them.
In this interview, Tessa Richards - the BMJ's patient partnership editor, talks to Katherine Cowan, independent consultant and a senior advisor the the James Lind Alliance, which has pioneered patient involvement with their research priority setting partnerships.
In this conversation they talk about how these work, the challenge of navigating between different groups with what are often very different views and agendas, and why she thinks healthy debate on divergent views is no bad thing

Should universal distribution of high dose vitamin A to children cease?

Up to $500m a year could be put to better use by stopping ineffective and potentially harmful supplementation programmes in poorer countries, argues John Mason, professor emeritus at Tulane University School of Public Health and Tropical Medicine.
However Keith West, professor of infant and child nutrition at Johns Hopkins Bloomberg School of Public Health disagrees, saying that such programmes have been proved to save millions of lives and should be withdrawn only when robust evidence permits.
Read the full head to head debate:
http://www.bmj.com/content/360/bmj.k927