Medicine and Science from The BMJ

Exercise in old age - ”we need kendo classes in Huddersfield”

There's a crisis in old age care - not just in the UK, around the world, as population demographics shift, and the proportion of older people increase - there's a worry about who's going to look after them, and how much is it going to cost?
However, a new analysis on bmj.com says this picture need not be so gloomy - they say that encouraging exercise in older people could save billions - by keeping frailty at bay and increasing healthy life expectancy.
We're joined by two of the authors of that analysis - Scarlett McNally, consultant orthopedic surgeon at Eastbourne District General Hospital, and Muir Gray, public health doctor.
Read the full analysis:
http://www.bmj.com/content/359/bmj.j4609

Sex in surgery

New research published on bmj.com has evaluated how well women surgeons operate, when compared to their male colleagues - and shows that there is a marginal improvement in patient outcomes.
To discuss how that was studied, and what the findings mean, we're joined by Chris Wallis, a resident at the University of Toronto, and Raj Satkunasivam, a urologic-surgeon and assistant professor at the Houston methodist hospital in Texas.
Also joining us, to contextualise that research, is Clare Marx - associate medical director of Ipswich Hospital NHS Ttrust, and former president of the Royal College of Surgeons.
Read the open access research:
http://www.bmj.com/content/359/bmj.j4366
and editorial:
http://www.bmj.com/content/359/bmj.j4580

Vinay Prasad - Cancer drugs from an oncologist point of view

Last week we published some new research which showed that 2/3 of new cancer drugs approved by the European Medicines Agency - the drug regulator for Europe - didn’t have any evidence of improved life expectancy or quality of life.
In this interview, Vinau Prasad, ematologist-oncologist and Assistant Professor of Medicine at the Oregon Health and Sciences University, explains how we came to accept surrogate measures in oncology trials, and how he tries to navigate the evidence for his patients.
Read his editorial:
http://www.bmj.com/content/359/bmj.j4528

There’s no clear evidence that most new cancer drugs extend or improve life

The majority of cancer drugs approved in Europe between 2009 and 2013 entered the market without clear evidence that they improved survival or quality of life for patients, finds a study published by The BMJ today.
Even where drugs did show survival gains over existing treatments, these were often marginal.
To discuss that, we're joined by Huseyin Naci, assistant professor of health policy at the London School of Economics.
Read the open access study: http://www.bmj.com/content/359/bmj.j4530

Telephone consultations - no cost savings, but increased GP workload

If you're a patient in the UK, increasingly, your first interaction with the healthcare system won't be the traditional face to fact chat with your doctor - instead you'll have a telephone consultation.
The prevalence of these telephone consultations is increasing, and being promoted by CCGs and private companies who administer them - usually as a cost saving measure.
Now new research published on bmj.com looks at these phone consultation - how often they happen, how patients feel about them, and how much money they actually save.
In this podcast we're joined by Martin Roland, emeritus professor of health services research at Cambridge University, to find out more.
Read the full research:
http://www.bmj.com/content/358/bmj.j4197

Selling off NHS silver?

Should we welcome plans to sell off NHS land?
The government seems likely to back the recommendations of Robert Naylor (national adviser on NHS property and estates) to raise capital by selling off inefficiently used assets, but Kailash Chand (GP) worries that services could be threatened and that public consultation is lacking.
Read the Head To Head article: https://www.bmj.com/content/358/bmj.j4290

What Choosing Wisely looks like in the UK

Choosing Wisely was launched in the US, to much fanfare. Since then the movement has spread around the world, with successful chapters set up in Canada, Australia Brazil, Italy, Japan, new Zealand - and most recently the UK.
The campaigns have not been without criticism – from how individual recommendations were chosen, to the way in which patients have been involved.
In this podcast, we're joined by joined by 3 of Choosing Wisely UK’s steering group, professor Sue Bailey, head of the steering committee, Ramai Santhirapala, honorary consultant in anaesthesia and perioperative medicine, and, Richard Lehman, GP.
http://www.choosingwisely.co.uk/

Diabetes remission - ”treating blood glucose, when the disease process is to do with body fat”

In the UK - type 2 diabetes now affects between 5-10% of the population - and accounts for around 10% of our total NHS budget. For the individuals affected, treatments are effective at helping control glucose levels - however, the sequela associated with the disease - vascular problems, and a life expectancy that’s 6 years shorter - are still an issue.
However, for some, remission seems to be a possibility.
To discuss we're joined by Mike Lean, professor of human nutrition at the university if Glasgow, and co-author of an analysis, published on bmj.com, which impels doctors to make sure that type to diabetes remission is coded properly.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j4030

The problems with peer review

One of the hurdles that anyone who submits research or analysis to The BMJ has to deal with is peer review.
The problems of the process, and some of the potential solutions, was a big part of the Peer Review Congress which took place last week.
In this interview, Sophie Cook, The BMJ's UK research editor, talks to Lisa Bero, who’s a professor of evidence based medicine at Sydney University, and spends a lot of time investigating the integrity of health research.

HIV in pregnancy - ”without the big picture, people aren’t going to be able to take the medication”

A new Rapid Recommendation from The BMJ suggests that for pregnant women, they may wish to avoid certain antiviral treatments for HIV.
This recommendation differs from the WHO's, and to discuss why that is, and what makes that difference important, we're joined by Reed Siemieniuk, a physician and methodologist from McMaster University, and Alice Welbourn, campaigner for gender and sexual and reproductive health rights, in the context of HIV and violence against women.
Read the full rapid recommendation:
http://www.bmj.com/content/358/bmj.j3961
And Alice Welborn's opinion article:
http://blogs.bmj.com/bmj/2017/09/11/alice-welbourn-who-and-the-rights-of-women-living-with-hiv/