Medicine and Science from The BMJ

Is the FDA really too slow?

The FDA faces perpetual criticism that it is too slow in it’s approval process for getting drugs to market, but one former FDA employee Tom Marciniak, and one professor, Victor Serebruany from Johns Hopkins University have analysed that process and disagree.
Tom Marciniak has been a commentator on the approval process, both critical of industry and the FDA in The BMJ - and in this interview he talks about that process, his new analysis, and how he thinks we could be more sure about the safety and efficacy of drugs coming onto the market.
Read this full analysis:
http://www.bmj.com/content/357/bmj.j2867

”For the public good, not for careers” - Iain Chalmers and Doug Altman on research waste

Twenty years ago the statistician Doug Altman railed against, “The Scandal of Poor Medical Research,” in an editorial in The BMJ.
10 years later, Iain Chalmers and Paul Glaziou calculated that costs $170 billion annually in wasted research grants.
In this podcast, recorded at Evidence Live, we spoke to Altman and Chalmers about their campaigns to improve the design, conduct, and reporting of clinical trials, and why that level of waste still occurs.
Reward Alliance - http://rewardalliance.net/
Equator Network - http://www.equator-network.org/
Research publication audit "Getting our house in order" - http://bmjopen.bmj.com/content/6/3/e009285

Dementia prevalance in 2040

The Alzheimer’s society, in the UK, predicts that if the rates of dementia remain constant there’ll be 1.7 million people in the country living with the condition by 2050. We also know that things like improvements in cardiovascular health are changing those rates.
New research published on bmj.com attempts to model what the outcomes of those changing factors might be, and Sara Ahmadi - Abhari, a research associate in the Department of Epidemiology and Public Health at the University College London, joins us to discuss that model.
Read the open access research:
http://www.bmj.com/content/358/bmj.j2856

Transhealth - how to talk to patients about pronouns

Two articles published on the bmj.com aim to help doctors treat patients who request support with their gender identity.
Firstly a practice pointer on how to refer to gender clinic, and secondly a What Your Patient Is Thinking article about trans people's experiences in the healthcare system.
In this podcast, two of the authors of that patient experience article, Emma-Ben and Reubs, join us to discuss identity, pronouns and what genderqueer means.
I am your trans patient
http://www.bmj.com/content/357/bmj.j2963
Gender dysphoria: assessment and management for non-specialists
http://www.bmj.com/content/357/bmj.j2866

Childhood IQ and cause of death

Findings from a range of prospective cohort studies based around the world indicate that higher intelligence in children is related to a lower risk of all cause mortality in adulthood - and now a new study, published on bmj.com, is trying to dig into that association further, with a whole population cohort and data on cause specific mortality.
Ian J Deary, professor of differential psychology at the University of Edinburgh and one of the authors of that study, joins us to discuss what this tells us, and what might be causing that association.
Read the full open access study:
http://www.bmj.com/content/357/bmj.j2708

The Evidence Manifesto - it’s time to fix the E in EBM

"Too many research studies are poorly designed or executed. Too much of the resulting research evidence is withheld or disseminated piecemeal. As the volume of clinical research activity has grown the quality of evidence has often worsened, which has compromised the ability of all health professionals to provide affordable, effective, high value care for patients.”
Evidence is in crisis, and Carl Heneghan, director for the Centre for Evidence Based Medicine, and Fiona Godlee, editor in chief of The BMJ set out the 9 points of the Evidence manifesto, which tries to set a road map for strengthening the evidence base.
1) Expand the role of patients, health professionals and policy makers in research
2) Increase the systematic use of existing evidence
3) Make research evidence relevant, replicable and accessible to end users.
4) Reduce questionable research practices, bias, and conflicts of interests
5) Ensure drug and device regulation is robust, transparent and independent
6) Produce better usable clinical guidelines.
7) Support innovation, quality improvement, and safety through the better use of real world data.
8) Educate professionals, policy makers and the public in evidence-based healthcare to make informed choices.
9) Encourage the next generation of leaders in evidence-based medicine.
http://www.bmj.com/content/357/bmj.j2973

Stress at work

Stress is one of the leading causes of work absence, recently overtaking back-pain, and an increasing part of a GPs workload. However good quality evidence about how to deal with stress is hard to come by.
Alexis Descatha, an occupational/emergency practitioner, at the University hospital of Poincaré, gives some practical advice on what to do when you suspect stress is the underlying cause of a consultation, and what to do once you have confirmed that.
Read the full practice article:
http://www.bmj.com/content/357/bmj.j2489

”The interest of diesel drivers over the interest of the public” - tackling air pollution

Air pollution is a truly damaging environmental insult to the human body. The numbers of premature deaths, in the UK alone, that can be attributed to it are calculated to be 40,000 a year.
Yet despite this, action to tackle the problem - as with the other huge environmental issue of our time, climate change - is distinctly lacking.
Robin Russel-Jones dermatologist and chair of Help Rescue the Planet - joins us to discuss what should be done to tackle the problem.
Read the full analysis:
http://www.bmj.com/content/357/bmj.j2713

How to build a resillient health system

The 2014 west African Ebola epidemic shone a harsh light on the health systems of Guinea, Liberia, and Sierra Leone. While decades of domestic and international investment had contributed to substantial progress on the Millennium Development Goals, national health systems remained weak and were unable to cope with the epidemic.
Margaret Kruk associate professor of global health at the Harvard TH Chan School of Public Health, joins us to discuss what makes a health system resilient, and how Liberia in particular has learned lessons from Ebola.
Read the full analysis:
http://www.bmj.com/content/357/bmj.j2323

Your brain on booze

A new study on BMJ.com, examines the effect of moderate drinking on brain structure. We know that heavy drinking has a deleterious effect on our brains, and is linked to dementias. However, for sometime it’s been thought that moderate drinking is actually protective.
Anya Topiwala, clinical lecturer in old age psychiatry at the University of Oxford, joins us to discuss the association between alcohol consumption and those structural elements.
Read the full research:
http://www.bmj.com/content/357/bmj.j2353