Medicine and Science from The BMJ

Living kidney donation

Globally each year more than 30 000 people become living kidney donors. Living kidney donation is constantly evolving, with new ways of pooling donors and recipients to maximise opportunity. With increased numbers, there is increasing information regarding the long term outcomes associated with donation.
Pippa Bailey, clinical lecturer in renal medicine at the University of Bristol, and Aisling Courtney, consultant nephrologist at Belfast City Hospital join us to explain who can donate, to whom, and the possible impact of donation on the donor’s health.
Read the full update:
http://www.bmj.com/content/354/bmj.i4746

The ethics of placebo

In a clinical trial, we usually think of risk in terms of the new active compound - will it have unwanted effects. However, two analyses in The BMJ are concerned about the risk associated with the control arm.
Robin Emsley is a professor of psychiatry at Stellenbosch University in South Africa, he and colleagues have written about the risk associated with forgoing treatment in patients with schizophrenia.
Read the full analysis: http://www.bmj.com/content/354/bmj.i4728
Jonathan Mendel, lecturer in human geography at the University of Dundee, and Ben Goldacre, senior clinical research fellow at the University of Oxford, have examined the ethical approval given to trials, and are concerned that identified risks are not adequately communicated to patients.
Read the full analysis: http://www.bmj.com/content/354/bmj.i4626

Ghostwriting redefined

Alastair Matheson, independant consultant and former ghostwriter, describes how the pharmaceutical publications industry seeks to legitimise ghostwriting by changing its definition while deflecting attention from wider marketing practices in academic publishing.
Read his full analysis:
http://www.bmj.com/content/354/bmj.i4578

Reprehensible, but the people carrying out atrocities have very low rates of mental disorders

Oversimplification and lack of evidence stigmatise people with mental illness and impede prevention efforts, says Simon Wessley, professor of psychiatry at King's College London, in an editorial published on thebmj.com.
Read the full editorial:
http://www.bmj.com/content/354/bmj.i4869

Late effects of anticancer chemotherapy: It’s hard to trust your body, after it’s betrayed you

Lily was diagnosed at 14 years old with stage four Hodgkin's lymphoma and received six rounds of chemotherapy and two weeks of radiotherapy. She survived but now lives with the long term effects of that therapy - and joins us to discuss how it has impacted her quality of life.
We're also joined by Saif Ahmad and Thankamma Ajithkumar, oncologists from Cambridge University Hospitals NHS Foundation Trust, who give advice for generalists on late effects of anticancer chemotherapy that may affect quality of life.
Read the full clinical review:
http://www.bmj.com/content/354/bmj.i4567

”It suggests that older people have a lower value in society” - Ageism in global development

The United Nation's Millennium Development Goals, and the subsequent Sustainable Development Goals, define premature mortality as being a death under the age of 70.
As demographic change means more people are living longer than this, Peter Lloyd-Sherlock, professor of social policy and international development at the University of East Anglia, argues that this will lead to discrimination against older people.
Read the full analysis:
http://www.bmj.com/content/354/bmj.i4514

Not just our ethical credibility as a profession, but our shared humanity

"I say to all Australian doctors - young, old, the political and the apolitical - that on this depends not just our ethical credibility as a profession, but our shared humanity. "
Following the leaked emails published in The Guardian newspaper, alleging abuse of asylum seekers detained by the Australian government on the Pacific island of Nauru, David Berger joins us again to say it is time that doctors take a stand and march to protest against this treatment.
Read his full editorial:
http://www.bmj.com/content/354/bmj.i4606
Listen to the head to head debating if doctors should boycott working at the detention centres:
https://soundcloud.com/bmjpodcasts/should-doctors-boycott-working-in-australias-immigration-detention-centres

Education round up - ICE, examinations, and adherence

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 new monthly audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice.
In our first audio edition, GPs Sophie Cook and Helen Macdonald, psychiatry trainee Kate Adlington, and HIV and sexual health trainee Deborah Kirkham talk about communication skills – ICE - obtaining a patient’s ideas, concerns and expectations about their health.
http://www.bmj.com/content/354/bmj.i3729
They also examine the lack of evidence for cardiovascular examination.
http://www.bmj.com/content/354/bmj.i3309
And finally, they talk about how 50% of patients with treatment resistant hypertension may actually be treatment non-adherent, and what that could mean for other conditions.
http://www.bmj.com/content/354/bmj.i3268

A maladaptive pathway to drug approval

The European Medicines Agency (EMA) has embraced a new model of drug testing and marketing called “adaptive pathways”, allowing new drugs for “unmet medical needs” to be launched on the market faster, on the basis of fewer data.
While industry claims this is necessary, an analysis on thebmj.com looks at the assumptions underlying the new pathway, and raises concerns about the negative impact on patient safety and the cost of healthcare.
To discuss, we're joined by Courtney Davis, senior lecturer at King’s College London, Peter Gøtzsche, director of the Nordic Cochrane Centre and Joel Lexchin, a professor at York University in Toronto.
Read the full analysis:
http://www.bmj.com/content/354/bmj.i4437

Evidence for examination

You may have spent hours practicing for your examination exams, but how evidence based are the techniques taught?
Andrew Elder, a professor at the University of Edinburgh, and author of the clinical review “How valuable is physical examination of the cardiovascular system?” joins us to discuss.
Read the full review:
http://www.bmj.com/content/354/bmj.i3309
Andrew also discussed likelihood ratios; which are useful in understanding the relative use of tests in different clinical scenarios: https://soundcloud.com/bmjpodcasts/likelyhood-ratios-in-diagnostic-tests