Medicine and Science from The BMJ

Likelihood ratios in diagnostic tests

Andrew Elder, a professor at the University of Edinburgh talks about likelihood ratios in diagnostic testing, and how they’re helpful in thinking about how context changes the predictive value of a test.
This is part of a wider discussion on the evidence behind clinical examination of the cardiovascular system https://soundcloud.com/bmjpodcasts/evidence-for-examination
Read the full clinical review:
http://www.bmj.com/content/354/bmj.i3309

Poor adherence to antihypertensives

It is estimated that 50% of patients who have what appears to be treatment resistant hypertension are actually not taking their drugs as prescribed.
Indranil Dasgupta, a consultant nephrologist at the Heart of England NHS Foundation Trust joins us to discuss what factors may influence non-adherence, and how to encourage patients to divulge that information.
Read the full article:
http://www.bmj.com/content/354/bmj.i3268

Anticipatory care

“How long have I got, doc” is a TV medical drama cliche - but like all cliches has it’s feet in real life - and it’s medicine’s attempt to answer these questions that the authors of an analysis article on TheBMJ.com are questioning.
Kirsty Boyd is a consultant in palliative care in NHS lothian, a trainer and a researcher with the University of Edinburgh. Scott Murray is a GP, and St Columba's Hospice Chair of Primary Palliative Care, also at the University of edinburgh. They argue that it’s time to rethink how we talk about prognosis, and what conversations to have as patients become more unwell.
Read the full analysis:
http://www.bmj.com/content/354/bmj.i3802

Ivan Oransky watching retractions

Ivan Oransky, co-founder of Retraction Watch and global editorial director at MedPage Today, discusses which areas of science are most affected by research fraud, and what motivates individuals to risk their careers by fabricating data.

How does maximizing shareholder value distort drug development?

With the emergence of sofobuvir, a new direct acting antiviral, treatment for Hepatitis C infection is currently undergoing it's greatest change since the discovery of the virus 25 years ago.
However Gilead, who manufacture the treatment, are under fire for the cost of the druge - around $90 000 for a course of treatment.
Victor Roy, doctoral researcher at the University of Cambridge, discusses how the new drug was discovered and came to market, and what happened to the profits from sale.
Read the full analysis:
http://www.bmj.com/content/354/bmj.i3718

What went wrong with care.data?

Failures in implementation of data sharing projects have eroded public trust.
In the wake of NHS England’s decision to close down its care.data programme, Tjeerd-Pieter van Staa professor of health e-research at the University of Manchester, examines what lessons must be learnt, and what we can do better next time.
Read the full analysis:
http://www.bmj.com/content/354/bmj.i3636

You’ve been ICE’d

We’re taught that patients' ideas, concerns, and expectations are central to a successful consultation, but has ICEing gone too far?
A “What your patient is thinking” article published this week talks about the pressure that asking questions in the wrong way can put on a patient.
Sophie Cook, education editor for The BMJ, is joined by the author of that article - The BMJ’s patient editor, Rosamund Snow, and by Roger Neighbour, former president of the royal college of general practice, and author of "The Inner Consultation".
http://www.bmj.com/content/354/bmj.i3729

Should we scrap the internal market in England’s NHS

The "internal market" was created after the 1987 UK general election focused attention on inadequate funding in the NHS, long waiting lists for elective surgery, and large unwarranted variations in clinical care.
Economists attributed these problems to a lack of incentives for efficiency, and the remedies offered included increasing competition in the NHS.
Twenty nine years later, this interesting experiment is not likely to have been worth it, says Alan Maynard, professor emeritus of health economics at the University of York. But Michael Dixon, a GP and commissioner in Devon, says that if properly funded and liberated from some of the administrative burdens of "red tape," the internal market could increase accountability.
Read their full debate:
http://www.bmj.com/content/354/bmj.i3825

Treating hip osteoarthritis

2.46 million people in England have osteoarthritis of the hip, and many of those go on to eventually have a hip replacement - which is now widely considered one of the most commonly performed and successful operations in the world.
Jessamy Bagenal, clinical fellow with The BMJ, talks to Nick Aresti, a specialist registrar in trauma and orthopaedic surgery and one of the authors of a clinical update on hip osteoarthritis, recently published on thebmj.com
In a linked podcast, Nick Nicholas, a patient who has hip OA gives us his perspective.
Read the full article:
http://www.bmj.com/content/354/bmj.i3405
Listen to the linked podcast:
https://soundcloud.com/bmjpodcasts/having-hip-osteoarthritis

Having hip osteoarthritis

2.46 million people in England have osteoarthritis of the hip, and many of those go on to eventually have a hip replacement - which is now widely considered one of the most commonly performed and successful operations in the world.
Jessamy Bagenal, clinical fellow with The BMJ, talks to Nick Nicholas, an obstetrician who has had OA and one of the authors of a clinical update on hip osteoarthritis, recently published on thebmj.com
In a linked podcast, Nick Aresti, a specialist registrar in trauma and orthopaedic surgery to talks about management of the condition.
Read the full article:
http://www.bmj.com/content/354/bmj.i3405
Listen to the linked podcast:
https://soundcloud.com/bmjpodcasts/treating-hip-osteoarthritis