Medicine and Science from The BMJ

Middle East respiratory syndrome

Middle East respiratory syndrome (MERS) is an acute viral respiratory tract infection caused by the novel betacoronavirus.
Cases have been limited to the Arabian Peninsula and its surrounding countries, and to travellers from the Middle East or their contacts.
The clinical spectrum of infection varies from no symptoms or mild respiratory symptoms to severe, rapidly progressive pneumonia, acute respiratory distress syndrome, septic shock, or multiorgan failure resulting in death.
In this podcast Sarah Shalhoub, infectious diseases consultant at King Fahad Armed Forces Hospital, in Saudi Arabia joins us to discuss the history of the disease, clinical presentation, and what can be done to support those infected.
Read the full clinical update:
http://www.bmj.com/content/355/bmj.i5281

Beyond data sharing - ”It was me who got my research team out of jail... that’s my data”

Elizabeth Pisani, visiting senior research fellow at King's College London, collects data on sex workers and injecting drug users in low and middle income countries.
For years she has been sharing her data, and joins us to explain why she went from being protective of her research to to making it freely available - and talk about some of the practicalities of keeping participants anonymous.
Read the full analysis:
http://www.bmj.com/content/355/bmj.i5295

Head to head - Should all GPs be NHS employees?

Independent contractor status creates unnecessary stress, argues Azeem Majeed, GP partner and professor of primary care at Imperial College London.
Laurence Buckman, GP partner and former head of the BMA GP committee, values his autonomy and distance from a non-benign employer.
Read the full head to head:
http://www.bmj.com/content/355/bmj.i5064
We also hear from former columnist and current partner in a federated practice, Des Spence, who thinks that the days of small GP surgeries are numbered.
Independent or employed? There is a third way. . .
http://www.bmj.com/content/355/bmj.i5329

Preventing Overdiagnosis In Barcelona

The Preventing Overdiagnosis conference is part of The BMJ's campaign against Too Much Medicine.
Helen Macdonald clinical editor for The BMJ was at the conference, and talked to some of the key speakers there about what they believe the key issues are, and what's being done to roll back the harms of too much medicine.
http://www.bmj.com/too-much-medicine
http://www.preventingoverdiagnosis.net/

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