Medicine and Science from The BMJ

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

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