Medicine and Science from The BMJ

Heath in Europe, When to order ANA tests

Professor Michael Marmot has spearheaded WHO Europe’s Health 2020 report, which looks at the disparity in the social determinants of health across the region. He joins us to explain why he’s hopeful for change.Also, Spencer Ellis, consultant rheumatologist at Lister Hospital in Stevenage, explains when and why to order antinuclear antibody (ANA) tests.

Statins: benefits and harms for low risk patients

NB: In our interview about statins, Abramson quotes the figure of an 18% relative increase in risk of adverse effects of statins. This figure should be couched in uncertainty, and a correction has been posted on bmj.com to reflect that - http://www.bmj.com/content/348/bmj.g3329--------------------------------------------------------------------It may soon be recommended that statins are prescribed to patients with a low risk of cardiovascular disease. John Abramson from the Department of Health Care Policy at Harvard Medical School explains why the risks associated with taking the drug may have been underplayed.Also this week, interviews with Steve Field, the new chief inspector of hospitals, and Richard Vautry, deputy chairman of the BMA's GP committee, recorded at the National Association of Primary Care's annual Best Practice conference.See also:Should people at low risk of cardiovascular disease take a statin?http://www.bmj.com/content/347/bmj.f6123

Tobacco industry vs science, vCJD in the UK

The BMJ, BMJ Open, Heart, Thorax, and Tobacco control – all journals in BMJ’s stable, have announced they will no longer carry research funded in part, or in whole, by the tobacco industry. Fiona Godlee, BMJ Editor in chief, explains what that means, and Allen Brandt, professor of the history of science at Harvard University, gives us a potted history of the way in which the tobacco industry has manipulated science.
Also this week, Sebastian Brandner, professor of neuropathology at UCL, explains his research into the population prevalence of the prion which causes vCJD.
See also
Prevalent abnormal prion protein in human appendixes after bovine spongiform encephalopathy epizootic
http://www.bmj.com/content/347/bmj.f5675
Journal policy on research funded by the tobacco industry
http://www.bmj.com/content/347/bmj.f5193

Brain tumours in children, and why all polyps are not equal

There are many overlapping classifications for bowel polyps. Geir Hoff, professor of gastroenterology at the University of Oslo, explains why he fears screening for one type has lead to overtreatment of another.
Also, Sophie Wilne, consultant paediatric oncologist at Nottingham University Hospitals NHS Trust, discusses the clinical signs of brain tumours in children and young adults, and what treatment should follow.
See also:
Identifying brain tumours in children and young adults
www.bmj.com/content/347/bmj.f5844
New polyps, old tricks: controversy about removing benign bowel lesions
www.bmj.com/content/347/bmj.f5843

Leaving the RCGP

As Clare Gerada's stint as RCGP chair comes to a close, she gives BMJ news reporter Gareth Iacobucci a typically honest exit interview.
And David Loxterkamp, a primary care physician in Belfast, Maine, tells us why he thinks metrics are obscuring humanism in medical care.
See also:
Clare Gerada: “It’s like the wild west in healthcare” http://goo.gl/SiWZ5y
Humanism in the time of metrics—an essay by David Loxterkamp http://goo.gl/FRD0xC

Possible racial bias in the RCGP exam

A study on bmj.com raises raises concerns over possible “subjective bias owing to racial discrimination” in the MRCGP - the Royal College of General Practitioner''s postgraduate exams required to become a registered GP in the UK. Aneez Esmail, professor of primary care at the University of Manchester and the paper's lead author, explains the background to the study and its findings. Read the accompanying editorial and news story, which includes a response from RCGP chairwoman Claire Gerada.See also:Academic performance of ethnic minority candidates and discrimination in the MRCGP examinations between 2010 and 2012: analysis of datahttp://www.bmj.com/content/347/bmj.f5662BMJ author hits out at attempts to dismiss findings of possible racial bias in RCGP examhttp://www.bmj.com/content/347/bmj.f5871

A new chief inspector of hospitals

Professor Sir Mike Richards, previously National Cancer Director at the Department of Health, and former head of the Academic Division of Oncology at King's College London, is the new chief inspector of hospitals in England.In his new role he will have the power to enter hospitals, both in planned and unplanned inspections, to highlight problems before they develop into another scandal of the kind that happened in Mid-Staffordshire. He talks about his new role to Nigel Hawkes.See also:“We know where to probe,” says Mike Richards, the new chief inspector of hospitals http://www.bmj.com/content/347/bmj.f5557

Safety from Syria

UN Refugee Agency High Commissioner António Guterres described the Syrian crisis this week as the great tragedy of the century, a "disgraceful humanitarian calamity with suffering and displacement unparalleled in recent history." Every 15 seconds a Syrian seeks refuge in neighbouring countries. UNHCR spokesperson Andrej Mahecic describes a typical refugee's journey from the stricken country and how their health needs are addressed when they reach refugee camps and host communities in Jordan, Lebanon, and Turkey.See also:http://www.bmj.com/content/347/bmj.f5413

Treating childhood autism, and cardiac imaging for stable chest pain

NICE has published now guidelines on the treatment of children with autism. Mabel Chew BMJ practice editor talks to Tim Kendall, director of the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists, who helped draw up the guidelines.Mabel also talks to Declan P O’Regan, consultant radiologist at the MRC Clinical Sciences Centre in London, and an author of our rational imaging article on investigating stable chest painSee also:http://www.bmj.com/content/347/bmj.f3940http://www.bmj.com/content/347/bmj.f4865

HPV testing in preventing cervical cancer

What do clinicians need to know about the developing role of HPV in cervical cancer prevention? BMJ clinical reviews editor Sophie Cook speaks to Henry Kitchener, professor of gynaecological oncology, and Emma Crosbie, senior lecturer and honorary consultant in gynaecological oncology, both at the University of Manchester.Read the full clinical review:http://www.bmj.com/content/347/bmj.f4781