Medicine and Science from The BMJ

Newer insulins and stents in diabetic patients

This week we concentrate on diabetes"The difference between insulin management in type 1 and type 2 diabetes is rather like the difference between driving a sports car and driving a lorry," says Edwin Gale, emeritus professor of diabetes at the University of Bristol. He tells us why this means the newer insulins that have benefits in the treatment of type 1 diabetes may not be as good for type 2.Sripal Bangalore, director of research at the New York University School of Medicine, discusses his research into the relative effectiveness of different types of stents in diabetes patients

Reducing emergency admissions: are we on the right track?

Schemes which reduce emergency admissions sound like a good thing, but Martin Rowland, professor of health services research, Cambridge Centre for Health Services Research, University of Cambridge, explains how they can go off track.And Mabel Chew gets some advice on the prognosis of children with acute coughs from Matthew Thompson, a senior clinical scientist in the Department of Primary Care Health Sciences, Oxford University.

Stayin’ Alive, in the cardboard city

A head to head article this week asks: "Does celebrity involvement in public health campaigns deliver long term benefit?”. The British Heart Foundation’s Hands Only CPR campaign, featuring Hollywood actor Vinnie Jones, seems to be having positive effects. Maura Gillespie, head of policy and advocacy at the BHF, explains why.Also this week, care for the homeless is often fragmented and transient. A team at University College Hospital in London is trying to unite the disparate agencies involved to ensure long term medical and social care for these vulnerable people. They tell us how their pilot service has improved outcomes and reduced costs.

Treating the masses, overtreating the few

In the US, overly aggressive treatment is estimated to cause 30 000 deaths among Medicare recipients alone each year. Reporter Jeanne Lenzer has investigated the problem for the BMJ, and explains why she thinks profit driven healthcare is to blame.And, experience of treating rare conditions can take time to build. Rej Bhumbra, a surgical trainee in orthopaedic oncology, explains how his time in India fast tracked his learning.

Bariatric surgery, neuromuscular blocking agents, and calcium in primary parahyperthyroidism

Bariatric surgery is under scrutiny from NCEPOD, the National Confidential Enquiry into Patient Outcome and Death, Ian Martin, NCEPOD's clinical co-ordinator for surgery, takes us through the highlights of its latest report. Also this week, Julie Paik, instructor and physician at Harvard Medical School, tells us about a new risk factor for primary hyperparathyroidism. And finally, some neuromuscular agents may lead to respiratory complications after surgery. Matthias Eikermann, director of research in the surgical intensive care unit at Massachusetts General Hospital, explains how they investigated this vexed problem.

Smoking in Japan

Deborah Cohen explains how a joint BMJ and Daily Telegraph investigation helped uncover problems with device regulation in Europe. Previous research has shown smoking reduces life expectancy by about a decade, but only by four years if you are Japanese. Sarah Darby, from the University of Oxford, explains why her new research shows they are actually just as unhealthy as their British counterparts.

Fishy data

Rajiv Chowdury, a research associate from the Department of Public Health and Primary Care at the University of Cambridge, explains why eating whole fish is better than fish oil - at least when it comes to cerebrovascular disease. Also this week Peter Doshi and Tom Jefferson from the Cochrane Collaboration talk about the BMJ's open data campaign, and how publishing correspondence with Roche, the WHO and Centers for Disease Control and Prevention might reveal the missing data on Tamiflu.

The silent misdiagnosis

This week, Al Mulley, Dartmouth Center for Health Care Delivery Science, and Tessa Richards, BMJ associate editor, discuss the silent misdiagnosis: that of patient preferences.Removing pre-cancerous cells spotted through screening is the foremost defence against cervical cancer. However, a recent BMJ paper has shown that women who go through this have a fourfold risk of going on to develop cancer compared to women who’ve only ever had normal smears, even if they complete follow up and are given the all clear. Matejka Rebolj, postdoctoral researcher, Department of Public Health, University of Copenhagen, and Chris Meijer and Maaike Bleeker, pathologists in the Department of Pathology, VU Medical Centre, Amsterdam, discuss what could be done to mitigate the risk.

Countering counterfeits

Last year 125 people died in Pakistan after taking contaminated cardiac medication. The disaster is one example of the dangers of counterfeit and substandard medicines, an issue the WHO is struggling to control.In this podcast we hear from Amir Attaran, Canada research chair in law, population health, and global development policy at the University of Ottawa, on the international wrangling he sees at the political level. And Sania Nishtar, president of Heartfile, an independent think tank based in India, discusses what went wrong in Pakistan, and how to prevent it happening again.

Checking out the check-ups

Lasse Krogsbøll, from the Nordic Cochrane Centre, explains research into whether general health checks improve mortality and morbidity in the population. Also, the European Medicines Agency (EMA) this week announced plans to make trial data used as the basis for its decisions publicly available. BMJ Deputy editor Trish Groves finds out more from some of the key players in the campaign for open data.