Medicine and Science from The BMJ

If patients living in one area have more diagnoses than those living in another, use more care, but have similar mortality rates, you would think they were simply sicker, but that the extra care they were receiving must be good and making them better. Not so, says new research published on bmj.com. John Wennberg, emeritus professor of community and family medicine at the Dartmouth Institute in the US, joins us to explains how this flawed logic is harmfully perpetuating overdiagnosis and variation in care. Also, post Mid Staffs, how do we put compassion back at the heart of care? A BMJ round table discusses this, and we have edited highlights. The full round table is also available on the podcast page.

Andrew Witty is the CEO of GlaxoSmithKline. He’s been credited with taking on a pharma company with a history of behaving badly in the past – as shown by a record $3bn fine levied by the US government last year. How much is he able or willing to change the culture of an industry, which is under pressure to alter its practices? Rebecca Coombes finds out. Also this week, Michael Dowling, president and CEO of the North Shore-LIJ Health System in New York, has built his organisation up from two hospitals undergoing a difficult merger into a giant integrated system. He explains his no-nonsense approach to making change work.

Recorded at the recent Nuffield health policy summit, this round table asks how to impliment the Francis reports recommendations. Taking part were: Robert Francis, chair of The Mid Staffordshire NHS Foundation Trust Public Enquiry Simon Stevens, president of global health at the UnitedHealth Group Sam Barrell, chief clinical officer of South Devon and Torbay CCG Niall Dickson, CEO of the General Medical Council Stephen Dorrell MP, chair of the HOC Health Select Committee Nigel Edwards, director of the Global Healthcare Group, KPMG Jan Filochowski, chief executive, Great Ormond Street Hospital for Children NHS Foundation Trust Julie Moore, chief executive of University Hospitals Birmingham Bruce Keogh, medical director of the NHS Alastair McLellan, Editor of Health Services Journal Jeremy Taylor, chief executive, National Voices Ruth Thorlby, senior fellow at the Nuffield Trust.

Are all calories equal? Thermodynamics would say that energy is energy, be it derived from carbohydrate, fat, or protein. But things get more complicated when appetite is taken into consideration , says Robert Lustig, professor of pediatric endocrinology at the University of California, San Francisco. Also this week, life expectancy in Europe is increasing, but at the same time health inequalities are widening. Claudia Stein, director of the Division of Information, Evidence, Research, and Innovation at the World Health Organization's regional office for Europe, talks about a new report that highlights both the good and the bad of Europe's health.

A clinical review this week looks at the diagnosis and treatment of carotid atherosclerosis, including when to screen and the threshold for intervention. Alun Davies, professor of vascular surgery at Imperial College London, also answers how useful or harmful screening offered commercially is. Also this week, the BMJ’s editorial board met to discuss how patient participation should be represented and encouraged by the journal. We captured some of their views.

The issues of hidden data are well known, and the BMJ’s open data campaign page documents some of the problems which have arisen as a result of clinical trial data remaining undisclosed. At Evidence Live 2013 in Oxford this week, Fiona Godlee, BMJ editor in chief, convened a group of those closely involved with the AllTrials campaign, to discuss where we are now and what still needs to be done

The World Health Organization has chosen hypertension as the public health threat it will focus on for the next year. The problem is particularly pressing in India, and Anita Jain, the BMJ's India editor, spoke to François Decaillet, Coordinator for Health Programs, WHO India, about what needs to be done to tackle hypertension in the country's population.

Delirium is often missed in primary and secondary care. Edison Vidal, assistant professor in internal medicine at the Universidade Estadual Paulista, Brazil, advises on diagnosing and managing the condition. Rheumatoid arthritis, non-biological drug treatments, or both, might suppress tumour surveillance and in theory increase the risk of melanoma. Pauline Raaschou, consultant in clinical pharmacology at the Karolinska Institutet, Sweden, explains what she found while investigating the association.

This week, we discuss how Australia’s national human papillomavirus (HPV) vaccination programme has caused a dramatic drop in genital warts. Does this foretell elimination of all disease caused by HPV in the country? And some advice on how to diagnose and manage pulmonary hypertension.

Patients are increasingly going online to find and discuss information about their condition. What are they getting on the web that they’re not getting from clinicians, and how is this changing healthcare? Also, how to care for a dying patient in hospital.