Medicine and Science from The BMJ

When a new drug reaches market, the race is on to find more indications for its use - exploratory trials are set up, and positive results can lead to the off label prescriptions (eg Pregabalin for lower back pain. However, these initial indications are rarely confirmed with further, better quality, evidence. Jonathan Kimmelman is an associate professor at MCgill University in Canada, thinks it's time to explore less, and confirm more - and joins us to explain why. Read the full analysis: http://www.bmj.com/content/360/bmj.k959

Ravi Gupta, is a resident in internal medicine at Johns Hopkins in Baltimore - and as he said has seen the influence of sudden price hikes on his patients - between 2010 and 2015 more than 300 drugs in the U.S. have seen sudden increases of over %100. Ravi and his co-authors have suggested, and tested the feasibility of, a possible answer to those price hikes - a small tweak that should protect patients from the possibility that they’ll suddenly be unable to afford their essential medication. Read the full research: http://www.bmj.com/content/360/bmj.k831

”An additional person died every seven minutes during the first 49 days of 2018 compared with what had been usual in the previous five years. Why? In this podcast, Danny Dorling, Halford Mackinder professor of geography at the university of Oxford, talks about the spike in mortality, what that means for overall life expectancy in the UK (spoiler, it’s not great) and what he thinks could be fuelling the change. Read the full editorial http://www.bmj.com/content/360/bmj.k1090 For more information, this article by Dorling and Hiam has further analysis: https://theconversation.com/rapid-rise-in-mortality-in-england-and-wales-in-early-2018-an-investigation-is-needed-93311

That’s Jo Shapiro is a surgeon and manager in Brigham and Women’s hospital, she’s also director of the Center for Professionalism and Peer Support, and has written an editorial for The BMJ on tackling unprofessional behaviour. In this discussion, she and I talked about what she thinks (beyond the illegal) are the most damaging behaviours seen around a hospital, what needs to be done to set up an environment that allows the victims of unprofessional behaviour to speak out about senior members of staff, and how she goes about confronting perpetrators about their behaviour. Read the full editorial: http://www.bmj.com/content/360/bmj.k1025

Our latest debate asks, should doctors recommend acupuncture for pain? Asbjørn Hróbjartsson from the Center for Evidence-based Medicine at University of Southern Denmark argues no - evidence show's it's no worse than placebo. Mike Cummings, medical director of the British Medical Acupuncture Society argues yes - that there is evidence of efficacy, and trials haven't been designed to accurately measure that. We also hear from Kumari Manickasamy, a GP in north London, and someone who used acupuncture to control her pain during pregnancy despite knowing the lack of evidence. Read the debate and commentary: http://www.bmj.com/content/360/bmj.k970 http://www.bmj.com/content/360/bmj.k990

In this year's Nuffield Summit round table we're asking, how can the NHS become a good employer? At the moment, there is a recruitment and retention crisis across the workforce, doctors and nurses are leaving the NHS in droves, rota gaps are prevalent. A recent BMA survey showed that the majority of junior doctors are now planning to take a career break. So against this backdrop, what can the NHS do to nurture it's employees, and make medicine an exciting proposition for the millennial, and subsequent, generations. Taking part are: Fiona Godlee (Chair), editor-in-chief, The BMJ Candace Imison, director of policy, The Nuffield Trust Bob Klaber, consultant paediatrician and associate medical director, Imperial College Healthcare NHS Trust Claire Lemer, consultant in general paediatrics and service transformation, Guys and St Thomas’s NHS Foundation Trust Nishma Manek, GP trainee in London, national medical director’s clinical fellow Clifford Mann, consultant in Emergency Medicine, Taunton and Somerset NHS Foundation Trust, national clinical advisor for NHS England’s Accident and Emergency Improvement Plan

Its now widely agreed that one of the key ways of reducing the current high level of "waste " in biomedical research is to focus it more squarely on addressing the questions that matter to patients - and the people and medical staff that care for them. In this interview, Tessa Richards - the BMJ's patient partnership editor, talks to Katherine Cowan, independent consultant and a senior advisor the the James Lind Alliance, which has pioneered patient involvement with their research priority setting partnerships. In this conversation they talk about how these work, the challenge of navigating between different groups with what are often very different views and agendas, and why she thinks healthy debate on divergent views is no bad thing

Up to $500m a year could be put to better use by stopping ineffective and potentially harmful supplementation programmes in poorer countries, argues John Mason, professor emeritus at Tulane University School of Public Health and Tropical Medicine. However Keith West, professor of infant and child nutrition at Johns Hopkins Bloomberg School of Public Health disagrees, saying that such programmes have been proved to save millions of lives and should be withdrawn only when robust evidence permits. Read the full head to head debate: http://www.bmj.com/content/360/bmj.k927

International travel is increasingly common. Between 10% and 42% of travellers to any destination, and 15%-70% of travellers to tropical settings experience ill health, either while abroad or on returning home, Malaria is the commonest specific diagnosis, accounting for 5%-29% of all individuals presenting to specialist clinic, followed by dengue, enteric fever, and rickettsial infections . In this podcast Doug Fink specialist registrar, and Victoria Johnston consultant, in infectious diseases at The Hospital for Tropical Diseases join us to discuss diagnosis, and treatment - and why the clinically most interesting diagnosis is rarely the right one. Read the full practice article: http://www.bmj.com/content/360/bmj.j5773

In a new analysis John McArthur and Krista Rasmussen, from the Global Economy and Development Program at the Brookings Institution, and Gavin Yamey from Duke University, have set out to analyse the potential for lives saved by the goals set in the Sustainable Development Goals In this conversation I talked to Gavin and John about the numbers, which countries have to accelerate their development to meet those goals - and we also address some of the criticisms of the SDGs - that they’re too wide ranging, that they lack a political dimension, and that they are unrealistic. Read the full analysis and more on the SDGs: http://www.bmj.com/content/360/bmj.k373 http://www.bmj.com/content/sustainable-development-goals