Medicine and Science from The BMJ

The use of novel psychoactive substances is increasing, however there is little information about what these are, and how they work. Dr Derek Tracy, consultant psychiatrist at Oxleas NHS Foundation Trust, and David Wood, consultant physician and toxicologist at Guy's and St Thomas' NHS Foundation Trust join us to explain that doctors already know how to deal with these, if they think about them in terms of traditional drug use. Read the two related articles: http://www.bmj.com/content/356/bmj.i6814 http://www.bmj.com/content/356/bmj.i6848

http://evidencelive.org/manifesto/ The BMJ, and the Centre for Evidence Based Medicine in Oxford have long collaborated to document the problems with the creation and use of Evidence based medicine - and together we host evidence gatherers, synthesisers and users in the conference Evidence Live. We know what the problems are - but what would positive change, when it comes to the creation and use of medical evidence look like? To find out we’re doing a series of discussions at various places around the world - where we’re talking to people who have a particular insight into one area of the evidence ecosystem. Ultimately we’re collating this into what we’re calling the evidence manifesto. In this discussion we went to the The Farr Institute which is a of 21 academic institutions and health partners in the UK - whose mission is to deliver high-quality, cutting-edge research using ‘big data”.

Should gluten-free foods be available on prescription? A gluten free diet is the main treatment for celiac disease, and gluten-free food has been available on prescription from the NHS. However, as finances become tighter, in some areas patients no longer have that option. Prescriptions of gluten free food is the same as a prescription for a drug, argues David Sanders, professor of gastroenterology from Royal Hallamshire Hospital, but James Cave lambasts a costly system that frustrates patients and doctors alike. Gemma Gleed is the mother of a child with coeliac disease, who has had her prescriptions cancelled. Read the debate: http://www.bmj.com/content/356/bmj.i6810

Surrogate endpoints are commonly used in clinical trials to get quicker results, however Michael Baum, emeritus professor at University College London, worries that by not focusing on real outcomes - length of life, and quality of life - that these are being used to justify expensive treatments which may not benefit patients. Read the full analysis: http://www.bmj.com/content/355/bmj.i6286

State regulation is necessary for safety, says Simon Capewell, professor of public health and policy at the University of Liverpool. Richard Lilford, professor of public health at the University of Warwick, argues that restricting adults’ choice can undermine such aims. Read the debate: http://www.bmj.com/content/355/bmj.i6341

In this year's Christmas BMJ 2016 podcasts, we’ve been discussing morality, compassion, truth. In this final one, it's time for war. After the second world war, there was an attempt to bring a moral sense to conflict - and Julian Sheather, specialist adviser on ethics and human rights to the BMA, and author of the christmas editorial “medicine under fire” is worried about the retrenchment of those ideals. http://www.bmj.com/content/355/bmj.i6464 Peter Wever is a doctor in The Netherlands, and has been uncovering the story of the number 10 stationary hospital, in st-omer in northern france - a British army hospital that was targeted and destroyed during the first world war. http://www.bmj.com/content/355/bmj.i6509

In response to the turmoil of 2016, with political campaigns being run on, and won on, misinformation - many commentators are disparing that we’ve become a post-truth society. And what is truth anyway? Tracy Brown, director of Sense about Science, the charity set up to champion evidence in everyday life, is less pessimistic about the public's appetite for evidence. http://www.bmj.com/content/355/bmj.i6467 Anders Huitfeldt, a postdoctoral scholar at Stanford University School of Medicine, and has been trying to puzzle out “Is caviar a risk factor for being a millionaire?” http://www.bmj.com/content/355/bmj.i6536

Underneath all of our civilisation and science, we’re still primates - and the connection between patient and doctor can be reinforced by simply taking a hand. Robin Youngson, cofounder of hearts in healthcare, and Mitzi Blennerhassett, who has written extensively on patient engagement, have co-authored an editorial calling for the humanisation of medicine, and we talk to them about the power of touch. Read the editorial: www.bmj.com/content/355/bmj.i6262 Andrew Steptoe is the British Heart Foundation professor of psychology, at University College London. He and colleagues have been using a large cohort study to measure the link between overall happiness and health. Read the full research: www.bmj.com/content/355/bmj.i6267

In an ideal world, policies would be evidence based - but governments are made of humans, who have positions and ideologies and moral bases. In this podcast Anthony Painter, from the RSA will be talking about why universal basic income may work, but who’s proponents cross ideological barriers, and writer and philosopher AC Grayling explains how economic arguments become moral crusades. A universal basic income: the answer to poverty, insecurity, and health inequality? http://www.bmj.com/content/355/bmj.i6473 Morality and non-medical drug use http://www.bmj.com/content/355/bmj.i5850

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 second audio edition, GPs Sophie Cook and Helen Macdonald, surgical trainee Jessamy Baganel, and internalist and methodologist Reed Siemieniuk, talk about the evidence for vitamin D supplements. http://www.bmj.com/content/355/bmj.i6201 The new Rapid Recommendation series in the BMJ http://www.bmj.com/content/354/bmj.i5085 Communication with patients who have learning difficulties, or others who have experienced torture. http://www.bmj.com/content/355/bmj.i5296 http://www.bmj.com/content/355/bmj.i5019 And safety netting of people with low, but not no, risk of cancer. Can safety-netting improve cancer detection in patients with vague symptoms?