Medicine and Science from The BMJ

The United Nation's Millennium Development Goals, and the subsequent Sustainable Development Goals, define premature mortality as being a death under the age of 70. As demographic change means more people are living longer than this, Peter Lloyd-Sherlock, professor of social policy and international development at the University of East Anglia, argues that this will lead to discrimination against older people. Read the full analysis: http://www.bmj.com/content/354/bmj.i4514

"I say to all Australian doctors - young, old, the political and the apolitical - that on this depends not just our ethical credibility as a profession, but our shared humanity. " Following the leaked emails published in The Guardian newspaper, alleging abuse of asylum seekers detained by the Australian government on the Pacific island of Nauru, David Berger joins us again to say it is time that doctors take a stand and march to protest against this treatment. Read his full editorial: http://www.bmj.com/content/354/bmj.i4606 Listen to the head to head debating if doctors should boycott working at the detention centres: https://soundcloud.com/bmjpodcasts/should-doctors-boycott-working-in-australias-immigration-detention-centres

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 first audio edition, GPs Sophie Cook and Helen Macdonald, psychiatry trainee Kate Adlington, and HIV and sexual health trainee Deborah Kirkham talk about communication skills – ICE - obtaining a patient’s ideas, concerns and expectations about their health. http://www.bmj.com/content/354/bmj.i3729 They also examine the lack of evidence for cardiovascular examination. http://www.bmj.com/content/354/bmj.i3309 And finally, they talk about how 50% of patients with treatment resistant hypertension may actually be treatment non-adherent, and what that could mean for other conditions. http://www.bmj.com/content/354/bmj.i3268

The European Medicines Agency (EMA) has embraced a new model of drug testing and marketing called “adaptive pathways”, allowing new drugs for “unmet medical needs” to be launched on the market faster, on the basis of fewer data. While industry claims this is necessary, an analysis on thebmj.com looks at the assumptions underlying the new pathway, and raises concerns about the negative impact on patient safety and the cost of healthcare. To discuss, we're joined by Courtney Davis, senior lecturer at King’s College London, Peter Gøtzsche, director of the Nordic Cochrane Centre and Joel Lexchin, a professor at York University in Toronto. Read the full analysis: http://www.bmj.com/content/354/bmj.i4437

Andrew Elder, a professor at the University of Edinburgh talks about likelihood ratios in diagnostic testing, and how they’re helpful in thinking about how context changes the predictive value of a test. This is part of a wider discussion on the evidence behind clinical examination of the cardiovascular system https://soundcloud.com/bmjpodcasts/evidence-for-examination Read the full clinical review: http://www.bmj.com/content/354/bmj.i3309

You may have spent hours practicing for your examination exams, but how evidence based are the techniques taught? Andrew Elder, a professor at the University of Edinburgh, and author of the clinical review “How valuable is physical examination of the cardiovascular system?” joins us to discuss. Read the full review: http://www.bmj.com/content/354/bmj.i3309 Andrew also discussed likelihood ratios; which are useful in understanding the relative use of tests in different clinical scenarios: https://soundcloud.com/bmjpodcasts/likelyhood-ratios-in-diagnostic-tests

It is estimated that 50% of patients who have what appears to be treatment resistant hypertension are actually not taking their drugs as prescribed. Indranil Dasgupta, a consultant nephrologist at the Heart of England NHS Foundation Trust joins us to discuss what factors may influence non-adherence, and how to encourage patients to divulge that information. Read the full article: http://www.bmj.com/content/354/bmj.i3268

“How long have I got, doc” is a TV medical drama cliche - but like all cliches has it’s feet in real life - and it’s medicine’s attempt to answer these questions that the authors of an analysis article on TheBMJ.com are questioning. Kirsty Boyd is a consultant in palliative care in NHS lothian, a trainer and a researcher with the University of Edinburgh. Scott Murray is a GP, and St Columba's Hospice Chair of Primary Palliative Care, also at the University of edinburgh. They argue that it’s time to rethink how we talk about prognosis, and what conversations to have as patients become more unwell. Read the full analysis: http://www.bmj.com/content/354/bmj.i3802

Ivan Oransky, co-founder of Retraction Watch and global editorial director at MedPage Today, discusses which areas of science are most affected by research fraud, and what motivates individuals to risk their careers by fabricating data.

With the emergence of sofobuvir, a new direct acting antiviral, treatment for Hepatitis C infection is currently undergoing it's greatest change since the discovery of the virus 25 years ago. However Gilead, who manufacture the treatment, are under fire for the cost of the druge - around $90 000 for a course of treatment. Victor Roy, doctoral researcher at the University of Cambridge, discusses how the new drug was discovered and came to market, and what happened to the profits from sale. Read the full analysis: http://www.bmj.com/content/354/bmj.i3718