Medicine and Science from The BMJ

A person’s right to refuse treatment is based on their capacity to make a rational decision – but what is the situation when someone is admitted after a suicide attempt? Can you be simultaneously rational and suicidal? Anthony David from the Institute of Psychiatry gives us his views. A second interview deals with Barrett’s oesophagus, which is on the increase. The same is true for adenocarcinoma of the oesophagus, which can arise from the condition. We talked to Rebecca Fitzgerald from the Hutchison/MRC Research Centre how developments in treatment, and a new method of sampling, could make a national screening test a possibility.

In a series of articles, this spotlight focuses on recognising and managing the end of life, having the difficult conversations with patients about their death, and the importance of taking into account the spiritual aspects of death. In this podcast Duncan Jarvies talks to the authors of 2 of those articles. Professor Jane Maher, oncologist and CMO of Macmillan Cancer Support, talks about the importance of end of life care. Dr Mike Knapton, GP and CMO of the British Heart Foundation, talks about their move into palliation.

This week we’re joined by Martin McKee, professor of European public health at the Loncon School of Hygiene and Tropical Medicine. He’s also research director of the European observatory on health systems and policies, a group that promotes evidence based healthcare policies in Europe. We’ll be discussing the effect the squeeze in funding is having on health care in Europe, and the various strategies different countries are using to save money.

Last week saw Safety 2010, the international conference on preventable accidents. We hear from some of the speakers there why safety comes second when it comes to global health. Also this week, female sexual dysfunction - fact or fiction. In advance of a BMJ debate on the topic, we get to the heart of the issue.

Last week BMJ Careers published “The new lost tribe,” describing the cohort of surgical trainees moving from ST2 to ST3. In this podcast Edward Davies, BMJ Careers editor, and Tom Dolphin, a member of the BMA junior doctors’ committee, describe how competition for training places is affecting career progression.

This week Beate Wieseler from IQWiG (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) tells us how they uncovered data on the antidepressant reboxetine. Also Angela Thomas and Julia Anderson, haematologists from the Comprehensive Care Haemophilia and Thrombosis Centre, Royal Infirmary of Edinburgh, explain how to investigate a child who bruises easily.

In this week’s podcast Jayati Das-Munshi, from the Institute of Psychiatry, London, talks about her study into the mental health effects of ethnic density. Also, hyper/hypo - antonyms that can sound almost identical. Adam Frankel and Phillip Vecchio from the Princess Alexandra Hospital in Woolloongabba, Australia, explain their their plan to do away with these troublesome prefixes.

China’s New Rural Cooperative Medical Scheme, aims to provide health insurance to 800 million rural citizens. We’ll be finding out from Scott Rozelle, from Stanford University and Qingye Meng from Peking University, the background to the formation of the scheme, and its place in the wider Chinese medical system.

A BMJ investigation this week raises concerns about the ability of the US Food and Drug Administration to monitor the safety of medical devices through post-approval surveillance. We ask: is the FDA giving device manufacturers an easy regulatory ride? Also, the National Institute for Health and Clinical Excellence (NICE) is set to lose the power to restrict the use of any drug that exceeds its £30k cost per quality adjusted life year ceiling. Alan Maynard, professor of health economics at the University of York, discusses what this will mean.

This week the podcast’s all about risk, as we bring you two reports from Risky Business, the conference where speakers from a wide range of hazardous industries came together to share ideas. Pat Crosskerry tells Rebecca Coombes how his work shows thinking more analytically, and less intuitively, could help doctors make better diagnostic decisions, and save lives. We also look at the contentious subject of medical litigation, and ask if it improves patient safety.