The BMJ Podcast

The number of people estimated to be latently infected with TB - that is infected with TB, which has not yet manifested symptoms - is around 2 billion. That is 1 in 3 people on the planet are infected by the bacteria. The World Health Organization’s website notes that on average 5-10% of those infected with TB will develop active TB.

That number is terrifying, but a new analysis published in the BMJ, suggests that the assumption that latent TB often has a very long incubation period of many years may be wrong - and that may change how we calculate the number of people affected, and our whole approach to tackling the disease.

This podcast features Lalita Ramakrishnan, professor of immunology and infectious diseases at Cambridge University, Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania, and Marcel Behr, professor of medicine at McGill university.

Together they discuss the analysis article "Revisiting the timetable of tuberculosis" - https://www.bmj.com/content/362/bmj.k2738

Dyspareunia is a common but poorly understood problem affecting around 7.5% of sexually active women. It is an important and neglected area of female health, associated with substantial morbidity and distress.

Women may be seen by several clinicians before a diagnosis is reached, There are also specialist psychosexual clinics, where men and women can be referred for sexual problems. Little has been written on the holistic approach to care for women with dyspareunia, therefore, some of the advice here is based on expert experience.

Joining us to talk about care are Leila Frodsham, consultant gynaecologist and lead for psychosexual medicine, and Nikki Lee, speciality trainee in obstetrics & gynaecology, both at King’s College London. We’re also joined by Poppy, who experienced dyspareunia and has undergone treatment.

Read the full education article:

https://www.bmj.com/content/361/bmj.k2341

Sue Farrington is chair of the Patient Information Forum, a member organisation which promotes best practice in anyone who produces information for patients.

In this podcast, she discusses what makes good patient information, why doctors should be pleased when patients arrive at an appointment with a long list of questions, and why patients are savvy about believing "doctor google".

https://www.pifonline.org.uk/

Doctors and the farming industry are often blamed for overuse of antibiotics that spurs the growing problem of antimicrobial resistance - but the professions are using different methods to combat resistance and reduce overuse.

In this roundtable, we bring medics and vets together to discuss the problem - where antibiotic resistance arises, how resistance genes propagate through the environment and between countries, and what non-drug approaches can be used to reduce the need for antibiotics.

Sandy Trees, Vet Record editor in chief, and retired veterinary surgeon

Stuart Reid, principal of the Royal Veterinary College

Jenny Bellini, cattle and dairy vet, Friars Moor Livestock Health in Dorset

Peter Hawkey, professor of clinical and public health bacteriology, University of Birmingham

Tim McHugh, professor of medical microbiology at University College London

Emmanuel Wey, consultant in infection, Royal Free Hospital, London

It’s been quite a year for the NHS - it just turned 70, had a winter crisis like never before, got over junior doctor strikes, but then was hit by a series of scandals about breast screening, and now opiate prescriptions.

At the same time, we’ve seen demonstrations in favour of the service and even widespread public backing for more money. So how do all of these things mix into the way in which the British public view the NHS?

In this podcast, Ben Page - chief exec of Ipsos MORI, the polling company, joins us to discuss the fluctuations in public opinion.

Read the provocation:

https://www.bmj.com/content/361/bmj.k2663

More NHS at 70 coverage:

https://www.bmj.com/nhs-at-70

Ray Moynihan is a senior research assistant at Bond University, a journalist, champion of rolling back too much medicine, and host of a new series “The Recommended Dose” from Cochrane Australia.

In the series, Ray has talked to some of the people who shape the medical evidence that underpin healthcare around the world - the series aim is to elucidating their worldview, and how their thinking shapes their work.

Over the next couple of months, we’ll be co-publishing the series - so keep an ear out for those interviews in your podcast feed.

At evidence live this year, one of the sessions was about the work of Evidence Aid - and their attempt to bring high quality evidence to the frontline of a humanitarian crisis.

In that situation, it’s very difficult to know what will work - a conflict, or even immediately post-conflict situation is characterised by chaos - and merely doing something is vital. But though each situation is unique, sharing what’s worked elsewhere can be key to maximising the help given to vulnerable people.

At Evidence Live this year, the focus of the conference was on communication of evidence - both academically, and to the public. And part of that is the role that investigative journalism has to play in that.

At the BMJ we’ve used investigative journalistic techniques to try and expose wrong doing on the part of government and industry - always in collaboration with clinicians and researchers.

To explain a bit more about the world of journalism and campaigning, we're joined by to Shelley Jofre - from the BBC, Jet Schouten - from Radar, Kath Sansom - who started the online sling the mesh campaign & Deb Cohen, former investigations editor at The BMJ.

When tackling societal problems - like the opioid epidemic in the US - there are two ways of approaching it. One is to reduce demand - by organising treatment programmes, or reducing the underlying reasons why people may become addicted in the first place - but that’s hard. So governments often turn to the other route - reducing supply - and that’s what the US government did in 2014 when it rescheduled oxycodone combination products from schedule 3 to schedual 2 - essentially making it harder for people to obtain a prescription.

Now reducing that legal supply, without in hand reducing the demand, led to fears that those people with an opioid addiction would just turn to illicit routes to obtain their drugs - and new research published on bmj.com has attempted to find out if that happened.

We're joined by 3 of the authors, James Martin, associate professor of criminology at Swinburne University; Judith Aldridge, professor of criminology at the University of Manchester; and Jack Cunliffe, lecturer in quantitative methods and criminology at the University of Kent.

Read the full research:

https://www.bmj.com/content/361/bmj.k2480

There’s a lot going on in the world at the moment - Ebola’s back, Puerto Rico is without power and the official estimations of death following the hurricane are being challenged. The WHO’s just met to decide what to do about it all, as well as sorting out universal healthcare, access to medicines, eradicating polio, etc etc.

To make sense of that a little, we grabbed Ashish Jha - Director of the Harvard Global Health Institute to shed some light into how decisions about global health are made, and why he tries to see the world as it actually is - not how he wishes it would be.

Reading list:

Mortality in Puerto Rico after Hurricane Maria

https://www.nejm.org/doi/full/10.1056/NEJMsa1803972

https://www.bmj.com/universal-health-coverage