Medicine and Science from The BMJ

This week we’re at the World Innovation Summit for Health, where we’re a media partner - the meeting is focussing on conflict, equity and resilience.  In that vein, we’re joined by Christos Christou, international president of Médecins Sans Frontières (MSF) to talk about attacks on healthcare staff, and the difficulty and importance of maintaining neutrality in conflict zones. Ara Darzi, surgeon, executive chair of the conference, and author of the recent NHS review, joins us to talk about  antimicrobial resistance, and how diagnostics and a small funding commitment could head off the problem. And finally, we change our focus to the US, and hear about new research into adverse events during surgery with authors Antoine Duclos and David Bates from Harvard Medical School.   Reading list.   We need to do more to keep antibiotics working WISH report - Tackling Antimicrobial Resistance: How to Keep Antibiotics Working for the Next Century Safety of inpatient care in surgical settings: cohort study

In this episode, we speak to the doctor overseeing the WHO’s emergency response for the eastern mediterranean region - including Gaza, Lebanon, Sudan and Yemen. Richard Brennan joins us to talk about protecting health services, and workers, in the escalating armed conflicts that are affecting the region. Menaka Paranathala and Emma Rourke, from The BMJ, are on to talk about improving research into women’s health. A new UK project, MESSAGE, aims to give consideration to sex and gender in life science research. Palliative care is not just for end-of-life, and rethinking how it’s integrated into every speciality is the key to improving care for patients, argue Richard Harding, Anna Peeler, and Oladayo Afolabi from the Cicely Saunders Institute. Links WISH report - Protecting Health in Armed Conflict MESSAGE (Medical Science Sex and Gender Equity) project BMJ Opinion - Palliative care is an overlooked global health priority WISH report - Palliative Care

It’s an often cited statistic that if healthcare was a country, it would be the fifth largest carbon emitter. At The BMJ we want to change that, and move healthcare towards a more sustainable future.  In this week’s episode, we’ll hear about our annual climate edition from two of The BMJ’s editors, Sophie Cook and Juliet Dobson.  We’ll be diving into Cli-Fi and asking how climate fiction can galvanise our collective response to climate change. Our panel includes Howard Frumkin, professor emeritus at University of Washington. Lakshmi Krishnan, internist and Director of Medical Humanities at Georgetown university, and Sarah Grossman, journalist and author of Fire So Wild. And Finally, Tereza Kasaeva, director of the WHO’s Global Tuberculosis Programme, explains how migration and food insecurity, exacerbated by climate change, are affecting TB - and why, despite effective treatment, there are still over a million deaths from the disease annually.    Our panel's cli-fi book recommendations A Fire So Wild - Sarah Grossman The Last Man - Mary W. Shelly The Broken Earth  - NK Jemisin Oryx and Crake - Margaret Attwood The Ministry for the Future - Kim Stanley Robinson Olga Dies Dreaming - Xóchitl González Land of Milk and Honey - C Pam Zhang Day of the Triffids - John Wyndham   Links The BMJ’s annual climate issue Cli-Fi—helping us manage a crisis Writing towards a healthier future amid climate disaster WISH report - Tuberculosis   Lakshmi’s references Fundamental Role of Arts and Humanities in Medical Education  Capable of being in uncertainties’: applied medical humanities in undergraduate medical education The introduction of medical humanities in the undergraduate curriculum of Greek medical schools: challenge and necessity The medical humanities at United States medical schools

How science can be transformed into policy? One of the seemingly intractable issues when it comes to legislative change in the US is gun control.  One reason policy change is so difficult, is the US specific evidence vacuum, but that’s beginning to change. We're joined by Louis Klarevas, an academic at the University of Colombia and author of the book “Rampage Nation, securing america from gun violence" and Shannon Watts, from Moms Demand Action which is a grassroots movement of Americans fighting for public safety measures that can protect people from gun violence.   Even when there is evidence, the trade-offs needed for legislative change can still paralyse policy makers. Citizen assemblies, a form of democratic participation that asks the public for their views, has helped clarify some key healthcare issues, from assisted dying in Jersey, to abortion access in Ireland. Rebecca McKee from the Institute of Government argues they could be used to fix the NHS, and joins us to explain how.   Reading list More gun regulation, less firearm harm Citizens’ assemblies, health, and health policy        

Under-nutrition harms health, but so does over-nutrition. The Bill and Melinda Gate’s foundation has just released their Goalkeepers' report - highlighting the detrimental impact that poor nutrition is having on children’s health.  Rasa Izadnegahdar, director of Maternal, Newborn, Child Nutrition & Health at the foundation joins us to explain how they are targeting nutritional interventions. Also this week, a new investigation in The BMJ has found that the UK government’s  Scientific Advisory Committee on Nutrition - the people who help guide the UK’s nutrition policy - have competing interests with the food industry. We hear from Chris van Tulleken, University College London; Rob Percival, the Soil Association; and Alison Tedstone, chair of the Association for Nutrition.   Reading list: Goalkeepers Report 2024 UK government’s nutrition advisers are paid by world’s largest food companies, BMJ analysis reveals    

There's a real drive to strengthen quality of care in facilities around the world. However, no matter where you are, improving healthcare depends on quality data—and collecting and using that data can be challenging without the time and expertise. In this podcast, we explore how different healthcare systems, especially those with limited resources, are tackling the challenge of data collection and use head-on.   The BMJ has partnered with the World Health Organization and the World Bank on a Collection on Quality of Care. This podcast, the second in a series exploring themes from the Collection, features researchers and implementers from Ghana, Qatar, and the US. They share insights on improving and using data in resource-constrained environments, offering valuable perspectives relevant to healthcare systems worldwide facing similar challenges.   Provenance statement: This podcast is part of a Collection on Quality of Care proposed and funded by the World Health Organization and the World Bank. The BMJ commissioned, edited, and published the podcast. Emma Veitch, Rachael Hinton and Duncan Jarvis were the lead editors for The BMJ.

The news that GPs in England have voted for industrial action has spooked the healthcare system - Katie Bramall-Stainer, the chair of the BMA's General Practice Committee explains what's lead to this, and why trust in the government has gone. After the games, olympians and paralympians return to their normal lives - but what does that mean for their healthcare, especially in the US where insurance is expensive? Jonathan Finnoff, chief medical officer for the US Olympic and Paralympic committee joins us to explain how athletes are supported outside the games.   Reading list; GP leader: “If general practice is the bedrock of the NHS, then the NHS is collapsing”  

This week we're questioning the effectiveness of the Galleri Test for early cancer detection with investigation authors Margaret McCartney and Deborah Cohen. They delve into the decision-making and politics behind this test's introduction in the UK. The episode also covers the growing NHS waiting list crisis and how Imran Ahmed and his team at Guy's and St. Thomas' NHS Trust are using high intensity theatre (HIT) lists to increase surgical throughput - and what other teams need to know, if a national rollout of this model is to happen. Reading list Galleri promises to detect multiple cancers—but new evidence casts doubt on this much hyped blood test Are surgical HIT lists the answer to bringing down NHS waiting times?

The Paris games have just started - and France has made a concerted effort to ensure that this year's Olympics will have a legacy of physical activity for the whole population. However, mega sporting events don't always have that effect, and Fiona Bull, head of physical activity for the WHO, joins us to explain why it's increasingly important that they do. We'll also hear from Professor Sir Denis Perera Gray about how a lifetime of general practice, and why continuity needs to be at the heart of any improvement to primary care. Finally, Harry Brunjes went from being a village GP to the chair of English National Opera, and explains what the two careers have in common.   Reading list Olympic Games: linking sports mega events to population physical activity

We celebrate 10 years of patient and public partnership strategy at The BMJ with a patient-centred podcast. We ask how should the new Labour government engage patients in shaping the future of the NHS. We also dive into the concepts of social care and peer support, and learn from Brazil's experience in social participation. Highlights: 01:52 - The Patient "takeover" 05:43 - Social care with Charlotte Augst 19:53 - Peer support groups with Claire Reid and Partha Kar 31:48 - WHO’s resolution on social participation with Mark Barone Reading: Editor's Choice - Listening to patients at all levels of healthcare, Emma Doble, patient editor

Women's Health, breast cancer screening, epidurals, and GP voices New U.S. guideline on breast cancer screening  have been extended to women in their 40s -  Katy Bell, from the University of Sydney, and Stacy Carter, from the University of Wollongong explain why the good intention of that change wont be mirrored in outcomes - and may even induce harm. Research in The BMJ shows epidurals during labour can reduce severe maternal morbidity Rachael Kearns describes why analgesia may improve those outcomes, and why some myths about epidurals may be reducing their usage. Lastly,  a GP confronts the Prime Minister on the disintegration of the NHS and its effects on general practitioners.   02:23 Breast cancer screening guidelines 14:00 Epidurals and maternal morbidity 26:42 A GP confronts the Prime Minister    Reading list: Breast cancer screening from age 40 in the US Epidural analgesia during labour and severe maternal morbidity: population based study GP who confronted Rishi Sunak received “hundreds” of supportive messages from doctors

As increasing numbers of mammalian, and human, cases of H5N1 are documented we askShould we worry about a growing threat from “bird flu”?  Wendy Barclay, from Imperial college London, and Christopher Dye, from Oxford University join us to explain why they think we should. Our commission on the future of the NHS has released a manifesto for a sustainable NHS that still meets it's founding principles. Helen Salisbury, GP and BMJ columnist, joins the podcast to lay it out. Finally, a musical interlude from the World Doctor's Orchestra.   00:18 H5N1 Bird Flu: Rising Threat 15:35 The manifesto for a better NHS 27:46 World Doctors' Orchestra   Reading list; BMJ Editorial - Should we worry about a growing threat from “bird flu”? BMJ Opinion - A manifesto for a healthier NHS, a healthier UK https://www.world-doctors-orchestra.org   Stay up to date with our daily email alert - https://www.bmj.com/today

In the UK, a general election has been called - and around the world, ½ the global population will be voting this year; so in this episode we’ll be talking about how elections and health intersect. Firstly, what are the UK parties’ plans for health? Abi Rimmer, The BMJ's UK features editor joins us with the latest information. The world’s largest democracy is polling, so how are Indian politicians talking about health?  Sanjay Nagral, surgeon and director of the Department of Surgical Gastroenterology at Jaslok Hospital & Research Centre in Mumbai takes us through the campaign promises. And finally, Jody Heymann is founding director of the WORLD Policy Analysis Center at UCLA and explains why this is the most consequential US election for woman's health in a generation.   01:30 Election Fever and NHS Plans 07:35 Impact of Elections on Health in India 21:20 Women's Health in the US Elections   Reading list Feature: The untold health toll of voting Editorial: Workplace rights around pregnancy and childbirth

With the anticipation of a new government in the UK, shadow health secretary Wes Streeting will hit the ground running - with a winter season (and it's inevitable crisis) and ongoing industrial desputes with junior doctors. Elisabeth Mahase ask him about his plans to handle these challenges if elected. We also find our selves in the puzzling situation of potential GP unemployment in the UK despite a high demand for primary care doctors, Helen Salisbury, GP and columnist for The BMJ explains how we've got into this situation. Finally, Peter Doshi has been looking at the financial entanglement of FDA heads with the companies they are regulating - 9 of the previous 10 FDA heads have gone on to work for industry in some respect. He has also investigated how complex financial instruments can make these conflicts more opaque. 02:03 Anticipating a New Government and the NHS Winter Crisis 10:50 The Kafkaesque Dilemma of GP Unemployment 23:10 FDA Leaders' Financial Entanglements: A Deep Dive Reading list Workforce and winter under Labour: Wes Streeting on his plan for the NHS Helen Salisbury: No jobs for GPs—we’ll be missed when we’re gone Revolving doors: board memberships, hedge funds, and the FDA chiefs responsible for regulating industry

Where next for psychological safety? Amy Edmundson is professor of Leadership and Management at the Harvard Business School. Her work on psychological safety has underpinned so much quality improvement, and she joins us fresh of the stage at the International Forum on Quality and safety in healthcare to talk about the next steps in creating a safe work place. The BMJ has published two new investigations, looking at the alcohol and tobacco industry funding of public health and education - we’ll hear how the companies who create the problems, are now styling themselves as the solution. Rebecca Coombes joins us to explain what The BMJ has found, and May van Schalkwyk, a researcher from the London School of Hygiene & Tropical Medicine, explains how commercial conflicts are shaping the wrong education tactics. And finally, our NHS commissioners have more recommendations - this time on workforce issues. Mary Dixon-Woods, director of THIS institute at the University of Cambridge, and Matt Morgan, intensive care consultant in Cardiff, tell the NHS to get serious about staffing. 02:03 Amy Edmondson on Future Health and Psychological Safety 10:24 The Impact of Corporate Funding on Public Health 19:57 Addressing NHS Workforce Challenges: Insights and Solutions Reading list; Our new podcast - Future Health International forum keynote -  Medscape caves in on courses funded by tobacco giant Philip Morris, while medics fear global push into medical education Investigation - Big alcohol: Universities and schools urged to throw out industry-funded public health advice Commission on the future of the NHS - The future of the NHS depends on its workforce    

Hilary Cass, the former president of the Royal College of Paediatrics, has spent the last 3 years collating the evidence for treatment of gender questioning young people; engaging with those young people, their families and their clinicians - all with the aim of improving NHS treatment of this complex and vulnerable group. In this interview, Kamran Abbasi, editor in chief of The BMJ, speaks in depth to Cass about her review - about evidence base for transitioning, but also about the way in which the siloing of care for young trans people has failed them.  They discuss the need to support young people in their journey - Cass is clear that the NHS should allow young people to explore their gender, but that ultimately, that may not mean medical intervention at all.    Reading list The Cass Review - final report The systematic review and meta-analyses published in Archives of Disease in Childhood BMJ Opinion: Gender medicine for children and young people is built on shaky foundations

Derogation, the way in which striking doctors can be recalled to the ward to protect patient safety, was agreed by NHS England and the BMA. Now, new data The BMJ has uncovered shows that the mechanism was rarely used - and when it was tried, was often rejected. Gareth Iacobucci explains what that means about relations between the government, the NHS, and doctors. Felice Jacka, director of the Food & Mood Centre at Deakin University, is one of the authors of our recent ultra-processed foods umbrella review - and joins the podcast to talk about the link between diet and health; and why goverments need to pay more attention to the food system. Finally, John Appleby, senior associate at the Nuffield Trust, and Gillian Leng, dean and president elect of the Royal Society of medicine, have been thinking about healthcare funding, and how more stability is essential in securing the service's future.   Reading list Hospital leaders warned that failure to recall striking doctors risked patient safety in some trusts, documents show Ultra-processed food exposure and adverse health outcomes NHS funding for a secure future   Chapters 00:31 Derogation and doctor strikes 06:59 Ultra processed food producers and health 13:59 Rethinking NHS funding

In this week's podcast:   How AI will affect the clinician-patient relationship? Our annual Nuffield Summit roundtable asks how the promise of tech tools stacks up against reality, and how the future of the therapeutic relationship can be protected (participants below).   Your code is as important as your methods, which is why The BMJ now requires you to share it - Ben Goldacre and Nick De Vito, from the Bennett Institute for Applied Data Science at the University of Oxford, explain why it's so important, and how The BMJ's new data and code sharing policy could change research transparency.   Nye Bevin set up the NHS when the UK was in the economic doldrums, and the public's need for care was becoming an emergency - BMJ columnist Matt Morgan has helped turn that story into a play, currently showing at the National Theatre; and reflects on the parallels between now and then.   1:58 Nuffield Summit roundtable 17:32 New BMJ rules on data and code sharing 29:03 Aneurin "Nye" Bevan play   Taking part in our roundtable were: Rebecca Rosen, Senior Fellow at the Nuffield Trust and GP Juliet Bouverie, CEO of The Stroke Association Daniel Elkeles, CEO of London Ambulance Service Neil Sebire, Professor and Chief Research Information Officer at Great Ormond Street Hospital Reading list: How is technology changing clinician-patient relationships? Mandatory data and code sharing for research published by The BMJ Scalpels and spotlights: bringing theatre to the theatre

The U.S. Supreme Court is hearing a case on the approval of mifepristone for medical abortion - a case which could change the availability of the drug in the US, and which hinges on papers linking abortion to mental distress. However, those papers are contested (including a paper published by BMJ), and some have been retracted already - Julia Littell and Antonia Biggs tell us how that science is being used in court, and why retraction is essential. Awakening from anaesthetic is difficult enough, but imagine you're three and only communicate through sign language - which no one can understand. We hear from Kirsten, a mother who thinks everyone should learn at least a few key sign language phrases. Finally, the London Medical Orchestra is turning 70 - having had their start in The BMJ's letters pages. Stuart Delve and Peter Gough help explain the orchestra's longevity.   01:00 The Supreme Court Case on Medical Abortion 10:27 The Role of Journal Editors in Scientific Integrity 19:54 The Impact of Deafness on Patient Experience 30:57 The Joy of Music in a Medical Career: London Medical Orchestra   References Analysis: Correcting the scientific record on abortion and mental health outcomes WYPIT: The importance of British Sign Language Asha's instagram for BSL tips London Medical Orchestra's 70th anniversary concert - 6:30pm, Sun, 10 Mar 2024  

Social media, and the rate at which the online world is changing, is worrying - especially the speed at which health disinformation can speed around the globe. We look to tech companies for a solution to the problems of their own making - but Heidi Larson, director of the Vaccine Confidence Project, and professor of anthropology, risk and decision science at LSHTM, joins us to explain why we should be cautious about focussing our attention there. Next on the podcast, research just published in The BMJ looks at the efficacy of exercise at controlling depressive symptoms - but helps finally answer the key question - which exercise works best. Lead author, Michael Noetel, senior lecturer in psychology at the University of Queensland, joins us to explain the research, and how well exercise stacks up against pharmacological treatments. Finally, while it’s tempting to try and put the pandemic behind us, its effects linger - and many healthcare staff are still dealing with their experience of that time. Rachel Clarke, a palliative care doctor in the UK, joins us to explain why she has felt the need to document the pandemic, first in a book and now in a new TV drama set to air in the UK next week.    06:15  Heidi Larson on vaccine confidence and social media 15:31 Exploring the effectiveness of exercise for depression 26:56 Rachel Clark on seeing her experiences reflected on screen   Reading list BMJ Collection: How are social media influencing vaccination Feature: Medical misinformation on social media—are the platforms equipped to be the judge? Research: Effect of exercise for depression