Medicine and Science from The BMJ

CRISPR technology has revolutionised biological research, and for the first time it’s out of the lab and into the NHS, as NICE has approved its use as cost effective. Kenneth Charles, senior lecturer in haematology at the University of the West Indies explains how the treatment works, and what concerns he has about it's implementation. Also this week, a new investigation on bmj.com has looked at a number of British companies who are offering to collect children's teeth for stem cell extraction and storage. Freelance investigative journalist Emma Wilkinson explains the "outrageous" claims she found them making. Finally - we’re finishing with the football. Team GB had a strong showing this year -  our over 25 men’s team brought the trophy home, and our womans team competed for the first time To explain more about the medical world cup we're joined by Minnan Al-Khafaji, captain of the women’s team, and Jamie Thoroughgood, captain of the men’s team.   Read more. Banking baby teeth: companies may be misleading parents with “outrageous claims” CRISPR therapy for sickle cell disease Follow the British Medical Football Team on instagram

If you’ve been in a high street pharmacy or supermarket recently, chances are you’ll have seen home test kits for all sorts of indications; blood sugar level, vitamin deficiencies, thyroid function, and even some forms of cancer. A new series of article in The BMJ revealing serious concerns with the reliability of these home tests, and raises questions about their regulation. Jonathan Deeks, professor of Biostatistics at the University of Birmingham, joins us to discuss what these tests are, and how his team have rated their usability. Also this week, the sad death of a child in Liverpool from measles highlights the growing outbreak in the UK - and this may be one of the first times many doctors have come across the infection. Frances Dutton, GP at the Small Heath Medical Practice reminds us how to recognise the sign of the infection.   Reading list Direct-to-consumer self-tests sold in the UK in 2023 How to recognise and manage measles

Professor Gillian Leng, President of the Royal Society of Medicine was asked to carry out an independent review into the role of physician and anaesthetic associates. She sits down with Kamran Abbasi, editor in chief of The BMJ, to discuss her findings. In the UK, the rollout of physician associates, NHS staff who took on some of the tasks of doctors, has been both haphazard and controversial. Originally copied from similar roles in the U.S., British PAs were introduced in the early 2000s. The level of clinical responsibility they were asked to take on began to vary around the country, driven mostly by the workforce needs of individual Trusts. The lack of clarity about their roles lead to disquiet with doctors, worry for patients, and an increasingly toxic debate on social media. 01.00 What is the Leng Review? 10:00 Recommendation one: Renaming 14:00 Recommendation two: Easier identification 16:00 Recommendation three: How to work? 20:00 Recommendation four: Diagnosis 25:00 Recommendation five: Oversight & Regulation 32:00 Prescribing and ordering ionizing radiation? 40:00 A failure of workforce planning and vision ? 49:00 The NHS 10 year plan

This week we’re focusing on the NHS. On the 3rd of July the UK’s Prime Minister, Kier Starmer finally announced the NHS’ 10 year plan. His Labour government laid out a vision for where the healthcare service should head over the next decade. The announcement has been met with mixed responses. The plan has some good ideas - but a lack of vision combined with scarcity of detail leave many questions about how well its aims can be implemented. In this podcast we're joined by 3 experts to dissect the details of this plan Jennifer Dixon is chief executive of the Health Foundation Katie Bramhall-Stainer is a working GP, and chairs the BMA’s General Practice committee. David Oliver is a consultant geriatrician, and a columnist for the BMJ Reading list News analysis: What is the NHS 10 year plan promising and how will it be delivered? Editorial: Government’s 10 year plan for the NHS in England David Oliver's column: The NHS 10 year plan—more a set of ambitions than a plan

Rebecca Coombes interviews Dr. Tom Dolphin, consultant anaesthetist and newly elected chair of the BMA Council. Watch this interview on our YouTube.    

Last December, The BMJ published an investigation into the 2009 PLATO trial - exposing serious problems with that study’s data analysis and reporting.  Our follow up investigation has shown that those data problems extend to other key supporting evidence in AstraZeneca’s initial application to regulators. Peter Doshi, senior editor in the BMJ’s Investigations unit, and Rita Redberg, cardiologist and Professor of Medicine at UCSF and former editor of JAMA Internal Medicine, join us to explain what this means for scientific integrity, and trust in the FDA's approval processes.   Also in this episode. A group of international authors are arguing that weightloss advice given in primary care might actually be doing more harm than good - it’s ineffective and potentially reinforces damaging stigma.  To explain why they came to that conclusion we're joined by Juan Franco editor in chief of BMJ EBM, and a practicing GP in Germany, and Emma Grundtvig Gram, from the Centre for General Practice at the University of Copenhagen Reading list Doubts over landmark heart drug trial: ticagrelor PLATO study Ticagrelor doubts: inaccuracies uncovered in key studies for AstraZeneca’s billion dollar drug Beyond body mass index: rethinking doctors’ advice for weight loss

In this episode, we hear about ketamine addiction. It's in the news, but the rise in addiction amongst young people in the UK has caused concern for some time.  Irene Guerrini and Nicola Kalk, both addiction psychiatrists from the National Addiction Centre, join us to explain why its become a problem. In November 2024 Wes Streeting, the UK’s health and social care minister, announced that he was planning to introduce league tables for hospitals - and would be linking managers' pay and continued employment to those outcomes.  Richard Lilford, from the University of Birmingham, Timothy Hofer, from the University of Michigan, and Ian Leistikow, an inspector at the Dutch Health and Youth Care Inspectorate, join us to explain why this is a bad idea. Non-prescribed ketamine use is rising in the UK Hospital league tables, targets, and performance incentives should be used with care

Devi Sridhar's new book  “How Not to Die  (Too Soon) - The Lies We’ve Been Sold, and the Policies That Could Save Us” is focussing on the way wellness culture ignores the societal context in which health is really created. As a trained personal trainer and professor of global public health, Devi's straddling both of those worlds, and joins us to talk about how she would tackle our lowering life expectancy. Also, John Downey, from the Centre of Health Technology at Peninsula Medical School, and Martha Lee from NHS Devon Integrated Care Board, have written about Plymouth's "Living Lab" - which has been set up to test how health tech can actually work in the real world, but also (importantly, critically) how it can be properly evaluated and integrated into the NHS and social care. Reading list How Not to Die (Too Soon) Harnessing predictive prevention to shift elderly care from hospital to community in England

Recent escalations in the ever simmering tension between India and Pakistan brought us closer to conflict - conflict between two nuclear powers. For a long time doctors have campaigned for nuclear disarmament, and Chris Zielinski, president of the World Association of Medical Editors, makes the case for returning WHO's mandate to measure the potential impact of nuclear war. Also the militarization of the region is detrimental to the health and wellbeing of the populations in both India and Pakistan. co-chairs of The BMJ's South Asia editorial board, Sanjay Nagral and Zulfiqar Butta, explain why a focus on the daily material and health needs of citizens is the way to change political rhetoric in the region. Gordon Guyatt, distinguished professor at McMaster University, was one of the people responsible for starting GRADE - which is a structured system for assessing the quality of evidence in systematic reviews and clinical practice guideline. Gordon thinks that process has become too complicated - so he’s now championing “Core GRADE”. He joins us to explain why.   Reading list Ending nuclear weapons, before they end us Why Core GRADE is needed: introduction to a new series in The BMJ

China was declared malaria free in 2021 - and we'll hear how persistence was key to their success, and what new technologies are available to help the rest of the world become malaria free, from Regina Rabinovich, director of the Malaria Elimination Initiative at the Barcelona Institute for Global Health.  Sonia Saxena, professor of primary care at Imperial College London, and Miguel O’Ryan, dean of the medical faculty of the University of Chile join Kamran to talk about what broke academic medicine, and why it's time for a revolution. New research shows that data from retracted papers is still having an alarming effect on clinical practice. Chang Xu, Hui Liu, and Fuchen Liu from the Naval Medical University in Shanghai, and Suhail Doi from Qatar University, join us to talk about their study which has maped retracted papers impact on systematic reviews and clinical guidelines.    Reading list Malaria control lessons from China Vision 2050: a revolution in academic medicine for better health for all Investigating the impact of trial retractions on the healthcare evidence ecosystem (VITALITY Study I) - An example of the BMJ's approach to updating metaanalysis after a study retraction 

The UK government is debating legislation to allow assisted dying in England and Wales, which puts doctors at the forefront of deciding if their patient will be eligible for a medically assisted death - the key criteria being a 6 month prognosis. But is making a 6 month prognosis actually clinically reliable? To discuss we're joined by a panel of experts on end of life; Scott Murray, emeritus professor of primary palliative care at the University of Edinburgh Simon Etkind, assistant professor of palliative care at the University of Cambridge Nancy Preston, professor of supportive and palliative care, Lancaster University Suzanne Ost, professor of law, Lancaster University Reading list Assisted dying and the difficulties of predicting end of life Breaching the stalemate on assisted dying: it’s time to move beyond a medicalised approach   Also in this episode, we dim the lights and raise the curtains - there is a public fascination with doctors who kill and the stage show turned podcast, ‘An Appointment with Murder’, takes a deep dive into the crimes of GPs John Bodkin-Adams and Harold Shipman. Kamran is joined by Harry Brunjes and Andrew Johns to talk medical murder. An Appointment With Murder on Apple Podcasts    

Kamran Abbasi interviews Professor Ashish Jha, Dean of Public Health at Brown University and former COVID-19 pandemic advisor to President Biden. Watch this interview on our YouTube. Trump’s second term has touched everything in the US political sphere - and health is no exception. With research funding for medicine and science weathering under Trump’s storm of cuts, how can Americans who care about public health and data navigate a course through the swells? Professor Jha discusses how to resist an anti-vaccine resurgence, and comments on revisionist narratives that drive ill-conceived public health policies.   02:20 The MAHA movement and RFK Jnr. 07:40 Does evidence still matter? 13:35 Trump administration is helping China 15:10 Policymaking in Trump’s shadow 23:35 Where do universities go from here? 28:48 Censorship, research funding and academic freedom 33:35 Health inequalities within America 36:20 A resurgent anti-vax message 41:24 What Ashish’s got wrong about the pandemic response 45:31 When is enough for research data? 47:14 Future hope and how to pushback in smart ways   Reading list: Professor Jha’s December 2024 editorial on the Trump admin’s plans for American healthcare coverage 

The UK’s chancellor has announced a £5bn cut to benefits, much of which will be borne by those on long-term disability allowance. Gerry McCartney, professor of wellbeing economy at Glasgow University explains about why these cuts will not only hurt the most vulnerable, but will be counterproductive to the government's wish to get people back to work. Also, Suzanne O'Sullivan, consultant neurologist and author, joins us to talk about her new book "Age of Diagnosis". The book used clinical cases to explore the issues of medicalisation, and Suzanne explains why overdiagnosis doesn't mean that care isn't needed.   Reading list; UK welfare reforms threaten health of the most vulnerable Guardian edited extract from "The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far"  

In the UK, the prime minister has announced the disbanding of NHS England, Nigel Crisp - former chief executive of the NHS, explains why he thinks that it’s important the health service is closer to the political decision makers, and why this could be the time to really acknowledge the healthcare emergency. On the international stage, the Trump administration's withdrawal from the WHO is throwing global health into disarray - Illona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva, joins us to explain which new alliances are emerging, why the funding that has disappeared may never be replaced, and how tech will surpass pharma when it comes to industry influence. Finally, there is a triple burden of malnutrition for adolescent girls in south Asia - which creates a cycle of ill health that is hard to break. However, Zulfiqar Bhutta, chair in global child health at the Hospital for Sick Children in Toronto, thinks the region can come together to change both government and society to champion young women’s health. Reading list: Abolishing NHS England: risks and opportunities https://www.bmj.com/nhs-commission https://www.bmj.com/collections/nourishing-south-asia

We've just published a new rapid review on the safety and efficacy of physician and anaesthetic associates in the UK, which was commissioned to support the ongoing Leng review of these new roles in the NHS. Trish Greenhalgh, professor of primary care at the University of Oxford, joins us to discuss the data she found. Habib Naqvi is director of the NHS Race and Health Observatory, and is holding up a mirror to the NHS on it's support for ethnic minority patients and doctors - he joins us to talk about the work they've done, and why Reform UK's manifesto pledge to disband the Observatory is a matter of pride.  Finally, our annual trip to the Nuffield Summit is not complete without a roundtable, this year we asked the question "What is stopping staff from speaking up?". Our panellists raised the usual issues of hierarchy and psychological safety, but also how the lack of positive change from senior leadership has habituated people into thinking "why bother". Our panel; Katie Bramall-Stainer, chair of the General Practice Committee of the BMA Jugdeep Dhesi, consultant in geriatric medicine at Guys and St Thomas Hopsital Henrietta Hughes, the UK's patient safety commissioner Thea Stein, chief executive of the Nuffield Trust    Reading list Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research Together we can challenge the racism that persists in healthcare    

From pay restoration, to making sure there are enough training posts for resident doctors, the BMA has been busy. In this podcast, Kamran Abbasi, the editor in chief of The BMJ, spoke to Phil Banfield, chair of the BMA’s council.   They talk about the ongoing pay discussions, how the BMA is working with the new government - touching on both speciality training places, and the role of physician assistants. The conversation also covers the BMA's changing strategy, which aims to empower local members to take on the fights they care about, and how the organisation is linking both their trade union and professional activities.

In this episode of the BMJ's Medicine and Science podcast, editor-in-chief Kamran Abbasi discusses the urgent need to tackle disinformation in health, especially in the context of the US, with Heidi Larson and Martin McKee from the London School of Hygiene and Tropical Medicine.    We also hear from Jane Ballentyne, professor of anaesthesia and pain medicine at the University of Washington, about new guidelines that strongly recommend against the use of spinal injections for chronic pain - and why that recommendation might be hard for some patients and doctors to hear.   Finally, we revisit the progress made in addressing racism in UK medical schools over the past five years with Gareth Iacobucci, The BMJ's assistant news editor.   Running order 01:44 Defining Misinformation and Disinformation 04:08 Vaccines and Misinformation 05:38 Strategies to Combat Disinformation 10:04 Denialism and Its Implications 16:21 BMJ Rapid Recommendations on Spinal Injections 26:27 Racism in Medical Schools: An Update   Reading list Spinal interventions for chronic back pain Racism in medical schools: are things improving?

Providing quality healthcare is demanding, often stressful, and requires sustained effort. When resources are stretched and pressure mounts, compassion can slip - but compassion is an essential tool for leaders, who need to support their teams to continue delivering the best possible care.   In this final episode of The BMJ’s podcast series on quality of care, Rachael Hinton, BMJ Editor, speaks to three healthcare leaders. They discuss how fostering kind and compassionate leadership and care can improve morale, combat burnout, and contribute to better patient outcomes.   01:48 Lydia Okutoyi talks compassionate leadership in Kenya 08:39 Pedro Delgado talks refocusing on the human factor and tools for kind leadership 15:02 Alexander Ansah Manu talks reaping quality of care benefits in Ghana   This podcast was produced as part of the BMJ Collection on Quality of Care, developed in partnership with the World Health Organisation and the World Bank. Visit bmj.com/qualityofcare to view the full Collection. The BMJ commissioned, edited, and published this podcast. This episode edited by Brian Kennedy.  

This week Rebecca Coombes is back with another big-food investigation, this time about fast-food giant MacDonalds subverting attempts to stop it opening stores near schools. Sticking with industry behaving badly, May van Schalkwyk, from the University of Edinburgh, wonders why we haven't learn lessons from the attempts to control big tobacco companies, when it comes to other industries that harm health. And finally, AI in healthcare - Karim Lekadir, from the University of Barcelona, explains new guidelines which can help evaluate which AI applications are trustworthy.   Reading list McDonald’s triumphs over councils’ rejections of new branches FUTURE-AI: international consensus guideline for trustworthy and deployable artificial intelligence in healthcare

Exercise and a better diet, prior to surgery, can improve outcomes. Daniel McIsaac, a professor of anaesthesiology from the University of Ottowa and lead author of that research, joins us to talk about getting those results into practice. Julia Sinclair, professor of addiction psychiatry at the University of Southampton, explains how the NHS has lost sight of the impact alcohol consumption has on clinical care, and why we need a strategy to tackle it. Finally, Matt Morgan, consultant in intensive care and BMJ columnist, has written another book - this time about patients who are revived after cardiac arrest, and the profound effect it can have on their outlook in life.    Reading list: Relative efficacy of prehabilitation interventions and their components UK needs national strategy to tackle alcohol related harms A Second Act