Medicine and Science from The BMJ

What does the death of NHS England, and the western alliance, mean for health?

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

The data on physician associates in the UK, and speaking up in the NHS

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 BMAJugdeep Dhesi, consultant in geriatric medicine at Guys and St Thomas HopsitalHenrietta Hughes, the UK's patient safety commissionerThea 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
 
 

Phil Banfield on the British Medical Association's plan to support doctors

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.

Combating disinformation, and time to stop spinal injections for chronic pain

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?

Why compassion isn't just nice, it's essential

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.
 

The industry playbook to combat public health, and FUTURE-AI

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

Prehabilitation before surgery, alcohol's impact on clinical care, and life after a cardiac arrest

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
 

Can a deal be done to keep the US in the WHO?

US President Donald Trump has signed an executive order to withdraw the US out of the WHO. This would cut funding for the UN’s medical agency by one-fifth.
Will they really exit, or can a deal be made? Lawrence Gostin hopes so, and as a professor of law at Georgetown, and director of the World Health Organisation Collaborating Center on National and Global Health Law, he is working with senior US and WHO officials to try and understand what reforms could be made to WHO what would allow a such a deal to be be struck.
Gostin also believes that the president cannot withdraw from the WHO with an executive order, but instead requires congressional approval - and is exploring the options for legal challenge to the move.
 
00:00 Intro
01:01 US history with the WHO
03:31 Executive order
06:35 WHO’s relationship with China
11:14 Funding
12:47 Benefits to US from the WHO
18:05 H5N1 threat
19:43 World benefits from US involvement
21:57 A deal to be made?
24:55 Legal action?
26:37 Administration responses
 
Read Professor Larry Gostin’s co-written opinion piece on the dangers of a US withdrawal from the WHO here: https://www.bmj.com/content/388/bmj.r116

Conviviality and TV doctors, polar bear tales, and Christmas research

In the last podcast of 2024, Richard Smith, former editor of The BMJ and head of UKHACC will be making the case for being more convivial. Tina Korownyk, professor of family medicine at the University of Alberta is the ghost of Christmas past for TV doctors.
Tim Feeny and Navjoyt Ladher take us through this year's Christmas research papers.
And finally, Mari Martensen, a paramedic, explains what makes being a medic in Svalbard bear-able.
 
Reading list.
The dangers of industrialisation—why we need to rebuild a convivial society
Televised medical talk shows—what they recommend and the evidence to support their recommendations
Christmas 2024: How to transport a polar bear, and other idiosyncrasies for Arctic emergency medical services
The full Christmas archive

Big food infiltration of UK Schools, and chocolate consumption and diabetes

Conflicts of interest harm health, and a new investigation uncovers the infiltration of big food manufacturers into UK schools. Emma Wilkinson reports on that investigation. Kamran and  Rebecca Coombes, head of journalism, discuss moves to reduce industry's impact on food policy in the UK.
A new research paper has identified a link between eating chocolate and lower rates of diabetes. Binkai Liu, doctoral student and Qi Sun, associate professor, at the Harvard T.H. Chan School of Public Health explain what they found.
Finally, Sam Hutt is a doctor in the NHS, but is better known by his stage persona “Hank Wangford”. Hank performed a celebration of the NHS at Glastonbury this year, and has now released that song. He joins us to talk about what inspired him.
 
Reading list
Food industry has infiltrated UK children’s education: stealth marketing exposed
Chocolate intake and risk of type 2 diabetes
Hank Wangford