Medicine and Science from The BMJ

Conflict zones, women’s health research, and reimagining palliative care

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

Climate leadership - knowledge is power

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

Getting science into policy for gun control and NHS reform

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
 
 
 
 

Nutrition for health and conflicts of interests

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
 
 

Improving data for quality care when resources are stretched

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.

GPs' industrial action, and the olympians after the games

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”
 

Multi-cancer detection and NHS HIT Lists

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?

Ensuring an Olympic legacy, and fixing primary care

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

The patient issue

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 Augst19:53 - Peer support groups with Claire Reid and Partha Kar31:48 - 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

Extending access for breast cancer, and epidural outcomes

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