Medicine and Science from The BMJ

The problem of prognostication in assisted dying.

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
 
 

Trump is trying to destroy universities - Ashish Jha, Dean of Public Health at Brown University

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 

Reducing benefits will not get disabled people back to work, and explaining overdiagnosis

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"
 

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