Medicine and Science from The BMJ

Cancer screening: when does testing go too far?

The heated debate on prostate cancer screening boils down to one question: should men be routinely screened?
Two recent position statements from the UK’s national screening committee published in the BMJ show that screening decisions are steeped in complexity. 
The benefits of screening may be easier to grasp, but the harms of overdiagnosis and overtreatment are given less attention. Can we close the divide between the public and academic discourse?
 
Guest: Sian Taylor-Phillips is professor of population health at the University of Warwick and a member of the UK national screening committee.
 
Further Reading:
UK National Screening Committee position statement on surrogate outcomes in cancer screening trials
Prostate cancer screening: Committee rejects calls for mass testing programme despite pressure
More interviews from the BMJ on our Youtube channel.

Child mortality has reduced, but there are worrying trends

New estimates of Global Patterns in Neonatal, Child, and Adolescent Mortality have been published - and while there has been a huge improvement, those gains are in danger - and we’re seeing worrying trends.
 
Kate Strong, a Scientist at the World Health Organization and Lucia Hug, a specialist in statistics and monitoring for UNICEF, join us to explain the data - and why they are worried about our ability to measure this in the future.
 
Helen Sharman is the first British Astronaut to make it to space - this week she was at the Royal College of GPs giving the General Medical Council's annual Marx lecture. She joins us to discuss how research in space might impact healthcare on Earth, and what the NHS can learn from cosmonaut teamwork. 
 
Finally, The government and doctors in England are not getting on well - we’ve had a series of strikes from the resident doctors, GPs are in dispute about the imposition of a new contract, and now consultants are being polled on industrial action.  BMA Consultants Committee co-chairs Shanu Dutta and Helen Neary explain why.
 
Reading list
 
Neonatal, Child, and Adolescent Mortality
Global, regional, and national levels and trends in under 5, infant, and neonatal mortality during 1990-2024 with scenario based projections to 2030
Global, regional, and national levels and trends in older child, adolescent, and youth (5-24 years) all cause mortality from 1990 to 2024: modelling study
Systematic estimates of global causes of neonatal and under 5 mortality in 2000-24: secondary data analysis using bayesian multinomial logistic regression
Estimates of global causes of death for children and adolescents aged 5-19 in 2000-24: secondary data analysis using bayesian multinomial logistic regression
 
Full interview on YouTube:
Why NHS Senior Doctors in England Are Considering Strike Action

How to make healthcare more human

Does healthcare have a moral emergency?
In this episode of the Medicine and Science podcast, Kamran Abbasi sits down with healthcare leaders Maureen Bisognano, president emerita of the Institute for Healthcare Improvement and Bob Klaber, director of strategy at Imperial College Healthcare NHS Trust, to discuss why they're calling the lack of humanity in medicine an emergency.
We ask why this dangerous imbalance between the rational (efficiency, data, and metrics) and the relational (human connection, empathy, and listening) has developed in modern medicine. We also learn how simple changes, like asking "What matters to you?" instead of just "What's the matter?, can help us put the humanity back into healthcare.
 
Reading list
Read the BMJ Article: Healthcare's moral emergency: reconnecting healthcare with its mission and purpose
Michael West on workforce kindness
Amy Edmondson on psychological safety
Len Berry on cancer care & kindness
 

What does Wes Streeting's exit mean for the NHS modernisation bill?

It has been a tumultuous time in UK health politics. UK Health Minister ,Wes Streeting, has freshly resigned. What does this mean for his newly introduced NHS Modernization Bill as it heads through Parliament?
Together with Hugh Alderwick, Director of Policy and Research at the Health Foundation, we unpack the bill's sweeping centralization of power, the abolition of NHS England, and the contentious role for US tech firm Palantir in the new NHS.
And, we explore a major milestone for women's healthcare. A condition affecting an estimated 170 million women globally has officially been renamed from Polycystic Ovary Syndrome (PCOS) to Polyendocrine Metabolic Ovarian Syndrome (PMOS). Rachel Morman, Chair of the PMOS charity Verity, joins us to explain why dropping "cysts" from the name is a vital step toward recognizing this as a complex, multi-system condition, and how this co-designed change will fundamentally reshape diagnosis, treatment, and future research.
Further reading:
Health Bill brings NHS management back into government
PMOS: What's in a name? Everything
PCOS name change to PMOS must be managed to avoid confusing patients, says expert

Social media companies are using the tobacco industry playbook to addict children

Twitter was launched 20 years ago, followed quickly by the iPhone and Instagram. Today, nearly 60% of the world’s population uses social media. Medical experts are sounding the alarm on the potential for these platforms to cause systemic harm. This past year has seen large events in the legal and public health battle against tech giants, with millions of dollars awarded in damages to child victims. Why has pinning down these companies proven difficult? And, what are the parallels between the social media industry and the historical tactics of "Big Tobacco"?
Guests:
Matthew Bergman is a practicing attorney and the founder of the Social Media Victims Law Center, as well as a professor at Lewis & Clark Law School in Portland, Oregon.
Ilona Kickbusch is an editorial board member of the BMJ and a visiting professor at the Digital Transformations for Health Lab at the University of Geneva, specializing in the commercial determinants of health.
Further reading:
From tobacco to TikTok: what public health litigation history tells us about holding social media accountable
What is the evidence for social media addiction?

Revisiting the Cass Review on gender identity services, and non-invasive brain stimulation for children with autism

The BMA has released their long awaited review of the Cass report. The original report looked at the provision of NHS gender identity services for children and young people, and involved a review of the science underpinning those services. It also set out a plan to improve care for gender diverse young people. 
We talk with David Strain of the BMA’s board of science to discuss their findings, and hear why they were critical of the Secretary of State, Wes Streeting's response to Cass’s review.And, we hear about new research published with The BMJ that aims to help children with autism. The researchers used a non-invasive magnetic stimulation technique to target specific regions of the brain, with the goal of promoting sociality. We discuss the benefits, and how this technique might translate to treatment plans for patients.
Guests:
David Strain is an associate professor in cardio-metabolic health at the University of Exeter and Chair of the BMA’s Board of Science.
Benjamin Becker is a professor of psychology and neuroscience at the University of Hong Kong, specializing in brain-based interventions for mental disorders.
Further reading:
Puberty blockers: BMA critique vindicates Cass review but questions government “overreach”
Accelerated non-invasive brain stimulation in childhood autism
 
 

The US UK trade deal will cost the NHS billions, and only serve to increase pharma profits

The new trade deal struck between the UK and US came into force in April. 
The deal will
double the amount that the NHS spends on new medicines, by the end of 2036 (from 0.6 - 0.6% of GDP).
 increase the threshold that the National Institute for Health and Care Excellence (NICE) sets for drug approvals - which will allow more to be approved, but will also allow companies to charge more for their pharmaceuticals,
 include a change to the rebate the NHS receives, to ensure that the extra drug spend occurs.
Cumulatively this will increase our drug spend by £56 billion in the next 10 years, which will have to come out of current healthcare spending - which experts are calling a catastrophe for the NHS.
Joining Kamran Abbasi to discuss are Sally Gainsbury, a senior policy analyst Nuffield Trust and Karl Claxton, professor of economics at the University of York. We also hear from Francis Ruiz, policy analyst at the London School of Hygiene and Tropical Medicine.
Reading list
The UK government must publish a detailed impact assessment of the costs and benefits of the US-UK medicines partnership
A budget apart: the case for ringfencing medicines in the UK
 
 
 
 

MS drug controversy, adoption outcomes in Sweden, and the multi-factorial reality of Alzheimer’s

A blockbuster MS drug undergoes FDA re-evaluation. We explore the story of Ocrelizumab, a treatment for primary progressive multiple sclerosis, following a patient petition that highlighted internal disagreements among agency reviewers regarding its efficacy.
We look to Sweden, where new research involving sibling pairs separated by adoption investigates how early-life environments shape long-term health and social outcomes.
Finally, we revisit the dominant medical narrative on Alzheimer’s disease. Why is it so difficult to move towards comprehensive treatments? Has the focus on amyloid plaques hindered our understanding of other critical factors like vascular health and social inequality?
Peter Doshi is a senior editor at The BMJ and an associate professor of pharmaceutical health services research at the University of Maryland.
Erik Peterson is an associate professor at the Karolinska Institute in Stockholm, specializing in psychiatric epidemiology and adoption studies.
Carol Brayne is a professor emerita of public health medicine at the University of Cambridge and a leading expert in the epidemiology of dementia.
Reading List:
Multiple sclerosis: Could Roche's bestselling drug Ocrevus be doing more harm than good in women with primary progressive MS?
Home environment conditions during childhood and psychosocial outcomes across three generations in Sweden: population based adoption-discordant sibling comparison study
 

The Trump administration is an international health emergency

Covid 19 was the last Public Health Emergency of International Concern (PHEIC). Our guests in this podcast think that the Trump Administration should be declared the next one.
Joining Kamran Abbasi are, Fatima Hassan,  human rights lawyer and Director of the Health Justice Initiative in South Africa, and Matthew Herder, Director of the Health Justice Institute at Dalhousie University in Canada explain why they think that the actions and consequences of the Whitehouse meet the bar for WHO to delcare an emergency
We examine the global consequences of recent US policy shifts, including:
The withdrawal from the World Health Organization (WHO) and its implications for international health governance.
Significant funding cuts to global health programs, including PEPFAR and the CDC, and how these disruptions affect life-saving HIV and TB treatments in the Global South.
The rise of "unhinged nationalism" in health policy, from North American measles outbreaks to the extraction of trade concessions in exchange for medical aid.
The role of US health leadership in fueling vaccine hesitancy and dismantling scientific research at the NIH.
 
Reading list:
Trump and his administration as a public health emergency of international concern
Why the expanded global gag rule is a deadly triple tripwire for recipients of US foreign aid
The power of the markets: the scandal that keeps on taking

The 15th strike, and bringing compassion back to A&E

Coming up in this week’s episode:
The 15th Strike: As the latest six-day walkout by resident doctors in England concludes, the BMJ's news team examines the state of the ongoing dispute over pay and training places.
Iain Beardsell, consultant in emergency medicine in Southampton explain why he thinks reintroducing compassion could be the key to tackling the systemic issues facing emergency departments
And finally, The BMA announces major changes to how it represents doctors in private practice - we hear why they think the US has some better legislation around health insurance than the UK.
 
Reading list:
Resident doctor strikes: Streeting demands to “meet with the organ grinders” as latest action ends
The BMJ interviews Jack Fletcher 
Make compassion visible in emergency medicine again
BMA boosts support for private practice as NHS failings prompt more patients to pay for care