Medicine and Science from The BMJ

Talk Evidence - Freedom Day

The 19th of July in the UK saw the relaxation of covid rules that have been in place for 18 months - social distancing requirements in venues, mask wearing in public will no longer be legally mandated.
There are a lot of questions about what this will mean for the pandemic, and in this episode of Talk Evidence Helen MacDonald, Joe Ross and Duncan Jarvies are joined by Iain Buchan, professor of public health in Liverpool, who has been involved in 2 key studies on covid transmission.
Firstly, lateral flow tests - the big questions has been how well do they work in the wild - and how well do they have to work, to be useful in test trace and isolate? Iain tells us about new research into the innova test.
Secondly, events - the football has shown that events can still be a big source of transmission, and the UK government put in place a number of trial events, all carefully monitored by public health researchers - Iain tells us about one nightclub test in Liverpool, and what we can glean from it.
Reading list;
Performance of the Innova SARS-CoV-2 antigen rapid lateral flow test in the Liverpool asymptomatic testing pilot: population based cohort study
https://www.bmj.com/content/374/bmj.n1637
The UK government's events programme
https://www.gov.uk/government/publications/events-research-programme-phase-i-findings/events-research-programme-phase-i-findings#findings
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/979461/S1195_Science_framework_for_opening_up_group_events.pdf
Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data
https://www.bmj.com/content/373/bmj.n1343
Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial
https://www.bmj.com/content/374/bmj.n1585
Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis
https://www.bmj.com/content/374/bmj.n1446

Women’s health and gender inequalities - The science of women’s health

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities
www.bmj.com/gender
In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive.
As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions.
In this first podcast, Lulit Yonas Mengesha talks to Cara Tannenbaum
Lulit Yonas Mengesha is right at the beginning of her medical career, she's a medical student in Ethiopia, but has already become passionate about woman's health
Cara Tannenbaum is is Scientific Director of the Institute of Gender and Health at the Canadian Institutes of Health Research.
Lulit and Cara discuss how women have been excluded from healthcare research - and how that affects practice today, how there are gaps in our understanding of basic biology, as well as how different life experiences affect outcomes.
The additional interviews are from; Lavanya Vijayasingham, Claudia Lopes, and Claire Wenham

Wellbeing - the need for culturally aware support

We know the pandemic has disproportionately affected the NHS workers who come from a ethnic minorities, we also know that doctors from an ethnic minority face additional barriers to accessing support - so how well have the various support schemes put in place during the pandemic helped those doctors from ethnic minorities?
Dammie Olubawale, medical student and grants and partnerships manager at Melanin Medics, joins us to talk about a fund they've created specifically to help doctors of black African and Caribbean heritage, to access support tailored to them.
Dammie explains some of the reasons which doctors, particularly from that heritage, may be more reluctant to access support - and how organisations large and small need to think about tailoring their wellbeing initiatives to include all staff.
To access the melanin medics wellbeing fund visit
https://www.melaninmedics.com/wellbeing-fund

Women’s health and gender inequalities - Campaigning for change

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities
https://www.bmj.com/gender
In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive.
As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions.
In this first podcast, Adrienne Germaine talks to Fila Magnus.
Adrienne starter her career as an activist for women's health in the 1970s, and went on to become president of the International Women's Health Coalition
Fila Magnus is Director of Communications at the International Youth Alliance for Family Planning, and was born in the same year as the Declaration was signed.
Fila and Adrienne discuss campaigning, now and then, and how the work that led to the declaration can be built on, but is never over...
The additional interviews are from; Emma Fulu, Sheena Hadi, Oswaldo Montoya, and Claudia Garcia-Moreno.

Talk Evidence - GP data, excess mortality and FDA approval

In this Talk Evidence, Helen Macdonald, Joe Ross and Duncan Jarvies discuss what's going on in the world of EBM.
Firstly, a while ago on the podcast, we concluded that excess mortality would be the best way to measure the impact of the pandemic - and now a new paper looks at different country's excess mortalitites over the past year. We're joined by author Nazrul Islam Physician-Epidemiologist at the University of Oxford (and a research editor for The BMJ) to talk about why comparisons may still not be sensible.
Read the full research here - https://www.bmj.com/content/373/bmj.n1137
The Delta variant is dominating headlines, and infections in the UK now - but until recently the Alpha one was ascendent, and new research has helped characterise how the mortality rate of that variant differed from previous viruses. We discuss how that research was done.
Read the full research - https://www.bmj.com/content/372/bmj.n579
GP data in the UK - the planned cut-off for granting access to your GP data for researchers has been extended, but there are still a lot of questions remaining. Helen has tried to find out some basic answers, and is still confused.
Finally, the FDA has approved a new drug for treatment of dementia - and researchers (and the FDA's own panel of experts) are up in arms. Joe Ross tells us why he thinks the decision was the wrong one, and why patients may be harmed because of it.
https://edition.cnn.com/2021/06/17/opinions/biogen-alzheimers-drug-opinion-ramachandra-ross/index.html

Wellbeing - are men worse at sounding the alarm about their mental health?

We've been bringing you stories of doctors wellbeing for a while in the podcast, but we noticed a pattern. Woman would come on and talk about their own difficulties, men would talk about other peoples - so we wanted to dive into that a bit, and called out on twitter for men who would be willing to open up to our listeners about their own mental health.
This interview is with Zeshan Quereshi - registrar in paediatrics, author and TedX talker. In this conversation we talk about why it is that men are particularly disinclined to open up about their difficulties at work, and what Zeshan has done to try and support his own.
Zeshan's TedX talk
https://www.youtube.com/watch?v=uctoTk64GVM

Coronavirus Second Wave - wrapping up the UK’s response

Finally it seems that life might return to normal in the UK, as the vaccination efforts continue apace, and despite concern about increasingly spreading variants, our hospitals are not being overwhelmed.
Because of this, we are changing our approach to covering the pandemic - and taking this second wave podcast to pastures new, but before that, in this last episode we’re going to look backwards and forwards, at the UK’s response.
On the panel today are
Matt Morgan, consultant in critical care, Nisreen Alwan, associate professor in public health, Partha Kar, consultant in diabetes, and Helen Salisbury, GP.
www.bmj.com/coronavirus

Wellbeing - Questions to ask yourself, if you think medicine may no longer be for you

The pandemic has wrought a lot of change, not least to doctors relationship to their careers. While still loving the patient interaction, we're increasingly hearing that doctors are disillusioned with the other aspects of medicine.
If you're feeling that way, there are ways to structure your thinking to help you make sense of your career. In this podcast Claire Kaye, former portfolio GP and now coach, explains how she went about deciding medicine wasn't for her, and how she helps doctors go through that process too.
You can find Claire at
https://www.drclairekaye.com/
https://www.instagram.com/drclairekaye_executivecoaching/

Talk Evidence covid-19 update - Research on vaccine safety, treatment for dementia

In this week's Talk Evidence, Joe Ross, BMJ editor and professor at Yale again joins Helen Macdonald to talk about emerging evidence on Covid-19.
They also welcome to the podcast Juan Franco, family physician in Buenos Aires, and professor at the Instituto Universitario Hospital Italiano, and new editor-in-chief of BMJ Evidence Based Medicine.
This week, the team bring you updates on;
Post-covid syndrome in individuals admitted to hospital with covid-19 - how are people with long covid faring.
Finally published research from Scandinavia on the risk of thrombotic events after administration of the Oxford-AstraZeneca vaccine - how big is the risk, and what does that mean for the overall benefit of that vaccine.
How difficult the UK population found it to understand and stick to the rules with our test, trace and isolate system - and some of the questions that this raises for this public health approach.
and finally, research that showed non-drug interventions are as good as pharmaceuticals at treating people with depression and dementia - and the holistic effect that alleviating depression can have.
Full reading list
Ayoubkhani, Daniel, Kamlesh Khunti, Vahé Nafilyan, Thomas Maddox, Ben Humberstone, Ian Diamond, and Amitava Banerjee. 2021. “Post-Covid Syndrome in Individuals Admitted to Hospital with Covid-19: Retrospective Cohort Study.” BMJ 372 (March): n693.
https://www.bmj.com/content/372/bmj.n693
Pottegård, Anton, Lars Christian Lund, Øystein Karlstad, Jesper Dahl, Morten Andersen, Jesper Hallas, Øjvind Lidegaard, et al. 2021. “Arterial Events, Venous Thromboembolism, Thrombocytopenia, and Bleeding after Vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: Population Based Cohort Study.” BMJ 373 (May): n1114.
https://www.bmj.com/content/373/bmj.n1114
Smith, Louise E., Henry W. W. Potts, Richard Amlôt, Nicola T. Fear, Susan Michie, and G. James Rubin. 2021. “Adherence to the Test, Trace, and Isolate System in the UK: Results from 37 Nationally Representative Surveys.” BMJ 372 (March): n608.
https://www.bmj.com/content/372/bmj.n608
Watt, Jennifer A., Zahra Goodarzi, Areti Angeliki Veroniki, Vera Nincic, Paul A. Khan, Marco Ghassemi, Yonda Lai, et al. 2021. “Comparative Efficacy of Interventions for Reducing Symptoms of Depression in People with Dementia: Systematic Review and Network Meta-Analysis.” BMJ 372 (March): n532.
https://www.bmj.com/content/372/bmj.n532

Roopa Dhatt - Getting woman into leadership positions in healthcare

This interview is part of our BMJ interview series, where we talk to the people who are changing medicine. The series thus far has been a bit male dominated - reflecting the leadership in medicine at the moment, if not the actual workforce.
One woman who's planning to change that is Roopa Dhatt, executive director of Woman in Global Health - a new grassroots organistion which is making waves with its demand for equality of representation for woman in global health decision making.
In this interview, we talk to Dr Dhatt about the genesis of Woman in Global Health, and how they've managed to cement real commitment from the WHO. We also discuss how her experience of being Indian and American has shaped her understanding of equality in medicine, and how the covid-19 pandemic has highlighted the way in which women are discounted.