Medicine and Science from The BMJ

ADHD therapies, and the NHS gig economy

There is an enormous amount of research on treatment for ADHD - pharmaceutical and otherwise. But not all of those trials, or meta-analyses, are of high quality; and not many compare the whole literature. 
Now a new umbrella review - a review of reviews - tries to give a broad overview of the whole evidence base. Corentin Gosling, associate professor at the Université Paris Nanterre, joins us to set out the benefits and harms of ADHD therapies.
 
Also, the BMJ’s been investigating the employment of doctors on “local” contracts in the NHS - and our latest look at this exposes what some have described as a “gig economy”, with doctors plugging rota gaps but missing out on training, development, and salary progression. Rebecca Coombes, head of journalism at The BMJ explains more.
 
Finally, Tom Frieden is former head of the US Centers for Disease Control, and current CEO of Resolve to Save Lives - he’s written a new book on public health. He joins us to talk about what actually improves health at a population level, and why the current US administration’s approach to staffing the CDC is leaving the country open to danger.
 
Reading list
Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making
Revealed: Thousands of NHS doctors are trapped in insecure “gig economy” contracts
 

The Covid Inquiry - special episode

 
"Damning” and “unforgivable failures” is how some papers headlines reacted to criticism of former UK prime minister Boris Johnson in the second of 10 reports from the UK Covid Inquiry.
Under pressure, in 2001 Boris Johnson announced a covid inquiry led by a former judge, Baroness Hallett. Each report is examining a different area of the pandemic's impact, and module 2 is about decision making and political governance.
The report describes inertia, toxic cultures, and an inability to learn lessons - disfunction that contributed to many extra deaths. 
To dissect the report and discuss what needs to change, we're joined by;
Rebecca Coombes - The BMJ’s head of journalism
Kevin Fong - anaesthetist and lead for major incident planning at University College Hospital
Matthew Flinders - Professor of Politics and Public Policy at the University of Sheffield
 

Climate, “car spreading”, and conflict

It’s the BMJ’s annual climate issue - and in this episode, we’ll be hearing about more ways in which climate mitigation is good for health.
 
Firstly, climate change is fuelling conflict, and exacerbating the impact it has on fragile healthcare systems. Andy Haines, from the London School of Hygiene and Tropical Medicine, and Barbora Sedova, from Potsdam Institute for Climate Impact Research, discuss how climate and conflict intersect, and what they think needs to be done to combat it.
 
“Car spreading”, the recent tendency for cars to become bigger and heavier is not only harming the climate, but it’s also harming pedestrians.  Anthony Laverty, associate professor of public health at Imperial College London, and trauma surgeon Cleo Kenington explain why SUVs are more lethal in accidents, and why France is bucking the trend in sales.
 
Finally, Jocalyn Clark, the BMJ’s international editor joins us to talk about women’s health innovation and why tech bros aren’t the people to be leading it.
 
Reading list:
 
The climate issue: Brazil and the climate crisis
 
Tackling the complex links between climate change, conflict, and health
 
Reducing the harms from ever larger cars
 
Transforming women’s health through innovation

Doctors against the far right

Far right rallies have been held across the UK, culminating in a large parade in London where Elon Musk spoke. At the same time, politicians from across the political spectrum are following the talking points of far right parties - and shifting their policies rightward, even the Labour home secretary has said she wishes to double the period migrants have to be in the UK before they can become citizens.
That has made a group of medics decide it’s time for doctors and other healthcare professionals to use their voice and speak up - against the demonisation of migrants into the UK, and for their fellow NHS staff. They are demanding that those in positions of power do so too.
 
Some of those medics join us on the podcast today;
Alistair Stewart, consultant psychiatrist in Manchester 
Omnya Ahmed, resident doctor in London 
Jordan Rivera, occupational therapist in London
 
Also this week, doctor, researcher, comedian and Matt Hutchinson is adding author to his list, and has released the book “Are You Really the Doctor? My Life as a Black Doctor in the NHS” - he joins Shivali Fulchand to talk about balancing all of this bits of his career - and how standup comedy has helped him maintain his career in the NHS.
 
Reading list
Everybody’s business: call to all NHS staff to oppose the influence of racism and the far right

The shaky science of the Q-collar, exercise for osteoarthritis, and patient choice.

This week on the podcast
The BMJ investigates Q-COLLAR, an American device that distributors claim can reduce brain injury from contact sports. Investigators James Smoliga and Mu Yang take us through the evidence, and former NFL punter turned US bobsled team member Johnny Townsend explains what this means for sportspeople.
Bin Wang from Zhejiang University School of Medicine explains what the new network metaanalysis finds is the best exercise options for knee osteoarthritis
And, what our patient panel really think about “patient choice”.
 
links
How an FDA cleared “brain protection” device built on shaky science made it to the NFL
Comparative efficacy and safety of exercise modalities in knee osteoarthritis
The BMJ's patient and public partnership

The difficulty of delirium diagnosis, the lack of agency in the 10 year plan, and Gaza wounds

In this episode of the podcast;
In July this year, the Government published their 10 year health plan for England - A new analysis just published on BMJ.com takes an in depth look at the chances of that plan succeeding, and where the government needs to focus time and resources. Bob Klaber, paediatrician and director of strategy, research and innovation at Imperial College Healthcare, and Helen Salisbury, GP and columnist for the BMJ join us to discuss.
Journalist Chris Stoker-Walker's grandfather suffered from delirium at the end of his life, but the journey to that diagnosis was difficult - Chris joins us to talk about the impact that had on his family, and Elizabeth Sampson, professor of liaison psychiatry from Queen Mary University of London, explains why it's under-researched.
Finally, we've been reporting from Gaza for 2 years, and it's been very difficult to get accurate information out of the region. However, new research published on bmj.com has surveyed medics there, to document the patterns of wounding in the civilian population - to improve the medical response to the conflict. Omar El-Taji and Ameer Ali, resident doctors in the NHS join us to explain what they found.
 
Reading list:
Delivering on the 10 year health plan for England
Why can’t we do anything about delirium?
Patterns of war related trauma in Gaza during armed conflict
 

Doctors still have questions about the UK's assisted dying bill

In today’s episode: Assisted Dying moves closer to becoming UK law. The proposed legislation to allow people to end their own lives has moved through a second debate in the House of Lords. What do MPs and doctors think of the Bill as it stands? And, new ways to pull research findings from observation alone makes us question whether correlation really doesn’t equal causation. We find out - what is Target Trial Emulation?
The BMJ’s Elisabeth Mahase speaks to Labour MP Kim Leadbeater, sponsor of the Assisted Dying Bill. Why did she propose the legislation? What has been her impression of its movement through Parliament and the opposition it has faced? We also hear from Jamilla Hussain and Gareth Owen, doctors who attended a BMJ parliamentary roundtable on the topic.
Finally, the BMJ’s Duncan Jarvies talks to our research editors about new ways to develop evidence from observational studies. What are the limits to this new technique of causal inference?
Reading list
MP behind assisted dying bill warns that terminally ill people and their families are being failed, ahead of Lords debate
Assisted dying bill: Lords debate concerns over lack of safeguards
Transparent reporting of observational studies emulating a target trial: the TARGET Statement

Starvation in Gaza is a multi-generational disaster

In today’s episode:
Rethinking how we measure the harm caused by the  arms industry
The life long, and multigenerational, impact of starvation in Gaza
What is the appropriate focus on prevention in general practice?
 
The BMJ's international editor, Jocalyn Clark talks about a new series we've just published - examining the arms industry as a commercial determinant of health. Jocalyn also speaks to Mark Bellis, from Liverpool John Moores university about why he thinks it’s time we take the impact of the arms industry on health seriously.
The blockade on food reaching Gaza is in place again, risking more starvation. Elizabeth Mahase, clinical reporter for the BMJ, has been finding out about the acute, chronic, and generational impact on the palestinian population. She speaks to Jonathan Wells, professor of anthropology and paediatric nutrition at University College London, and Tessa Roseboom, professor of early development and health at the University of Amsterdam, Marie McGrath former head of the Emergency Nutrition Network, and Chris McIntosh, humanitarian response advisor for the charity, Oxfam.
Finally, an analysis we published earlier this year made the case that "tsunami" of preventative care is destabilised the work of GPs. Helen Macdonald was at the Preventing Overdiagnosis conference and spoke to some of the authors - Minna Johansson, associate professor at University of Gothenberg, Stephen Martin, professor at UMass Chan Medical School, and Iona Heath, retired GP and former president of the RCGP.
 
Reading list
Arms industry as a commercial determinant of health
Starvation is a lifelong sentence: Gaza’s civilians must be protected in accordance with international humanitarian law
Sacrificing patient care for prevention: distortion of the role of general practice
 

CRISPR, stemcell banking, and a football world cup

CRISPR technology has revolutionised biological research, and for the first time it’s out of the lab and into the NHS, as NICE has approved its use as cost effective. Kenneth Charles, senior lecturer in haematology at the University of the West Indies explains how the treatment works, and what concerns he has about it's implementation.
Also this week, a new investigation on bmj.com has looked at a number of British companies who are offering to collect children's teeth for stem cell extraction and storage. Freelance investigative journalist Emma Wilkinson explains the "outrageous" claims she found them making.
Finally - we’re finishing with the football. Team GB had a strong showing this year -  our over 25 men’s team brought the trophy home, and our womans team competed for the first time To explain more about the medical world cup we're joined by Minnan Al-Khafaji, captain of the women’s team, and Jamie Thoroughgood, captain of the men’s team.
 
Read more.
Banking baby teeth: companies may be misleading parents with “outrageous claims”
CRISPR therapy for sickle cell disease
Follow the British Medical Football Team on instagram

The pitfalls of home test kits

If you’ve been in a high street pharmacy or supermarket recently, chances are you’ll have seen home test kits for all sorts of indications; blood sugar level, vitamin deficiencies, thyroid function, and even some forms of cancer.
A new series of article in The BMJ revealing serious concerns with the reliability of these home tests, and raises questions about their regulation.
Jonathan Deeks, professor of Biostatistics at the University of Birmingham, joins us to discuss what these tests are, and how his team have rated their usability.
Also this week, the sad death of a child in Liverpool from measles highlights the growing outbreak in the UK - and this may be one of the first times many doctors have come across the infection. Frances Dutton, GP at the Small Heath Medical Practice reminds us how to recognise the sign of the infection.
 
Reading list
Direct-to-consumer self-tests sold in the UK in 2023
How to recognise and manage measles