Medicine and Science from The BMJ

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

Large, plausible and imminent - time to take H5N1 seriously

As increasing numbers of mammalian, and human, cases of H5N1 are documented we askShould we worry about a growing threat from “bird flu”?  Wendy Barclay, from Imperial college London, and Christopher Dye, from Oxford University join us to explain why they think we should.
Our commission on the future of the NHS has released a manifesto for a sustainable NHS that still meets it's founding principles. Helen Salisbury, GP and BMJ columnist, joins the podcast to lay it out.
Finally, a musical interlude from the World Doctor's Orchestra.
 
00:18 H5N1 Bird Flu: Rising Threat
15:35 The manifesto for a better NHS
27:46 World Doctors' Orchestra
 
Reading list;
BMJ Editorial - Should we worry about a growing threat from “bird flu”?
BMJ Opinion - A manifesto for a healthier NHS, a healthier UK
https://www.world-doctors-orchestra.org
 
Stay up to date with our daily email alert - https://www.bmj.com/today
 
 

Elections and health in India, the UK, and the USA

In the UK, a general election has been called - and around the world, ½ the global population will be voting this year; so in this episode we’ll be talking about how elections and health intersect.
Firstly, what are the UK parties’ plans for health? Abi Rimmer, The BMJ's UK features editor joins us with the latest information.
The world’s largest democracy is polling, so how are Indian politicians talking about health?  Sanjay Nagral, surgeon and director of the Department of Surgical Gastroenterology at Jaslok Hospital & Research Centre in Mumbai takes us through the campaign promises.
And finally, Jody Heymann is founding director of the WORLD Policy Analysis Center at UCLA and explains why this is the most consequential US election for woman's health in a generation.
 
01:30 Election Fever and NHS Plans
07:35 Impact of Elections on Health in India
21:20 Women's Health in the US Elections
 
Reading list
Feature: The untold health toll of voting
Editorial: Workplace rights around pregnancy and childbirth

The prospect of unemployed GPs

With the anticipation of a new government in the UK, shadow health secretary Wes Streeting will hit the ground running - with a winter season (and it's inevitable crisis) and ongoing industrial desputes with junior doctors. Elisabeth Mahase ask him about his plans to handle these challenges if elected.
We also find our selves in the puzzling situation of potential GP unemployment in the UK despite a high demand for primary care doctors, Helen Salisbury, GP and columnist for The BMJ explains how we've got into this situation.
Finally, Peter Doshi has been looking at the financial entanglement of FDA heads with the companies they are regulating - 9 of the previous 10 FDA heads have gone on to work for industry in some respect. He has also investigated how complex financial instruments can make these conflicts more opaque.
02:03 Anticipating a New Government and the NHS Winter Crisis10:50 The Kafkaesque Dilemma of GP Unemployment23:10 FDA Leaders' Financial Entanglements: A Deep Dive
Reading list
Workforce and winter under Labour: Wes Streeting on his plan for the NHS
Helen Salisbury: No jobs for GPs—we’ll be missed when we’re gone
Revolving doors: board memberships, hedge funds, and the FDA chiefs responsible for regulating industry

Fixing healthcare's workforce problems

Where next for psychological safety? Amy Edmundson is professor of Leadership and Management at the Harvard Business School. Her work on psychological safety has underpinned so much quality improvement, and she joins us fresh of the stage at the International Forum on Quality and safety in healthcare to talk about the next steps in creating a safe work place.
The BMJ has published two new investigations, looking at the alcohol and tobacco industry funding of public health and education - we’ll hear how the companies who create the problems, are now styling themselves as the solution. Rebecca Coombes joins us to explain what The BMJ has found, and May van Schalkwyk, a researcher from the London School of Hygiene & Tropical Medicine, explains how commercial conflicts are shaping the wrong education tactics.
And finally, our NHS commissioners have more recommendations - this time on workforce issues. Mary Dixon-Woods, director of THIS institute at the University of Cambridge, and Matt Morgan, intensive care consultant in Cardiff, tell the NHS to get serious about staffing.
02:03 Amy Edmondson on Future Health and Psychological Safety10:24 The Impact of Corporate Funding on Public Health19:57 Addressing NHS Workforce Challenges: Insights and Solutions
Reading list;
Our new podcast - Future Health
International forum keynote -  "Learning to fail" with Amy Edmundson and Don Berwick
Investigation - Medscape caves in on courses funded by tobacco giant Philip Morris, while medics fear global push into medical educationInvestigation - Big alcohol: Universities and schools urged to throw out industry-funded public health advice
Commission on the future of the NHS - The future of the NHS depends on its workforce
 
 

Improving NHS gender identity services - Hilary Cass

Hilary Cass, the former president of the Royal College of Paediatrics, has spent the last 3 years collating the evidence for treatment of gender questioning young people; engaging with those young people, their families and their clinicians - all with the aim of improving NHS treatment of this complex and vulnerable group.
In this interview, Kamran Abbasi, editor in chief of The BMJ, speaks in depth to Cass about her review - about evidence base for transitioning, but also about the way in which the siloing of care for young trans people has failed them. 
They discuss the need to support young people in their journey - Cass is clear that the NHS should allow young people to explore their gender, but that ultimately, that may not mean medical intervention at all. 
 
Reading list
The Cass Review - final report
The systematic review and meta-analyses published in Archives of Disease in Childhood
BMJ Opinion: Gender medicine for children and young people is built on shaky foundations

Derogation, an ultra processed food system, and catch up pay for the NHS

Derogation, the way in which striking doctors can be recalled to the ward to protect patient safety, was agreed by NHS England and the BMA. Now, new data The BMJ has uncovered shows that the mechanism was rarely used - and when it was tried, was often rejected. Gareth Iacobucci explains what that means about relations between the government, the NHS, and doctors.
Felice Jacka, director of the Food & Mood Centre at Deakin University, is one of the authors of our recent ultra-processed foods umbrella review - and joins the podcast to talk about the link between diet and health; and why goverments need to pay more attention to the food system.
Finally, John Appleby, senior associate at the Nuffield Trust, and Gillian Leng, dean and president elect of the Royal Society of medicine, have been thinking about healthcare funding, and how more stability is essential in securing the service's future.
 
Reading list
Hospital leaders warned that failure to recall striking doctors risked patient safety in some trusts, documents show
Ultra-processed food exposure and adverse health outcomes
NHS funding for a secure future
 
Chapters
00:31 Derogation and doctor strikes
06:59 Ultra processed food producers and health
13:59 Rethinking NHS funding

The future of the clinical relationship, code sharing, and a Nye-t at the theatre

In this week's podcast:
 
How AI will affect the clinician-patient relationship? Our annual Nuffield Summit roundtable asks how the promise of tech tools stacks up against reality, and how the future of the therapeutic relationship can be protected (participants below).
 
Your code is as important as your methods, which is why The BMJ now requires you to share it - Ben Goldacre and Nick De Vito, from the Bennett Institute for Applied Data Science at the University of Oxford, explain why it's so important, and how The BMJ's new data and code sharing policy could change research transparency.
 
Nye Bevin set up the NHS when the UK was in the economic doldrums, and the public's need for care was becoming an emergency - BMJ columnist Matt Morgan has helped turn that story into a play, currently showing at the National Theatre; and reflects on the parallels between now and then.
 
1:58 Nuffield Summit roundtable
17:32 New BMJ rules on data and code sharing
29:03 Aneurin "Nye" Bevan play
 
Taking part in our roundtable were:
Rebecca Rosen, Senior Fellow at the Nuffield Trust and GP
Juliet Bouverie, CEO of The Stroke Association
Daniel Elkeles, CEO of London Ambulance Service
Neil Sebire, Professor and Chief Research Information Officer at Great Ormond Street Hospital
Reading list:
How is technology changing clinician-patient relationships?
Mandatory data and code sharing for research published by The BMJ
Scalpels and spotlights: bringing theatre to the theatre