Medicine and Science from The BMJ

Resetting General Practice with Martin Marshall, Jenny Doust and Toyin Ajayi

In this week’s episode, our focus is on what the post-COVID world of general practice might look like. The pandemic has exposed the inequalities in our social and healthcare systems, but has also given GPs some much-needed headspace to reflect on changes to make going forward. Will we be able to turn general practice off and on again, like a faulty computer? Will we just drift back to the status quo, or will we seize this opportunity to shake up the old routines in order to redefine the role of the GP and to benefit the ever-evolving needs of our patients?
Our guests:
Martin Marshall is Chair of the Royal College of General Practitioners, a professor of Healthcare Improvement at UCL, and a GP practising in East London.
Jenny Doust is a Clinical Professorial Research Fellow at the School of Public Health at the University of Queensland, and practises as a GP in Brisbane.
Toyin Ajayi is Chief Health Officer, and co-founder, of Cityblock Health, which is a New York-based health and social services company delivering personalised healthcare to marginalised communities.
Tom, Navjoyt and Jenny mentioned some resources they have found useful while looking at racism in medicine - which we have compiled into this document https://bit.ly/DBIRacismResources

The corona virus pandemic in South America

At the end of May, the WHO said that South America has become the new epicentre of the covid-19 pandemic.
The majority of those with covid are in Brazil - not entirely surprising given it is the most populous - but in neighbouring Peru, numbers are growing too.
And it’s to Peru that we turn to talk to our guest today, Valerie Paz-Soldan is a social scientist and director of the Tulane Health Office for Latin America - part of the university’s school of public health and tropical medicine.
She joins us to talk about the pattern of the virus in Peru in particular, but elsewhere in the region, and how the pandemic is overwhelming an already stressed healthcare system.
https://www.bmj.com/coronavirus

Wellbeing - the art of the staycation

n normal times, around this time we’d start thinking about weekend breaks and summer holidays abroad. More than most healthcare staff and other key workers are in dire need of time out. Given the uncertainties around foreign travel, how can we recreate in some way that holiday feeling. Simon Calder, travel correspondent for The Independent newspaper, offers his staycation tips and alternative travel advice.

Talk Evidence covid-19 update - surgisphere data, and protests in a pandemic

This week, we’re asking questions about surgisphere data, and how it might have got into such high impact journals, we’re also talking about the protests around the world about structural racism - and how they intersect with the covid pandemic.
(1.39) Helen and Carl talk about the data underlying the newly retracted papers on hydroxychloroquine and ace-inhibitors or ARBs and covid.
(7.45) Fiona Godlee, the BMJ’s editor in chief, comes onto the pod to talk about retractions, and why they’re often called for, an rarely done.
(25.10) We talk about the protests, and Carl gives us his opinion on the risk of covid transmission during them (spoiler; he thinks it’s low)
(37.40) Sonia Saxena, professor of primary care at Imperial College London gives her verdict on the Public Health England report into this disproportionate effect of covid on ethnic minorities in the UK, and pushes back against it being a biological instead of a sociological determination.
Reading list:
Sonia’s analysis into transforming the health system for the UK’s multiethnic population https://www.bmj.com/content/368/bmj.m268
 News Analysis - Covid-19: PHE review has failed ethnic minorities, leaders tell BMJ
https://www.bmj.com/content/369/bmj.m2264
The PHE report into the disparate risk of covid to ethnic minorities
https://www.gov.uk/government/publications/covid-19-review-of-disparities-in-risks-and-outcomes

Wellbeing - how Burmese Buddhism can help

How might Burmese Buddhism help deal with pandemic stress? Christopher Bu drew on his familial heritage and the tradition of practicing mindfulness to cope with the stresses of studying to be a doctor. He invites us to consider how the same techniques might be useful psychological tool for all healthcare workers during this challenging time.

Talk evidence covid-19 update - second wave and care home failings

In this episode of Talk Evidence, we'll be finding out if second waves are inevitable (or even a thing), how the UK's failure to protect it's care homes is symbolic of a neglected part of public life, and why those papers on hydroxychloroquine were retracted.
This is Talk Evidence - the podcast for evidence based medicine, where research, guidance and practice are debated and demystified.
Helen Macdonald, UK research editor for The BMJ, and Carl Heneghan, professor of EBM at the University of Oxford and editor of BMJ EBM, talk about some of the latest developments in the world of evidence, and what they mean.
This week:
2.00 - Helen looking into a second wave - and finds out from Tom Jefferson, an epidemiologist with the Cochrane Collaboration's acute respiratory infections group, that a "wave" might be a misnomer.
12.00 - Mary Daly, professor of sociology and social policy at the University of Oxford, tells us where the UK went wrong with care homes, and what we’d need to do to stop it happening again.
31.20 - Carl and Helen discuss those hydroxy chloroquine papers, now retracted. This was recorded before that happened, but we decided to keep this section in, because they talk about the reasons the papers should be viewed with caution, and the importance of scrutiny of the data.
Reading list:
The talk from Mary Daly at Green Templeton College.
https://www.gtc.ox.ac.uk/news-and-events/event/covid-19-and-care-homes-what-went-wrong-and-why/

Counting the ways Donald Trump failed in the pandemic

The Trump administration was left a playbook for pandemics when they entered the Whitehouse, but even before covid-19 was a threat systematically dismantled the public health protections put in place to follow that playbook.
In this podcast, Nicole Lurie, Gavin Yamey and Gregg Gonsalves talk about how the US response to public health was mismanaged, how it has become politicized, and what that playbook suggested should have been done. They also talk about rebuilding public health in the US after this is all over.
Our guests;
Nicole Lurie, former Assistant Secretary for Preparedness and Response under the Obama administration, senior clinical lecturer at Harvard Medical School and advisor to the Coalition for Epidemic Preparedness Innovation
Gavin Yamey, professor of global health and public policy at Duke University
Gregg Gonsalves, assistant professor of epidemiology at Yale School of Public Health.
This podcast is hosted by Joanne Silberner.

Testing times with James McCormack and Jess Watson

For GPs, testing patients is their “bread and butter”. This week, we discuss the “better safe than sorry” attitude towards testing, which is so common among doctors – are we guilty of over-testing purely out of force of habit, or are we worried about missing something vital, and therefore find reassurance in doing them? How should we interpret test results, and how do these results affect the way we manage our patients? And, with the huge focus on COVID-19 testing in the media, how do we communicate the current risks and uncertainties surrounding it to our patients?
Our guests:
James McCormack is a professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia, and the co-host of a popular weekly podcast called Best Science (BS) Medicine podcast. His work focuses on helping healthcare professionals to understand medical data, by taking the best available evidence and making it as simple and practical as possible.
Jess Watson is a GP, working in Bristol, and an expert on medical testing. She is a researcher with an interest in the use of diagnostic tests in primary care, specifically inflammatory marker blood tests.
Reading list:
James's BS Medicine Podcast
https://therapeuticseducation.org/
Jess's Practice Pointer - Interpreting a covid-19 test result
https://www.bmj.com/content/369/bmj.m1808

Talk evidence covid-19 update - remdesivir redux, the overwhelming volume of research

That remdesivir study has finally been published - what does it say and is it as independant as claimed. Also, as the world's focus turned to covid, so have researchers - and they've produced over 15000 papers. How can we sift through the flood of research and know what's any good?
(2.30) Helen Macdonald talks to Elizabeth Loder about the volume of research we're seeing, and why journals and peer reviewers are struggling to check it all.
(8.15) The study on remdesivir has been published - the trial was stopped early, and the primary outcome switched - we talk about how that increases uncertainty over the results, and could actually delay the treatment.
(26.50) We hear from a couple fo readers who wanted to correct us about averages, means, medians.
Reading list:
The US NIH AID study on remdesivir, published 22nd May in the New England Journal of Medicine
Research - preliminary report https://www.nejm.org/doi/full/10.1056/NEJMoa2007764
NEJM - looking at the dose duration https://www.nejm.org/doi/full/10.1056/NEJMoa2015301
Editorial - an important first step https://www.nejm.org/doi/full/10.1056/NEJMe2018715

Ray Moynihan - Declarations of interest in healthcare leaders

*Non covid content alert*
While the last couple of months have been covid-19 focused, the work of the beforetimes carries on - including a topic the BMJ is perennially interested in, industry funding of medics.
Ray Moynihan, researcher at Bond University, has been looking at financial ties between some healthcare association leaders, and industry, in the US, and reports that in new research published this week in The BMJ.
Read the full open access research;
Financial ties between leaders of influential US professional medical associations and industry: cross sectional study - https://www.bmj.com/content/369/bmj.m1505