Medicine and Science from The BMJ

Tech and the NHS - A tale of two cultures

The NHS is about caring for people, free at the point of care, creating a safety net which catches the most vulnerable. Tech has been defined by the facebook maxim "move fast, break things" - looking to disrupt a sector, get investment and move on. 
We want to be able to harness the potential utility of digital tech in the NHS - but how can those two cultures be reconciled, and what salutary lessons should we learn from other industries (pharmaceuticals, devices) before we embark on these new ventures.
In this podcast we hear from;
Neil Sebire, Chief Research Information Officer and Director, Great Ormond Street Hospital Digital Research, Informatics and Virtual Environments (DRIVE) Unit
Dr Ramani Moonesinghe, Professor and Head of Centre for Perioperative Medicine, University College London
Indra Joshi, Digital Health and Artificial Intelligence Clinical Lead at the newly formed NHS X

Finding out who funds patient groups

We’ve been banging the drum about transparency of payment to doctors for years - we’ve even put a moratorium on financial conflicts of interest in the authors of any of our education articles. Not because we think that all doctors who receive money from industry are being influenced to push their agenda - but because we have no way of telling when that’s happening…
At the same time, and rightly, patient groups are becoming more involved in setting things like research priorities, and in guideline development - and we’re campaigning to increase that involvement. but as that involvement increases, it’s also important to make sure that potential industry influence is made transparent.
Piotr Ozieranski, is an assistant professor at the Department of Social and Policy Sciences at the University of Bath and one of the authors of a new analysis which attempts to build a picture of industry funding of UK patient groups.
Read the full analysis:
https://www.bmj.com/content/365/bmj.l1806

Talk Evidence - cancer causing food, prostate cancer and disease definitions

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.
(1.05) Carl rants about bacon causing cancer
(7.10) Helen talks about prostate cancer, and we hear from the author of the research paper which won Research Paper Of The Year at the BMJ awards.
We also cover disease definition and a call to have GPs more involved in that process, (24.12)and a new call for papers into conflicts of interest (29.40)
Reading list:
MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis.
https://www.ncbi.nlm.nih.gov/pubmed/29552975?dopt=Abstract
Reforming disease definitions: a new primary care led, people-centred approach
https://ebm.bmj.com/content/early/2019/04/11/bmjebm-2018-111148
Commercial interests, transparency, and independence: a call for submissions
https://www.bmj.com/content/365/bmj.l1706

What caused the drop in stroke mortality in the UK

Stroke mortality rates have been declining in almost every country, and that reduction could result from a decline in disease occurrence or a decline in case fatality, or both. Broadly - is that decline down to better treatment or better prevention.
Olena Seminog, a researcher, and and Mike Rayner, professor of population health, both from the Nuffield Department of Population Health at the University of Oxford, join us to discuss their study which has used a large database to try and determine what has most affected stroke mortality.
Read the full open access research paper:
https://www.bmj.com/content/365/bmj.l1778

Helping parents with children who display challenging behaviour

Looking after a young child is hard enough, but when that child has learning difficulties and displays challenging behaviour - the burden on parents can be extreme.
That behaviour may prompt a visit to the doctor, and in this podcast we’re talking about how parents can be supported in that - what services are available. We’ll also be discussing what is normal behaviour, and what might prompt a referral to a specialist team for further assessment.
In this podcast we're joined by 2 of the authors of a recent practice pointer - Managing challenging behaviour in children with possible learning disability. Angela Hassiotis - professor of psychiatry of intellectual disability at University College London and Michael Absoud - consultant in paediatric neurodisability at the Evelina London Children’s Hospital.
We also have Rebecca - mother of a child who displayed some of these behaviours, and is actually a parent/carer case worker supporting families of children with disabilities.
Read the full practice article:
https://www.bmj.com/content/365/bmj.l1663

Tackling gambling

In the UK we have a complex relationship with gambling, the government licences the national lottery, and uses profit from that to fund our art and museum sector - horse racing is a national TV event, and we've seen a proliferation of betting shops on our high streets.
At the same time, there's increasing acceptance that gambling causes problems for some people - to the extent that it's been termed a "hidden epidemic" and a public health problem. And it's to that point that the authors of a new analysis have written in the BMJ - if we see gambling as a public health problem, why aren't we treating it as such.
To talk about that, we're joined in the studio by Heather Wardle - Wellcome humanities and social science research fellow at the LSHTM.
Read the full analysis:
https://www.bmj.com/content/365/bmj.l1807

The sex lives of married Brits

The National Surveys of Sexual Attitudes and Lifestyles is a deep look into the sex lives of us brits - and has been running now for 30 years, giving us some longitudinal data about the way in which those sex lives have changed. The latest paper to be published, based on that data, looks at the frequency of sex - how often different groups are having sex on a weekly basis, and has reported a drop in that frequency for some groups.
Joining us to talk about the research, and why we're having less sex, is Kaye Wellings, Professor of Sexual and Reproductive Health at the London School of Hygiene and Tropical Medicine.
Read the full open access research:
https://www.bmj.com/content/365/bmj.l1525

Doctors and extinction rebellion

Starting in the middle of April, the group “Extinction Rebellion” have organised a series of non-violent direct action protests. Most notably bringing central London to a standstill - but these events are now continuing around the country.
Predictably, they have received a lot of criticism - they have also received a lot of support - amongst those arrested at the protests have been a few doctors, despite reservations that some may have for the impact on their careers.
In this podcast, we'll hear from three people who have decided to support extinction rebellion, about why they do, and what the medical community's support might mean for climate change.
We're joined by Rowan Williams, Master of Magdalene College, Cambridge and former Archbishop of Canterbury - the principle leader of the church of England. Robin Stott, retired physician and campaigner, and Alex Armitage, paediatric trainee.
Schoolchildren’s activism is a lesson for health professionals
https://www.bmj.com/content/365/bmj.l1938
Just 11 years to avert disaster
https://www.bmj.com/content/365/bmj.l1801

Introducing Sharp Scratch - our new podcast for students and junior doctors

Here's a taster for our new student podcast - Sharp Scratch. We're talking about the hidden curriculum, things you need to know to function as a doctor, but are rarely formally taught.
This is a taster - if you enjoy, subscribe! https://podcasts.apple.com/gb/podcast/student-bmj-podcast/id331561304
Sharp Scratch episode 1: Surviving the night shift.
Why nights shifts mess with your brain, how astronauts will cope with the time difference on Mars, and the power of frozen grapes when you need a boost.
Join medical students Laura, Ryhan, Declan, and newly qualified doctor Chidera as we figure out how to survive the night shift. Featuring a guest interview with NASA researcher Erin, leader of the Fatigue Countermeasures Group.
https://www.bmj.com/sharpscratch

Gypsy and Traveller health

In the UK, there's an ethnic group that is surprisingly large, but often overlooked by society, and formal healthcare services. The gypsy traveller community have poorer health outcomes because of systemic issues around access to health and education.
In this podcast we're joined by Michelle Gavin and Samson Rattigan, who both work for Friend's Families and Travellers - and who have have been working hard in East Sussex to bridge the gap between the healthcare system and those who identify as gypsies or travellers, and explain some of the simple ways in which GPs and hospitals can support this neglected group.
https://www.gypsy-traveller.org/