Medicine and Science from The BMJ

A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast.
We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail.
This week has seen pledges about GP numbers, so we're focussing on primary care - and are joined by two GPs, Clare Gerada, co chair of the NHS Assembly, and former chair of the Royal College of GPs, and Rebecca Rosen, who is also a senior fellow at the Nuffield Trust.
Reading list:
Health, wellbeing, and care should be top of everyone’s political agenda
https://www.bmj.com/content/367/bmj.l6503
Labour pledges to outspend Conservatives on health with £26bn NHS “rescue plan”
https://www.bmj.com/content/367/bmj.l6537
Tories promise 6000 extra GPs by 2024
https://www.bmj.com/content/367/bmj.l6463
Is the number of GPs falling across the UK?
https://www.nuffieldtrust.org.uk/news-item/is-the-number-of-gps-falling-across-the-uk

Reverse innovation may sound like some attempt to return to the dark ages - but it has a specific meaning, especially when it comes to med-tech. It’s about where we look for innovation - and overturning our preconceived ideas of where new ideas come from.
Mark Skopec, and Matthew Harris - both from Imperial College London are two of the authors of a new analysis, setting out to highlight those preconceptions, and creating new routes to bring innovation into the NHS.
Read the analysis:
https://www.bmj.com/content/367/bmj.l6205

Talk Evidence is back, with your monthly take on the world of EBM with Duncan Jarvies and GPs Carl Heneghan (also director for the Centre of Evidence Based Medicine at the University of Oxford) and Helen Macdonald (also The BMJ's UK research Editor).
This month Helen talks about the messy business of colon cancer screening - which modality is best, and in what population is it actually effective (1.40)
Carl talks about how the Netherlands did the right research at the right time to stop a new pregnancy scan before it became routine (10.35)
The Rant: acronyms in research papers (17.45)
Mini Rant: politicisation of the NHS, and Carl pitches for yet another job (25.15)
Research in the news has talked about the importance of when drugs are taken, to maximise efficacy. Melvin Lobo, cardiologist specialising in hypertension joins us to explain that research and why we seem to have forgotten about that effect.
Reading list:
Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline
https://www.bmj.com/content/367/bmj.l5515
Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial
https://www.bmj.com/content/367/bmj.l5517
Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478

Giving staff the confidence to speak out is important in healthcare - It's a key aspect of the WHO patient safety checklist, decreasing incidence of medical error, but it's also important to stop incidents of harassment and abuse which undermine staff and increase burnout.
Creating that culture is a difficult task, but two hospitals in the southern hemisphere have been trying to do do that by putting in place ways which support staff in making complaints when they wouldn't normally feel confident to do so.
In this podcast we hear from Alex Sia, CEO of KK hospital Singapore, Jeanette Conley, medical executive at Adventist Healthcare in Sydney and Mark O”Brien, medical director of the Cognitive Institute, who talk about their challenges and successes in changing the way they work.
For more on burnout;
https://podcasts.apple.com/co/podcast/burnout-dont-try-to-make-canary-in-coal-mine-more-resilient/id283916558?i=1000446459269
http://www.bmj.com/wellbeing

The NHS Practitioner Health Programme - once only for doctors in London, now it’s being rolled out across the NHS to provide the largest, publicly funded, comprehensive physician health service, in the world.
However, while helping the individual is essential, systemic change needs to be made to support doctors in our healthcare system.
Clare Gerada, GP and medical director of NHS PHP joins us to talk about how the expanded service will work, and what role regulation and inspections should play in wellbeing.
For more on the NHS PHP
https://blogs.bmj.com/bmj/2019/10/31/clare-gerada-protecting-practitioners-health/
020 3049 4505
https://php.nhs.uk/

There has been a lot of noise made about calorie counts on labels - the idea being it’s one of those things that might nudge people to make healthier choices.
So much so that in 2018, in the USA, it became mandatory for food chains with more than 20 outlets to label the calories in their food.
But the effectiveness of that is hard to gauge - it’s relied on reporting from customers, which leads to an incomplete picture. The really killer data would be from the chains themselves, but they’re reluctant to share that widely.
That's where new research comes in - and we're joined in the podcast by Joshua Petimar, postdoctoral researcher at the Harvard T.H. Chan School of Public Health, and Jason Block, associate professor at Harvard Pilgrim Healthcare Institute & Harvard Medical School, to discuss what they've done.
Read the full research:
https://www.bmj.com/content/367/bmj.l5837

A TB infection can take two forms, active and latent. Active disease is transmissible, and causes the damage to the lungs which makes TB one of the biggest killers in the world.
In the latent form, the bacteria Mycobacterium tuberculosis is quiescent and can stay that way for years until it becomes active and causes those clinical signs.
Testing for the active version of the disease is done directly, but when it comes to latency, we use the tuberculin skin test to see if someone has an immunological response - and when that happens we consider them to have latent disease.
However, in this podcast Lalita Ramakrishnan, professor of immunology and infectious diseases at the University of Cambridge; Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania; and Marcel Behr, professor of medicine at McGill University question that conclusion.
Read their full analysis:
https://www.bmj.com/content/367/bmj.l5770/
Their previous analysis:
https://www.bmj.com/content/362/bmj.k2738.abstract
And search for their previous podcast - "Have we misunderstood TB's timeline?"

This week, Dr Arnav Agarwal joins Ray to share the perspective and experiences of a young, recently graduated doctor working in a busy, metropolitan hospital. Despite the long shifts and demanding environment, Arnav makes time and space to reflect on work, life and mortality through his thought-provoking poetry and volunteer work.

This week, Ray ventures into the notoriously complex field of nutrition with special guest, Professor Marion Nestle. Named by Forbes as one of the world's most powerful foodies, Marion’s stellar career spans five decades of research, teaching, advocacy work and the publication of countless prize-winning books.

Statins are now the most commonly used drug in the UK and one of the most commonly used medicines in the world, but debate remains about their use for primary prevention for people without cardiovascular disease.
Paula Byrne from the National University of Ireland Galway, joins us to talk about the evidence of benefit for low risk individuals, and what needs to be done to finally answer the questions about efficacy and harms.
Read the full analysis:
https://www.bmj.com/content/367/bmj.l5674