Medicine and Science from The BMJ

Talking overdiagnosis

In this month's Talk Evidence, Helen and Juan are reporting from Preventing Overdiagnosis - the conference that raises issues of diagnostic accuracy, and asks if starting the process of medicalisation is always the right thing to do for patients.
 
In this episode, they talk about home testing, sustainability and screening. They're also joined by two guests to talk about the overdiagnosis of obesity - when that label is stigmatising and there seem to be few successful treatments that medicine can offer, and the need to educate students in the concepts of overdiagnosis and too much medicine, to create a culture change in medicine.
 
Links;
The Preventing Overdiagnosis conference
The BMJ EBM papers on choosing wisely.
 

Planet centred care - It’s all about working together

Healthcare is a complex system, and if we want to make changes such as those needed for sustainable healthcare, we need to work across multiple teams, and make sure we hear everyone’s voice, including our patients’. In this episode we’ll discuss how we can communicate and work with those different groups, and some novel ways of getting the message across from T-rexes worth of plastic gloves to art made out of surgical waste.
 
Guests for this episode:
Nicola Wilson, lead clinical educator, Great Ormond Street Children’s hospital, and Maria Koijck, artist and former patient. You can read more about the Gloves are Off project here https://www.gosh.nhs.uk/news/gloves-are-off/  
You can see Maria’s film here: https://www.mariakoijck.com/

Planet centred care - Greening the gaze

Planet centred care is new podcast series for the BMJ exploring issues related to environmentally sustainable healthcare, aimed at all clinicians, and anyone working in healthcare, who want to make sure they can continue to help patients while not harming the planet. 
In this episode we’ll discuss that first radicalising moment. That moment where you start to see all the things you can do to make healthcare more sustainable and how it is hard to un-see that. For everyone, that moment may come from a different place, or different perspective.
Our guests for this episode:
Gareth Murcutt who was at first reluctant until he saw the size of the impact he could make; Gwen Sims whose eyes were opened by moving health systems (and continents) and Alifia Chakera who didn’t expect to find a huge sustainability saving so close to home when she took up a new clinical role before the pandemic. 
Hosts:
Loren De Freitas and Florence Wedmore, the BMJ

The problem with trainees - The GMC’s National Training Survey results data

In our final episode of this season, we're going quantitative, with the newly released data on how trainees in the UK are faring.
Each year the UK's General Medical Council, the doctor's regulator, surveys trainees in the NHS to ask them questions about stress and burnout, harassment and discrimination, and how well supported they feel in their training. They also ask trainers about the same things.
Unsurprisingly, the year the results look bad - with increasing levels of burnout across the board, but particularly in new trainees. At the same time trainers are feeling unable to use their time supporting learning, and instead are propping up the system.
To discuss this, Clara Munro and Ayisha Ashmore are joined by Colin Melville, medical director, and director of education and standards, at the GMC. 
 
All the data discussed, and the interactive tool that Colin mentions, are available on the GMC's National training survey 2023 results page.
 
 

Ensuring the integrity of research, and the future of AI as authors

In this month's Talk Evidence, we're getting a little meta - how do we keep an eye on research to make sure it's done with integrity. Helen Macdonald is BMJ's Publication ethics and content integrity editor - and we quiz her about what that actually means on a day to day basis.
Ensuring the integrity of research could be made both easier, and harder, by the ascendance of large language models, Ian Mulvany, BMJ's chief technology officer joins us to talk about how we can harness the power of this new technology.
 

Taking on the van Tullekens; how Margaret McCartney changed their minds about COIs

They're the trusted public figures of the medical profession, but many of the most famous medics in the UK will have been approached by, and accepted money from, companies wishing to promote their products - and the public will never know.
To talk about conflicts of interest in media doctors, we’re joined by two of the most recognisable medics on our screens - Chris and Xand van Tulleken, and the GP who persuaded them to think about what they receive cash for, Margaret McCartney.
Read our investigation into how the UK's medical royal colleges receive millions from drug and medical devices companies and Margaret McCartney's plea that “You have to be above reproach”: why doctors need to get better at managing their conflicts of interest

Talk Evidence - post pandemic pruning, breast cancer screening, and orphan drugs

In this episode of Talk Evidence,  Helen Macdonald, Joe Ross, and Juan Franco are back to update us on what's happening in the world of medical evidence.
Firstly, the news about the end of the covid-19 pandemic was trumpeted, but the changes to research funding have been more quite - and the team discuss what this means for ongoing work to understand the effects of covid, but also in terms of preparedness for the next pandemic.
Next, breast cancer screening recommendations, in the USA, have been reduced from women over the age of 50, to those over the age of 40. We discuss the modelling study which lead to that recommendation change, and what the consequence may be in terms of overdiagnosis.
Finally, 40 years ago, the U.S. Orphan Drug act was passed to encourage the development of treatments for rare conditions - but new research looks at how many clinically useful drugs have come onto market, and an analysis examines the way in which the system could be gamed by narrowing disease definitions to create small populations of patients.
 
Reading list
Is the UK losing its world leading covid surveillance network just when it needs it most?
Breast cancer: US recommends women start screening at 40
FDA approval, clinical trial evidence, efficacy, epidemiology, and price for non-orphan and ultra-rare, rare, and common orphan cancer drug indications
 
 

Pride in healthcare

We're in pride month, and this year the celebration of LGBT+ people seems to be increasingly contentious.  Healthcare's treatment of queer people has improved hugely since the days when being gay was considered a mental disorder, and would end a doctor's career - but that doesn't mean that everything is equal.
In this episode of Doctor Informed, we're hearing from two doctors who are out and proud at work, about what  it's been like to be queer in medicine, and what good allyship looks like.
Our Guests
Michael Farqhuar is consultant in sleep medicine at the Evelina London Children's Hospital, he also helped set up the NHS Rainbow badge scheme.
Greta McLachlan is a general surgical trainee, and member of the Royal College of Surgeon's Pride in Surgery Forum

Doctor Informed - surviving in scrubs

The culture which allows sexism to perpetuate in healthcare is no better illustrated than by The BMJ's investigation into sexual abuse in the NHS.
However, The BMJ are not the first organisation to highlight the problems - Surviving in Scrubs  have been collating stories of sexism in healthcare, and making waves about the issues for a while.
In this episode of Doctor Informed, Clara Munro is joined by the founders of Surviving in Scrubs, to discuss their campaign, how to create a culture of zero tolerance for sexism at the ward level, and why they think sexism should be a professional issue.
Our guests;
Becky Cox is an academic GP researching domestic abuse and GP specialist in gynaecology in Oxford.
Chelcie Jewitt is an emergency medicine trainee in Liverpool.
Bron Biddle, founder of Ambulance Voices, and an employee in the ambulance service.
 
Links;
https://www.bmj.com/me-too-investigation
Previous Doctor Informed interview with Baroness Helena Kennedy

Talk Evidence - cloning, reporting, and disseminating

Helen Macdonald, Juan Franco, and Joe Ross are back with our monthly update on the world of evidence based medicine.
This episode delves into new methodologies which can use observational data to emulate trial data. We discuss a new systematic review and meta-analysis of RCTs for surgical treatment of sciatica. There is elaboration and explanation of the CONSORT Harms 2022 statement - and we'll be asking if it goes far enough. Finally, the old chestnut of surrogate endpoints in cancer treatment trials - are benefits communicated to patients accurately?
Reading list;
Nirmatrelvir and risk of hospital admission or death in adults with covid-19: emulation of a randomized target trial using electronic health records - https://www.bmj.com/content/381/bmj-2022-073312
Surgical versus non-surgical treatment for sciatica
https://www.bmj.com/content/381/bmj-2022-070730
CONSORT Harms 2022 statement, explanation, and elaboration
https://www.bmj.com/content/381/bmj-2022-073725
Funders crack down on unpublished clinical trials—but is it enough?
https://www.bmj.com/content/381/bmj.p840
Communication of anticancer drug benefits and related uncertainties to patients and clinicians
https://www.bmj.com/content/380/bmj-2022-073711