Medicine and Science from The BMJ

“I had two herniated discs in my back, and I was still running” - addicted to exercise

It’s been called “the universal panacea” - exercise has a positive effect on almost all health measures, and governments are actively campaigning for us to do more. But at the opposite end of the scale, the realisation that some people may be addicted to exercise is gaining traction.
In this podcast we're joined by Heather Hausenblas - professor of kinesiology at Jacksonville University, James Smoliga - associate professor of physiology at highpoint University, and Katherine Schreiber - who’s experienced exercise addiction, and written about her experience.
They describe the condition, and what drives people to become addicted to exercise. They also outline the key indicators of the addiction, and what options there are for treatment.
Read their article:
http://www.bmj.com/content/357/bmj.j1745

The evidence manifesto - better trials, better use of trial data

We're creating a manifesto for better evidence. The centre for Evidence Based Medicine at the University of Oxford, and the BMJ, are asking what are the problem with medical evidence, and how can we fix them?
In this second discussion we went to Nottingham​ University, to find out what the people who create the bread and butter of EBM - randomised control trials - think about the issues with evidence synthesis, and how the information they create is being used in practice.
http://evidencelive.org/manifesto/ - join the discussion, read, and comment on our manifesto.

Assessing and treating an electrical injury

Thankfully, electrical injuries are relatively uncommon - but that means that lack of evidence regarding the management of patients who have been electrocuted, which can cause concern for clinicians when these patients present.
In this podcast, Cath Brizzel, clinical editor for The BMJ, is joined by one of the authors of a clinical update on the management of electrical injury - Kumar Narayanan, a Consultant Cardiologist and Electrophysiologist at MaxCure Hospitals in India.
Read that full update, including the free infographic:
http://www.bmj.com/content/357/bmj.j1418

”We’re kicking the can down the road” - how to get agreement on the future of the NHS

Our latest debate asks whether there should be a Royal Commission (a high level enquiry, with statutory powers) into the future of the NHS.
A high level inquiry could detoxify the radical changes needed and command wide support, say Maurice Saatchi, conservative peer, and Paul Buchanan, The BMJ's patient editor; but Nigel Crisp, independent peer, thinks that a less formal, more flexible and collaborative approach could be quicker.
Read the debate:
http://www.bmj.com/content/357/bmj.j1621

Fighting inequality, corruption, and conflict - how to improve South Asia’s health

The BMJ has published a series of articles, taking an in-depth look at health in South Asia. In this collection, authors from India, Pakistan, Nepal, Bangladesh, Sri Lanka, and Afghanistan collaborate to identify evidence-based solutions to shape health policy and interventions, and drive innovations and research in the region.
In this podcast, two of the driving forces behind the series - Dr Zulfiqar Bhutta, from Aga Khan University, and Dr Samiran Nundy from the Ganga Ram Postgraduate institute for Medical Education and research - join Anita Jain to discuss the key issues affecting the region now.
Read all of the open access articles:
http://www.bmj.com/health-in-south-asia

STPs - who, what, why, when, where.

The NHS Delivery Plan - setting out what’s in store of the English NHS in the coming years, has been delivered by Simon Stevens the chief executive. Key to those are the sustainability and transformation plans (STPs) which have been made in 44 areas, and yet again reorganise care - crucially, this time, with social care included in the mix.
In this podcast Hugh Alderwick, senior policy advisor at the King’s Fund explains what STPs are, and what they're planning, and crucially, the cash involved.
Read the full analysis:
http://www.bmj.com/content/356/bmj.j1541

High integrity child mental healthcare

Around 1 in 10 children and young people worldwide have mental health difficulties that substantially affect their lives.
Child mental health services often concentrate on risk reduction, at the expense of the wider aspects of a child's wellbeing.
As part of the high integrity healthcare series, this podcast focuses on novel ways of providing support to children and adolescents, and particularly Pause - a city centre drop in centre in Birmingham, England.
Read the full analysis:
http://www.bmj.com/content/357/bmj.j1500

What is high integrity healthcare?

This week, a new series starts in The BMJ - the aim is to rethink how hospitals, clinics, community services and public health work - with the aim of stopping the perverse blocks and incentives that prevent doctors, and other healthcare professionals, from providing the care that patients want and need.
Talking to Navjoyt Ladher, are Albert Mulley - professor of medicine at the Dartmouth Institute, and Jane Druce, an evaluations manger, and Donal Collins, a GP - both of whom work in an NHS Vanguard area, where new ways of delivering care are being tested.
Read the full analysis:
http://www.bmj.com/content/356/bmj.j1401

”Watching the world through a clear fog” - recognising depersonalisation and derealisation

Transient symptoms of depersonalisation and derealisation - feeling detached from the world, and feeling as if you are watching events at a remove - are common. However for some, persistent symptoms can make the disorder extremely distressing.
In this podcast, Kate Adlington is joined by Elaine Hunter, consultant clinical psychologist, Anthony David, professor of cognitive neuropsychiatry, and by Jane Charlton and Fiona Godlee - who have both experienced depersonalisation/derealisation over a number of years.
Read the full education article:
http://www.bmj.com/content/356/bmj.j745

American healthcare - what next?

For seven years, Republicans have vowed to repeal the Affordable Healthcare Act (Obamacare), and that promise took a central place in President Trump's campaign. The first major vote to replace it was due to happen last week, but was cancelled at the 11th hour.
In advance of the potential vote, The BMJ published a debate asking "Should US doctors mourn for Obamacare?". Now we're asking the authors of that debate, what next?
Joining Peter Doshi are Adam Gaffney, from Harvard Medical School and Saurabh Jha from the Hospital of the University of Pennsylvania.
Read their original debate:
http://www.bmj.com/content/356/bmj.j1441