Medicine and Science from The BMJ

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

Addiction in doctors

Everyone has coping mechanisms, but sometimes those ways of coping become problem behaviours - addictions.
In this episode of Doctor Informed, we're focussing on how to spot the signs that you may be sliding into addiction, how to have conversations with friends and colleagues if you worry about their behaviour, and how seeking treatment is the best way to avoid GMC scrutiny.
Joining Clara Munro are Liz Croton and Zaid Al-Najjar, GPs who work for NHS Practitioner health - a mental health and addiction service specifically for health professionals. They are also joined by Ruth Mayall, a retired consultant anaesthetist who has experienced addiction herself, and has contributed to the Association of Anaesthetists guidance on drug and alcohol abuse.
Some resources mentioned in the podcast;
NHS Practitioner Health
https://www.practitionerhealth.nhs.uk/
The Sick Doctor's Trust
http://sick-doctors-trust.co.uk/
British Doctors & Dentists Group
https://www.bddg.org/
Substance use disorder in the anaesthetist
https://anaesthetists.org/Home/Resources-publications/Guidelines/Substance-use-disorder-in-the-anaesthetist
Substance abuse in anaesthetists
https://academic.oup.com/bjaed/article/16/7/236/2196385?login=false

Talk Evidence - automatic approval, evidence apps, and pay for performance data

In this month’s Talk Evidence, Helen Macdonald, Juan Franco and Joseph Ross are back to talk us through some of the latest research,
They’ll talk about pay-for-perfomance schemes, and whether the data they routinely collect is measuring outcomes or tickboxes. They’ll also talk about a new analysis published on bmj.com which suggests ways in which that data could be better.
We’re also by Huseyin Naci, associate professor of health policy at the London School of Economics and Political Science, who will tell us about proposed changes to drug regulation in the UK - and we discuss research which has linked speedier regulatory approval to more adverse advents in post marketing studies.
Finally, we talk about point of care apps. The availability of medical information in the clinic has changed practice, but how good is that information? We hear about research which has evaluated those point of care apps (including BMJ’s Best Practice app) and rates them against different criteria.
Reading list
Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland
https://www.bmj.com/content/380/bmj-2022-072098
How can we improve the quality of data collected in general practice?
https://www.bmj.com/content/380/bmj-2022-071950#
UK to give “near automatic sign off” for treatments approved by “trusted” regulators
https://www.bmj.com/content/380/bmj.p633
Smartphone apps for point-of-care information summaries
https://ebm.bmj.com/content/early/2023/03/14/bmjebm-2022-112146

Nappuccinos and circadian rhythms

Fatigue can have as much of an affect in your ability to function as alcohol, and yet while you would be chastised for drinking before appearing on the ward, hospitals have systematically removed the spaces where tired clinicians can rest and recover.
The Royal College of Anaesthetists have been campaigning to raise awareness of the dangers of fatigue, and it seems that anaesthetic trainees have benefitted from that, with sleep pods and flexible schedules - but other specialties are lagging behind.
In this podcast, Roo McCrossan, a consultant anaesthetist joins our host Clara Munro, a surgical trainee, and Ayesha Ashmore, obstetric trainee, to talk about how to fight fatigue. They discuss circadian rhythms, what to eat, nappuccinos, and why trusts should make more sleeping spaces.
For more information about fighting fatigue;
https://anaesthetists.org/Home/Wellbeing-support/Fatigue/-Fight-Fatigue-download-our-information-packs

Why guideline authors need to pay attention to doctor’s time

We're bringing you an episode of the BMJ's podcast for primary care, Deep Breath In, which we think you'll enjoy.
How long would it take GPs to enact all of the guideline recommendations that they might be expected too? Far more GP hours than exist in any healthcare system; but as medicine has turned its attention to primary prevention, and expanded the populations whose health we seek to improve, those guidelines are taking up more and more time.
A recent analysis in The BMJ has proposed the concept of “Time Needed to Treat” - and implores guideline makers to take account consultation time as a precious, finite, resource when thinking about their recommendations.
In this episode of Deep Breath In, we’re joined by Minna Johansson, family doctor and director Global Center for Sustainable Healthcare, who co-authored that analysis to talk about how the concept has gone down, and what it might mean for rethinking what primary care is supposed to do.
Reading list:
Guidelines should consider clinicians’ time needed to treat
https://www.bmj.com/content/380/bmj-2022-072953

Nuffield Summit 2023 - healthcare needs flexible working

As workforce gaps in the NHS, and other healthcare systems around the world widen, the need to improve staff retention has become an ever more pressing concern. Yet work-life balance issues continue to drive staff away from the service.
What is the imperative to get flexible working right, and what can be done to remove the barriers facing healthcare workers seeking to change the way they work?
Joining us in the discussion are;
Kamran Abbasi, editor in chief of The BMJ
Rachel Hutchings, fellow at the Nuffield Trust
Sarah Sweeney, interim chief executive, National Voices
Farzana Hussain, a GP in Newham, London
Thea Stein, chief executive of Leeds Community Healthcare NHS Trust
The report that Rachel Hutchings has authors is summaried in a BMJ feature - Challenges of combining a career in surgery with parenting https://www.bmj.com/content/380/bmj.p449