We were accepting of an increase in deaths every winter 'flu season, but Ashish Jha thinks that is not longer a tenable position. Lessons he learned during his time as the White House Covid-19 coordinator have convinced him we should be taking a different approach to the winter season. In this interview with Mun-Keat Looi, The BMJ's international features editor, we hear about living with COVID, the future of antivirals, vaccines, and surveillance. They talk about long COVID, the investment required to fight future outbreaks effectively, and the role of the US in the global health response.    

Each episode of Talk Evidence we take a dive into an issue or paper which is in the news, with a little help from some knowledgeable guests to help us to understand what it all means for clinical care, policy, or research.    In this episode: Helen Macdonald take a deep dive into cancer screening tests, prompted by a paper in JAMA which showed most have no effect on all cause mortality, and news that the NHS is evaluating a single test which screens for 50 common cancers - we ask Barry Kramer, former director of the Division of Cancer Prevention, at the U.S. National Cancer Institute to help explain how to hold those two pieces of knowledge. Juan Franco has been looking into diet and obesity, prompted by new research in The BMJ and a new Cochrane review, looking at the role of low glycemic index foods in weightloss - we ask Khadidja Chekima, nutritional researcher at Taylor’s University in Malaysia, to define

Organisational and student leaders explore the responsibilities of the British Medical Association and The BMJ to understand and respond to its colonial history. Our panel Kamran Abassi, editor in chief, The BMJ, London, UK Omolara Akinnawonu, Foundation year doctor, Essex, UK, and outgoing co-chair of the BMA medical students committee Latifa Patel, elected chair of the UK BMA's Representative Body and BMA EDI lead Host - Navjoyt Ladher, clinical editor for The BMJ  

Leaders from academic and funding organisations discuss the transformative change required to overcome extractive and inequitable research practices in global health, and the need for examining power and privilege within traditional research institutions. Our panel Samuel Oti, senior program specialist, International Development Research Centre, Ottawa, Canada, and member of the Global Health Decolonization Movement in Africa (GHDM-Africa) Muneera Rasheed, clinical psychologist and behaviour scientist and former faculty, Aga Khan University, Karachi, Pakistan Liam Smeeth, professor of clinical epidemiology and director of the London School of Hygiene and Tropical Medicine, London, UK Angela Obasi, senior clinical lecturer, Liverpool School of Tropical Medicine, UK Seye Abimbola, editor of BMJ Global Health, and health systems researcher from Nigeria currently based at the University of Sydney, Australia Jocalyn Clark, i

International health leaders discuss how feminist and decolonial advocates in health face similar resistance and attempts to sow divisiveness, and how they can join forces to promote health equity and justice for all. Our panel Raewyn Connell, sociologist and professor emerita at the University of Sydney, Australia Sarah Hawkes, professor of global public health and director of the Centre for Gender and Global Health, University College London, UK Sanjoy Bhattacharya, head of the school of history and professor of medical and global health histories, University of Leeds, UK Asha George, professor and South African research chair in health systems, complexity, and social change, University of the Western Cape, South Africa Host - Navjoyt Ladher, clinical editor for The BMJ  

Experts discuss how failing to confront colonial pasts is linked to present lack of progress in global health equity, why health leaders need historical educations, and how, for Indigenous peoples, it’s not just a colonial history but a colonial present. Our panel Seye Abimbola, editor of BMJ Global Health, and health systems researcher from Nigeria currently based at the University of Sydney, Australia Catherine Kyobutungi, Ugandan epidemiologist and executive director of the African Population and Health Research Center, Nairobi, Kenya Sanjoy Bhattacharya, head of the school of history and professor of medical and global health histories, University of Leeds, UK Chelsea Watego, professor of Indigenous Health at Queensland University of Technology, Australia Host - Navjoyt Ladher, clinical editor for The BMJ

Healthcare leaders discuss the ways in which colonial-era bias and eugenics persist in today’s medical education and clinical practice in the UK and beyond, and what meaningful change is required to overcome racial and other healthcare inequalities Our panel Annabel Sowemimo, sexual and reproductive health registrar and part-time PhD student and Harold Moody Scholar at King’s College London, UK Thirusha Naidu, head of clinical psychology, King Dinuzulu Hospital, and associate professor, Department of Behavioural Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa Subhadra Das, UK based researcher and storyteller who specialises in the history and philosophy of science, particularly scientific racism and eugenics Amali Lokugamage, honorary associate professor, Institute of Women's Health, University College London, and consultant obstetrician and gynaecologist, Whittington Hospital, London, UK<

We’ve heard throughout the series from people who have a passion for sustainability, and have successfully made changes in their organisations to reduce the planetary impact of their work. In doing so, they will have recruited other people who have a similar outlook - but they will have also convinced people who aren’t prioritising sustainability.   In this last podcast of the series, we’re delving into that - how to talk to colleagues and patients, in ways which connect with their own needs and preferences.   To help with that, we’re joined by David Pencheon, director of the Sustainable Development Unit for NHS England, who’s been successfully talking about these issues for years, and Kate Wylie, executive director of Doctors for the Environment Australia.

One element of sustainable healthcare is simply reducing the amount of healthcare you’re doing by not doing the things that are of no value to patients. However, how do we do this in practice? And why is it often so hard? What is the role of fear in this discussion? These are all questions we will discuss in this episode.     To help us with this we’ll be joined by Prof Ben Newell (cognitive psychologist from University of New South Wales, whose research interest includes judgement and decision making). and Dr Lucas Chartier,  emergency medicine physician at the University Health Network in Toronto. Ben Newell also has also recently released a book, Open Minded, co-authored with David Shanks on the role of the unconscious mind in our decisions making 

Acting on climate change is often framed as having to give stuff up, to cost more money, to make sacrifices. Yet in healthcare we find the opposite can often be true: there are many actions we can take which reduce the carbon footprint of healthcare which actually end up with better outcomes for our patients. In this episode, we hear from two examples of that. Singing for breathing is a type of social prescribing to help people with chronic lung disease manage their breathlessness, reducing their need to be reliant on healthcare to do this, while also finding joy and a sense of community. Stephen is one patient who has benefited from this service, and will tell us more about the impact it had on his life. In another example, Lynn Riddell, an HIV consultant will tell us how a change in their clinical pathway helped a cohort of patients reduce the amount of travelling to and from the clinic, still manage their condition safely and give them back precious time and contr

Acting on climate change is often framed as having to give stuff up, to cost more money, to make sacrifices. Yet in healthcare we find the opposite can often be true: there are many actions we can take which reduce the carbon footprint of healthcare which actually end up with better outcomes for our patients. In this episode, we hear from two examples of that. Singing for breathing is a type of social prescribing to help people with chronic lung disease manage their breathlessness, reducing their need to be reliant on healthcare to do this, while also finding joy and a sense of community. Stephen is one patient who has benefited from this service, and will tell us more about the impact it had on his life. In another example, Lynn Riddell, an HIV consultant will tell us how a change in their clinical pathway helped a cohort of patients reduce the amount of travelling to and from the clinic, still manage their condition safely and give them back precious time and contr

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.  

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 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

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 <a href='https://www.gmc-uk.org/education/how-we-qua

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.  

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

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 b

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

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 ambul

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

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 disorde

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. Re

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

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 cons

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

In this episode of Talk Evidence, Helen Macdonald is joined by Juan Franco and Joe Ross, to bring you the newest evidence in The BMJ. First, chronic pain. As prescribers move away from opioids, Juan finds an overview of systematic reviews asking whether anti-depressants might help. Joe finds new research on the link between six healthy lifestyle markers and cognitive decline. Helen looks at a trial to reduce prescribing among older people with suspected urinary tract infection or UTI. Juan has a nuanced take on the updated evidence on masks to reduce the spread of respiratory viruses. Finally, an international group of researchers traced the health claims made about infant formula milk back to the evidence or lack of it Reading list: Efficacy, safety, and tolerability of antidepressants for pain in adults https://www.bmj.com/content/380/bmj-2022-072415 Association between healthy lifestyle and memory decline in older adults https://www.bmj.com/content/380/bmj-2022-072691 Ef

Grit is one of those concepts (like the dreaded resilience) that has a specific meaning, but has become a buzzword in healthcare. It’s the ability to persevere in the pursuit of a goal, in the face of obstacles - and it’s something all doctors have. However that trait has benefits and drawbacks. It’s not necessarily fixed, but will depend on context, and it is measurable but not a very helpful measure in isolation. In this episode, Clara Munro is joined by Declan Murphy and Ayisha Ashmore - and they sit down with neurourgeon and researcher Simone Betchen, who has measured grit in women surgeons, and helps them understand their grit scores. Reading list Grit in surgeons https://pubmed.ncbi.nlm.nih.gov/34218313/

Claire Mulrenan, specialist registrar in public health, and Mark Petticrew, professor of public health evaluation, both working at the London School of Hygiene and Tropical medicine were surprised to see high-fat, high-salt fast food brands being featured heavily on the website of one of the UK's most beloved children's comics. In this podcast, they describe why they think that is harmful, and why the Beano should think again about its editorial policies, to protect children's health. To read the full investigation:
www.bmj.com/content/380/bmj.p197

In this week's episode, we're focusing on covid and the ongoing crisis in the NHS. Helen Macdonald, Juan Franco and Joseph Ross cast their evidence seeking eyes over research into outcomes as well as the workload of doctors. Firstly, Joe tells us about a new big data study into longer term outcomes after mild covid-19, how those ongoing symptoms relate to long covid, and how often they resolve themselves. Juan looks back to his homeland to see what Argentina which was very early to offer children vaccinations against covid-19. He tells us how a new study design can help understand how effective different combinations of vaccines were. Joe has a Danish registry paper, which links people's employment status after a MI, explains how that gives us an insight into morbidity following that event. Helen looks at a new analysis which outlines the concept of "time needed to treat" - a measure of how much time it would take a clinician to actually carry out a guideline - and you'd be surpri

One size doesn’t fit all - so what are the alternative career paths of doctors in the NHS? The treadmill of medical school, to foundation training, to specialist training, to a consultant position takes years and is not very trainee-centric in it’s design. So are there other ways for doctors to be able to work in the NHS, still progress their career, but also tailor the job to themselves? And what are the drawbacks of trying to do that? In this podcast, Clara Munro is joined by Flo Wedmore and new panelist Jason Ramsingh, a surgical trainee in Newcastle. They speak to Rob Fleming an SAS (speciality and associate specialist) doctor in anaesthetics.

As we gear up for the winter in the northern hemisphere, the need to stay warm and eat well is pressing - but in 2022, there are global pressures working against us. Russia invaded Ukraine, and the subsequent restrictions on exports from both of those countries is being felt in terms of fuel costs - but also food costs. At the same time, this year has seen droughts and flooding which have affected global food production, as well as continuing restrictions around covid and economic activity. All of these factors are working together to increase food insecurity. Our Guests; Sheryl Hendricks, professor of food security at the University of Pretoria Renzo Guinto, chief planetary doctor at PH Lab Tim Benton, director of the Environment and Society Programme at Chatham House.

It's almost time for the Christmas edition of the BMJ to hit your doormats, and in this festive edition of Talk Evidence we're going to be talking Christmas research. Joining Helen and Juan, we have Tim Feeney, BMJ research editor and researcher into Surgical outcomes at Boston University. In this episode we'll be hearing about the health of footballers, and if a career in the sport predisposes Swedish players to substance use disorders. We'll hear about the performance of BMJ’s editors, when it comes to assessing the impact of a paper. We'll find out if AI algorithms can pass UK radiology exams, misinformation and a belief that everything causes cancer, and finally, some tips from BMJ’s statisticians to set the world right

In this episode of the Dr. Informed podcast, the topic of discussion is death and dying, and how to involve patients in DNACPR decisions. The panel discuss the importance of doctors having discussions with patients about end-of-life care as a way of creating the best possible death for patients. The conversation also touches on the challenges that doctors may face when having these difficult discussions and they give some advice on how they to overcome them. Joining Clara are; Mark Taubert, palliative care consultant, and national chair of future care planning for the Welsh Government Kat Shelley, an anaesthetics trainee, who has stage four breast cancer, and is receiving palliative care Lucy-Anne Frank, an elderly care consultant. The article "Do not resuscitate me in Barbados" is published by BMJ Supportive and Palliative Care, and is free to access at; https://spcare.bmj.com/content/11/3/310

In this month's episode, Helen Juan and Joe delve into the clinical - with a new review of endometriosis, and why the difficulty in diagnosis has lead to a dearth of evidence and attention on the condition. Joe tells us about a risk prediction tool that could be useful in helping to mitigate some of the problems of antihypertensive treatments. We're also having a geek out about a group of papers we've published lately, on how well evidence is created, maintained, and diseminated. Reading list; Development and external validation of a risk prediction model for falls in patients with an indication for antihypertensive treatment: retrospective cohort study https://www.bmj.com/content/379/bmj-2022-070918 Pathophysiology, diagnosis, and management of endometriosis https://www.bmj.com/content/379/bmj-2022-070750 Effective knowledge mobilisation: creating environments for quick generation, dissemination, and use of evidence https://www.bmj.com/content/379/bmj-2022-070195 Consistency

#MedTwitter consists of an online community of researchers, health practitioners and students who have created an open source decentralised forum for information sharing, medical education and professional networking. #MedTwitter also provides a space for publications to be shared and promoted. While many will credit Twitter with giving a voice to clinicians, it also comes with challenges, the potential for abuse, or the spread of misinformation. Joining Clara to discuss are; Jonathan Guckian, a dermatology registrar in Leeds, and director of social media and communications at the Association for the Study of Medical Education (ASMI). Flo Wedmore, a medical registrar and NHS sustainability fellow Declan Murphy, an academic medical fellow S2 in ophthalmology in Newcastle, and former Sharp Scratch panelist.

Last month, saw the WISH 2022 - the World Innovation Summit for Health, where experts from around the world came and presented their ideas. In this podcast we'll hear from Dame Sally Davies, the UK’s Special Envoy on Antimicrobial Resistance - she explains how covid, and treatment uncertainty, put paid to conservative prescribing; and what innovations in microbial treatment are on the horizon. Following that, James Campbell, director of the health workforce department at the WHO, who joins us to talk about new data they have on the wellbeing, and why the international market for healthcare staff is no longer the simple solution for vacancies. The BMJ's collections we mentioned are on empowering and engaging patients (https://www.bmj.com/empowering-and-engaging-patients) and food security and health in a changing environment (https://www.bmj.com/food-security-and-health-in-a-changing-environment)

In this month's Talk Evidence, Helen Macdonald, The BMJ's research integrity editor, is joined again by Juan Franco, editor in chief of BMJ EBM, and Joe Ross, US research editor. They're straying beyond the pages of The BMJ, and discussing an NEJM paper about colonoscopy for colorectal cancer screening. We have a listener request, asking about evidence for England's " NHS Diabetes Prevention Programme" - what do we know about how lifestyle interventions work at a population level? Juan puts on his Cochrane hat to answer the query. We stay with diabetes, and Joe tells us about his research trying to see if routinely collected observational data could be used to match the outcomes of an RCT into drug treatments. Finally, Helen updates us about what she's been doing about a case of plagiarism in one of BMJ's journals - and what that means for researchers who are writing in multiple journals about their work. Reading list Effect of Colonoscopy Screening on Risks of Colorectal Canc

In this episode of Doctor Informed, we're talking sustainability. The BMJ has a special edition on the climate crisis, and finding hope amid dispair - and we want to help our listeners with some of that. Clara is joined by three of the NHS's sustainability fellows, Florence, Who is a medical registrar, Emily a paedatrics trainee, and Li, an anaesthetics trainee For more on the climate crisis, read The BMJ's special edition https://www.bmj.com/content/379/8356

It's October's Talk Evidence, and that means the autumn is upon us including those autumnal viruses. Here in the UK covid is on the rise, and Joe Ross is looking at some research on how good those elusive lateral flows are at detecting infection among people with symptoms of covid. Juan will give us an update on the covid inquiry, the collection of analysis articles The BMJ is publishing looking at the interface of evidence and policy in our decisions about how to handle the pandemic. Since the pandemic moral among clinicians in many health systems has fallen even further, workloads have spiralled. Coupled with other problems with workforce planning and investment in health and healthcare, this is increasing burnout - with a consequential impact on patient care. Helen will tell us about new research which is trying to put some numbers to how much clinican burnout effects patient outcomes Finally, we're turning to a very clinical topic that we don't often cover in Talk Evidence - o

It's zoomers vs boomers on this week's Doctor Informed, as we assemble a multigenerational team to talk about the "good old days" and if the youth of today are really snowflakes. Clara Munro is joined by Nikki Nabavi, a medical student at Manchester University and a regular on Sharp Scratch (The BMJ's student podcast); Ayisha Ashmoore, an trainee in obstetrics and gynaecology, in the East Midlands; and Alastair Munro, a retired professor of oncology (and Clara's dad).

In our new season of Doctor Important, we'll be discussing topics that are not always talked about, and today, by popular request of our listners, we're talking about Coroner's Court and inquests - two things that strike terror into doctors, but are often not as bad as you may fear. Our panel; Clara Munro is a surgical trainee in the North East Deanery. She's joined by her colleage Katie Strong, another surgical trainee. We also have returning to Doctor Informed Ayisha Ashmore, an Obs and Gynae registrar in the East Midlands. Our Expert guest this week is Beth Walker, a former palliative care registrar who now works as an advisor for Medical Protection.

This is our last episode of series 1 of Doctor Informed, and with it we're coming full circle. Clara will be talking to our first two guests, Mary Dixon-Woods and Bill Kirkup, having now heard from all of our other experts over this series. In this first series, we've learned about speaking out, team work, compassionate leadership - all the things that are needed to help clinicians challenge the status quo, So in this episode, we'll be asking Mary how much she thinks things have changed, and Bill how he manages a career challenging the healthcare system. Our guests Mary Dixon-Woods is director of THIS Institute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients. For links to the work that Mary talked about visit https://www.thisinstitut

In this week's episode, Joe Ross, professor of medicine at Yale, and The BMJ's US research editor, and Juan Franco, researcher at Heinrich-Heine-Universität and editor in chief of BMJ EBM are in the hot-seat. They will discuss new research on the effectiveness of antidepressants - based on all the individual patient data submitted to the FDA between 1979 and now. We'll take a look at a study of industry sponsorship of cost effectiveness analysis, and seeing similar patters of publication bias to RCTs. And finally we'll be talking about new research on the ongoing, and emergent pandemics - covid and monkeypox. Reading listResponse to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis https://www.bmj.com/content/378/bmj-2021-067606) Using individual participant data to improve network meta-analysis projects https://ebm.bmj.com/content/early/2022/08/10/bmjebm

Previous Doctor Informed episodes have discussed how to prevent patient safety issues from occurring, but sometimes situations are beyond anyone's control - like COVID. It can be hard to look back, especially if difficult decisions and compromises were made, including ones we did not completely agree with, or if there could be criticism of the way we responded. We ask how individual doctors, teams, and organisations could respond to and recover from major problems? In this episode, we're joined by Annelieke Driessen, a THIS Institute fellow and medical anthropologist. She is a research fellow at the University of Oxford and honorary assistant professor in medical anthropology at the London School of Hygiene and Tropical Medicine, who has spent hours listening to and understanding patient experiences of ICU during the pandemic. We'll also hear from Dominque Allwood, Chief Medical Officer at UCL Partners, and Director of Population Health at Imperial College Healthcare NHS Trust, who f

In this episode, Juan Franco, editor in chief of BMJ EBM, and Helen Macdonald, The BMJ's research integrity editor, sit down to discuss what's new in the world of evidence. Firstly, last week they went to the first EBM Live conference for two years - and report back on what happened when the evidence community got back together. We have two research papers looking at knees and shoulders, and finding out about the balance of risks and benefits. In covid news, we're still finding new symptoms associated with infection, 2.5 years after the pandemic started. We'll also hear how complex it is to research vaccine efficacy now. Reading list: Smell and taste dysfunction after covid-19 https://www.bmj.com/content/378/bmj.o1653 Serious adverse event rates and reoperation after arthroscopic shoulder surgery https://www.bmj.com/content/378/bmj-2021-069901 Viscosupplementation for knee osteoarthritis https://www.bmj.com/content/378/bmj-2022-069722 Waning effectiveness of BNT162b2 and ChAdOx1

As the Russian invasion of Ukraine continues, living under the uncertainty has become the new normal for thousands of patients with diabetes who are dependant on insulin. Supporting patients with non-communicable disease is the reality of all disaster situations now, and that added layer of complexity makes coordinating responses even harder. In this podcast, we'll hear how people with diabetes are being supported in Ukraine, and what is being done to improve things, despite the continued fighting. Our guests; Iryna Vlasenko, Vice President of the International Diabetes Federation Slim Slama, unit head for NCD management at the WHO Yaroslav Diakunchak, family physician in Brovary, Kyiv.

In this week's episode, Helen Macdonald is joined by Joseph Ross, US research editor for The BMJ, and Juan Franco, editor of BMJ EBM. They begin by discussing a review of obesity interventions in primary care, and Joe wonders if GPs are really the best people to tackle the issue. https://www.bmj.com/content/377/bmj-2021-069719 Cervical screening in the UK now includes HPV testing, and they look at research which examines whether this could mean longer periods between screening tests. https://www.bmj.com/content/377/bmj-2021-068776 They all enjoy a new State of the Art Review into Revascularization in stable coronary artery disease. https://www.bmj.com/content/377/bmj-2021-067085 Juan and Joe look at a review into combinations of covid-19 vaccinations - and wonder whether we'll ever see more trials to fit into this meta-analysis. https://www.bmj.com/content/377/bmj-2022-069989 Finally, they find out how your political persuasion has affected mortality in the US, with new researc

A recent investigation, by The BMJ, showed a worrying increase in incidence of violence, directed to wards GPs, and reported to the police. In this episode of Deep Breath in, Tom and Jenny are joined by Gareth Iacobucci, assistant news editor for The BMJ who broke the story. They'll hear from a GP affected, and get some advice on preventing violence, and deescalation, from two mental health experts, who deal with the most agitated patients. Our guests: Adam Janjua, a GP in Fleetwood, Lancashire. Marcela Schilderman, a consultant psychiatrist at South London and the Maudsley NHS Foundation Trust and Anita Bignell, a mental health nurse, at South London and the Maudsley NHS Foundation Trust Reading list Violent incidents at GP surgeries double in five years, BMJ investigation finds https://www.bmj.com/content/377/bmj.o1333

In Doctor Informed, we've been hearing a lot about the problems of healthcare, but we also want to talk about solutions. Whatever we're going to do to fix healthcare, whether that's bullying, or burnout, or patient safety - it's going to require change. And change is hard. In this episode Clara Munro is joined by Graham Martin, director of research at THIS Institute. They discuss the dreaded phrase "But it's always been done this way", and why failing is the path to success, and the true importance of listening. Our guests; Penny Pereira, Q managing director at the Health Foundation. Q helps promote improvement within the health and care system, encouraging and supporting a wide range of people to effectively lead improvement. https://www.health.org.uk/about-the-health-foundation/our-people/q-and-q-labs-team Moira Durbridge, director of safety and risk at University Hospitals of Leicester NHS Trust. Moira trained as a nurse, and continues to work clinically, as well as her

Helen Macdonald, The BMJ's research integrity editor is back with another episode, and this week is joined by Joe Ross, professor of medicine and public health at Yale, and US research editor for The BMJ, and Juan Franco, editor in chief of BMJ EBM, and Professor at the Instituto Universitario Hospital Italiano de Buenos Aires In this episode they discuss; The US supreme court looks set to overturn Roe v Wade, creating a patchwork of abortion provision across the U.S. We consider the role which evidence might play in documenting how health is affected by that decision, and whether medical evidence is being used at all in the debate. We'll give you a quick update on treatment for Covid-19 We know that trials are needed for new treatments, but in the face of an exponentially growing amount of observational data, is it time for a shift in that certainty? Joe tells us about his research into whether trials and observational studies of three drugs in covid produce the same answer? A

The influence of public health on politics, at least at the beginning of the pandemic, had never been stronger - but now it seems as hard to persuade politicians to pay attention as ever, yet political will is essential in making different sectors work together to create a healthier world. In this podcast, The BMJ's editor in chief, Kamran Abbasi is joined by Shyama Kuruvilla, senior strategic adviser at World Health Organization, and Kent Buse, director of the global healthier societies program at The George Institute for Global Health. They discuss examples of where multisectoral working has managed to bridge the gaps between sectors, and how healthcare needs to get political to make that success more widespread. This is part of the collection "The world we want: Actions towards a sustainable, fairer and healthier society" - https://www.bmj.com/pmac-2022

This is a special episode of our podcast for GP's, Deep Breath In, where we tackle the everyday challenges of being a GP. With the focus on covid, and the pressure on hospitals, it may be easy to overlook what’s happening in general practice in the UK - but changes are afoot. Our new health secretary Sajid Javid doesn’t seem to like our long standing GP practice arrangement, NHS England has imposed new weekend working arrangements on the already stretched service, and the workforce pressures continue. In this episode of Deep Breath In, our GP panel of Tom Nolan, Navjoyt Ladher, and Jenny Rasanathan are joined by Gareth Iacobucci, The BMJ’s assistant news editor, to give them the lowdown on what’s happening around primary care, who some of the key players are, and what his predictions for 2022. You can find Deep Breath In on all major podcast apps https://www.bmj.com/podcasts/deepbreathin

Paula Redmond, clinical psychologist who supports healthcare workers experiencing burnout and other difficulties related to their job. Before this, she worked for the NHS until she experienced bullying, and a lack of support from her organisation, which made her strike out on her own. In this wellbeing podcast, she describes the way in which her experience of bullying affected her, and how she used the creative process to help her move on. She and Cat Chatfield discuss what creativity actually is, and why small projects can be just as useful as big complex ones - depending upon what you need at the time. Futher reading: a Blog series on bullying in healthcare: https://drpaularedmond.com/category/bullying_in_healthcare/page/2/ a mindful embroidery craftivism project ("Do no harm but take no shit") https://drpaularedmond.com/donoharm/

Over the course of the last few years, the BMJ has published a series of articles in our Quality Improvement series - aiming to give those new to improvement science a good grasp of how to think about changing things in healthcare. Then covid-19 came along, and it seemed like all of healthcare was now aimed at just surviving in the face of the pandemic, and all thoughts of quality improvement projects went out the window... But did they? Cat Chatfield, is joined by Will Warburton, former director of quality improvement at the Health Foundation, and advisor on the series. To read all of the open access articles mentioned in the discussion, visit https://www.bmj.com/quality-improvement

In this episode we’re going to be talking about misogyny in surgery, recent revelations about sexual harassment in the theatre have emerged - but these behaviours have been endemic for a while, even as the profession seemed to ignore them. Joining Clara Munro is Baroness Helena Kenned, the author of a recent report into diversity in medicine, who, as a barrister, has long worked on discrimination cases. The reports mentioned in the episode are from the Royal College of Surgeons; https://www.rcseng.ac.uk/about-the-rcs/about-our-mission/diversity-review-2021/

In this episode of Talk Evidence, Helen Macdonald, the BMJ’s research integrity editor is joined by Joe Ross, US research editor, and Juan Franco, editor in chief of BMJEBM, to talk about all things evidence. Joe gives us an update about covid, including new research on safety of the vaccine Association between covid-19 vaccination, SARS-CoV-2 infection, and risk of immune mediated neurological events https://www.bmj.com/content/376/bmj-2021-068373 Juan updates us on a potential new prophylactic for recurrent UTIs, Methenamine hippurate, which could be an alternative to antibiotics. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women https://www.bmj.com/content/376/bmj-2021-0068229 Helen tells us about some research which evaluates the way in which intersecting identities combine to make students experience of medical school more difficult. Marginalized identities, mistreatment, discrimination, and burnout among US medical studen

The issue of food on nightshifts is a perennial grumble in the NHS, and though it might seem trivial, what does it say of an organisation if they demand their staff work when they're hungry, and what is the onward implication for that on patient care? To discuss all of these issues, we're joined by Neely Mozawala, a community specialist diabetes podiatrist, and Sahlia Saliha Mahmood-Ahmed, a gastroenterologist who have started the #24hrhotfoodfortheNHS campaign.

Medicine is complex, and as a doctor you won't always do the right thing - but you can prepare yourself for when mistakes happen, both emotionally and logistically. In this episode of Doctor Informed, Clara Munro is joined by Susanna Stamford, a patient who was on the receiving end of a mistake, which catalysed her interest in patient safety. We're also joined by Anthea Martin, from Medical Protection, who dispels some myths about saying sorry. Ayisha Ashmore returns to the pod to digest the lessons from our experts. Futher reading: The video that Susanna mentioned is available to watch on youtube bitly.com/ManagingAdverseEvents

The covid-19 pandemic has stretched healthcare staff like never before. As part of the 2022 Nuffield Trust summit, The BMJ hosted a roundtable discussion looking at why workers leave the NHS and how staff wellbeing and retention can be improved. Joining us to discuss are: Kamran Abbasi, editor in chief, The BMJ Billy Palmer, senior fellow, Nuffield Trust Lucina Rolewicz, researcher, Nuffield Trust Mark Britnell, global healthcare expert and senior partner, KPMG International Neil Greenburg, consultant occupational and forensic psychiatrist, King's College London's centre for military health research Rose Penfold, National Institute for Clinical Research academic clinical fellow in geriatrics Rammya Mathew, GP and quality improvement lead for Islington GP Federation Partha Kar, diabetes consultant and NHS England's national advisor for diabetes Danny Mortimer, chief executive of NHS Employers The Nuffield Trust report, "The Long Goodbye" which was discussed in this roundtable is a

In this episode of the podcast we’re going to be talking about rural healthcare - and specifically the difficulties that distance, demographics, and funding have introduced into the world’s covid-19 response. Rural regions made vulnerable by limited healthcare infrastructure, lower rates of vaccination, and opposition to government policies are the new frontlines in the pandemic, but support systems have not adjusted to the growing rural needs for health education, testing, vaccination, and treatment. Michael Forster Rothbart, Kata Karáth, and Lungelo Ndhlovu report from the US, Ecuador, and Zimbabwe

In previous episodes of Doctor Informed, we've talked about the importance of speaking out, but the culture in your organisation might not always make that easy, especially if you feel something has gone wrong and you might be blamed for it. Blame culture, no blame culture, just culture - there are many terms which are used to describe the environment in which individuals and teams work, the feel within a team and an organisation. In this episode we'll explore what they mean, why blame can be detrimental to patient safety, and give some tips on how to investigate problems without throwing blame around. Our guests in this episode; Joselle Wright - Deputy Director of Midwifery, Gynaecology and Sexual Health at Walsall Healthcare NHS Trust Susanna Stanford, who became involved in patient safety after experience of a spinal anaesthetic failing during a c-section in 2010. She is an ambassador for the Clinical Human Factors Group.

In previous episodes of Doctor Informed, we've talked about the importance of speaking out, and how to do that better, but as you progress through your medical career, you will become the person to whom those with problems will turn. In this episode we will explore listening. As a senior clinician, how can you make the space in your work to be a good listener, when what you hear might not be what you want to hear? Our guests; Megan Reitz is a professor of Leadership and Dialogue at Hult Business School. John Higgins is research director at The Right Conversation. Reading Speaking truth to power: why leaders cannot hear what they need to hear https://bmjleader.bmj.com/content/5/4/270

In the first Talk Evidence of 2022, we'll be asking about the evidence for isolation - now that isolation periods are being reduced, or even stopped in the event of a negative lateral flow test, we'll find out what data that's based on, and if it's appropriate. Vaccinations and treatments for covid-19 have been the one major success story of the pandemic, but that doesn't mean we should abandon the principles of openness and transparency when it comes to scrutinising the data - we'll hear what access to the data which underlies regulatory approval could do now. Finally, the impacts of climate change were set out in a WHO report in November last year - and recent weather seems to underline their conclusions. We'll discuss new evidence linking the environment and health, and ask what clinicians can do with that. Reading list: Mitigating isolation: The use of rapid antigen testing to reduce the impact of self-isolation periods https://www.medrxiv.org/content/10.1101/2021.12.23.2126832

In the previous episodes of Doctor Informed, we've heard why it's so important to talk about patient safety concerns, and some of the mechanisms that allow hospital staff to raise them, but knowing why and how doesn't always make it easier to speak out. In this episode we're exploring the concept of a voiceable concern – identifying what counts as a concern, and what counts as an occasion for voice by an individual, is not a straightforward matter of applying objective criteria- for example how do you tell if you're witnessing poor practice, or just something that lies outside your area of understanding? Or how do you know if the common practice in this particular ward is actually an outlier when looking at other hospitals? Our guests this week; Mary Dixon-Woods is director of THIS Institute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a h

Rachel Levine Trained as a paediatrician, before becoming firstly the state of Pennsylvania's Physician General, then its Health Secretary. During president Joe Biden's administration, she was nominated to become the U.S.'s assistant secretary of health. That lead to her becoming a four-star admiral in the U.S. Public Health Service Commissioned Corps, and thus the first openly transgender four-star officer in the US. In this podcast, we discussed the pandemic - but also wider problems affecting Americans' health, notably climate change, inequality and the opioid crisis. We also discuss the health and care of LGBT+ people, in the U.S, and around the world. This interview was recorded on the 16th of December 2021.

The BMJ has special criteria for considering Christmas research: first it should make you laugh, and then it should make you think. In this festive episode of the Talk Evidence podcast, our regular panel of Helen Macdonald and Joe Ross are again joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine. They’ll give you a peek into what makes for good Christmas research, and why what may seem silly on the surface has a deeper meaning.

As clinicians, we're all taught that patient safety is everyone's responsibility - but on the ground it can be hard to know how to most effectively report concerns, especially if you're not sure how those concerns will be received. In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore, and they ask "who is actually responsible for patient safety?" To answer that we're joined by 2 guests Bill Kirkup, independent investigator who has worked on the reports into failings in Mid-Staffordshire, and Gosport. Henrietta Hughes - GP, and the NHS's first guardian, Henrietta championed the creation of freedom-to-speak-up guardians in the English NHS, to ensure that clinicians are able to freely speak out.

Fiona Godlee is stepping down as Editor-in-Chief of The BMJ after 16 years in the position. She was the first female editor of the journal, and over her tenure has seen a lot of changes - both to the publication she's run, and to the wider world of medicine. To mark her departure, Helen Macdonald sat down with Fiona to ask her a bit about those early days at the journal, on her view of women taking leadership roles in medicine, on her thoughts about some of the big issues facing science, and what is coming next. Note from the editor; apologies for the audio quality in the first half.

In this second podcast focussing on the covid response in South Asia, we’re focussing on the intersection of conflict and covid in the region. The pandemic has highlighted the underlying weaknesses in many health systems - but could it also be used as a catalyst for change, and be a step towards easing tensions? To discuss this, Kamran Abbasi, executive editor of The BMJ, is joined by Zulfiqar Bhutta, head of the Institute for Global Health and Development, Aga Khan University, and Arun Mitra senior vice president of Indian Doctors for Peace & Development. To read more; Conflict, extremism, resilience and peace in South Asia; can covid-19 provide a bridge for peace and rapprochement? https://www.bmj.com/content/375/BMJ-2021-067384

In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore - and they're getting to grips with being a compassionate colleague. While the topic might seem warm and fuzzy, there's some good hard science to suggest that compassionate leadership at every level of healthcare can make a huge difference to staff, and improve patient outcomes. Most people innately have the skills need to be compassionate colleagues - but often the pressures of the job can make it the lowest of priorities in our everyday interactions. Our two guests this week think that's wrong though - and say that compassionate leadership is one of the most important things to get right. Joining us are, Michael West, senior fellow at The King's Fund and professor of Work and Organisational Psychology at Lancaster, and Bob Klaber, consultant general paediatrician and director of strategy, research and innovation at Imperial College Healthcare NHS Trust Michael has written the book on compassionate lead

In the wellbeing podcast, the dread topic of phone usage has come up again - how social media, and an "always on" culture can affect our wellbeing. But knowing that, and changing our behaviour are two different things - so to give some advice on reducing our reliance on phones, Abi and Cat are joined by Nidhi Gupta, assistant professor of pediatrics at Vanderbilt University Medical Center, who's been using techniques from behavioural addiction to help with device usage. For more from Nidhi, visit https://phreedom.net/ Some of the research that Nidhi mentions https://publications.aap.org/pediatrics/article/138/5/e20162591/60503/Media-and-Young-Minds A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children https://pubmed.ncbi.nlm.nih.gov/18316661/ Distraction: an assessment of smartphone usage in health care work settings https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437811/ Treatment Considerations in Internet and Video

When you hear the reports from a major patient safety issue, it will be shocking to hear how they have played out - but the patterns in behaviour, of people and institutions which have gone disastrously wrong, can be seen throughout healthcare. As this first series of Doctor Informed unfolds, we'll be exploring these patterns, and bring you evidence and expertise on tackling them - Doctor Informed is about going beyond medical knowledge to make you the best doctor you can be. In this first episode we're talking to experts who have seen these patterns firsthand, and whose work is all about tackling them; Bill Kirkup is a clinician turned investigator - he's led investigations into failings at a maternity and neonatal unit in Morcambe Bay, into the Oxford paediatric cardiac surgery unit and into Jimmy Savile’s involvement with Broadmoor Hospital. He was also a member of the Hillsborough Independent Panel Mary Dixon-Woods is director of THIS Insitute, and a Health Foundation Profe

In this month’s Talk evidence, we’re going back to our roots and avoiding covid - so sit back and listen to Helen Macdonald and Joe Ross discuss a new nutrition study to prevent fractures in older adults by eating dairy, and a meta-analysis which helps you choose pain relief medications for management of osteoarthritis. We’ll hear from Steven Woloshin about the virtual Overdiagnosis conference, and why he’s so excited about a new category in the National Library of Medicine. Finally, we have a study on urinary retention and risk of cancer that has been over 25 years in the making. Reading list; Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care https://www.bmj.com/content/375/bmj.n2364 Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis https://www.bmj.com/content/375/bmj.n2321 To access the webinars Steven was talking about. https://www.preventingoverd

Doctor Informed is a new podcast for hospital doctors, from The BMJ - created in collaboration with THIS Institute, and sponsored by Medical Protection. Medical expertise is fundamental to the practice of medicine. But other skills and knowledge are important too. Doctor Informed gives the inside story on the evidence about giving the best care and having positive relationships with patients and colleagues. In this trailer, meet two of the hosts of Doctor Informed - Clara Munro, a surgical trainee in the North East Deanery, and Jenni Burt, senior social scientist at THIS Institute. www.bmj.com/podcasts/doctorinformed

It's easy to decide to do something like exercise, or a hobby to improve your wellbeing, but actually following through and make that a regular part of your week can be much harder. In this podcast, Pedro Delgado, vice president of the Institute for Healthcare Improvement, joins Abi and Cat to explain how he turned some of the QI methodology he's been taught over the years on himself, and improved his wellbeing during the pandemic. www.bmj.com/wellbeing

In this podcast series, Kamran Abbasi, executive editor of The BMJ will convene experts from South Asia to discuss how the pandemic has affected the region, how measures like lock-down and vaccination have been handled, and the impact of the pandemic on the social determinants of health. In this first podcast, we're focussing on India and Nepal, and are joined by; Srinath Reddy, president of the Public Health Foundation of India. Biraj Swain, who works in global development in Asia and East Africa, is a senior media critic and Buddha Basnyat, director of the Oxford University Clinical Research Unit in Nepal. For more covid coverage www.bmj.com/coronavirus

This week our regular panelists, Helen Macdonald and Joe Ross, are joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine - to take a primary care focussed look at what's been happening in the world of evidence. On this week’s episode. As kids go back to school, winter bugs surge and pressure mounts on health services we look at two trials which aimed to use reduce antibiotic prescribing for respiratory tract infections in nursing homes and primary care Juan brings us an update on prescribing medicinal cannabis for pain, based on a recent BMJ rapid recommendation article and linked systematic review and meta-analysis And finally, in covid news, how likely are you to be admitted or die from covid after one or two SARS-CoV 2 vaccinations? Reading list Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents - https://www.bmj.com/content/374/bmj.n2198 Procalcitonin and lung ultrasonog

There has been a lot of work on the way in which surgeon's are affected by tiredness - and the whole medical workforce can probably relate to their experience. But there's a difference between tiredness and fatigue, and that difference might be important in understanding what's happening in your own life. Dale Whelehan is a physiotherapist, and PhD candidate at Trinity college Dublin, where he is investigating behavioural psychology and the effect of tiredness and fatigue on surgeons - in this podcast he describes how he thinks about those two things, what we know about the effect on wellbeing, and some strategies which might help manage them.

The infrastructure of Afghanistan healthcare is under threat, as international agencies who run clinics withdraw from the country. At the same time, some of the healthcare workforce are leaving the country, while those who remain face the prospect of their wages drying up as the economy of the country collapses. But there remain people dedicated to providing healthcare, and in this podcast we hear from, Wais Mohammad Qarani, president of the Afghanistan Midwifery and Nurses Council, about what changes might be seen under the new regime, and what needs to be done to support care in the country.

The final evacuation planes have left Kabul airport, and Afghanistan’s government have ceded power to the Taliban. Amongst the international community, worries about what that transition of power means for the people of Afghanistan have centred around the rights of women, access to education for the whole population, and the continuing prosperity of the country… However what this means for health is still uncertain. Nadia Akseer is an Afghan scientist and epidemiologist, now working at John's Hopkins Bloomberg School of Public Health and who has published extensively the health of her home country Reading list; Achieving maternal and child health gains in Afghanistan https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30002-X/fulltext Association of Exposure to Civil Conflict With Maternal Resilience and Maternal and Child Health and Health System Performance in Afghanistan https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2754253 Coverage and inequalit

In this month's Talk Evidence, Helen Macdonald and Joe Ross are back with a wry look at the world of Evidence Based Medicine. They give us a round up of real world data emerging to address various uncertainties about vaccinations against covid Helen has an update on NHS Digital’s project to extract GP coding for planning of healthcare and research, and talks to Natalie Banner from Understanding Patient Data, to find out what the public really cares about. Finally, as routine care must go on a clinical review on cardiovascular disease in older adults introduces us to geroscience. Reading list Vaccines; Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study - https://doi.org/10.1136/bmj.n1943 Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study - https://doi.org

The Midlands Charter, is a set of principles that hospitals in the midlands region of England have signed up to, to improve the health and wellbeing of trainees working in the area. It was created in a huge collaboration of trainees, NHS England, Health Education England and the GMC. Dan Smith is a junior doctor at Nottingham University Hospitals NHS Trust, and one of the authors of that charter. He joins us to explain how they're QI thinking to improve doctors wellbeing, and how other areas can follow their lead. Read the full charter: https://www.england.nhs.uk/midlands/information-for-professionals/nhs-midlands-charter/ To join the collaborative https://future.nhs.uk/MidlandsCharter/grouphome

Rota gaps are a big problem when it comes to loading stress on the medical workforce, and there is big pressure to spread the workforce as evenly as possible across wards and shifts. However the tyranny of the rota - especially when changing rotations or working across multiple sites, means that often doctors personal wishes, or big life events are not taken into account. The dehumanising status of becoming just a number in the system is not helping people have the kind of fulfilling careers that encourages people to stay within the workforce, and helps guard them from burnout. So how do we square that circle? Anas Nader, CEO of Patchwork Health, joins us to talk about why his own burnout lead him to try and fix the rota problem - and where he has got to now. Findout more at: https://www.patchwork.health/ Note - BMJ company has invested in patchwork health

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities www.bmj.com/gender In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive. As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions. In this podcast, we're joined by lawyer and activist Hina Jilani, who has been campaigning for women's rights in her native Pakistan for h

In the wellbeing podcast, we have had a lot of personal experience of the pandemic, and schemes to support staff - but always we've wanted to know if there's research which can tell us how universal those experiences have been. In this podcast, Abi and Cat are joined by Danielle Lamb, senior research fellow at University College London, and Sam Gnanapragasam, clinical fellow in psychiatry at South London and the Maudsley NHS Trust. Danielle and Sam are both investigators on NHS Check - a representative survey of NHS staff about their mental wellbeing during covid-19. https://nhscheck.org/

The 19th of July in the UK saw the relaxation of covid rules that have been in place for 18 months - social distancing requirements in venues, mask wearing in public will no longer be legally mandated. There are a lot of questions about what this will mean for the pandemic, and in this episode of Talk Evidence Helen MacDonald, Joe Ross and Duncan Jarvies are joined by Iain Buchan, professor of public health in Liverpool, who has been involved in 2 key studies on covid transmission. Firstly, lateral flow tests - the big questions has been how well do they work in the wild - and how well do they have to work, to be useful in test trace and isolate? Iain tells us about new research into the innova test. Secondly, events - the football has shown that events can still be a big source of transmission, and the UK government put in place a number of trial events, all carefully monitored by public health researchers - Iain tells us about one nightclub test in Liverpool, and what we can glea

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities www.bmj.com/gender In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive. As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions. In this first podcast, Lulit Yonas Mengesha talks to Cara Tannenbaum Lulit Yonas Mengesha is right at the beginning of her medical career

We know the pandemic has disproportionately affected the NHS workers who come from a ethnic minorities, we also know that doctors from an ethnic minority face additional barriers to accessing support - so how well have the various support schemes put in place during the pandemic helped those doctors from ethnic minorities? Dammie Olubawale, medical student and grants and partnerships manager at Melanin Medics, joins us to talk about a fund they've created specifically to help doctors of black African and Caribbean heritage, to access support tailored to them. Dammie explains some of the reasons which doctors, particularly from that heritage, may be more reluctant to access support - and how organisations large and small need to think about tailoring their wellbeing initiatives to include all staff. To access the melanin medics wellbeing fund visit https://www.melaninmedics.com/wellbeing-fund

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities https://www.bmj.com/gender In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive. As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions. In this first podcast, Adrienne Germaine talks to Fila Magnus. Adrienne starter her career as an activist for women's health in t

In this Talk Evidence, Helen Macdonald, Joe Ross and Duncan Jarvies discuss what's going on in the world of EBM. Firstly, a while ago on the podcast, we concluded that excess mortality would be the best way to measure the impact of the pandemic - and now a new paper looks at different country's excess mortalitites over the past year. We're joined by author Nazrul Islam Physician-Epidemiologist at the University of Oxford (and a research editor for The BMJ) to talk about why comparisons may still not be sensible. Read the full research here - https://www.bmj.com/content/373/bmj.n1137 The Delta variant is dominating headlines, and infections in the UK now - but until recently the Alpha one was ascendent, and new research has helped characterise how the mortality rate of that variant differed from previous viruses. We discuss how that research was done. Read the full research - https://www.bmj.com/content/372/bmj.n579 GP data in the UK - the planned cut-off for granting access to yo

We've been bringing you stories of doctors wellbeing for a while in the podcast, but we noticed a pattern. Woman would come on and talk about their own difficulties, men would talk about other peoples - so we wanted to dive into that a bit, and called out on twitter for men who would be willing to open up to our listeners about their own mental health. This interview is with Zeshan Quereshi - registrar in paediatrics, author and TedX talker. In this conversation we talk about why it is that men are particularly disinclined to open up about their difficulties at work, and what Zeshan has done to try and support his own. Zeshan's TedX talk https://www.youtube.com/watch?v=uctoTk64GVM

Finally it seems that life might return to normal in the UK, as the vaccination efforts continue apace, and despite concern about increasingly spreading variants, our hospitals are not being overwhelmed. Because of this, we are changing our approach to covering the pandemic - and taking this second wave podcast to pastures new, but before that, in this last episode we’re going to look backwards and forwards, at the UK’s response. On the panel today are Matt Morgan, consultant in critical care, Nisreen Alwan, associate professor in public health, Partha Kar, consultant in diabetes, and Helen Salisbury, GP. www.bmj.com/coronavirus

The pandemic has wrought a lot of change, not least to doctors relationship to their careers. While still loving the patient interaction, we're increasingly hearing that doctors are disillusioned with the other aspects of medicine. If you're feeling that way, there are ways to structure your thinking to help you make sense of your career. In this podcast Claire Kaye, former portfolio GP and now coach, explains how she went about deciding medicine wasn't for her, and how she helps doctors go through that process too. You can find Claire at https://www.drclairekaye.com/ https://www.instagram.com/drclairekaye_executivecoaching/

In this week's Talk Evidence, Joe Ross, BMJ editor and professor at Yale again joins Helen Macdonald to talk about emerging evidence on Covid-19. They also welcome to the podcast Juan Franco, family physician in Buenos Aires, and professor at the Instituto Universitario Hospital Italiano, and new editor-in-chief of BMJ Evidence Based Medicine. This week, the team bring you updates on; Post-covid syndrome in individuals admitted to hospital with covid-19 - how are people with long covid faring. Finally published research from Scandinavia on the risk of thrombotic events after administration of the Oxford-AstraZeneca vaccine - how big is the risk, and what does that mean for the overall benefit of that vaccine. How difficult the UK population found it to understand and stick to the rules with our test, trace and isolate system - and some of the questions that this raises for this public health approach. and finally, research that showed non-drug interventions are as good as pharmac

This interview is part of our BMJ interview series, where we talk to the people who are changing medicine. The series thus far has been a bit male dominated - reflecting the leadership in medicine at the moment, if not the actual workforce. One woman who's planning to change that is Roopa Dhatt, executive director of Woman in Global Health - a new grassroots organistion which is making waves with its demand for equality of representation for woman in global health decision making. In this interview, we talk to Dr Dhatt about the genesis of Woman in Global Health, and how they've managed to cement real commitment from the WHO. We also discuss how her experience of being Indian and American has shaped her understanding of equality in medicine, and how the covid-19 pandemic has highlighted the way in which women are discounted.

In medicine, a lot of work has been done to encourage person centred care - but can that maxim be extended to the people working within the healthcare system? Subodh Dave has just been elected as dean of the Royal College of Psychiatrists, and joins us fresh from talking at the International conference on physician health to speak about his ambition to humanise medicine. In this podcast, Subodh, Abi and Cat discuss what lessons from the pandemic need to remain, why at this time it's really important to look out for your colleague with family overseas, and how ice cream trucks meant much more than a cold treat. www.bmj.com/wellbeing

On this wellbeing podcast, Abi and Cat are joined by Emma Lishman, a clinical psychologist and part of the North Bristol NHS Trust's staff wellbeing team.Emma helps doctors return to training after a break - be that for maternity leave, or covid-19. Emma describes some of the fears that doctors who have been shielding have expressed coming back onto the ward, the ways in which teams may inadvertently make those worse, and the problems with complying with risk assessments in the face of staffing pressures. Wellbeing podcasts have focused a lot on the importance of openness about mental health in the NHS, but in this podcast, you'll also hear how reluctant clinicians are to discuss physical health problems - and why the taboo around all aspects of illhealth needs to be tackled. For more wellbeing https://www.bmj.com/wellbeing

Recorded on Tuesday 13th of April, as the shops open in the UK, and England is heading to the beer gardens. The roll out of the vaccination programme has completed its first phase, and second doses have been given to the most vulnerable people - and now the under 50s are starting to get their first doses. In this podcast, Duncan Jarvies, multimedia editor for The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire. The genomicc trial Matt mentions is still recruiting - if you're interested more detail is available here https://genomicc.org/

The synergistic linking of increasing health and wealth is broadly accepted - it's an integral part of the thinking between the Sustainable Development Goals, and the World Bank's call for universal healthcare as a way of boosting a country's economy. But the quantification of that link - the extent to which a particular health intervention, has broader economic impacts, is actually pretty poorly understood. In this podcast, we hear from some economists, who have an idea about how we could - fairly easily - measure those impacts at the same time we measure clinical efficacy. Joining us are, Dean Jamison, professor emeritus of global health at the University of Washington Osondu Ogbuoji, assistant research professor at Duke Global Health Insitute. Till Bärnighausen, director of the Heidelberg Institute of Global Health Sebastian Vollmer, professor of development economics at the University of Göttingen The collection that prompted this discussion is "Health, Wealth and Profits

The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined again by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale. This week we update you on treatment - the WHO's guidelines for covid and ivermectin, and why they're not ready to recommend it's use in treatment, and prophylactic anticoagulation treatment. We hear about two papers from the UK and Switzerland which look at children and covid, and we pick up on varients of concern and long covid. Reading list. Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England https://www.bmj.com/content/372/bmj.n628 Clustering and longitudinal change in SARS-CoV-2 seroprevalence in school children in the canton of Zurich, Switzerland: prospective cohort study of 55 schools https://www.bmj.com/content/372/bmj.n616 Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: mat

In the UK, phase 2 of our coronavirus vaccination strategy may be delayed by supply problems, at the same time many GPs, who carried out the majority of the first vaccination phases, are declining to take on the addition burden and are trying to return to normal clinical work. In this podcast, Duncan Jarvies, multimedia editor for The BMJ, talks to the full panel; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton.

In this Wellbeing podcast, sponsored by medical protection, Abi Rimmer and Cat Chatfield talk to Susanna Petche and Reina Popat, GPs and members of First You - an organisation of healthcare workers, promoting wellbeing in the NHS. They discuss why it is that clinicians learn to subjugate their own wellbeing to their patients', and the ways in which working in the healthcare system perpetuate that. They discuss how systemic change can come through individual action, and how peers can band together to support each other.

This round table, recorded at the nuffield summit 2021, asks what does following the science actually mean - do ministers understand the nuance of the science in the pandemic, and how does uncertainty get interpreted through the lens of ideology and the power of compelling stories. Taking part are: Kamran Abassi, executive editor of The BMJ Partha Kar, consultant in diabetes and endocrinology Deborah Cohen, health correspondent for BBC Newsnight Tom Sasse, associate director at the Institute for Government Christina Pagel, professor of Operational Research at University College London Matt Morgan, intensive care consultant Andy McKeon, chair of the Nuffield Trust Isobel Hardman, assistant editor of The Spectator Mary Dixon-Woods, director of This Institute Ben Page, chief executive of Ipsos MORI Alexandra Freeman, executive director of the Winton Centre for Risk & Evidence Communication Will Moy, chief executive of Full Fact Nigel Edwards, chief executive of the Nuffield Trust

In a slightly different talk evidence, Helen Macdonald and Duncan Jarvies are bringing you a couple, of in depth interviews, Firstly, Anthony Harnden, GP, academic and member of the UK's Joint Committee on Vaccination and Immunisation takes us inside their decision making, and explains what evidence they look at, how they assess it, and what the next year of vaccination may look like. Also in this episode, Gordon Guyatt, one of the founders of EBM, joins us to talk about Grade - the framework in which evidence for guidelines can be assessed - and explains why the most important thing is not the RCTs, but being very clear about what the guideline is supposed to achieve. https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation https://www.gradeworkinggroup.org/

Never has the spotlight been as strong on a clinical trial as that on the Pfizer BioNTech vaccine, the first approved for covid-19. In this interview, Joanne Silberner spoke to its lead principal investigator, Stephen Thomas chief of infectious diseases at SUNY Upstate Medical University, New York, became the lead principal investigator for one of the most closely watched clinical trials in history. They discuss the moment the positive results came through, what will happen to the people who are still enrolled in the trial, but got a placebo dose, and why the trial was designed in the way it was. www.bmj.com/coronavirus

Many surgeries have been cancelled during the pandemic, with good reason, as early data showed the increase in mortality associated with a coronavirus infection, but now waiting lists grow, and there are questions about how the NHS will pick up the slack. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to the full panel; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton. They are joined by Mary Venn, research fellow, and honorary surgical registrar in London, who's been looking into the pandemic's effect on surgery. For more on that research: http://nihrglobalsurgery.org/surgeryduringcovid To register for our covid known unknowns webinar - https://www.bmj.com/covid-19-webinars

Ashling Lillis is a now consultant in acute medicine at Whittington Health NHS Trust, but she was almost a consultant in intensive care medicine - but a mental health crisis just 6 months before she qualified made her reassess her career, and choose a different path. In this podcast, Ash talks to Abi and Cat about the difficulty many doctors have when discussing their mental health - and how speaking out about her own experiences, has encouraged others to talk to her privately - and opened her eyes to the extent of the problem in the NHS. www.bmj.com/wellbeing

Jeremy Farrar, is director of the Wellcome Trust, as well as advisor to the government on SAGE. Trained as a medic and with a PhD in neuro-immunology, he was a professor of Tropical Medicine and Global health at the University of Oxford. In this podcast, he tells us why he thinks that vaccine nationalism is a very short-termist response the pandemic, and why he's bullish about new variants of the SARS-CoV-2 virus. www.bmj.com/coronavirus

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton. This week our special guest is Rachel Clarke, author and palliative care specialist. The panel discuss how end of life care has changed in the pandemic, and how clinicians have become targets of abuse on social media, for speaking out about things like masks and hospital capacity.

The observation period, after receiving a covid-19 vaccination may be the only 15 minutes someone in the NHS might get all day. In this podcast, we're joined again by Chris Bu, psychiatry trainee who has previously spoken to us about how Burmese Buddhism helped him in his training. He takes us through a guided mindfullness meditation, tailored to that post-vaccination period, to help you make the most of your observation time. www.bmj.com/wellbeing

The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale. This week we pick up on a preprint in medRxiv, which has been attracting attention on social media - it tries to look at the longer term effects of covid hospitalisation. Joe explains why he thinks propensity matching can be summarised as "doing your best". Finally, as more and more care moves remotely, we discuss a trial on a digital intervention to help manage poorly controlled hypertension remotely. Reading list: Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study https://www.medrxiv.org/content/10.1101/2021.01.15.21249885v1.full.pdf Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial https://www.bmj.com/content/372/bmj.m4858<

Neil Greenberg is a psychiatrist, and professor of Defence Mental Health at King's College London. He spent 23 in the military, and now continues to work with them on things like peer led traumatic stress support packages. A recent survey of NHS staff showed disturbing signs that covid-19 has caused a widespread trauma in staff, so in this podcast we talked to Neil about trauma and moral injury, what some of the warning signs are, and what individuals and organisations can do to help their colleagues. www.bmj.com/wellbeing

Jeremy Hunt probably needs no introduction to our audience - the UK's longest serving health minister, he now chairs Westminster's Health and Social Care Committee - the powerful committee that holds the government to account for its policy choices. In this interview Gareth Iacobucci asks Hunt if he regrets his decision to impose the contract on junior doctors which lead to their industrial action, how workforce issues have left the NHS in a poor state to deal with a health emergency. They also talk about the potential for a public enquiry into the government's handling of the pandemic, and what an upcoming committee report into the same issue might find.

The "public health emergency of international concern" was issued by the WHO a year and a lifetime ago. As the UK ramps up testing for the South African virus variant, and is full steam ahead on vaccination, we look back at what we've learned in that time. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire. They talk about working in the NHS at the moment, the utility of international comparisons, and their remaining questions about vaccination regimes. www.bmj.com/coronavirus

It’s been just over a year since the WHO declared the pandemic a “Public Health Emergency of International Concern” - if you cast your mind back to then, the news was full of reassurances about how prepared the UK and the USA were for a pandemic. Now a year later, with the benefit of hindsight, that confidence was wildly overstated - but why was that, what is the gap between that theoretical readiness, and reality. In this podcast we're joined by talking to Tom Frieden - former director of the Centres for Disease Control and Prevention, under President Obama, and who has a long history of public health leadership. He talks about the gap between the apparatus to do something, the the political will to do that. Why data have been lacking, and the interaction between a infectious and non-infectious diseases. www.bmj.com/coronavirus

Recorded on the 26th January 2021 The UK has become, officially, the worst performing country in terms of Covid-19 deaths, per head of population - and the number of people in hospital is still higher than at any point in the pandemic. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire. They talk about working in the NHS at the moment, and the challenges in things like oxygen and vaccine supplies. How the pandemic has exposed a gap in general medicine, and the importance of challenging poor responses at all levels.

In the UK, over 37,000 people are in hospital with covid-19, and the NHS comes closer than ever to being overwhelmed - though 4 million people have received their first dose of the vaccine, we are warned that things will get worse before they get better. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton, about the pressure on hospitals, why GPs are questioning the need for max vaccination centres, and why the public health approach can't be just lockdown and vaccinations. www.bmj.com/coronavirus

US president elect Joe Biden wasted no time in appointing a special advisory board of experts to guide America out of its coronavirus crisis. One of those experts is Celine Gounder, an infectious diseases epidemiologist who has worked on Ebola, tuberculosis, and HIV in Africa and South America. She’s a clinical assistant professor of medicine and infectious diseases at New York University’s School of Medicine, as well as an active writer and podcast host, including of Epidemic In this podcast she talks to Joanne Silberner about the ways in which the taskforce is helping prepare for action immediately after the inauguration, what the big challenges they need to tackle are, and how they plan to rebuild trust in the U.S. covid response. https://www.bmj.com/content/372/bmj.n33

In this episode of Talk Evidence, Jon Deeks, professor of biostatistics at the University of Birmingham, returns to the pod with an update on lateral flow tests - and why the government plan for using them in asymptomatic screening for covid-19 doesn't follow the science. We're also joined by Allyson Pollock, clinical professor of public health at Newcastle University, and author of a recent editorial in The BMJ about asymptomatic transmission of SARS-CoV-2. She explains why she thinks supporting social isolation is the missing piece of our approach to tackling the pandemic. Covid-19 INNOVA testing in schools: don’t just test, evaluate https://blogs.bmj.com/bmj/2021/01/12/covid-19-innova-testing-in-schools-dont-just-test-evaluate/ Asymptomatic transmission of covid-19 https://www.bmj.com/content/371/bmj.m4851

Andrew Pollard is Director of the Oxford Vaccines Group - who, along with Astra Zeneca, have developed an modified adenovirus vaccine for SARS-CoV-2. In this interview we talk to him about the development of that vaccine - what he thinks about the UK government's plan to increase the interval between doses; if he worries about a mutating virus and vaccine escape; and how the university came to make a deal with a commercial company to provide cost-price vaccinations for the world. www.bmj.com/coronavirus

The Samaritans have traditionally been there for people in a crisis, those who are on the verge of ending their life by suicide - but during this pandemic, with the personal toll of caring for covid-19 patients, they are also here to provide emotional support for NHS staff however they are feeling. In this podcast, Ben Phillips, head of service programmes for Samaritans joins us to explain how being listened to can help - and how to tactfully point your colleagues towards that emotional help if you feel they need it. If you need support at this time you can call 0800 069 6222 or visit https://www.samaritans.org/how-we-can-help/health-and-care/

The growth in the need for food aid, in the UK, has been staggering. That's why The BMJ has chosen the Independent Food Aid Network (IFAN) as its annual charity appeal. Nutritional guidelines which work for everyone is difficult, even harder for food aid providers who have to factor in things like long term storage, reduced access to fresh produce and in some cases the inability to afford the electricity to cook with. In this podcast, Sabine Goodwin, IFAN's coordinator is joined by Isabel Rice, dietician at the charity Centrepoint, and Dee Woods, co-chair of IFAN and who co-runs Granville Community Kitchen, a food aid provider in London. Please time the time to donate at; https://www.foodaidnetwork.org.uk/bmj

Recorded Tuesday 5th Jan 2021 As the UK enters lockdown, again, schools are closed, the NHS struggles under the surge of cases, new variants of SARS-COV-2 virus stalk the world, and vaccination programmes make a faltering start. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton, about the pressure on critical care, England's vaccination roll out, the closure of schools and why communication is undermining trust in the vaccines. All the BMJ's corona virus coverage is currently free to access www.bmj.com/coronavirus

The BMJ has long campaigned for better patient and public participation in research, making the case that it leads to better outcomes for patients and for society - but an article published in the Christmas edition of The BMJ goes further than that - and talks about the insights that participants in research provide- insights that the academic team would never be able to have themselves. In this podcast, Seb Crutch a professor of neuropsychology, and Martin Rossor, national director for dementia research - who have been involved in neurological research as academics, and also by Valerie Mansfield, who’s a member of a patient support group, discuss how the scientific establishment can recognise those invaluable insights. Read the full article: https://www.bmj.com/content/371/bmj.m4478

As 2021 hoves into view, we look back at a year of extraordinary evidence. Helen Macdonald is joined by Joe Ross, one of The BMJ's research editors, as well as a researcher at Yale. They discuss the way in which clinical pre-prints have become an important part of the research ecosystem, especially during the pandemic, and pick up on some of the non-coronavirus things you might have missed in the deluge of data.

In this end-of-year podcast from Deep Breath In, we're bringing you a light hearted look back at 2020, and trying to remember some of the non-covid-19 medicine that has crossed our desks. This festive quiz features the deep breath in gang, as well as Cat Chatfield from the Wellbeing podcast, and Helen Macdonald from our Talk Evidence podcasts. Reading list; Thyroid disease assessment and management: summary of NICE guidance https://www.bmj.com/content/368/bmj.m41 Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline https://www.bmj.com/content/365/bmj.l2006 Judd Brewer's advice for coping with burnout https://drjud.com/

If you've had time to digest this year's Christmas edition of The BMJ, you might have wondered how those papers get into The BMJ. Well in this Talk Evidence podcast, Helen Macdonald, UK research editor at The BMJ talks to two of her research team colleagues, John Fletcher and Tim Feeney, as they talk through why they chose their favourite papers. Toxicological analysis of George’s marvellous medicine https://www.bmj.com/content/371/bmj.m4467 Does medicine run in the family—evidence from three generations of physicians in Sweden https://www.bmj.com/content/371/bmj.m4453 The time to act is now https://www.bmj.com/content/371/bmj.m4143

How do human behaviours affect patient outcomes? And what has that got to do with Christmas? Graham Shaw, director of Critical Factors, and Peter Brennan, a maxillofacial surgeon in Portsmouth, join us to explain what human factors are, why they’re not a bigger part of medical training, and talk about their importance as the NHS comes under greater and greater pressure because of the surge in covid-19 cases. They also offer a word of advice to Santa, about making sure a festive never-event never happens. www.bmj.com/wellbeing

Every year, the BMJ has a charity appeal - we’ve regularly focused on organisations like MSF, or Lifebox - providing support to areas of the world which don’t have good healthcare provision… This year though, covid-19 has changed everything - and we’re focussed inwards, on the UK. With growing unemployment, sections of the population being laid off, and with the well documented delays in receiving universal credit - food insecurity has become a major issue in the sixth largest economy in the world. In this podcast Martin Caraher, emeritus professor of food and health policy at City University of London, explains how this crisis is a long time coming, and the result of the inattention of successive governments to the issue of hunger. We also hear from Sabine Goodwin, coordinator of the Independent Food Aid Network, the recipients of this years award funds, about how the their network is being affected by the covid-19 pandemic, and how your money will be used to supports food banks,

Until hear death in 2019, Annabel and her husband James Weaver, spent a lot of time together in hospitals - in patient and outpatient wards, waiting in makeshift waiting rooms in corridors and atriums. And while you or I might notice things about the way in which the hospital looks - James and Annabel noticed the way in which is sounded. James is perusing a PhD at Queen Mary University of London into acoustics and the intelligibility of sound - and in this podcast we delve into the sound of a hospital, and why it can make communication between staff and patients so hard. Read James's Christmas article, The sound of medicine https://www.bmj.com/content/371/bmj.m4682

Robert Poynton is an associate fellow of the Saïd Business School at the University of Oxford, and author of books designed to help people work in ways which help both their career and wellbeing. In this wellbeing podcast, we focus on "Do Pause; you are not a to do list" - a book that Cat has had on her to do list for months. Rob explain to us what the concept of "pausing" is, and why he thinks a small gesture can have a significant effect on our ability to deal with the stresses of day to day work life. Rob's books are available on Bookshop Do Pause https://uk.bookshop.org/a/98/9781907974632 Do Improvise https://uk.bookshop.org/a/98/9781907974014

As London and some neighbouring counties move up to tier 3, and Germany, Italy and The Netherlands impose tighter restrictions over over the coming days of Christmas, in this podcast we ask - should Christmas gatherings be cancelled? In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire. They're joined by Mike Tildesley, reader in mathematics at Warwick School of Life Sciences, who models infectious disease spread. They discuss why the key to controlling is pruning network connections - but why that concept hasn't been well explained to the public, what's happening in Cardiff, where ICU is running at 120% capacity, and how the vaccine roll out is being coordinated in primary care. For more on the pandemic www.bmj.com/coronavirus

The last few weeks we’ve been feverish in our coverage of vaccines - the evidence base for them is, how they’ve been evaluated and licensed, and who’s going to get them first. But what we’ve not covered much is what it’s like to do, and take part in, a vaccine trial. In this special podcast, we’re going to hear from John Wright, director of the Bradford Institute of Health Research. He’s been keeping a “doctors diary” for BBC radio, and in this podcast we’re doing a deeper dive into that - and finding out about the people working on, and volunteering to test, a corona virus vaccine.

The vaccines are being rolled out - but approval is still on an emergency basis, and the evidence underpinning those decisions is only just becoming available for scrutiny. In this podcast we talk to Baruch Fischhoff, professor at Carnegie Mellon University and expert on public health communication about how that messaging should be done. Peter Doshi, associate editor at The BMJ, and vaccine regulation researcher also joins us to talk about the data now released on the vaccine trials - what questions does it raise, and what are the next steps for researching safety. For more on The BMJ's covid-19 coverage www.bmj.com/coronavirus

As the first people outside of a trial have started receiving Pfizer's sars-cov-2 vaccine, including Matt, but that's not the end of the story for the pandemic, there are still logistics of rollout, plus treating those who have already contracted the disease. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire. They discuss why it's impossible to get the vaccine into care homes, because of the need for very low temperature storage, why the survival rate in ICU has gone down, and how messaging on the non-vaccine ways of preventing spread need to be tightened up, especially now. For more of The BMJ’s covid-19 coverage. www.bmj.com/coronavirus

Anne Hicks, is an emergency medicine consultant in Plymouth, and for 16 years was the medical director for the British Antarctic Survey (she stepped down last year). The British Antarctic Survey operates all through the antarctic winter - where for 90 days, the sun sets and plunges their base into cold and darkness. So who better to give us some advice on coping with the strict covid-19 rules during our winter period. Anne talks to Cat Chatfield about the ways in which structure, even the seemingly small and arbitrary, can help, how to spot signs of someone struggling, and how the lack of daylight affects teams working at the bottom of the world. https://www.bmj.com/wellbeing

As the first vaccine for corona virus is approved, and England joins the other nations of the UK outside of full lockdown, we are all entering tiers of restrictions - variable across the country, which will continue until that vaccine coverage is enough to slow transmission in the community. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and are re-joined by Karl Friston, neurologist and member of iSAGE. They discuss what we know about the efficacy of these tiers, and how they interact with things like track and trace, and the mass testing taking place in Liverpool. For more of The BMJ’s covid-19 coverage. www.bmj.com/coronavirus

The government has decided to pursue a strategy of mass-testing in Liverpool, in a pilot to see what effect that has on containment of corona virus. A lot of criticism has been levelled at the scheme, from the sensitivity of the lateral flow test used, to whether this is screening and should be referred to the national screening committee to be evaluated. Calum Semple, professor of child health and outbreak medicine at the University of Liverpool is evaluating the project, and joins us to explain what we can understand from this - how initial data shows the new testing regime is reaching more of the population, and why he thinks this is a public health intervention, not a personal screening test. www.bmj.com/coronavirus

The BMJ is a champion of openness and transparency in research, in clinical practice and in health policy. However, if you’ve kept and eye on the journals recently, you’ll have seen that governments have been less diligent about keeping an eye on competing interests than they should be. In this podcast we’re joined by Jolyon Maugham QC - one of the founding members of the Good Law Project, who have successfully litigated against the government on Brexit, and are now turning their eyes to procurement during the pandemic. Jo talks to Kamran Abbasi about how big the contracts have been, how the UK’s system lacks the checks and balances to prevent a government from forging ahead, and if cronyism and corruption have damaged the pandemic response www.bmj.com/coronavirus

As further promising news emerges of vaccine effectiveness, although still with no data published, and as plans emerge for the return home of university students and limited festive winter celebrations. But as we talked about in the last podcast, there needs to be a concerted effort to re-centre patients and the public within the decisions made about how the NHS will treat covid patients and those with continuing healthcare conditions impacted by the pandemic. National Voices, a coalition of charities that stands for patient centred care, have been talking to patients about what matters to people during COVID-19 and beyond, and have written a report with some clear recommendations to health and care leaders and professionals. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampt

Uncertainty abounds - even as we get better data on treatments, with the big RCTs beginning to report, and new trials on masks, the evidence remains uncertain, in both the statistical realm (confidence intervals crossing 0) and in what to do in the face of that continuing lack of clear effect. As always Helen Macdonald and Duncan Jarvies are looking at the evidence, and this week are joined by John Brodersen, professor of general practice at the University of Copenhagen. Helen talks to Bram Rochwerg, methodology lead on the WHO treatment guidelines for covid, about why their latest review has stopped recommending remdesivir for covid-19 treatment. John tells us about the Danmask study - what question it was actually trying to answer. We also discuss the ways in which there is a tendency to express certainty where there is none, and why distrusting simple solutions to complex problems is a good rule of thumb. Reading list: A living WHO guideline on drugs for covid-19 https://www.b

Clare Gerada and Zaid Al-Najjar have been treating doctors for a while now, through the NHS Practitioner Programme. In that time they have noticed some themes in the issues that bring doctors to them, from isolation to stress. In this podcast they reflect on what they've learned about the problems that affect doctors, and how covid-19 has exacerbated some, and surprisingly reduced others. Their book Beneath the White Coat: Doctors, Their Minds and Mental Health is out now https://www.routledge.com/Beneath-the-White-Coat-Doctors-Their-Minds-and-Mental-Health/Gerada/p/book/9781138499737

Covid-19 continues its grip on the Northern Hemisphere alongside news of a vaccine trial showing real success at first glance. In this second wave update, we explore the latest issues with healthcare professionals from primary care, secondary care, and public health, and discuss what is happening in their field, and put their questions to experts. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton. They are joined by Katrina Pollock, senior clinical research fellow in vaccinology at Imperial College London, to talk about: the three vaccines in the news; why different groups may require different vaccines; and how to choose who to get the vaccination first. www.bmj.com/coronavirus

In the first wave of covid-19, hospitals started to reconfigure space and services, to provide rest areas and food for staff, to help them cope with the surge in patients. Michael West, professor professor of work and organisational psychology at Lancaster University Management School, returns to the podcast to talk about how well those changes helped staff - and what needs to be done, now that a second wave is hitting, to make sure those essential services don't disappear. www.bmj.com/wellbeing

Covid-19 continues its grip on the Northern Hemisphere alongside news of a vaccine trial showing real success at first glance. In this second wave update, we explore the latest issues with healthcare professionals from primary care, secondary care, and public health, and discuss what is happening in their field, and put their questions to experts. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Alison Pittard, a consultant in anaesthesia and intensive care medicine in Leeds, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton. They are joined by Müge Çevik, an infectious diseases researcher at the University of St Andrews, to talk about: what’s happening with track and trace and how to make it work better; transmission and asymptomatic spread, in particular hospital-acquired infections; views on the news of Pfizer’s vaccine; and reaction to US presidential election. www.bmj.com/coron

A lump in the throat is a classic GP presentation, but one that often causes a lot of worry. Many people are struggling with high levels of anxiety anyway at the moment, and this may manifest physical symptoms, such as fatigue, insomnia and dysphagia. In this week’s episode, we discuss how to differentiate between causes of a lump in the throat: is my patient experiencing laryngopharyngeal reflux, or could it be cancer? How do we reassure distressed patients when we need to refer them on for imaging, or a consultation with a specialist, before we can rule out a malignant cause? We also talk about how to manage a patient who has difficulty swallowing pills, and the challenges of getting children, in particular, to take medication. Our guests: Nick Hamilton is a clinical lecturer in otorhinolaryngology at UCL, and also works as a specialist registrar in otorhinolaryngology head and neck surgery at North Thames Deanery, London. Deonne Dersch-Mills is the clinical practice leader fo

As the second spike in covid-19 cases grows, we want to take stock of what's happening in the NHS. In these second wave updates, clinicians from primary care, secondary care, and public health, discuss what is happening in their field, and put questions to experts. In this podcast, Fiona Godlee, editor in chief of The BMJ talks to Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton. They are joined by Andrew Hayward, professor of infectious disease epidemiology and inclusion health research, to talk about the lockdown in England, why the message should be clearer, what needs to be done to make the lockdown work, and how doctors are braced for the upcoming surge in cases. https://www.bmj.com/coronavirus

In this talk evidence covid-19 update, we’re taking on risk - how do you figure out your individual risk of dying from the disease? Try QCovid, but remember that it’s figuring out your risk back in April. When it comes to talking about risk, very few people actually engage with the number, so Alex Freeman from the Winton Centre for Risk and Evidence Communication at the University of Cambridge joins us to describe their research into more effective ways of presenting it. Huseyin Naci, from the London School of Economics, returns to the podcast to talk to us about the problems of pulling all the trial data together, and where covid-19 has made people work together most effectively in tackling that issue. Reading list; Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults https://www.bmj.com/content/371/bmj.m3731 Repurposed antiviral drugs for COVID-19 –interim WHO SOLIDARITY trial results https://www.medrxiv.org/conte

Chris Whitty probably needs no introduction to our UK audience - he's the chief medical advisor to the UK government, has played a pivotal role in shaping the country's response to Covid-19. He rarely does interviews - so in this conversation we wanted to ask him the questions that matter to clinicians, about how the pandemic will impact them over the winter. This was recorded yesterday, just before the announcement of the strict lockdowns in France and Germany. For more covid-19 coverage www.bmj.com/coronavirus

As the world sees an upsurge in infections, this "second wave" feels different to the first - we have a much better understanding of the biology of the virus, in hospitals, guidelines for treatment have been rapidly developed... and the pipeline of research to improve that has been created.  But a lot of questions remain - particularly about the dynamics of the spread of respiratory viruses. Which brings us onto this episode - in these weekly discussions, clinicians from across the healthservice and I will be joined by experts, so we can find out more about the issues that really matter to frontline staff. Joining us today are BMJ columnists, Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire. We also have The BMJ authors, Nisreen Alwan, consultant in public health, in Southampton and Karl Friston, neurologist and member of iSAGE For more of The BMJ’s covid-19 coverage. www.bmj.com/coronavirus

Personality disorder is often referred to as the “Cinderella” diagnosis of mental health. Around 1 in 20 people is estimated to have a personality disorder, and it is a neglected and under-resourced area of our healthcare system. In this week’s episode, we discuss the stigma surrounding personality disorder, which can often manifest itself in high levels of anxiety for both patients and GPs, when it comes to diagnosing and managing it, and how to help a patient come to terms with their diagnosis. With suicidal ideation being experienced by many people with a personality disorder on a regular basis, we also talk about how we may best manage a situation of a patient in crisis presenting in primary care. Our guests: Leisha Davies is a clinical psychologist, originally from South Africa, who currently works in private practice. Soumitra Burman-Roy is a consultant psychiatrist at the South London and Maudsley NHS Foundation Trust. He also works for Maudsley Learning, an organisation wh

As the second spike in covid-19 cases grows, we want to take stock of what's happening in the NHS. In these second wave updates, clinicians from primary care, secondary care, and public health, discuss what is happening in their field, and put questions to experts. In this podcast, Fiona Godlee, editor in chief of The BMJ talks to Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire - they discuss how full hospitals are getting, how many covid-19 cases are presenting in primary care, and how treating patients has fared as the pandemic hots up. For more on covid-19 visit https://www.bmj.com/coronavirus

The "second wave" of covid is hitting the UK, and clinicians are anticipating a spike in demand in the NHS. The inevitability of that is weighing on NHS staff's minds. In this podcast, Cormac Doyle, a retired senior army officer, who specialises in military mental health/ veterans and support other with psychological trauma, returns to the podcast to talk about his experience of deployment in the military, and how individuals and their employers can make the inevitability of a second wave less daunting. For more wellbeing from The BMJ - https://www.bmj.com/wellbeing

As the economic fall out of covid-19 starts to bite, attention is turning to how the state can support everyone - especially if the pandemic turns into a depression. Universal basic income, and a jobs guarantee are two of the potential mechanisms a country could deploy, both with different effects on people's health and wellbeing. In this podcast, Martin Hensher, associate professor of health system financing and organisation at Deakin university in Australia, and author of the new analysis "Covid-19, unemployment, and health: time for deeper solutions?" joins us to get you up to speed on the economic thought behind these two schemes. Read the full analysis; https://www.bmj.com/content/371/bmj.m3687

Persistent coughing in children is always a challenge, both for parents trying to describe and measure the cough, and for doctors making a diagnosis. In the current climate, this is all the more difficult, seeing as a continual cough is one of the major symptoms of COVID-19. UK Government guidance advises that anyone with a persistent cough should get a coronavirus test. But with the reopening of schools and the beginning of the cold & flu season both coinciding with a national shortage of tests available, should we all err on the side of caution and try to get a test at the first sign of a cough or sniffle, or can the data on cold virus symptoms help parents and GPs make an informed judgement on the likelihood that their child’s cough indicates COVID? Our guests: Tim Spector is a professor of Genetic Epidemiology, and director of the TwinsUK Registry, at King’s College London. Edward Snelson is a paediatrician in the paediatric emergency department at Sheffield Children’s Hospita

In this Talk Evidence covid-19 update, Jon Deeks, professor of biostatistics at the University of Birmingham gives us an update on testing technology. Will the point of care tests make a different to big live events, and how research and regulation need to change to tame the testing wild west. Paul Glasziou, professor of evidence based practice at at Bond University has set up a new collaboration to try and get better at creating evidence for non-drug/vaccine control of pandemics - and ponders why we're good at drug research, but terrible at other kinds.

David Pencheon, Renee Salas and Ed Maibach join us to talk about how healthcare can, and should, take leadership on climate change. With a few exceptions, the healthcare industry lags behind in efforts to reduce carbon emissions - in this podcast, we'll discuss why that is, why now is the time to take decarbonisation seriously, and why Covid-19 is a hindrance, but also a potential pivot point for change. A pathway to net zero emissions for healthcare https://www.bmj.com/content/371/bmj.m3785 For more on health and climate change https://www.bmj.com/campaign/climate-change

With the annual flu season looming, GPs are anticipating a frenzy of vaccinations, perhaps more so than ever this year. As so many 'flu and respiratory viruses circulate every year, and as the 'flu vaccine is for one strain of influenza only, is the vaccine worth getting, and what are the risks associated with vaccinating vs. not vaccinating? In this week’s episode, we discuss the high vaccine uptake in New Zealand, and the role that social distancing for COVID-19 may have played in their low numbers of seasonal flu. We also talk about whether or not the message we give to patients about the benefits and risks of vaccination is transparent enough, and how we might communicate better with them to allow them to make an informed decision. We feel pressure to increase vaccination rates, because we believe we are protecting people, but does the evidence support that? Our guests: Nikki Turner is the director of the Immunisation Advisory Centre (IMAC) at the university of Auckland. S

This episode was recorded on 18 September - just before the news came out about the new lockdown measures. We’ll hear Carl and Helen’s thoughts, but we also want to hear a broad range of views - so get in touch at bmj.com/podcasts. (1.15) The kids are back in school, and people are worried about the infection spreading. Helen takes us through the ISCARIC data on children's symptoms and outcomes from covid-19. (5.50) David Ludwig, professor of pediatrics at Harvard Medical School and BMJ editor, joins us to give an overview of paediatric covid. (15.30) Carl has thoughts about the spread of covid, and how it seems to be mirroring other respiratory illnesses. (18.00) We wonder about the evidence for the "rule of six"

Nudging seemed to be all the rage a few years ago - a way of changing individual behaviours to help people make better choices, about their diet, exercise and other habits. A lot of hype ensued, the UK government under Tony Blair even set up a “nudge unit” - but questions were asked about the efficacy of the approaches used, confusion about what a nudge actually was, and how to turn it into actual scalable change have followed the discipline. In this podcast Craig Fox, behavioural scientist at UCLA, and author of a new analysis “Details matter: predicting when nudging clinicians will succeed or fail” joins us to explain why he thinks nudging could work in medicine. https://www.bmj.com/content/370/bmj.m3256 To register for your free online place at BMJ Live 2020 visit https://live.bmj.com/

Dr Anthony Fauci needs no introduction, as head of the NIAID for almost four decades, and the U.S. government's leading advisor on infectious diseases, and leader in the country's response to Covid-19. In this interview with The BMJ, Dr Fauci covers parallels in his experience in the HIV/AIDS crisis with this latest public health emergency. He talks about how his understanding of Covid-19 has changed. We also tackle the reports of political intrusion into the CDC and, address worries about the rush toward a vaccine in time for the November elections. For more from The BMJ's covid coverage, all available for free https://www.bmj.com/coronavirus

Fatphobia has been described as society’s last ‘ism’. Whilst our understanding of weight and health has changed over time, there is still a stigma towards people who are overweight or obese, and an assumption that they must be unhealthy, and unhealthy by choice. However, the correlation between weight and health may not be as clear cut as our societal biases would lead us to believe, and, therefore, the challenge for GPs is to make a conscious efforts to overcome our preconceptions so that they may provide the best support for our obese patients. This week, we discuss the need for a zero tolerance towards fat shaming at an organisational level, and how we can make GP practices more accessible for this group of patients. We also talk about retraining the palette in order to sustain weight loss, and our duty to lobby for better community-based weight management services. Our guests: Stephanie deGiorgio is a GP, and the clinical lead in the UTC at Queen Elizabeth The Queen Mother Hospit

The social norms that guide our behaviour in the world aren’t often quick to change - but the imperative to wear a mask in public has rapidly taken hold, establish by law, but policed by the public. Mask shaming is a new phenomenon, but in this podcast, Brandy Schillace, author, historian and editor in chief of Medical Humanities (a BMJ journal) joins Cat and Abi to discuss how ineffective shaming is as a tool for behaviour change, and what mask-shaming reveals about the ways in which society treats those who are seen as non-conforming. For more on The BMJ’s wellbeing campaign www.bmj.com/wellbeing

There are have been local lockdowns in the UK, in places such as Oldham, Birmingham, Manchester – but what is the criteria for making that decision? In the non-Covid world: does honey alleviate symptoms in upper-respiratory tract infections? When does unexpected weight-loss warrant further investigation for cancer in primary care? Plus, in the light of findings from the Cumberlege review of safety in medical devices, the team discuss the issue of doctors’ declaration of interests.

Contraceptive pill check-up appointments used to be simple and straightforward for GPs, and frequently felt like a welcome reprieve from more complex consultations. However, there’s often more to them these days, especially given the rise in tailored regimens, with more and more women moving away from the standard of 21 pills followed by a 7-day break. In this week’s episode, we discuss common misconceptions around the pill cycle compared with a woman’s natural cycle, the various side effects caused by taking an oestrogen-dominant versus a progesterone-dominant pill, and the purely arbitrary nature of the standard regimen. How do we ensure that our patients are able to make an informed choice on their method of contraception, and how do we avoid the risk of contraceptive coercion? Our guests: Anne MacGregor is a professor, working in Secual ans Reproductive Healthcare at Barts Health NHS Trust. She is a specialist in women’s health, and also in headaches and migraines. Tara Ste

In Australia, a staggering 25% of doctors have had thoughts of suicide in the past 12 months, a recent survey said. Mental health problems are higher in medicine than any other job – and yet healthcare professionals are still stigmatised for seeking help. Partly in response to his own struggles, Geoff Toogood, a cardiologist in Melbourne, started an ingenious campaign called CrazySocks4Docs to highlight the issue. https://www.crazysocks4docs.com.au/

Trisha Greenhalgh, professor of primary care health sciences at the University of Oxford has been a powerhouse of covid-19 evidence synthesis. She pulled together advice on doing remote consultations, on wearing masks to prevent spread, and a host of other information. She’s now turning her attention to “long-covid” - as we learn more about the disease, it’s becoming apparent that it’s not just an acute infection, patients are reporting chronic long term consequences of having the virus. In this podcast, she describes what we know about long-covid, where the uncertainty lies, and what clinicians should be doing to help patients who are experiencing the symptoms. Management of post-acute covid-19 in primary care https://www.bmj.com/content/370/bmj.m3026

1.00) Carl has been looking at PCR testing, and explains why it picks up both viable SARS-cov-2, but also fragments of it’s RNA - leading to potential over diagnosis. (8.50 ) What did the Living systematic review and accompanying guidelines say about treatment options for covid-19 (14.35) Helen talks to Reed Siemieniuk,  general internist from McMaster University, about creating a living network meta-analysis, to try and synthesis all the evidence on covid-19 (22.48) Helen also talks to Bram Rochwerg, associate professor at McMaster University and consultant intensivist at Hamilton Health Sciences, about turning the outcomes of a meta-analysis into guidelines, and why at the moment they’re still calling for more evidence on Remdesivir (30.08) Finally, there are worries about the uncertainty expressed in the living review - and in the way in which we communicate that. Helen goes back to Reed to find out how the review might evolve in the future. (33.50) Covid isn’t just

Interest in vitamin D, and it’s association with a range of health outcomes continues - at least if the regular flurry of papers on the subject that are submitted to The BMJ are anything to go by, and with Covid-19, interest has piqued again. GPs are regularly asked to prescribe it, and to test for deficiencies. Low levels of vitamin D are associated with a large number of health outcomes, but, given the high costs and low accuracy of tests, would it be easier just to recommend taking supplements without testing vitamin levels first, taking a “won’t hurt but might help” approach? If so, should we all be taking them, and would doing so help to prevent against COVID-19? Our guests: Andrew Grey is an endocrinologist and an associate professor of Medicine at the University of Auckland. Tom Chatfield is a philosopher, author and broadcaster, whose work looks at humans and technology, as well as cognitive biases.

Fresh outbreaks of covid in Europe and a wave of infections in the United States have been in the news this week, highlighting the renewed need for social distancing – but to what extent? In this edition, we explore the real-world evidence for physical distancing measures as well as the research into whether or not facemasks make us behave more recklessly. We also discuss the non-covid themes of research transparency and a BMJ investigation into the lucrative business of orphan drugs.

In light of the publication of the Independent Medicines and Medical Devices Safety Review (the Cumberlege report) in early July, which assessed the use of vaginal mesh, sodium valproate and Primodos and their associated under-acknowledged complications, this week we discuss trust between patients and doctors, and how that relationship of trust can break down when patients feel that their concerns and their pain are not being recognised and supported. We talk about the influence of racial inequalities on trust and healthcare outcomes, GPs being an advocate for their patients, and we ask what structural changes to the healthcare system need to happen to allow us to spend more time with our patients and build up that trusting relationship with them? Our guests: Karen Praeter works on the admin team of Sling the Mesh, a campaign which raises awareness of the risks of having a vaginal mesh implant, having joined two years after her own mesh implant operation in 2015 which led to painful

Lockdown has been such a stressful period that many healthcare professionals developed abnormal behaviours to cope. Addiction is one such behaviour, be it to a substance – alcohol for example – or any other obsessive activity like exercise. Dr Caroline Walker, an NHS psychiatrist and therapist who has personal experience of addiction discusses the harmful behaviours to look out for and what to do about them.

This time of year we would usually be doing some podcasts from the BMJ awards - but the pandemic has delayed our plans. We’re still working on acknowledging some of the best medicine from around the UK, but in the meantime we’ve decided to give out the awards for outstanding contribution to health, and research paper of the year. In the following interview, Fiona Godlee - the BMJ’s editor in chief, talks to Marian Knight, lead author of the ANODE trial - The BMJ's research paper of the year. For more about The BMJ Awards categories and previous winners; https://thebmjawards.bmj.com/

This time of year we would usually be doing some podcasts from the BMJ awards - but the pandemic has delayed our plans. We’re still working on acknowledging some of the best medicine from around the UK, but in the meantime we’ve decided to give out the awards for outstanding contribution to health, and research paper of the year. In the following interview, Fiona Godlee - the BMJ’s editor in chief, talks to David Pencheon, director of the NHS sustainability unit about his work. For more about The BMJ Awards categories and previous winners; https://thebmjawards.bmj.com/

As the pandemic play out, we’ve seen ways in which the collection of covid data - and it’s sharing, has been flawed, with reports in the UK that local authorities haven't got granular data, and in the US that the CDC is being circumvented for data reporting. Kathleen Bachynski, assistant professor of public health at Muhlenburgh College, and Sridhar Venkatapuram, director of global health education & training at King's College London join us to discuss why data is fundamental to the social contract between the public and their government, and why undermining it is so dangerous.

Vaccines have been in the news this week - but when you dig into the stories, it turns out that the hype is about phase 1 trials. We're a long way from being sure any of the 150 possible vaccines being developed actually work. In this talk evidence we're talking to a researcher, a regulator, and a manufacturer about the way in covid-19 is upending normal vaccine development, which hurdles they'll have to reach to get onto the market, and how we'll know which one to choose when they are there. This week (1.10) We said that covid would have a knock-on effect on other treatments, and Helen looks at some research into acute coronary syndrome admissions in the UK. (6.53) Peter Doshi, assistant professor of pharmaceutical health services research at the University of Maryland School of Pharmacy and an editor for The BMJ, tells us what to watch out for in the PICO for a vaccine study. (15.20) Marco Cavaleri, head of Biological Health Threats and Vaccines Strategy at the European Medicin

The signs and symptoms of racism have long permeated our society, and are embedded in our clinical practice and medical education. Recent events in the US, including the murder of George Floyd, have brought the Black Lives Matter movement to the fore of public consciousness, and have sparked outrage and protests in countries around the world. COVID-19 has exposed the inequalities in our healthcare systems, as the virus has had a disproportionate impact on some ethnic minority communities. In this week’s episode, we discuss colonial undertones to contraception policy-making, how doctors remaining silent on racial issues are seen as complicit, and the lack of diversity in learning resources used in medical schools. How can we use the current climate as a teaching moment to engage with people, clinicians and patients, about their experiences of healthcare? And how do we begin to make reparations in medicine for centuries of institutionalised racism? Our guests: Annabel Sowemimo is a com

A series of medical scandals prompted Jeremy Hunt, former UK health secretary to launch the Independent Medicines and Medical Devices Safety Review - with the explicit aim of strengthening the patient voice in order to help build a "system that listens, hears and acts – with speed, compassion and proportionality" That report is out, and describes a system that does anything but. In this podcast, Sir Cyril Chantler, the review's vice chair discusses their recommendations, for better regulation, transparency and patient advocacy in the use of medicines and medical devices. Read the full report: https://www.immdsreview.org.uk/ The BMJ report into what we must learn from mesh https://www.bmj.com/content/363/bmj.k4254

US President Donald Trump has been pushing hard for an American vaccine against Covid-19. He's named the program Operation Warp Speed, which has many people worried that safety tests will be rushed. What are the prospects for an American vaccine against Covid-19? If the US is first, will it make its vaccines available to other countries? And what if it's not first? Three American vaccine experts talk with the BMJ about prospects for an American vaccine against the new coronavirus. Joining us are; Nicole Lurrie - senior lecturer at Harvard Medical School and a strategic adviser to the foundation working on global vaccines, CEPI. Paul Offit - professor at the University of Pennsylvania, and co inventor of a rotavirus vaccine. Prashant Yadav - senior fellow at the Centre for Global Development and a lecturer at Harvard Medical School.

We all know that healthcare professionals are stretching themselves to provide the care that’s needed right now. But there are instances when you might find yourself out of your comfort zone or being pushed too hard or fast. When is it ok to say no to these demands? We spoke to Kate Burnett who educates NHS staff on empowerment about how to voice your position clearly and how to reconcile the guilt you might feel of letting the side down. www.bmj.com/wellbeing

In this week's Talk Evidence we're hearing about how the death rate has dropped below average, disappointment about HIV drugs for covid-19 treatment, a trial to reduce polypharmacy, and why academic promotions matter to everyone else. 1.35 - Carl gives us one of his death updates 3.30 - Helen asks if it’s finally time to be able to do the international comparisons we’ve been waiting for? 16.10 - New research suggests that extreme PPE prevents transmission - but PPE came with a whole range of other viral suppression measures, and they all work together. 21.30 - The Recovery trial has said that  lopinavir-ritonavir isn’t effective against covid - enough for them to stop the arm of that trial. We talk about this and more treatment evidence. 24.00 - Can a digital intervention reduce poly pharmacy? A new trial on bmj.com says no, but we talk about the composite endpoint and the way the trial is powered. 36.25 - Why academic promotion matters to non academics

The relaxation of the COVID-19 lockdown regulations is raising a lot of questions, both for doctors and for patients. This week, we discuss how the lack of clarity and coherence in public health messages over the past few months has caused anxiety and confusion for our patients, especially those who have been told to shield. We talk about GPs tailoring shielding advice to suit the individuals they treat, the politicisation of mask wearing, and the flaws of ‘abstinence-only’ health messaging. How do we balance prompting overall health, rather than just working to prevent disease, and how do we start taking baby steps towards returning to normality? Our guests: Julia Marcus is an infectious disease epidemiologist and Assistant Professor at Harvard Medical School’s Department of Population Medicine . She is also an HIV researcher. Carol Liddle, a COPD patient, is a patient advocate on the panel for NACAP (National asthma and COPD audit), as well as a patient representative for the Task

For a long time, the BMJ has been interested in conflicts of interest and how that skews the research base. We also heard in our podcast on "Big Tan" that science is being used to sow seeds of doubt into the association between sunbeds and skin cancer, by scrutinizing the minutiae of a research paper, but ignoring it's bigger message. Now it's all just happening in medicine. This is an industry tactic. And to talk about that we're joined by David Michaels - who was the longest serving head of the Occupational Safety and Health Administration, and an epidemiologist and professor at the George Washington University School of Public Health. Read The BMJ's collection - Commercial influence in health: from transparency to independence https://www.bmj.com/commercial-influence To find out more from David, plus his two books on the influence of industry https://www.drdavidmichaels.com/

In the third part of our series of podcasts “Corona Virus as Seen Through a US Lens,” features editor for The BMJ, Joanne Silberner, talks to Dr. Adeline Goss about the experience of being a new mom and a hospital resident during the crisis. In The BMJ, Dr Goss recently wrote about the challenges facing medical residents as they deal with working during the virus. When she went on maternity leave a few months ago, nothing seemed amiss, beyond the normal stress of being a new mom. But when she returned to full time work on June 1, everything had changed. Goss kept an audio diary of her experience preparing and going back to work and we hear some of that during the podcast. For more of The BMJ's covid-19 coverage www.bmj.com/coronavirus

This week we're looking beyond the press release for dexamethasone, the long awaited review of antibody testing, and how well people are recovering after surviving acute covid-19. (2.36) The preprint for dexamethasone is finally out - considerably after the press release. Carl digs into it to find out how good the news actually is. (8.49) There are a couple of newly published systematic reviews on antibody testing, so we return to our testing guru Jon Deeks - professor of biostatistics at the University of Birmingham to give us an update. (23.52)Covid-19, it became apparent as the pandemic grew, was more than a respiratory disease - there are systemic effects on almost all organs. As people are recovering from the worst ravages of the disease, the long term consequences of those effects are becoming more clear - Lynne Turner-Stokes, professor of rehabilitation medicine at King's College London. Reading list; Effect of Dexamethasone in Hospitalized Patients with COVID-19: Prelimin

Earlier this year, the bmj published a racism in medicine issue - the issue was guest edited by Lord Victor Adebowale, chief executive of the NHS Confederation and Professor Mala Rao, professor of public health at Imperial College London. At the event to launch the issue, they managed to persuade Simon Stephens , chief executive of the NHS, to put money into a “race in health observatory” Mala joins us to talk about what that observatory is going to do, how it will maintain independence, it's role in synthesising, commissioning and implementing research, and where the organisation might begin in tackling the issue. Reading list NHS launches Race and Health Observatory after BMJ’s call to end inequalities https://www.bmj.com/content/369/bmj.m2191 The BMJ's racism in medicine issue (free to access) https://www.bmj.com/racism-in-medicine Interview with Yvonne Coghill https://podcasts.apple.com/us/podcast/yvonne-coghill-is-trying-to-fix-racism-in-the-nhs/id283916558?i=1000466962555 I

In this week’s episode, our focus is on what the post-COVID world of general practice might look like. The pandemic has exposed the inequalities in our social and healthcare systems, but has also given GPs some much-needed headspace to reflect on changes to make going forward. Will we be able to turn general practice off and on again, like a faulty computer? Will we just drift back to the status quo, or will we seize this opportunity to shake up the old routines in order to redefine the role of the GP and to benefit the ever-evolving needs of our patients? Our guests: Martin Marshall is Chair of the Royal College of General Practitioners, a professor of Healthcare Improvement at UCL, and a GP practising in East London. Jenny Doust is a Clinical Professorial Research Fellow at the School of Public Health at the University of Queensland, and practises as a GP in Brisbane. Toyin Ajayi is Chief Health Officer, and co-founder, of Cityblock Health, which is a New York-based health and s

At the end of May, the WHO said that South America has become the new epicentre of the covid-19 pandemic. The majority of those with covid are in Brazil - not entirely surprising given it is the most populous - but in neighbouring Peru, numbers are growing too. And it’s to Peru that we turn to talk to our guest today, Valerie Paz-Soldan is a social scientist and director of the Tulane Health Office for Latin America - part of the university’s school of public health and tropical medicine. She joins us to talk about the pattern of the virus in Peru in particular, but elsewhere in the region, and how the pandemic is overwhelming an already stressed healthcare system. https://www.bmj.com/coronavirus

n normal times, around this time we’d start thinking about weekend breaks and summer holidays abroad. More than most healthcare staff and other key workers are in dire need of time out. Given the uncertainties around foreign travel, how can we recreate in some way that holiday feeling. Simon Calder, travel correspondent for The Independent newspaper, offers his staycation tips and alternative travel advice.

This week, we’re asking questions about surgisphere data, and how it might have got into such high impact journals, we’re also talking about the protests around the world about structural racism - and how they intersect with the covid pandemic. (1.39) Helen and Carl talk about the data underlying the newly retracted papers on hydroxychloroquine and ace-inhibitors or ARBs and covid. (7.45) Fiona Godlee, the BMJ’s editor in chief, comes onto the pod to talk about retractions, and why they’re often called for, an rarely done. (25.10) We talk about the protests, and Carl gives us his opinion on the risk of covid transmission during them (spoiler; he thinks it’s low) (37.40) Sonia Saxena, professor of primary care at Imperial College London gives her verdict on the Public Health England report into this disproportionate effect of covid on ethnic minorities in the UK, and pushes back against it being a biological instead of a sociological determination. Reading list: Sonia’s analysis i

How might Burmese Buddhism help deal with pandemic stress? Christopher Bu drew on his familial heritage and the tradition of practicing mindfulness to cope with the stresses of studying to be a doctor. He invites us to consider how the same techniques might be useful psychological tool for all healthcare workers during this challenging time.

In this episode of Talk Evidence, we'll be finding out if second waves are inevitable (or even a thing), how the UK's failure to protect it's care homes is symbolic of a neglected part of public life, and why those papers on hydroxychloroquine were retracted. This is Talk Evidence - the podcast for evidence based medicine, where research, guidance and practice are debated and demystified. Helen Macdonald, UK research editor for The BMJ, and Carl Heneghan, professor of EBM at the University of Oxford and editor of BMJ EBM, talk about some of the latest developments in the world of evidence, and what they mean. This week: 2.00 - Helen looking into a second wave - and finds out from Tom Jefferson, an epidemiologist with the Cochrane Collaboration's acute respiratory infections group, that a "wave" might be a misnomer. 12.00 - Mary Daly, professor of sociology and social policy at the University of Oxford, tells us where the UK went wrong with care homes, and what we’d need to do to

The Trump administration was left a playbook for pandemics when they entered the Whitehouse, but even before covid-19 was a threat systematically dismantled the public health protections put in place to follow that playbook. In this podcast, Nicole Lurie, Gavin Yamey and Gregg Gonsalves talk about how the US response to public health was mismanaged, how it has become politicized, and what that playbook suggested should have been done. They also talk about rebuilding public health in the US after this is all over. Our guests; Nicole Lurie, former Assistant Secretary for Preparedness and Response under the Obama administration, senior clinical lecturer at Harvard Medical School and advisor to the Coalition for Epidemic Preparedness Innovation Gavin Yamey, professor of global health and public policy at Duke University Gregg Gonsalves, assistant professor of epidemiology at Yale School of Public Health. This podcast is hosted by Joanne Silberner.

For GPs, testing patients is their “bread and butter”. This week, we discuss the “better safe than sorry” attitude towards testing, which is so common among doctors – are we guilty of over-testing purely out of force of habit, or are we worried about missing something vital, and therefore find reassurance in doing them? How should we interpret test results, and how do these results affect the way we manage our patients? And, with the huge focus on COVID-19 testing in the media, how do we communicate the current risks and uncertainties surrounding it to our patients? Our guests: James McCormack is a professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia, and the co-host of a popular weekly podcast called Best Science (BS) Medicine podcast. His work focuses on helping healthcare professionals to understand medical data, by taking the best available evidence and making it as simple and practical as possible. Jess Watson is a GP, working in Bristol, and

That remdesivir study has finally been published - what does it say and is it as independant as claimed. Also, as the world's focus turned to covid, so have researchers - and they've produced over 15000 papers. How can we sift through the flood of research and know what's any good? (2.30) Helen Macdonald talks to Elizabeth Loder about the volume of research we're seeing, and why journals and peer reviewers are struggling to check it all. (8.15) The study on remdesivir has been published - the trial was stopped early, and the primary outcome switched - we talk about how that increases uncertainty over the results, and could actually delay the treatment. (26.50) We hear from a couple fo readers who wanted to correct us about averages, means, medians. Reading list: The US NIH AID study on remdesivir, published 22nd May in the New England Journal of Medicine Research - preliminary report https://www.nejm.org/doi/full/10.1056/NEJMoa2007764 NEJM - looking at the dose duration https://ww

*Non covid content alert* While the last couple of months have been covid-19 focused, the work of the beforetimes carries on - including a topic the BMJ is perennially interested in, industry funding of medics. Ray Moynihan, researcher at Bond University, has been looking at financial ties between some healthcare association leaders, and industry, in the US, and reports that in new research published this week in The BMJ. Read the full open access research; Financial ties between leaders of influential US professional medical associations and industry: cross sectional study - https://www.bmj.com/content/369/bmj.m1505

How might stress affect your performance as a healthcare worker? That’s the question that Mark Stacey, a consultant obstetric anaesthetist in Cardiff, has been interested in for the past 10 years. He saw similarities in the aviation industry, which uses a theory of human factors to explain why things go wrong when humans interact with complex systems. Stress was a major culprit, in both aerospace and medicine, so he began to explore wellbeing as a way to reduce stress and, in turn, reduce adverse events. He has developed the idea of writing yourself a wellbeing prescription, which includes practical techniques such as the Baker’s Dozen and a gratitude diary. Useful tools Bakers Dozen https://www.cardiff.ac.uk/__data/assets/pdf_file/0003/808950/Bakers-Dozen-Toolkit.pdf A 30 day plan that Mark has put together http://www.cardiffandvaleuhb.wales.nhs.uk/improving-resilience-in-anaesthesia

This last week has seen questions raised about the integrity of some of the epidemiological data being produced by US states, and as rates continue to grow in some countries international comparisons are being questioned. To discuss the implication of that are; Sridhar Venkatapuram associate professor global health & philosophy at King's College London Kathleen Bachynski Assistant professor of public health at Muhlenberg College Martin Mckee Professor of European health at the London School of Hygiene and Tropical Medicine

This week we're focussing on what kind of information we need to be able to collect and use as the country transitions out of lockdown - and why local lockdowns may be here for some time. We also hear about the new antibody tests which are available in the UK - are they actually a game changer? (2.00) Helen explains what some new evidence says about hydroxychloroquine (spoiler; don’t take it for covid-19) (6.40) *Non covid alert* - Carl tells us about new research on compressions stockings for thromboprophylaxis, and the importance of doing research on non-pharmacological interventions (10.30) David Nabarro, Special Envoy of WHO Director-General on COVID19, (28.00) Helen goes back to Jon Deeks, professor of biostatistics at Birmingham, to find out more about these “accurate” tests for covid, endorsed by the government this week. Reading list: Clinical efficacy of hydroxychloroquine in patients with covid-19 https://www.bmj.com/content/369/bmj.m1844 Hydroxychloroquine in patie

With COVID-19 still ongoing, and at the forefront of the minds of doctors, patients and members of the public alike, difficult conversations are taking place - GPs are encouraged to talk about death with those who might not be ready to discuss it, and families are losing loved ones without being able to say goodbye. In this episode, we also look at survivor guilt, the range of emotions that grieving encompasses, and how to address the potentially thorny subject of advance care planning with COVID-19 patients. Our guests: Katherine Shear, internist and psychiatrist, is Director of The Center for Complicated Grief at Columbia University’s School of Social Work. She has been involved in research into treatments for grief for over 20 years. Scott Murray, a recently retired GP, has key interests in disease trajectory and advance care planning. He led the first Primary Palliative Care Research Group and he chairs the International Primary Palliative Care Network. He advocates high-quality

Does history count as a non-pharmaceutical intervention? Much of our view on what to do in this pandemic has been influenced by the 1917 Spanish 'flu outbreak - even though covid-19 seems to be acting differently. In this podcast, we talk to Howard Markel, a professor of pediatrics at Michigan, as well as professor in the history of medicine. He's written books on quarantines and epidemics, and was part of a team that did the medical and historical work that first showed the value of flattening the curve. This is the first of 4 podcasts from our US colleagues, looking at the disease in that country, which will be published over the next 2 months. For more on covid-19 www.bmj.com/coronavirus

Hydroxychloroquine is in the news again - as Trump and some news organisations are pushing it as a treatment, despite evidence (published in The BMJ) showing it lacks efficacy, and has a load of potential negative effects - including arrhythmias. We know that kind of information spreads online - particularly through social media, but how does it do that? In this podcast we talk to Adam Kucharski, and epidemiologist from the London School of Hygiene and Tropical Medicine, who has used disease modelling tools to look at fake news spread, and has some ideas about creating an online social distance. For more covid coverage www.bmj.com/coronavirus

Big data is being crunched to help us tackle some of the enormous amount of uncertainty about covid-19, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. In these podcasts, we're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week. (3.10) Calum Semple, professor of outbreak medicine at the University of Liverpool talks about the ISARIC project - predesigned research brought off the shelf and deployed during a pandemic. (14.20) Ben Goldacre, doctor, researcher and director of the EBM datalab at the University of Oxford, joins us to talk about how his team have managed to pull together records from 40% of NHS patients to look for patterns in covid-19 morbidity and mortality. Reading list OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. https://www.medrxiv.org/co

If you’re a regular listener to our podcasts, you’ll have heard how Covid is exposing the cracks in our systems of healthcare - from showing how poorly provisioned elderly social care is, to how antibody testing issues have exposing how innovation is uncoordinated and driven by the worst bits of the free market. In this podcast we talked to Soumya Swaminathan, the WHO’s first Chief scientist, and ask about how the world’s foremost normative body for health tackle some of this issues. We talk about agenda setting - and how the WHO is trying to prioritise neglected areas of research, how they’re starting to set standards for evidence driven by public rather than commercial priorities, and how, if and when a vaccine for corona virus is finally created - they can help it be distributed equitably, rather than to those with the most money to spend.

The first peak of the pandemic has passed, the situation in hospitals is more manageable. While healthcare workers are preparing for the long haul, Abi and Cat discuss how to deal with this period of post-crisis crash. In this podcast, we speak to Ali Milani, a former Labour politician who ran against Prime Minister Boris Johnson in his London constituency during the 2019 election. How might Milani’s experience of a year-long campaign and fallout compare to the current post-emergency stage of Covid-19? www.bmj.com/wellbeing www.bmj.com/coronavirus

We’re at the point in the pandemic that restrictions on the way people live and work are being relaxed around the world, but how that changes safety for the population is very different depending on your demographic - will you have to work with other people, will you have to take public transport to work, and can you wear a mask in public safely? To talk about the importance of not neglecting those most affected by covid-19 we’re joined by Kathleen Bachynski, assistant professor of public health at Muhlenberg College and Sridhar Venkatapuram, associate professor global Health & philosophy at King's College London For all The BMJ's covid coverage www.bmj.com/coronavirus

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (1.20) Carl gives us an update on the England and Wales admission data. (3.00) Helen talks about ways in which spread and severity of infection amongst household contacts. (8.20) We talk natural history of covid-19, and Harlan Krumholz, cardiologist at Yale, tells us what we know, and why it's difficult to have a full picture at the moment. (15.10) Helen picks up on a study from Tim Spectre and colleagues using an app to track cases. (20.00) Henry Scowcroft, one of The BMJ's patient editor, who also works for Cancer Research UK, joins us to talk about patients who are taking part in clinical tr

We are more than six weeks into the lockdown and if you were to gauge the mood of the nation, it would be one of fatigue. It started as an all-hands-on-deck emergency situation, but it now transpires that the current work situation for healthcare professionals is not going to change any time soon. This is a marathon rather than a sprint. So how can we better look after ourselves to cope with this new realisation? In this podcast we speak to Dr Caroline Walker, an NHS-based psychiatrist and therapist. Wait til the end for Caroline's simple technique she uses to help when feeling overwhelmed. Read Caroline and Clare Gerada's opinion piece https://blogs.bmj.com/bmj/2020/03/31/extraordinary-times-coping-psychologically-through-the-impact-of-covid-19/

In this week’s episode, we discuss bystander guilt, convergence, brain hacks and “how you can sneeze on someone’s brain from anywhere in the world”. How can GPs cope with the myriad worries around treating patients during the current pandemic, both on the frontline and in general practice? How do we recognise and break unhelpful anxious behaviour habits and stop fixating on the news? Our guests:
 Monica Schoch-Spana is a medical anthropologist and a Senior Scholar at Johns Hopkins Center for Public Health. She specialises in crisis and risk communication, community resilience to disaster, public engagement in policy-making and public health emergency preparedness. Jud Brewer is an addiction psychiatrist and neuroscientist, specialising in anxiety and habit change. He is the Director of Research and Innovation at Brown University’s Mindfulness Center, an associate professor of behavioural and social sciences at the School of Public Health at Brown, as well as of psychiatry at the univ

As the pandemic plays out - hospitals are reconfigured to increase critical care capacity, outpatient clinics become virtual, and elective procedures delayed. How are these affecting care for those who are in hospital but don't have covid-19? In this podcast, Matt Morgan,honorary senior research fellow at Cardiff University, consultant in intensive care medicine and Partha Kar, consultant in diabetes and endocrinology in Portsmouth, join us to discuss how their working week is changing. Read the BMJ's columns https://www.bmj.com/uk/news/views%20%26amp%3B%20reviews

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (1.10) Carl gives us an update on the UK's figures, and how deaths outside are now being counted. (2.10) When the pandemic slows down, and normal services resume - what should we start doing first? Helen picks up some evidence on what they might be. (6.05) There's a signal that covid-19 may be causing coagulopathies in some patients, and Helen picks up on a listeners request for more information. (11.22) John Deeks, professor of Biostatistics at the University of Birmingham, is leading a Cochrane initiative into examining the evidence around testing, and rivals Carl's rant when he explains how s

How can we help frontline clinicians? Sometimes medics may feel uneasy or even guilty and that they could be doing more. That was what a junior doctor in Abergavenny in Wales felt and she did something about it. In this podcast, we speak to Josie Cheetham about how she started her initiative to provide support boxes in hospitals for her colleagues working at the frontline, and how that initiative inspired others and mushroomed across the UK.

Around the world, as the covid pandemic plays out, and some countries are starting to ease their restrictions, this narrative of the economy and public health being opposing weights on a set of scales keeps returning - they need to be balanced. But before this, a healthy population is very much seen as being supportive of the economy. So is a pandemic different, or is that dichotomy false. Joining us to discuss are; Martin Mckee, professor of european health at LSHTM Kathleen Bachynski, assistant professor of public health at Muhlenberg College Sridhar Venkatapuram, associate professor global Health & philosophy at King's College London

As the pandemic plays out - the way in which doctors in the UK practice is changing, hospitals are reconfigured to increase critical care capacity, GPs are working from home and doing their day to day work remotely. Some of the changes have come at the detriment of staff and patient wellbeing but covid-19 has also helped cut through some of the inertia to get welcome changes done. In this podcast, Helen Salisbury, GP in Oxfordshire, and Clare Gerada, GP in south London, join us to talk about the way in which general practice has changed, and how they and their teams are experiencing that.

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (1.00) Carl gives us an update on the UK’s covid-19 related mortality (7.40) When the evidence is uncertain, and the outcomes so massive, then the ethical dimensions of decisions become even more apparent. Helen talks ethics in guidelines with Julian Sheather, advisor on ethics and human rights to the BMA and MSF. (25.37) Update on covid-19 research, looking at viral particle shedding. (29.24) We’ve mentioned the potential wasted effort in covid-19 research, and Helen speaks to Paul Glaziou, director of the Institute for Evidence Based Research at Bond University, about the waste he’s alread

A new podcast from The BMJ, to help GP's feel more connected, heard, and supported. Subscribe on; Apple podcasts - https://bit.ly/applepodsDBI Spotify - https://bit.ly/spotifyDBI Google podcasts - https://bit.ly/googlepodsDBI In our first episode, we discuss the highs and lows of video consultations, and how coronavirus has altered the landscape of business as usual for GPs. How will this change affect our relationships with our patients? How do we cope with frustrating technical issues? Are we more likely to miss a crucial diagnosis if we can’t rely on physical examinations? And, finally, are teleconsultations the future of GP practice? Our guests: Trish Greenhalgh is a former GP of 30 years who is now Professor of Primary Care Health Sciences at the University of Oxford. Trish is a leading researcher on video consultations. Fiona Stevenson is a medical sociologist and researcher based at UCL. She is the co-director of their e-health unit. Deep Breath Out - the Rob Auton Daily P

A new podcast from The BMJ, to help GP's feel more connected, heard, and supported. Subscribe on; Apple podcasts - https://bit.ly/applepodsDBI Spotify - https://bit.ly/spotifyDBI Google podcasts - https://bit.ly/googlepodsDBI This week, our topic is fear: we try to get a better understanding of fear, how it affects all of us as clinicians for better or for worse, and the impact that fear has on the ways in which we approach our patients & practice. Does fear distort our judgement, and increase the likelihood of blundering, or does a healthy dose of fear help to keep us grounded? Our guests: Iona Heath is a former GP and president of the Royal College of GPs. Danielle Ofri is an internist at Bellevue Hospital in New York, and Clinical Professor of Medicine at NYU School of Medicine. She has written several books on topics such as medical error and how doctors’ emotions affect their practice. The Deep Breath Out - The bees of Brockwell Park Surgery https://www.bmj.com/podcasts/d

There is no doubt that anxiety levels that clinicians are feeling during this pandemic are high. One military medic believes the current situation is comparable to his experience when posted during British campaigns in Afghanistan and Iraq. Cormac Doyle offers advice on how to deal with high-stress conditions, both in a work and at home, as well as how to negate the future effects of post-traumatic stress disorder. One strategy he supports is using Bilatural Stimulation using music, one example of which called “Strength Within” can be found here shorturl.at/fgrSW.

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (3.14) Jeff Aronson from Oxford University explains why remdesivir is a potential therapeutic, but is pessimistic about the quality of the studies being done on it (13.22) Carl explains why smoking cessation is still a key public health priority under covid-19 (16.30) Helen talks care homes, and interviews Mona Koshkouei, from Oxford University, about the research which shows staff are the main vector of infection. (27.20) David Spiegelhalter, professor of public understanding of risk, looks at the new data on excess deaths in the UK - and the difficulties with reporting that underlie it. Carl

We’ve published info on Telehealth in primary care - and have been overwhelmed by the response from GPs who are finding it useful. But it’s not only primary care that is dramatically shifting to remote care - routine hospital care is moving online too, so we’ve asked Rowena McCash - GP and out of hours triage trainer joins us to give some tips on how to change your communication for the situation. She explains safety netting in telephone triage, note taking, and why there are some advantages to working that way. www.bmj.com/coronavirus www.bmj.com/wellbeing

As we cover the covid-19 outbreak, we want to hear some of the stories from the frontline - And who better to heart of what this pandemic is doing to the profession in the UK, than some of the people who write regularly for The BMJ? In this first one, we wanted to look specifically at acute care - those at the sharp end of the response, so we're joined by David Oliver, consultant in geriatrics and internal medicine, and Matt Morgan, consultant in intensive care medicine. Read the columns https://blogs.bmj.com/bmj/category/columnists/matt-morgan/ https://blogs.bmj.com/bmj/category/columnists/david-oliver/ For more free information on covid-19 www.bmj.com/coronavirus

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (2.24) - Hydroxychloroquinine/chloroquinine - Robin Ferner, honorary professor of clinical pharmacology at the University of Birmingham explains why is it a potential therapeutic for covid-19, and why is it being hyped. (12.45) - We use prognostic models to make treatment decisions, but they have to be well conducted. Lots of them are being created for covid-19, but their quality isn’t great. Statisticians Laure Wynants Maastricht University and Maarten van Smeden from Utrecht University have done a systematic review of these models, and explain what’s needed for them to be useful. (26.30) PP

As part of our response to the covid-19 pandemic, we’re going to be running a series of discussions with experts about some of the big issues arising from the virus. In this one, we’re asking about the public health response to an outbreak - what’s necessary, and is it possible to go to far. Joining us are Martin Mckee - professor of european health at the London Schoole fo Hygiene and Tropical Medicine Kathleen Bachynski - assistant professor of public health at Muhlenberg College Sridhar Venkatapura - associate professor global health & philosophy at King's College London www.bmj.com/podcasts www.bmj.com/coronavirus

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week 5.00 - Carl gives us an update about pneumonia in primary care, should you give antibiotics when you're not sure if it's bacterial or viral 10.00 - The importance and difficulty of making guidelines now 15.00 - We hear from guideline maker Per Vandvik, about making guidance. 21.40 - Preprint servers for medicine are showing their use in this fast changing situation. Joseph Ross from Yale School of Medicine, and one of The BMJ's research editors, talks to us about the kind of information we're seeing on medRxiv. 31.10 - Testing. What are the tests, and when do we want specificity, and when do we

Wellbeing might not seem the obvious place to talk about PPE - but lack of appropriate PPE is causing healthcare staff a great deal of stress now. Mary Brindle is a pediatric surgeon and the director of The EQuIS (Efficiency Quality Innovation and Safety) Research platform at Alberta Children’s hospital. In this podcast she reflects on the use of PPE, talks a little about the culture of it - and how overuse by one person can amply the concerns of others, the effect on patients of seeing their carers in protective equipment (especially children), and the importance of communication when you can't see colleagues faces anymore. www.bmj.com/wellbeing www.bmj.com/coronavirus

Continuing our series on wellbeing during the pandemic, in this podcast we speak to Occupational Psychologist Roxane Gervais about how doctors can look after themselves during the covid-19 pandemic. We discuss the importance of reaching out to friends and family during this difficult time, how to deal with the loss of control, as well how to tackle feelings of guilt when you are unable to work clinically. For more wellbeing content www.bmj.com/wellbeing For more on covid-19 www.bmj.com/coronavirus

We knew a pandemic was coming at some point - it’s kind of why we have the WHO. We have had various smaller scale tests of the international response to an infectious disease outbreak - Ebola in west africa being the most recent. After that, reports criticised the WHO's response - citing problems around the swiftness of their action, the lack of coordination between countries, and the platforms for knowledge sharing. Is the agency doing any better in Covid-19? Suerie Moon is co-director of the Global Health Centre at the Graduate Institute of International and Development studies in Geneva, and author of one of those critical reports which was published in The BMJ. She joins us to assess how the WHO is responding.

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week 3.50 - There is a lot of confusion around symptoms, we hear what Carl's review of the case studies has found, and why he thinks fever and persistent dry cough may not be a sign of all cases. 10.30 - where are we with research into antiviral treatment 17.30 - John Ioannidis has expressed concerns about the quality data used in modelling and therefore our pandemic response. We hear what his concerns are, and what needs to be done to answer them. 29.10 - Iceland is the only country attempting to do population level screening, we hear from Kári Stefánsson, CEO of deCODE genetics which is worki

Reports from Italy, and more recently from the U.S. show the strain the healthcare system is under during this pandemic. We know that staff will step up in an emergency, but this isn’t a fire or a bombing, this is going to last for months. So how can organisations be proactive in supporting staff, and how can leaders try to mitigate the inevitable burnout. In this podcast, Michael West, professor of organisational psychology at Lancaster university, and author of the GMC report “Caring for doctors, caring for patients” joins us to talk about what compassionate leadership looks like in a time of covid-19. Resources www.bmj.com/coronavirus www.bmj.com/wellbeing www.bmj.com/podcasts https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf

This edition of talk evidence was recorded before the big increase in covid-19 infections in the UK, and then delayed by some self isolation. We'll be back with more evidence on the pandemic very soon. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence). in this episode (1.01) Helen talks about variation in prescription of opioids - do 1% of clinician really prescribe the vast majority of the drug? (8.45) Carl tells us that its time papers (in this case a lung screening one) really present absolute numbers. (17.30) Carl explains how a spoonfull (less) of salt helps the blood pressure go down (21.25) Helen puts test results under a microscope, and finds out that they may vary. (33.20) What do conflicts of interest in tanning papers mean for wider science? (48.05) Carl has a "super-rant" about smartphone apps for skin cancer - and a sensitivity of 0.

The NHS is a world leader in sustainable healthcare - and it's the staff who have have been leading the charge. The For A Greener NHS campaign is asking everyone who has made a change to the way they work, to submit evidence and help shape the whole organisation's response to the climate emergency. In this podcast, Isobel Braithwaite, public health registrar & academic clinical fellow at UCL, and Sandy Robertson, LTFT Emergency Medicine Trainee and Chair of RCEM environmental specialist interest group, join us to explain what they're doing, and what kind of evidence is needed. For more on the For A Greener NHS campaign https://www.england.nhs.uk/greenernhs/ To submit evidence https://www.engage.england.nhs.uk/survey/nhs-net-zero/

We all know we should be doing more exercise, and one way to do that is by active commuting - journeying to work on foot or by bike. One thing preventing people from taking up cycling is the fear of being involved in road traffic accidents, and that the risk isn't worth the benefit of the extra exercise. It’s even more confusing when air pollution has to be taken into account. Joining us to discuss new research into that risk/benefit calculation are Paul Welsh, a Senior Lecturer, and Carlos Celis, a research fellow, both Institute of Cardiovascular & Medical Sciences at the University of Glasgow. Read their open access research - Association of injury related hospital admissions with commuting by bicycle in the UK: prospective population based study https://www.bmj.com/content/368/bmj.m336

We know that the number of people living with multiple health conditions is rising year on year, and yet training, guidelines, organisations and physical spaces in healthcare still largely focus on single diseases or organ systems. The means that patients in the NHS are often treated as if their conditions exist in isolation, and that their care lacks coordination, and isn't as good as it should be. To look at why patients with multiple conditions pose a challenge to the NHS, and what we can do to improve the care they receive, we’re joined by Louella Vaughan, acute physician and senior clinical fellow at the Nuffield Trust Jihad Malasi, GP and clinical chair of Thanet CCG Rammya Mathew, GP and a quality improvement lead and columnist for The BMJ and David Oliver, consultant in geriatrics, clinical vice president of the RCP and columnist for The BMJ

In this week's special episode of Sharp Scratch, we've got something a little different for you! Last week the panel talked microaggressions, so this week we're hearing from an expert guest who is leading the work the NHS is doing to combat inequality in healthcare. If you like this special edition, let us know on Facebook, Instagram or Twitter using #SharpScratch This week's special guest: Yvonne Coghill, CBE is the director of Workforce Race Equality Standard (WRES) at NHS England and NHS Improvement. Yvonne has over 20 years’ experience in nursing, before taking up operational and strategic leadership posts. During her 40 plus years career, she has held a wide variety of clinical and managerial roles at the Department for Health and NHS Leadership Academy. In 2013 she was voted by colleagues in the NHS as one of the top 50 most inspirational women, one of the top 50 most inspirational nurse leaders and one of the top 50 black and minority ethnic (BME) pioneers, two years in a r

Last week the BMJ published it’s first special edition into Racism in Medicine. The issues tacked ranged from differential attainment in medical school, to the physiological effects that experiencing everyday discrimination has. The issue was guest edited by Victor Adebowale, the Chief Executive of the social care enterprise Turning Point, and Mala Rao, Professor of Public Health, at Imperial College London - and they, along with Simon Stevens, chief executive of the NHS, Chand Nagpul Chair of council of the BMA, and the Olalade Obedare, medical student from Nottingham University Medical School, talked at the event. www.bmj.com/racism-in-health.

We're taking a break from the usual Talk Evidence to focus on the new corona virus that has emerged in China. With a brand new disease, we have to build our evidence base from scratch - basic virology, epidemiology, pathogenicity, transmissibility, and ultimately treatment are all unknowns. In this episode of Talk Evidence, we're trying to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. (8.00) Peter Openshaw, professor of experimental medicine at Imperial College London, talks to us about the pathogenicity of covid-19 (17.30) Wendy Barclay, head of the Department of Infectious Disease at Imperial College London, describes what can change the R0 of a viral disease. (20.50) Raina MacIntyre, professor of biosecurity at the Kirby Institute at the University of New South Wales, talks to us about how effective masks are at preventing spread of viruses. (30.00) We discuss treatment options in the face of massive unc

There comes a tipping point in all campaigns when the evidence is overwhelming and the only way to proceed is with action. According to David Williams, it’s time to tackle the disproportionate effects of race on patients in the UK. David Williams, from Harvard University, developed the Everyday Discrimination Scale that, in 1997, launched a new scientific approach to assessing social influences, such as racism, on health. He’s shown that people who experience every day acts of discrimination— like getting poorer service in a bank or a restaurant, or being treated with less courtesy—will over time have worse health outcomes, including higher rates of heart disease, lower life expectancy, and greater infant mortality. In this podcast he is interviewed by Lilian Anekwe, assistant news editor for New Scientist. Read Lilian's article on tackling racism in the NHS https://www.bmj.com/content/368/bmj.m341 And all of the special issue on racism in medicine https://www.bmj.com/racism-i

In 2012, Eleni Linos, professor of dermatology at Stanford university, published a systematic review and meta-analysis of the link between non-melanoma cancer and sun-beds. That bit of pretty standard research, and a particular rapid response to it, has kicked of years of work - and in this podcast I talk to Eleni and her colleagues Stanton Glantz, and Yogi Hendlin about what they’ve uncovered. Reading list: Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning https://www.bmj.com/content/368/bmj.m7 Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis https://www.bmj.com/content/345/bmj.e5909

In many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters. However, Hugh Rayner, consultant nephrologist, and Peter Rees, former Chair of the Academy of Medical Royal Colleges' lay patient committee, suggest that hospital doctors who have changed their practice to include writing letters directly to patients have more patient centred consultations and experience smoother handovers with other members of their multidisciplinary teams. Read their article explaining what makes for a good outpatient letter; https://www.bmj.com/content/368/bmj.m24

In October 2019, Mary Dixon-Woods, director of the THIS Institute, dedicated to healthcare improvement. In that she explained how she believed healthcare improvement could be improved. The essay took the position that "Quality Improvement" isn't necessarily the best way to improve healthcare, and that more rigour needs to be brought to the field. That paper has created a great deal of discussion, so in this podcast we wanted to go back to Mary and ask her what she thinks about improvement, and how we can practically put into place some of the things she calls for. Read the full essay: https://www.bmj.com/content/367/bmj.l5514 And the rest of our healthcare improvement series: https://www.bmj.com/quality-improvement

Precocious puberty, that is puberty that starts before age 8 in girls and 9 in boys seems to be on the rise, but whether that’s because of an increase in incidence, or greater attention is unknown - what we do know that precocious puberty in girls is commonly idiopathic, while in boys is a red flag for pathology. But either way ther first point of call is the GP. In this podcast, Steven Bradley GP, and Neil Lawrence, paediatric trainee join us to discuss how common precocious puberty is, how GPs should respond to a family presenting with it, and if intimate examination is actually warranted in primary care. Read the full practice pointer: https://www.bmj.com/content/368/bmj.l6597

Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence)* This month: (1.20) Carl tells us about new research on treating sepsis with steroids that might inform practice. (4.58)Proscribing of prophylactic PPIs or H2-blockers for intensive care patients. (11.00) Carl wonders if we can actually rule out an increased risk of ovarian cancer with the use of talc. (17.46) Helen drops and EBM bombshell - is all the work needed to blind participants in a double blind randomised control trial actually worth it? (33.00) Helen is annoyed about a press release from the department of health, and kicks of 2020 by stealing Carl's rant spot. Reading list: Corticosteroids for Treating Sepsis in Children and Adults https://pubmed.ncbi.nlm.nih.gov/31808551-corticosteroids-for-tre

In a British cohort, 30% of patients who had survived childhood cancer had died within 45 years of diagnosis; only 6% were expected to have died. 51% had developed a new primary cancer, but a 26% died of cardiovascular disease - thought to be caused by their treatment. Consequently, efforts to reduce long term mortality have focused on reducing exposure to the most toxic aspects of anticancer treatment, including radiotherapy. In this podcast we’re joined by Daniel Mulrooney, associate professor in the Division of Cancer Survivorship, at St Jude Children’s Research Hospital and one of the authors of the paper Major cardiac events for adult survivors of childhood cancer diagnosed between 1970 and 1999: report from the Childhood Cancer Survivor Study cohort Read the full research: https://www.bmj.com/content/368/bmj.l6794

Is it possible to have a fair price for medicines? Yes, according to a new collection just published on bmj.com. The authors set out to evaluate how we could improve the functioning of the market for medicines, to honestly compensate industry for innovation, whilst allowing the poorest to afford them. Suerie Moon, co-director of global health at the Graduate Institute of Geneva joins us to explain what's wrong with how we decided what to pay for medicine's now, and how we could change that. Read the full collection: https://www.bmj.com/fair-pricing

Michael West is professor of organisational psychology, at Lancaster University, and co-author of a new GMC report into the wellbeing of NHS staff. The review he led together with the clinical psychiatrist Denise Coia, focused on primary interventions related to workplace factors and the systems that doctors work in, rather than secondary interventions such as resilience training. In this podcast interview, he describes what he found - and talks about how low wellbeing is amongst doctors, why the command and control nature of some management teams has increased the problem, and why he has hope because of some of the good practice he sees in NHS organisations. Read the full report: https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf

If you read the Christmas BMJ in the last few weeks, you might have noticed a lot around art and health - the way in which engagement in arts can help in prevention and treatment, but can also affect those more nebulous things which really matter to patients - loneliness, self expression, being connected to the wider community. That obviously links to social prescribing, which looks like it’s going to be one of the big changes to medicine which will happen in near future. In this podcast we hear from Simon Opher, a GP in gloucestershire who has had artists and poets in residence in his surgery, and has experience of setting up services which link art and health - and we discuss how to do that practically. SImon makes it sound easy, but also has a few tips for GPs out there who have an idea about a non-medical service that could help their patients, but doesn’t yet exist. We’ll also be talking to Helen Stokes Lampard, former chair of the Royal College of Surgeons and head of the new

If you’re lucky enough to not be back at work, you might be feeling like you need to quickly refresh your medical knowledge - and this podcast the BMJ’s education editors take you on a whistlestop tour through the BMJ’s education articles of 2019. Tom Nolan (GP in London) is joined by Navjoyt Ladher (GP in London), Anita Jain (GP in India) and Jenny Rasanathan (GP in Phnom Penh). Our reading list: Please don’t call me mum https://www.bmj.com/content/367/bmj.l5373 Which emollients are effective and acceptable for eczema in children? https://www.bmj.com/content/367/bmj.l5882 Pre-eclampsia: pathophysiology and clinical implications https://www.bmj.com/content/366/bmj.l2381 A borderline HbA1c result https://www.bmj.com/content/365/bmj.l1361

Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence) This month: (2.00) Helen look back at a Christmas article, which investigates a very common superstition in hospitals. (7.55) Carl has his pick of the top 100 altimetric most influential papers of the year. (12.40) We find out all about the preventing overdiagnosis conference which happened earlier in December. (34.15) Helen has her annual rant about misogeny in medicine. Reading list: Q fever—the superstition of avoiding the word “quiet” as a coping mechanism https://www.bmj.com/content/367/bmj.l6446 Altimetric Top 100 https://www.altmetric.com/top100/2019/ Fiona Godlee’s keynote at Preventing Overdiagnosis https://www.preventingoverdiagnosis.net/ Gender differences in how scientists present the impo

The internecine takes on medical specialty are a common thread in the Christmas BMJ, and this year we're doing it through the lens of driving. Which speciality speeds the most, who has the nicest cars? André Zimerman, soon to be cardiologist, and researcher lets us know - and also why you can't rely on being a doctor to get off a speeding ticket. At least in Florida. Read the full article: https://www.bmj.com/content/367/bmj.l6354

As editors, we feel like we’re spending a lot of time taking the superlatives out from articles - amazing, novel, important… But new research on BMJ.com suggests that we might not be doing that great a job, and that for some reason, papers authored by men tend to have more of them - because men put more in, or maybe a bias against woman writing in that way. Marc Lerchenmueller, assistant professor at the University of Mannheim joins us to talk about how they did the research, and what it means for women's careers. Read the full article https://www.bmj.com/content/367/bmj.l6573

We’re back for the December Talk Evidence, and this month we’re being very digital Firstly,(1.20) Helen tells us about arthritic fingers - should we be using prednisolone for treatment when people have painful osteoarthritis of the hand Then (13.30) Carl gets us all to check our fingers for clubbing, and we find out how useful it is as a test for lung cancer (23.10) Minna Johansson GP and Cochrane Sweden researcher explains why EBM needs to take into account sustainability, and why that isn’t just carbon footprint. (33.50) We talk AF and the Apple Watch - and why drop out is going to be a massive problem for the kind of big studies that they’re attempting to do with new consumer smart devices. This month's reading: Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE) https://www.sciencedirect.com/science/article/pii/S0140673619324894?via%3Dihub Cancer research UK - finger clubbing and mesothelioma https://www.cancerresearchuk.org/abou

In this special edition of talk evidence, Helen Macdonald and Carl Henneghan talk about creating an evidence base from harms. We hear from a member of the pubic who experienced harm from a drug, and now advises the FDA. A former regulator who explains why reporting harms is so important. And finally, an investigative journalist who explains what "ghost management" is.

The UK general election is happening this week, and you’ve probably made your mind up which MP you’re voting for already - and maybe the NHS has influenced that decision. This year has seen an increase in the number of doctors running for parliament, and in this podcast we find out what motivates doctors to step away from clinical practice, and why their voice on national issues is important to guide the health of their patients. We’re joined by Louise Irving, gp and former parliamentary candidate for the NHS action party, and Andy Cowper, editor of Health Policy Insight

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 we're focussing on what the NHS means to the election, from people who have been inside the political process and know about how campaign promises are made. We talk about retail pledges, and why spending claims which don't cause real change might come back to bite politicians. Joining us are Sally Warren, director of policy at The King's Fund, Siva Anandaciva, chief analyst at The King's Fund and Bill Morgan, former policy advisor and founding partner of Incisive Health www.kingsfund.org.uk/Podcast‎ https://www.kingsfund.org.uk/topics/general-election-2019

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 we're focussing on health beyond the NHS - public health spending, and pledges to tackle air pollution and climate change. To discuss we're joined by Jennifer Dixon, chief executive of the Health Foundation, and Nicky Philpott, director of the UK Health Alliance on Climate Change. Reading list The BMJ's 2019 election coverage https://www.bmj.com/content/general-election-2019 Health Foundation report: Mortality and life expectancy trends in the UK https://www.health.org.uk/publications/reports/mortality-and-life-expectancy-trends-in-the-uk UK Health Alliance on Climate Change general election briefing http://www.ukhealthalliance.org/general-

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 we're focussing on spending pledges. NHS budgets have not been keeping up with healthcare demand, and social care is in dire financial straits. David Oliver, consultant physician in Berkshire and author of the weekly BMJ “Acute perspective” column, and Hugh Alderwick, assistant director of policy at the Health Foundation. Reading list Acute perspective column https://blogs.bmj.com/bmj/category/columnists/david-oliver/ Health Foundations analysis of spending https://www.health.org.uk/news-and-comment/blogsf talk through what the parties are promising

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.n

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, sig

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.

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

Direct-to-consumer genetic tests are sold online and in shops as a way to “find out what your DNA says". They insights into ancestry or disease risks; others claim to provide information on personality, athletic ability, and child talent. However, interpretation of genetic data is complex and context dependent, and DTC genetic tests may produce false positive and false negative results. Rachel Horton, clinical training fellow, Anneke Lucassen, chair of British Society of Genetic Medicine, and Jude Hayward the RCGP clinical champion for genomics join us to discuss how this deluge of genetic data is affecting patients, GPs and clinical geneticists in the NHS. Read the full article: https://www.bmj.com/content/367/bmj.l5688

Blockchain is the digital technology that underpins cryptocurrencies such as bitcoin, and has been proposed as the digital panacea of our times. But Leeza Osipenko, from the London School of Economics, has thought about how it could actually be used in clinical trials, and what else would need to change in our regulatory environment to make that work. Read her full essay: https://www.bmj.com/content/367/bmj.l5561

In quality improvement, measurement is seen as a key driver of change - how well do you know you’re doing, if you can’t actually measure it. So, when something changes in the NHS (say a new guideline) how can you tell how quickly that’s filtering down to the front line. Ben goldacre, from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, joins us to talk about a new proof of concept published on bmj.com, which uses NHS prescribing data to analyse how change propagated through GP practices. Read the full open access research: https://www.bmj.com/content/367/bmj.l5205 https://openprescribing.net/

Our latest series kicks off with Australia’s multi-award-winning health and science reporter, Liam Mannix. He joins Ray to share his insights into the role and impact of evidence, advocacy and investigative reporting in today’s ever-changing media landscape.

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 Carl talks about evidence that restricting your diet might improve health at a population level (1.50) Helen talks about the data on a drop in alcohol consumption amongst Scots (7.04) A listener questions the team about their take on Tramadol (13.45) Helen talks about the problems with the trials we use to regulate drugs (18.00) And Carl explains why drug shortages aren't just a Brexit problem (31.30) Reading list: two years of calorie restriction and cardiometabolic risk (CALERIE): exploratory outcomes of a multicentre, phase 2, randomised controlled trial https://www.sciencedirect.com/science/article/pii/S2213858719301512?via%3Dihub Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled i

After ten years at the helm of the Cochrane Library, Dr David Tovey recently stepped down as Editor-in-Chief. This week he joins Ray to reflect on Cochrane’s past, present and future and share some of the challenges and rewards of leading one of the world’s largest and most trusted health research networks.

On the 1st of May, 2018 Scotland was the first country to try a new way of reducing alcohol consumption in its population. It introduced a minimum unit prices for alcohol. Now new research just published on BMJ.com is looking at the effect of that price increase - and measuring how well it has achieved the goal of reducing drinking in Scots. Peter Anderson, professor of alcohol studies at Newcastle University explains how well the result matched the expectation, and if the result targeted just lower earners, or all high volume drinkers. Read the full research: https://www.bmj.com/content/366/bmj.l5274

The BMJ in partnership with The Harvard Global Health Institute has launched a collection of articles exploring how to achieve effective universal health coverage (UHC). The collection highlights the importance of quality in UHC, potential finance models, how best to incentivise stakeholders, and some of the barriers to true UHC. One of those barriers, and it’s a big one, is climate change - patterns of disease will change, both communicable and non-communicable, cataclysmic weather will disrupt systems, and the economic impact is going to challenge our ability to pay for healthcare. But even against that backdrop, Ashish Jha, and Rene Salas - aren't totally pessimistic. They join us to talk about the intersection between climate and health, and where effective change can be made. Climate change threatens the achievement of effective universal healthcare https://www.bmj.com/content/366/bmj.l5302 Universal health coverage collection https://www.bmj.com/universal-health-coverage

Helen talks about new research on prevention of recurrent VTE - and Carl things the evidence goes further, and we can extend prophylaxis for a year. 13.00 - CRP testing for antibiotic prescription in COPD exacerbations, should we start doing it in primary care settings - and what will that mean. We also hear from Chris Butler, one of the trialists, who explains why being very clear about what you actually want to measure is important in study design. 26.50 - Carl wants you to read the Chief Medical Officer’s report, and we hear from Cathrine Falconer, who edited it, about how they put the recommendations together. 32.50 - Helen thinks that a new consultation from the UK government is collecting evidence in an unsystematic way, and that it’s an opportunity for listeners to submit some good evidence. Reading list: Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event http

Around half of trials that supported new cancer drug approvals in Europe between 2014 and 2016 were judged to be at high risk of bias, in a new study. Huseyin Naci,assistant professor of health policy a the London School of Economics joins us to talk about why potential bias may mean potential exaggeration of treatment effects, and could be costing our health systems a great deal of money. Read the full research: https://www.bmj.com/content/366/bmj.l5221 Listen on apple podcasts: https://podcasts.apple.com/gb/podcast/the-bmj-podcast/id283916558?mt=2&app=podcast

This week we saw the release of the much awaited Yellowhammer documents from the government, documents which outline some of the risks involved with Britain’s sudden departure from the EU. The documents themselves outline that there are risks to the supply of medicines - but do not set out the detail of how those risks have been mitigated, and what doctors and patients should do to plan for the possibility. In this podcast we hear from Andrew Goddard , president of the Royal College of Physicians, and Sandra Gidley, president of the Royal Pharmaceutical Society. We also have a statement from the Royal College of Radiologists.

This week the Trump administration has banned the sale of flavoured vapes in the USA. The reason for that is the sudden rash of cases of pulmonary disease, including deaths, linked to vaping. The mechanism by which vaping may be causing damage to the lungs is as yet unclear, and our understanding is hampered by the heterogeneous nature of the compounds involved and the mechanisms of delivery. David Hammond, professor in the school of public health and health systems at the University of Waterloo in Canada, is author of a recent editorial about vaping and joins us to discuss what this means for public health. Outbreak of pulmonary diseases linked to vaping https://www.bmj.com/content/366/bmj.l5445

In the UK, for just over a year, we've been paying the "Soft Drinks Industry Levy" - a tax on sugary beverages intended to reduce our consumption of free sugars. That was based on taxes that had happened in other countries, however, in the UK high sugar snacks, such as confectionery, cakes, and biscuits make a greater contribution to intakes of free sugars as well as energy than sugar sweetened beverages. Now new research models what extending the sugar tax to those snacks would do to our energy intake, and then onto the BMI of the nation. Pauline Scheelbeek, assistant professor in nutritional and environmental epidemiology at the London School of Hygiene and Tropical Medicine joins us to explain how they modelled that, and what the outcome might be Read the full open access research: https://www.bmj.com/content/366/bmj.l4786

Brexit. Who knows what’s going to happen in the next few weeks, months, years - the uncertainty is high. In the face of that, you’d hope that the government was doing all it could to plan for any eventuality - let alone for a massive, country altering one like suddenly crashing out without a deal - but Martin McKee, professor of public health at the London School of Hygiene and Tropical Medicine, and David Nicholl, Consultant Neurologist, don’t think that’s the case. In the debate about Brexit, increasingly we’re hearing about the impact on health in the UK - and in increasingly doomed ways. But what about across the rest of Europe? Natasha Azzopardi Muscat, president of the European Public Health Association, explains a little about what Brexit means for the whole of European public health. Assessing the health effects of a “no deal” Brexit: https://www.bmj.com/content/366/bmj.l5300

We heard a few podcasts ago about burnout - what it is, and why it should be thought of as a systems issue. Now a project in the Netherlands is trying to investigate who it is that is particularly at risk of burnout, and hopes to test whether individually tailored coaching and counselling can help those who are experiencing the symptoms change the way they’re working. Karel Scheepstra is a psychiatrist and researcher in the Amsterdam University Medical Centre, and joins us to discuss what we know about burnout in Dutch doctors, and what this new research hopes to uncover. For more from our wellbeing campaign; www.bmj.com/wellbeing

We know that exercise is good for you - the WHO recommends at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic physical activity each week. That recommendation is built on evidence that relied on self reporting that may underestimate the amount of lower intensity exercise those people were doing, and at the sometime overestimate the overall amount. That makes new research, published on bmj.com particularly interesting - it pulls together the published data on outcomes for measured activity, where study participants were given an accelerometer to wear. Ulf Ekelund, from the Department of Sports Medicine at the Norwegian School of Sport Sciences, joins us to discuss what they found, and what that means for those recommendations. Read the open access research: https://www.bmj.com/content/366/bmj.l4570

Welcome back to Talk Evidence - where Helen Macdonald and Carl Heneghan take you through what's happening in the world of Evidence. This month we'll be discussing tramadol being prescripted postoperatively, and a new EBM verdict says that should change(1.36). How much preventable harm does healthcare causes (11.20. A canadian project to help policy makers get the evidence they need (16.55) One of our listeners thinks "Simple" GPs are anything but (28.30) - and we'll be asking Alexa about our health queries. Reading list Treating postoperative pain? Avoid tramadol, long-acting opioid analgesics and long-term use https://ebm.bmj.com/content/early/2019/08/16/bmjebm-2019-111236 Prevalence, severity, and nature of preventable patient harm across medical care settings https://www.bmj.com/content/366/bmj.l4185 Helen Salisbury: “Alexa, can you do my job for me?” https://www.bmj.com/content/366/bmj.l4719

In 2001, Gottfried Hirnschall joined the WHO to work on the global response to HIV/AIDs, 18 years later he just retired as the director of WHO’s department for HIV and Hepatitis. The intervening period, almost half the time we’ve been aware of the disease the fight against the infection has been characterised by scientific breakthroughs, and disappointments - but the people mobilised against the virus have changed the way the world funds global health, the way patients are included in research agendas, and saved lives. Gottfried spoke to us during his post retirement holiday in France, and talked about his experiences, and what the legacy of HIV/AIDs will be.

Burnout is a problem in healthcare - it’s a problem for individuals, those who experience it and decide to leave a career they formerly loved, but it’s also a problem for our healthcare system. Burnout is associated with an increase in medical errors, and poor quality of care. Fundamentally it’s a patient safety issue. But, unlike other patient safety issues we tend to think about it, and try to prevent it, at an individual not systems level. However, Anthony Montgomery from the University of Macedonia, and Christina Maslach, from the University of California, Berkeley, urge us to start treating burnout as a systems issue. We hear about how we can spot burnout, and what can be done to try and mitigate it. Read their full analysis Burnout in healthcare: the case for organisational change https://www.bmj.com/content/366/bmj.l4774

The UK has just seen it’s hottest July on record, including the highest ever temperature recorded. With climate change in the forefront of our minds, it’s timely that we have two editorials on the sustainability and health. Michael Depledge, emeritus professor of environment and human health at University of Exeter Medical School, and author of the editorial Time and Tide, explains how closely the oceans and seas are linked to human health. Also Gillian Leng, deputy chief executive and director of health and social care at NICE has ideas about what the NHS can do to become more sustainable, and how we could evaluate the impact treatments have on the planet. Read the two editorials Time and tide - https://www.bmj.com/content/366/bmj.l4671 A more sustainable NHS - https://www.bmj.com/content/366/bmj.l4930

At EBM live recently, we ran a workshop with researchers, patients and clinicians to talk about patient rights in research - should patients be setting the full research agenda? Should they be full participants and authors? Helen Macdonald, BMJ’s UK research editor and co-host of our talk evidence podcast sat down to Paul Wicks, researcher and patient, and Emma Cartwright, The BMJ's What your patient is thinking editor, to reflect on what the workshop uncovered - and where we should be moving to next. Read more about the BMJ's patient and public partnership: https://www.bmj.com/campaign/patient-partnership Go to EBM live in Toronto in 2020 https://ebmlive.org/ebmlive-2020/

Cannabinoid hyperemesis syndrome is a relatively newly recognised condition - but, according to one study, can account for up to 6% of patients presenting to emergency departments. The causal mechanism is as yet unclear - but currently the only known way to prevent the syndrome is for the patient to stop their cannabis use. Yaniv Chocron, chief resident at Lausanne University Hospital, Lausanne, Switzerland talks us through spotting the condition, and what we think might be the mechanism of action. Read the full easily missed article: https://www.bmj.com/content/366/bmj.l4336

Cochrane Austria have been asking the public what they'd like to know about health. Not whether the latest drug is more efficacious, but whether glacier stone power cures hangovers. Gerald Gartlehner, director of the Cochrane Austria Centre joins us to explain what they do, and how their evidence has been received. Read more about the project (in German): https://www.medizin-transparent.at/

Fertility awareness based methods of contraception are increasingly being used for pregnancy prevention. In the US, the proportion of contraceptive users who choose such methods has grown from 1% in 2008 to approximately 3% in 2014.  Relative to other methods of pregnancy prevention, however, substantial misinformation exists around fertility awareness based methods of contraception, particularly about the effectiveness of specific methods and how to use them.  Rachel Urrutia, assistant professor of Obstetrics and Gynecology at the, University of North Carolina,  and Chelsea Polis, senior research scientist at the Guttmacher Institute join us to describe the various fertility awareness based methods, and the evidence base behind all the options available. Read the full clinical update https://www.bmj.com/content/366/bmj.l4245

This month we have some more feedback from our listeners (2.20) Carl says it's time to start smoking cessation (or stop the reduction in funding for smoking reduction) (11.40) and marvels at how pretty Richard Doll's seminal smoking paper is. It's gloves off for infection control (22.20) Andrew George, a non-executive director of the Health Research Authority joins us to talk about their consultation on research transparency, and explains how you can get involved (27.04) And we talk about a new tool for rating the transparency of pharma companies (37.40) Reading list: Impact of the WHO Framework Convention on Tobacco Control on global cigarette consumption https://www.bmj.com/content/365/bmj.l2287 Sixty seconds on . . . gloves off https://www.bmj.com/content/366/bmj.l4498 HRA transparency consultation https://www.hra.nhs.uk/about-us/consultations/make-it-public/our-vision-research-transparency/ Sharing of clinical trial data and results reporting practices among large pharmac

Margaret Heffernan has thought a lot about whistleblowing, and why companies don't respond well to it. She wrote the "Book Wilful Blindness: Why We Ignore the Obvious at our Peril". In this podcast she talks about how culture, and groupthink, leads to a culture where whistleblowers are ignored, and why the NHS needs to change the way it treats people who try and call out poor care. This was recorded at Risky Business - https://www.riskybusiness.events/ where you can find our more about the conference and watch previous talks.

It's been just over two years since a fire broke out in Grenfell tower, in west London, claiming the lives of 72 residents. 223 people survived, thanks to the work of the fire brigade and health care. In this podcast we hear from Andrew Roe, assistant commissioner at London Fire Brigade, and Anu Mitra, consultant emergency physician at St Mary's hospital - they talk about the support which has been provided, and where more needs to be done to help frontline staff cope with the horrors of the job. The interviews were recorded at Risky Business - https://www.riskybusiness.events/ - where you can find out more about the Risk in healthcare.

This week on the podcast, (2.02) a listener asks, when we suggest something to stop, should we suggest an alternative instead? (8.24) Helen tells us to stop putting people on treatment for subclinical hypothyroidism, but what does that mean for people who are already receiving thyroxine? (20.55) Carl has a black box warning about z drugs, and wonders what the alternative for sleep are. (30.11) Finally the NEJM has published Jeff Drazen's dozen most influential papers - but not a systematic review amongst them. Cue the rant. Reading list: Rapid rec on subclinical hypothyroidism https://www.bmj.com/content/365/bmj.l2006 Temporal trends in use of tests in UK primary care, 2000-15 https://www.bmj.com/content/363/bmj.k4666 Black box warning for z-drugs https://www.bmj.com/content/365/bmj.l2165 Drazen's dozen https://cdn.nejm.org/pdf/Drazens-Dozen.pdf

WHO Director-General Dr. Tedros recently said “Since it came into force 13 years ago, the Framework Convention on Tobacco Control remains one of the world’s most powerful tools for promoting public health,”. But is it? That’s what a to studies just published on bmj.com try and investigate - one of which pulls together all the data we have on smoking rates, from 1970 to 2015, and then a quasi-experimental study which tries to model what the effect of the FCTC has had. Steven Hoffman, and Matthieu Poirier from the Global Strategy Lab at York University join us to explain what their research means, and why it’s time to double down on our attempts to reduce smoking. Read the open access research: https://www.bmj.com/content/365/bmj.l2287 https://www.bmj.com/content/365/bmj.l2231

Nicole Stott is an engineer, aquanaut and one of the 220 astronauts to have lived and worked on the International Space Station. In a confined space, under huge pressure, with no way out, it's important that teams maintain healthy dynamics, and individuals can manage their stress adequately, and in this podcast Nicole explains a little about living on the ISS and how she coped for 91 days. Read more about the Space Art Foundation: https://www.bmj.com/content/365/bmj.l4244 More from Risky Business https://www.riskybusiness.events/

As Syria enters its ninth year of conflict, doctors are struggling to provide health care to a badly damaged country. While dealing with medicine shortages, mass casualties and everything that comes with working in a warzone, healthcare facilities and their staff are also facing an unprecedented number of targeted and often repeated attacks. According to a new report, there were 257 recorded attacks on hospitals, medical transportation and healthcare workers in Syria in 2018. And despite these attacks being illegal under international law, they are becoming the new normal. In this podcast, Elisabeth Mahase talks to Feras Fares, a gynaecologist from Syria, Len Rubenstein, chair of the Safeguarding Health in Conflict Coalition, and Declan Barry, an Irish pediatrician who worked with MSF in Syria in 2013.

Hi impact, low probability events are a planners nightmare. You know that you need to think about them, but how can you prioritise which event - terrorist attack, natural disaster, disease outbreak, deserves attention - and how can you sell the risks of that, but not oversell them? Risky business is a conference where some of these kind of things can be discussed - how do we think about risk, how do we plan for it - at this year’s conference we heard from one of the men who rescued the boys from a cave in Thailand, the fireman in charge of Grenfell, and the medical teams responding to the three latest terrorist attacks in the UK. In this podcast we talk to Amy Pope, former advisor to the Whitehouse during president Obama’s tenure. There she was charged with thinking about these high impact, low probability events. More from Risky Business https://www.riskybusiness.events/

It's What Matters To You day - #wmty - and in this podcast Anya de Iongh, The BMJ's patient editor, and Joe Fraser, author of Joe's Diabetes who works at NHS England on personalised care, get together to discuss what personalised care actually means, how it changes the ways in which patients and health professionals interact, and how it can be practically done. We also hear from three people who are making personalised care actually happen Jo McGoldrick is a health coach who works at Lions Health GP Practice in Dudley. Joanne Appleton is a Commissioning Manager for Personalised Care at Gloucester CCG Jono Broad lives with long term health conditions and is involved in regional and QI work around personalised care.

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

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</p

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

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

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 th

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 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

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/36

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

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/

An “author pays” publishing model is the only fair way to make biomedical research findings accessible to all, say David Sanders, professor of gastroenterology at Sheffield University, but James Ashton and worries that it can lead to bias in the evidence base towards commercially driven results - as those are the researchers who can pay for open access fees. Dave deBronkart just wants patients to have access to key research. Read the full head to head: https://www.bmj.com/content/365/bmj.l1544

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month. (1.20) Carl grinds his gears over general health checks, with an update in the Cochrane Library. (9.15) Helen is surprised by new research which looks at over prescription of antibiotics - but this time because the courses prescribed are far longer than guidelines suggest. (22.30) What is the true 99th centile of high sensitivity cardiac troponin in hospital patients? (29.02) Is it time to abandon statistical significance and be aware of the problem of the transposed conditional. Reading list: General health checks in adults for reducing morbidity and mortality from disease - https://www.ncbi.nlm.nih.gov/pubmed/30699470?dopt=Abstract Duration of antibiotic treatment for common infections in English primary care -https://www.bmj.com/content/364/bmj.l440 True 99th centile of high sensitivity cardiac troponin for hospital patients - https://www.bmj.com/content/364/bm

On the 7th of June, 1753, Dr Archibald Cameron was executed at Tyburn. "The body, after hanging twenty minutes, was cut down: it was not quartered; but the heart was taken out and burnt. " 250 years later, his sixth great grandson, Robert Syned found himself deeply involved in the process of execution, as an expert witness in a case about the use of a new drug for lethal injection in the USA. In this podcast, Robert joins us to talk about the dearth of evidence, and massive variation in the use of drugs used to execute someone, and reflects on how finding out about his ancestor meant to him in this process.

Jessica Perlo is the Director for Joy at Work at the Institute for Healthcare Improverment, and James Mountford is direct or of quality at the Royal Free London NHS Foundation Trust. Together they joined us at the International Forum on Quality and Safety in Healthcare to discuss joy at work - what that concept actually means, and practically, how hospitals can start implementing it. Watch Jessica’s session at the forum https://internationalforum.bmj.com/glasgow/2018/09/20/a1-leadership-models-for-co-producing-a-joyful-workforce/ BMJ's wellbeing campaign https://www.bmj.com/wellbeing https://www.facebook.com/groups/569230966796440/

Non-medical interventions are increasingly being proposed to address wider determinants of health and to help patients improve health behaviours and better manage their conditions - this is known as social prescribing. In England, the NHS Long Term Plan states that nearly one million people will qualify for referral to social prescribing schemes by 2024. In this podcast, Chris Drinkwater, emeritus professor of primary care and Louise Cook, a link worker, both at Newcastle University's Ways to Wellness - who provide social prescribing support. They describe the evidence base for the service, how they work with patients to coordinate their non-medical interventions, and how they measure success. Read the full clinical update: https://www.bmj.com/content/364/bmj.l1285

Change requires the application of power - the way in which individuals can accrue power has shifted in our digitally connected world. Traditional ways of influencing change in healthcare (getting the chief executive on side, having a quiet chat with the medical director) are not the only way to build a momentum. Henry Timms - author of “New Power” the internationally best selling book joins us to talk about about how much of his thinking on these power structures has come from healthcare. https://thisisnewpower.com/ https://twitter.com/hashtag/newpower Henry Timms onstage at the International Forum on Quality and Safety in Healthcare https://livestream.com/IFQSH/Glasgow2019/videos/189271449

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month. They start by talking about shoulders - what does the evidence say about treating subacromial pain, and why the potential for a subgroup effect shouldn't change our views about stop surgery (for now, more research needed). (16.00) Statins - more uncertainty about statins, this is now looking at older people. Age is a big risk factor for cardiovascular disease - at what point does that risk overwhelm any potential benefit from taking statins? (20.30)Carl explains his rule-of-thumb for turning relative risks into absolute risks, in a way can help doctors talk to patients about new evidence. (25.46)What's the evidence for doctors messes? Carl's rant of the week focuses on the calls (including the BMJ's campaign) to have spaces for doctors to relax in hospitals. He asks, is that better than putting in a gym? What's the evidence for that. Reading list: Subacromial decomp

As England’s presumed consent law for 2020 clears parliament, Veronica English, head of medical ethics and human rights at the BMA, say that evidence from Wales and other countries shows that it could increase transplantation rates. But Blair L Sadler, physician and senior adviser to California State University, consider such legal changes a distraction lacking strong evidence: they say that public education and trained staff would have a proven impact. We also hear from Erin Walker, the recipient of 2 liver transplants, about her concerns on families over-ruling donor's wishes. Read the full debate, and Erin's commentary: https://www.bmj.com/content/364/bmj.l967

It can be difficult to know what to do when a person in severe psychological distress presents to a general practice or community clinic, particularly if they are behaving aggressively, or if they are refusing help. Most patients who are acutely disturbed present no danger to others, however situations can evolve rapidly. Frontline staff need to know how to call for help, how to assess and manage physical risk, and how to de-escalate such situations. In this podcast Aileen O’Brien, reader in psychiatry and education at St George’s University of London joins us to give some advice on what to do in that situation - why deescalation is useful, and who else to involve. We also hear from someone who lives with bipolar disorder, and has had experiences of being acutely unwell in a public places, which have lead to police and psychiatric intervention. Read the full practice article: https://www.bmj.com/content/364/bmj.l578

In every generation there are a few that know the secret; the counterintuitive effects of loop diuretics. In this podcast Steven Anisman, cardiologist at the Dartmouth Hitchcock Department of Cardiovascular Medicine, joins us to explain about the threshold effects of these drugs, and why that might change the way in which you think about prescribing them. Read the full article on treatment of oedema with loop diuretics, and contribute to the discussion: https://www.bmj.com/content/364/bmj.l359

Renza Scibilia and Chris Aldred have diabetes, and their introduction to the idea of complications arising from the condition were terrifying. Because of this early experience, and Chris's later development of complications, they have campaigned to make doctors really think about the way in which they talk about complications with patients. Challenging the use of "non-compliant" and other stigmatising language. Chris has also documented his experience of developing an ulcer, and having it successfully treated, on social media, to open up the conversation and make us all #talkaboutcomplications. Chris Aldred is @grumpy_pumper on twitter, and blogs at http://www.the-grumpy-pumper.com. Renza Scibilia is @RenzaS on twitter and blogs at https://diabetogenic.wordpress.com/

In 2014, Oliver Johnson was a 28 year old British doctor, working on health policy in Sierre Leone after finishing medical school. Also working in Freetown was Sinead Walsh, then the Irish Ambassador to the country. Then the biggest outbreak of Ebola on record happened in West Africa, starting in Guinea and quickly spreading to Liberia, Sierre Leone and Nigeria. Oliver and Sinead have co-authored a book about the change that wrought on their lives, how they stepped into roles coordinating the international response to the disease and running a treatment centre. They join us today to talk about their experiences there. For more information about Ebola, including the current outbreak in the Democratic Republic of Congo visit https://www.bmj.com/ebola. For Sinead and Oliver's book - Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline is available now. https://www.amazon.co.uk/dp/B07DFLFF9P/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1

If you've been keeping up to day with The BMJ - online on in print, you might have noticed that we've got a new type of article - NIHR Signals - and they are here to give busy clinicians a quick overview of practice changing research that has come out of the UK's National Institute for Health Research. Tara Lamont, director of the NIHR dissemination centre, joins us to talk a bit more about the research underpinning these articles. You can find the full list of articles: https://www.bmj.com/NIHR-signals

More doctors are choosing to retire early, doctors who take career breaks find it hard to return to practice, and doctors at all stages of their careers are frustrated by the lack of support given to training and development in today’s NHS. Each year the BMJ holds a roundtable discussion at the Nuffield Summit - where health leaders come together to talk about the NHS. We wanted to know what more the NHS can do to provide fulfilling careers for staff and to improve support for doctors who want to keep working and those seeking to return to practice. Taking part in the discussion were: Tom Moberly - UK editor for The BMJ Rahkee Shah - paediatric registrar Ronny Cheung - consultant general paedatrician Claire Lemer - consultant paediatrician Candace Imison - Director of Workforce Strategy at the Nuffield Trust James Morrow - GP partner

Diabetes is synonymous with sugar, but diabetes insipidus, "water diabetes", can't be forgotten. Between 2009 and 2016, 4 people died in hospital in England, when lifesaving treatment for the condition was not given. In this podcast, we hear some practical tips for non-specialists to aid diagnosis, and how patients should be managed during hospital admission. On the podcast are Miles Levy, consultant endocrinologist from Leicester Royal Infirmary Pat McBride, head of family services at the Pituitary Foundation John Wass, professor of endocrinology at Oxford University Malcolm Prentice, consultant endocrinologist at Croydon University Hospital. Read the full practice article: https://www.bmj.com/content/364/bmj.l321

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month. They start by talking about how difficult a task it is to find evidence that's definitely practice changing, what GPs can learn from Malawian children with nonsevere fast-breathing pneumonia, how radiation dosage varies substantially - and consultant radiologist Amy Davies what that means for patients. They also rail against add-on tests for fertility, and the lack of evidence underpinning their use - will the traffic light system suggested help patients make treatment choices. Carl's rant this week is based on a new study by Steve Woloshin and Lisa Schwartz which documented 20 years of medical marketing in the USA. Reading list: Pneumonia in Malawi - https://www.ncbi.nlm.nih.gov/pubmed/30419120 Variation in radiation dose - https://www.bmj.com/content/364/bmj.k4931 Traffic light fertility tests - https://www.bmj.com/content/364/bmj.l226 Medical marketing - https

The problem we had publishing our feed has been fixed, and normal service has resumed. Thank you for subscribing to the podcast, if you have thoughts you'd like to express, we'd love to hear them. https://www.bmj.com/podcasts

Recent years have seen political and social progress for people who identify as LGBT+ (lesbian, gay, bisexual, and transgender; the “+” indicating inclusion of other minority sexual and gender identities). Yet international evidence shows ongoing health and social inequalities in this group, many of which emerge during adolescence and represent unique safeguarding risks. In this podcast, Kate Addlington, psychiatry trainee and associate editor at The BMJ is joined by Ginger Drage, expert patient educator at University College London, Jessica Salkind, academic clinical fellow in paediatrics & teaching lead for LGBT+, at Imperial College London and Rosanna Bevan, psychiatry trainee from East London Foundation Trust They discuss the the risks faced by LGBT+ young people, which include increased rates of self harm, suicide, and family rejection or abuse, and what steps clinicians can take to support and intervene if necessary. Read the full practice article: https://www.bmj.com/co

Current evidence is sufficient to justify a national screening programme, argues Mark Lown clinical lecturer at the University of Southampton, but Patrick Moran, senior research fellow in health economics at Trinity College Dublin, thinks there are too many unanswered questions and evidence from randomised trials is needed to avoid overdiagnosis Read the full debate: https://www.bmj.com/content/364/bmj.l43

Patients who experience chronic rhinosinusitis may way for a considerable period of time before presenting, because they believe the condition to be trivial. In this podcast, Alam Hannan, ENT Consultant at the Royal Throat Nose and Ear Hospital in London, explains why that belief is not founded, and describes which treatments can be effective at providing relief.

The Royal College of Physicians will survey all its members in February on this most controversial question. It says that it will move from opposition to neutrality on assisted dying unless 60% vote otherwise. The BMJ explores several conflicting views. From Canada, palliative care doctor Sandy Buchman explains why he sees medical aid in dying as a compassionate treatment that fully respects patient autonomy. The Canadian Medical Association is neutral on the issue, and Jeff Blackmer, its vice president for international health, shares how that stance enabled it to represent all its members, including doctors with conscientious objections. But many are unconvinced to say the least. Rob George, a UK palliative care doctor and professor at King's College London, says assisted suicide has no place in medicine. Tony Baldwinson, from the UK campaign group Not Dead Yet, worries for disabled people were society to endorse doctors actively ending lives. And Zoe Fritz, a consultant physicia

Jönköping has been at the centre of the healthcare quality improvement movement for years - but how did a forested region of Sweden, situated between it's main cities, come to embrace the philosophy of improvement so fervently? Goran Henriks, chief executive of learning and innovation at Qulturum in Jönköping joins us to explain. He also tells us about Esther, and why she figures so centrally in their planning.

In this EBM round-up, Carl Heneghan, Helen Macdonald and Duncan Jarvies are back to give you an update Dual vs single therapy for prevention of TIA or minor stroke - how does the advice that dual work better translate in the UK? Carl explains why Japan can teach us to get active and, how GPs can use that information to "drop a decade" in aging. Finally, Helen took some time to relax over Christmas - until she read a story in the Christmas edition about gender discrimination in medicine, and it reminded her of her time on the ward. Reading list: The BMJ Practice: Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke https://www.bmj.com/content/363/bmj.k4169 Delaying and reversing frailty: a systematic review of primary care interventions https://bjgp.org/content/early/2018/11/30/bjgp18X700241

We have had two articles published recently on bmj.com, looking at drug prevention of HIV; PeP - Post-exposure Prophylaxis and PreP - Pre-exposure Prophylaxis, neither prevent the virus from entering the body, but they do prevent the infection from taking hold. There are lots of questions that doctors have about these - what are the risk profiles of patients who should be offered the treatments? How can they be prescribed? What are the side effects? And if you're in England, where PreP is not yet available on the NHS, can doctors advise their patients to buy it online? Michael Brady, Sexual health and HIV consultant at Kings College Hospital and Medical Director of the Terrence Higgins Trust, joins us to help answer those questions. Further reading BMJ article on PeP https://www.bmj.com/content/363/bmj.k4928 BMJ article on PreP BASHH guidelines on PreP - https://www.bashhguidelines.org/media/1189/prep-2018.pdf https://iwantprepnow.co.uk http://www.aidsmap.com/

HbA1c concentration is used as the biomarker for long term glycaemic control, however if the lifespan of red blood cells is altered, that may lead to an over, or under estimation of that control. In this podcast Ravinder Sodi, consultant clinical biochemist at University Hospitals of Morecambe Bay NHS Foundation Trust, explains when to suspect HbA1c is not an accurate measure of glycemic control, and what alternative tests are available. Read the full article: https://www.bmj.com/content/363/bmj.k4723

Terence Stephenson is a consultant paediatrician who became been chair of the General Medical Council in 2015. His 4 year tenure has now come to an end, but during his time with the regulator the medical profession faced a number of challenges - the case of Hadiza Bawa Garba and a growing recruitment crisis in the NHS - the GMC is the gatekeeper for foreign doctors who who wish to work here. As the rules on EU doctors change, the GMC’s regulatory practice may have to change too. In this podcast, Abi Rimmer, a report and editor for The BMJ, went to Terrence’s office to talk to him about his career at the GMC, and his perspective on how the organisation has responded to those challenges. Read the related article: https://www.bmj.com/content/363/bmj.k5402

Susan Greenhalg is a research professor of chinese society in Harvard’s department of anthropology - not a natural fit for a medical journal you may think, but recently she has been looking at the influence of Coca Cola on obesity policy in China. She has written up her investigation in an article published on bmj.com this week, and joins us in the podcast to talk about why a communist country would embrace a message from an icon of capitalism, and what attitudes toward financial conflicts of interest exist in the country. Read the full feature: https://www.bmj.com/content/364/bmj.k5050 Accompanying editorial: https://www.bmj.com/content/364/bmj.l4

For many of you Christmas is over and, you’re back to work. Admin piled up over christmas? Feeling resentful for all those forms, and the weird codes they make you put in them? In this podcast I hope we can explain why that’s important, with 17th century death, the esoteria of reed codes, and why the WHO cares about spaceship accidents. Consumption, flux, and dropsy: counting deaths in 17th century London https://www.bmj.com/content/363/bmj.k5014 Christmas guide to clinical coding https://www.bmj.com/content/363/bmj.k5209

2018 will go down in history as a year of reckoning as the year that that some men’s behaviour came back to bite them. The continuing impact of #MeToo across the world has prompted another round of thinking about women’s experiences in medicine, which can be seen this year’s christmas journal In this podcast, Esther Choo and Eleni Lenos, join us to discuss their research into mother's experiences of being doctors - and how discrimination is still rife against them. Also Sarah Lowry, from the Royal College of Physicians brings us some other women's voices - this time from the RCP exhibition "This vexed Question: 500 years of women in medicine" Visit the exhibition: https://www.rcplondon.ac.uk/events/vexed-question-500-years-women-medicine Physician mothers’ experience of workplace discrimination: a qualitative analysis https://www.bmj.com/content/363/bmj.k4926 A lexicon for gender bias in academia and medicine https://www.bmj.com/content/363/bmj.k5218

the Christmas BMJ season is upon us - if you’re to go to our website now, you’ll see that it’s been a bumper year. In the podcast, we’re going to be bringing you a select few - we’ll be looking at motherhood. Trying to figure out what 17th Century causes of death were, and - as it’s christmas - in this pod we’ll be looking at food. We talk to Frances Mason and Amanda Farley, from the University of Birmingham, about their RCT examining the “Effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period" https://www.bmj.com/content/363/bmj.k4867 We also have Eric Robinson from the University of Liverpool explains how calorific restaurant food from his observational study, "(Over)eating out at major UK restaurant chains" https://www.bmj.com/content/363/bmj.k4982

In the second of our EBM round-ups, Carl Heneghan, Helen Macdonald and Duncan Jarvies are joined by Deborah Cohen, investigative journalist and scourge of device manufacturers. We're giving our verdict on the sensitivity and specificity of ketone testing for hyperemesis, and the advice to drinking more water to prevent recurrent UTIs in women. Deb joins us to talk about the massive, international, investigation into failing regulation for implantable devices - and shares some of the stories where these have harmed patients. Finally, Carl is excised about antivaxer ads on facebook - but Helen has seen some pro-vaccine ones which are poor science too. Reading list: Diagnostic markers for hyperemesis gravidarum https://www.ncbi.nlm.nih.gov/pubmed/24530975 Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2705079 The great implant scandle https://www.bbc.co.uk/ipl

A new collection of articles published by The BMJ includes twelve country case studies, each an evaluation of multisectoral collaboration in action at scale on women’s, children’s, and adolescent’s health. Collectively these twelve studies inform an overarching synthesis and accompanying commentaries, drawing together lessons learned in achieving effective multisectoral collaboration. In this podcast, Wendy Graham, professor of obstetric epidemiology at the London School of Hygiene and Tropical Medicine, and Shyama Kuruvilla, senior strategic advisor to the World Health Organisation, join us to discuss what can be learned from those case studies. Read all the case studies: https://www.bmj.com/multisectoral-collaboration

Infant formula manufacturers were made pariah in the 70s, because of their marketing practices - this lead to “The Code”, adopted by the WHO, which set out clear guidelines about what those practices should be. Now an investigation on bmj.com by Chris Van Tulleken, honorary senior lecturer at University College London, examines the practices associated with the marketing of specialist milk formula for children with cow’s milk protein allergy, and asks whether doctors organisations should be receiving money from that industry. Read the full investigation: https://www.bmj.com/content/363/bmj.k5056

Nausea and vomiting in pregnancy affects around 70% of pregnancies. It is mild for around 40% of women, moderate for 46%, and severe for 14%. By contrast, hyperemesis gravidarum is a complication of pregnancy rather than a normal part of it and occurs in around 1.5% of pregnancies. The psychosocial burden of HG can be heavy for women and their families. In this podcast, Caitlin Dean Phd Candidate, Gillian Ostrowski, general practitioner, Rebecca C Painter, consultant obstetrician join us to explain what hyperemesis is like for those who experience it, and discuss what treatment options are available. Read the full article: https://www.bmj.com/content/363/bmj.k5000

Healthy self confidence has an important role in surgery, but what came first - the surgeon or the ego? In this conversation, Christopher Myers, Yemeng Lu-Myers, and Amir Ghaferi join us to talk about the (very few) surgeons who behave badly in theatre, and why that behaviour has persisted, and can be detrimental. Read their full analysis: https://www.bmj.com/content/363/bmj.k4537

Until recently, The BMJ had a campaign of patient partnership - now we have a patient and public partnership campaign. The reason for that change is that medicine has an effect beyond the individual being treated - and this podcast interview is a very good example of that. Anya De Iong, patient editor for The BMJ, talks to Christine Morgan - independent chair of the Greater Manchester Carers Strategic Group. Christine has a mission to bring the needs of carers into thinking and planning about the NHS - and explains how the needs of patients and carers may be similar, and different.

You’ll have read in a clinical trial “Most patients had an acceptable adverse-event profile.” Or that a drug “has a manageable and mostly reversible safety profile.” And that “the tolerability was good overall.” In this podcast, Bishal Gyawali (@oncology_bg) joins us to describe what events those terms were actually describing in cancer drug trials, and how they reduce the readers appreciation of the adverse effects of these novel drugs. Read the full analysis: https://www.bmj.com/content/363/bmj.k4383

Welcome to this, trial run, of a new kind of BMJ podcast - here we’re going to be focusing on all things EBM. Duncan Jarvies, Helen Macdonald and Carl Heneghan - and occasional guests- will be back every month to discuss what's been happening in the world of evidence. We'll bring you our Verdict on what you should start or stop doing, geek out about stats, and rant about the unevidence based world in which we live. This week we talk about: Vitamin D https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30265-1/fulltext Oxygen https://www.bmj.com/content/363/bmj.k4169 The UK parliament's report on clinical trial transparency https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/1480/1480.pdf

Clinical trials for regulatory approval are designed to test efficacy, but new drugs might have adverse reactions - reactions those trials aren’t designed to spot. To talk about those adverse reactions - how to spot them, how to report them and what to do about them, we're joined by Robin Ferner, from the West Midlands Centre for Adverse Drug Reactions. Read the full practice article: https://www.bmj.com/content/363/bmj.k4051

Machines that can learn and correct themselves already perform better than doctors at some tasks, but not all medicine is task based - but will AI doctors ever be able to have a therapeutic relationship with their patients? In this debate, Jörg Goldhahn, deputy head of the Institute for Translational Medicine at ETH Zurich thinks that the future belongs to robot doctors - but Vanessa Rampton, Branco Weiss fellow at McGill Institute for Health and Social Policy, says they'll never be able to emulate the empathy required. We're also joined by Michael Mittelman, executive director of the American Living Organ Donor Fund, who has had complex healthcare needs for his whole life - to explain what he feels about the prospect of his care delivered by machine. Read the full debate: https://www.bmj.com/content/363/bmj.k4669

As the accompanying editorial to this article says, "oxygen has long been a friend of the medical profession Even old friendships require reappraisal in the light of new information." And that’s what a new rapid reccomendation - Oxygen therapy for acutely ill medical patients - does. To discuss we're joined by two of the authors, Reed Simieniuk, general internist at McMaster University and Gordon Guyatt, distinguished professor at McMaster University. Read the full recommendation: https://www.bmj.com/content/363/bmj.k4169

Cardiovascular factors are associated with risk of stroke - and those factors can be mediated by lifestyle and by genetic make up. New research published by The BMJ sets out to explore how these risks combine, and we're joined on the podcast by two of the authors - Loes Rutten-Jacobs, senior postdoctoral researcher at the German Center for Neurodegenerative diseases, and Susanna Larsson, associate professor at the Karolinska Institutet. Read the full open access research: https://www.bmj.com/content/363/bmj.k4168

On the podcast, we’ve talked a lot about the limits of medicine - where treatment doesn’t work, or potentially harms. But in that conversation, we’ve mainly focused on specific treatments. Now a new analysis, broadens that to talk about patients being admitted to a whole ward - intensive care. The authors of that article contend that, often, patients or their families don’t fully understand the implication of that admission. To discuss, we're joined by Jamie Gross, consultant in intensive care medicine at London North West University Healthcare NHS Trust, and by Barry Williams, patient representative at the Intensive Care Society. Read the full analysis: https://www.bmj.com/content/363/bmj.k4135

The common cold is usually mild and self limiting - but they’re very annoying, especially the runny nose and bunged up feeling that form the nasal symptoms. A new practice article, published on BMJ.com looks at the available evidence for treatment of those nasal symptoms - both pharmacological and alternative. In this podcast we're joined by Mieke van Driel - GP in Australia and a professor of primary care at The University of Queensland, and An De Sutter - GP in Belgium and professor of family medicine at Ghent University. Read the full article, and play with the interactive infographic: https://www.bmj.com/content/363/bmj.k3786

What can we learn from the shameful story of vaginal mesh? That thousands of women have been irreversibly harmed; that implants were approved on the flimsiest of evidence; that surgeons weren’t adequately trained and patients weren’t properly informed; that the dash for mesh, fuelled by its manufacturers, stopped the development of alternatives; that surgeons failed to set up mesh registries that would have identified complications sooner; and that the National Institute for Health and Clinical Excellence and the UK regulators let them off the hook. The BMJ has a published an investigation into vaginal mesh, which charts some of the issues above. In this podcast The BMJ talked to three women who have had a vaginal mesh implanted, and all suffered the negative consequences that have prompted these investigations. We bring you these stories to underline how life altering the situation has been for these woman, and to highlight the need for fully informed consent before anyone else has

There is very little guidance on withdrawing or tapering opioids in chronic pain (not caused by cancer). People can fear pain, withdrawal symptoms, a lack of social and healthcare support, and they may also distrust non-opioid methods of pain management. This can mean that patients receive repeat opioid prescriptions for extended periods of time. In this podcast, Harbinder Sandhu, health psychologist in pain management at Warwick Medical School, Andrea Furlan, associate professor of medicine at University of Toronto, and Sam Eldabe, consultant in pain medicine at The James Cook University Hospital join us to set out the evidence on tapering opioids - and give practical advice on how to support patients. We're also joined by Colin, who was prescribed opioids for a decade, before he decided to reduce his usage. What you need to know: For people with chronic pain and who do not have cancer, the benefits of long term opioids are outweighed by the issues of tolerance, dependence, and

Ted Kaptchuk, professor of medicine at Harvard Medical school - and leading placebo researcher, has just published an analysis on bmj.com describing the effect of open label placebo - placebos that patient's know are placebos, but still seem to have some clinical effect. Ted joins us to speculate about what's going on in the body, what this means for designing a more effective placebo, and asking whether it's time to start honestly prescribing placebos in the clinic. Read his full analysis: https://www.bmj.com/content/363/bmj.k3889

We want clinical trials to be thorough - but Vinay Prasad, assistant professor of medicine at Oregon Health Science University, argues that the problem of overdiagnosis may be as prevalent, in the way we measure disease in our research, as our practice. In this podcast he joins us to discuss the problem, and why he thinks what qualifies as disease in clinical trials may be getting so broad that outcomes are becoming less meaningful and harder to interpret. Read the full analysis: https://www.bmj.com/content/362/bmj.k3783

Brits have a reputation as Europe’s boozers - and for good reason, with alcohol consumption higher than much of the rest of the continent. That reputation is extended to our young people too - but is it still deserved? Joanna Inchley, senior research fellow at the University of St Andrews, explains new research on decreasing drinking - http://www.hbsc.org/ Also this week, as part of our coverage of the 70th anniversary of the founding of the NHS, we’ve been running a series of articles exploring this unique institution’s future. Neena Modi, professor of neonatal health, and Jonathan Clarke, clinical research fellow, from Imperial College London, passionately believe that the NHS needs to be publicly financed - and importantly, publicly provided. https://www.bmj.com/content/362/bmj.k3580

Last week we heard about how evidence in policy making is imperilled - but today we’re hearing about a plan to make evidence about health central to all aspects of government. Laura Webber, director of public health modelling at the UK Health Forum, Susie Morrow, chair of the Wandsworth Living Streets Group and Brian Ferguson, chief economist at Public Health England join us to discuss a “health in all policies” approach, with protected funding for preventive interventions. Read their full analysis: https://www.bmj.com/content/362/bmj.k3377

This week a very different kind of conversation on the Recommended Dose – one that considers the art of medicine more than the science. Iona Heath is a long-time family doctor who has worked in a London GP clinic for over 30 years, and at one time became President of the Royal College of General Practitioners. With an international profile, gained in part through her much-loved writing in the BMJ, Iona is unlike many of our previous guests. For a start, she loves words more than numbers, and literature more than clinical guidelines. Host Ray Moynihan caught up with Iona at a recent conference in Helsinki – where she'd just presented little data but much food for thought from the likes of novelists EM Forster and James Baldwin. Here, she shares more of her love of literature and thoughtful commitment to the best kind of patient care.

If you’re of a scientific persuasion, watching policy debates around Brexit, or climate change, or drug prohibition are likely to cause feelings of intense frustration about the dearth of evidence in those discussions. In this podcast we're joined by Chris Bonell, professor of public health sociology - in this podcast he airs those frustrations, and worries that the rise of populism is pushing evidence even further out of policy decision. Read the accompanying essay: https://www.bmj.com/content/362/bmj.k3827

More than ½ of patients leave hospital with changes to four or more of their long-term medications - but how appropriate are those changes? New research published on bmj.com looks at antihypertensive medication prescription changes to try and model that - and found that more than half of intensifications occurred in patients with previously well controlled outpatient blood pressure. To discuss what they found, we're joined by Timothy Anderson, primary care research fellow, and Michael Steinman, professor of medicine, both from UCSF. Read the open access research: https://www.bmj.com/content/362/bmj.k3503

We at The BMJ care about food, and if our listener stats are to be believed, so do you. In this podcast we’re looking at quality as an important driver of a good diet. At our recent food conference - Food For Thought - hosted in Zurich by Swiss Re we brought researchers in many fields of nutritional science together. We asked people with competing ideas to write articles to elucidate where there’s agreement, and where there is still contention. There was lots of disagreement - but one thing that was widely agreed on was that, quality of food matters. Quality is as, if not more, important than quantity. In this podcast we’ll be exploring what quality is, how industrial food production affects it, and how we conceptualise quality. Joining us are Martin White, Mathilde Touvier, Jean Adams, Nicola Guess and Alan Levinovitz. For the last podcast in the food series: https://soundcloud.com/bmjpodcasts/nutritional-science-why-studying-what-we-eat-is-so-difficult? For more on the Food for

The concept of overdiagnosis is pretty hard to get - especially if you’ve been educated in a paradigm where medicine has the answers, and it’s only every a positive intervention in someone’s life - the journey to understanding the flip side - that sometimes medicine can harm often takes what Stacey Carter director of Research for Social Change at Wollongong university described in an preventing overdiagnosis podcast last year as a “moral shock” - https://soundcloud.com/bmjpodcasts/preventing-overdiagnosis-2017-stacy-carter-on-the-culture-of-overmedicalisation This year, we asked some of the leaders in the field to describe what it was that opened their eyes to overdiagnosis and overtreatment - and recorded the session for you. You’ll hear from Fiona Godlee, editor in Chief of The BMJ, Steve Woloshin and Lisa Schwartz, directors of the Center for Medicine and Media at The Dartmouth Institute, John Brodersen - professor of general practice at the University of Copenhagen, and Barry Kra

This week saw the latest Preventing Overdiagnosis conference - this time in Copenhagen. The conference is a is a forum where researchers and practitioners can present examples of overdiagnosis - and we heard about the various ways which disease definitions are being subtly widened, and diagnostic thresholds lowered. In this podcast we talk to Allen Frances, psychiatrist and former chair of the Diagnostic and Statistical Manual of Mental Disorders. We also hear from friends of the podcast, Steve Woloshin and Lisa Schwartz about the way in which some disease awareness campaigns fuel inappropriate diagnosis. https://www.preventingoverdiagnosis.net/ https://www.bmj.com/too-much-medicine

The number of people estimated to be latently infected with TB - that is infected with TB, which has not yet manifested symptoms - is around 2 billion. That is 1 in 3 people on the planet are infected by the bacteria. The World Health Organization’s website notes that on average 5-10% of those infected with TB will develop active TB. That number is terrifying, but a new analysis published in the BMJ, suggests that the assumption that latent TB often has a very long incubation period of many years may be wrong - and that may change how we calculate the number of people affected, and our whole approach to tackling the disease. This podcast features Lalita Ramakrishnan, professor of immunology and infectious diseases at Cambridge University, Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania, and Marcel Behr, professor of medicine at McGill university. Together they discuss the analysis article "Revisiting the timetable of tuberculosis"

This week, a very special conversation with a maverick British medico who set up a tiny research centre in Oxford and watched it grow into a global collaboration of over 40,000 people across 130 countries. Three decades on, the Cochrane Collaboration now produces the world's most trusted health evidence that's used by patients, health professionals, researchers and policy makers around the world every day. Cochrane co-founder Iain Chalmers joins Ray to look back on the origins of the organisation and the extraordinary life of its namesake, Archie Cochrane. Iain also reflects on his work beyond the collaboration - from working in refugee camps in Gaza to teaching children in Uganda how to detect ‘bullshit’ health claims and more recently, establishing the James Lind Alliance. It's no surprise he's received the BMJ’s most prestigious award for a lifetime of achievement in healthcare, along with a knighthood from the Queen.

Dyspareunia is a common but poorly understood problem affecting around 7.5% of sexually active women. It is an important and neglected area of female health, associated with substantial morbidity and distress. Women may be seen by several clinicians before a diagnosis is reached, There are also specialist psychosexual clinics, where men and women can be referred for sexual problems. Little has been written on the holistic approach to care for women with dyspareunia, therefore, some of the advice here is based on expert experience. Joining us to talk about care are Leila Frodsham, consultant gynaecologist and lead for psychosexual medicine, and Nikki Lee, speciality trainee in obstetrics & gynaecology, both at King’s College London. We’re also joined by Poppy, who experienced dyspareunia and has undergone treatment. Read the full education article: https://www.bmj.com/content/361/bmj.k2341

Sue Farrington is chair of the Patient Information Forum, a member organisation which promotes best practice in anyone who produces information for patients. In this podcast, she discusses what makes good patient information, why doctors should be pleased when patients arrive at an appointment with a long list of questions, and why patients are savvy about believing "doctor google". https://www.pifonline.org.uk/

15s30m is a social movement to reduce frustration &amp; increase joy - the idea is to spend 15 seconds of your time now, and save someone else 30 minutes down the line. To talk about their movement we're joined by the founders, Rachel Pilling, consultant ophthalmologist, and Dan Wadsworth, transformation manager - both from Bradford Teaching Hospitals NHS Trust. They explain why this is quality improvement, but doesn't require a lot of theory or permission to put in place, and why empowering staff to make small changes increases joy and reduces frustration. Follow them on twitter - https://twitter.com/15s30m See some of their missions on youtube - https://www.youtube.com/channel/UCg6ECK8oq_-pYMTgAR6pt7w

Mendelian randomisation - it’s a technique that uses the chance distribution of genes in a population, combined with big data sets, to investigate causative relationships. But there are a lot of questions we have in The BMJ about how the technique works - the association between genes and apparently non-biologically mediated behaviours, how much the strict rule of not claiming causation based on observational data has actually been overturned, and general confusion about how the non-methodologists amongst us can read these studies. Neil Davies and George Davey Smith from University of Bristol, and Michael Holmes from the University of Oxford, join us to explain how the technique works, where it can be applied, and what readers should look out for when they're trying to assess the quality of a mendelian randomisation study. Read their full research methods and reporting paper: https://www.bmj.com/content/362/bmj.k601

It’s been quite a year for the NHS - it just turned 70, had a winter crisis like never before, got over junior doctor strikes, but then was hit by a series of scandals about breast screening, and now opiate prescriptions. At the same time, we’ve seen demonstrations in favour of the service and even widespread public backing for more money. So how do all of these things mix into the way in which the British public view the NHS? In this podcast, Ben Page - chief exec of Ipsos MORI, the polling company, joins us to discuss the fluctuations in public opinion. Read the provocation: https://www.bmj.com/content/361/bmj.k2663 More NHS at 70 coverage: https://www.bmj.com/nhs-at-70

This week influential Editor-in-Chief of JAMA Internal Medicine Dr Rita Redberg joins Ray for a wide ranging conversation on all things health. A Professor at the University of California San Francisco and high profile contributor to The Washington Post and New York Times, Rita is also a practising cardiologist who loves to see patients. She says that ‘being a doctor is really a privilege’. Together, Ray and Rita canvas many topics including shared decision making between doctors and patients, the tricky territory of medical device approvals, the controversy surrounding both statins and CT scans, and the implications of not including enough women in clinical trials.

Doctors and the farming industry are often blamed for overuse of antibiotics that spurs the growing problem of antimicrobial resistance - but the professions are using different methods to combat resistance and reduce overuse. In this roundtable, we bring medics and vets together to discuss the problem - where antibiotic resistance arises, how resistance genes propagate through the environment and between countries, and what non-drug approaches can be used to reduce the need for antibiotics. Sandy Trees, Vet Record editor in chief, and retired veterinary surgeon Stuart Reid, principal of the Royal Veterinary College Jenny Bellini, cattle and dairy vet, Friars Moor Livestock Health in Dorset Peter Hawkey, professor of clinical and public health bacteriology, University of Birmingham Tim McHugh, professor of medical microbiology at University College London Emmanuel Wey, consultant in infection, Royal Free Hospital, London

Getting feedback from people who use NHS services is essential to assessing their value - and improving their quality. Hospitals and general practices widely post information about patient's satisfaction with their services on their websites, but approach tells us little about how feedback changes things on the ground . In this podcast, James Munro, former doctor and academic and current CEO of Care Opinion, explains how their online platform works, how Trusts are using it as a quality improvement tool, and how health systems can capitalise on the learning potential of this large scale data collection. This is part of the series of interviews with people who are making partnership between health professional and patients work in the real world. Listen to Katherine Cowen, from the James Lind Alliance, talk about how to broker an agreement about research priorities. https://soundcloud.com/bmjpodcasts/katherine-cowan-reaching-a-priority

Wendy Burn is a consultant old age psychiatrist, and new president of the Royal College of Psychiatrists. Her work on dementia has given her an affinity for the neurobiological basis of psychiatry - and her tenure at the college is seeing a move to wards this neurobiological model in the teaching of the profession. In this interview she talks about her work, how the profession is changing, and why she thinks Kanye can be a model for mental health.

Ray Moynihan is a senior research assistant at Bond University, a journalist, champion of rolling back too much medicine, and host of a new series “The Recommended Dose” from Cochrane Australia. In the series, Ray has talked to some of the people who shape the medical evidence that underpin healthcare around the world - the series aim is to elucidating their worldview, and how their thinking shapes their work. Over the next couple of months, we’ll be co-publishing the series - so keep an ear out for those interviews in your podcast feed.

At evidence live this year, one of the sessions was about the work of Evidence Aid - and their attempt to bring high quality evidence to the frontline of a humanitarian crisis. In that situation, it’s very difficult to know what will work - a conflict, or even immediately post-conflict situation is characterised by chaos - and merely doing something is vital. But though each situation is unique, sharing what’s worked elsewhere can be key to maximising the help given to vulnerable people.

At Evidence Live this year, the focus of the conference was on communication of evidence - both academically, and to the public. And part of that is the role that investigative journalism has to play in that. At the BMJ we’ve used investigative journalistic techniques to try and expose wrong doing on the part of government and industry - always in collaboration with clinicians and researchers. To explain a bit more about the world of journalism and campaigning, we're joined by to Shelley Jofre - from the BBC, Jet Schouten - from Radar, Kath Sansom - who started the online sling the mesh campaign & Deb Cohen, former investigations editor at The BMJ.

Don Berwick, president emeritus of the Institute of Healthcare Improvement, and former Administrator of the Centers for Medicare and Medicaid Services. In this conversation he discusses how he went from being a paediatrician to running Medicare for Obama, how we can create headroom in stressed systems, and breaking the rules to make things better for patients and staff. Quality improvement series:

When tackling societal problems - like the opioid epidemic in the US - there are two ways of approaching it. One is to reduce demand - by organising treatment programmes, or reducing the underlying reasons why people may become addicted in the first place - but that’s hard. So governments often turn to the other route - reducing supply - and that’s what the US government did in 2014 when it rescheduled oxycodone combination products from schedule 3 to schedual 2 - essentially making it harder for people to obtain a prescription. Now reducing that legal supply, without in hand reducing the demand, led to fears that those people with an opioid addiction would just turn to illicit routes to obtain their drugs - and new research published on bmj.com has attempted to find out if that happened. We're joined by 3 of the authors, James Martin, associate professor of criminology at Swinburne University; Judith Aldridge, professor of criminology at the University of Manchester; and Jack Cu

Series two of The Recommended Dose kicks off with polymath and poet, Dr John Ioannidis. Recognised by The Atlantic as one the most influential scientists alive today, he’s a global authority on genetics, medical research and the nature of scientific inquiry itself – among many other things. A professor at Stanford University, John has authored close to 1,000 academic papers and served on the editorial boards of 30 of the world's top journals. He is best known for seriously challenging the status quo. His trailblazing 2005 paper 'Why Most Published Research Findings Are False' has been viewed over 2.5 million times and is the most cited article in the history of PLoS Medicine. In it, he argues that most medical research is biased, overblown or simply wrong. Here, he talks to Ray about the far-reaching implications of these findings for people both inside and outside the world of health. While most closely associated with exploring cutting-edge conundrums across science, genomics and e

There’s a lot going on in the world at the moment - Ebola’s back, Puerto Rico is without power and the official estimations of death following the hurricane are being challenged. The WHO’s just met to decide what to do about it all, as well as sorting out universal healthcare, access to medicines, eradicating polio, etc etc. To make sense of that a little, we grabbed Ashish Jha - Director of the Harvard Global Health Institute to shed some light into how decisions about global health are made, and why he tries to see the world as it actually is - not how he wishes it would be. Reading list: Mortality in Puerto Rico after Hurricane Maria https://www.nejm.org/doi/full/10.1056/NEJMsa1803972 https://www.bmj.com/universal-health-coverage

We at The BMJ care about food, and if our listener stats are to be believed, so do you. In this podcast we talk to a few of the authors of a new series, published next week on bmj.com, which tries to provide some insight into the current state of nutritional science - where the controversies lie, where there’s broad agreement, and the journey of our understanding of nutrition. The open access fees for those articles has been paid for by Swiss Re - a wholesale provider of reinsurance, insurance and other insurance-based forms of risk transfer - they have not had any input into the editorial process, which has gone through the same peer review as any of our other analysis articles. Swiss Re are also co-hosting a conference where we’ll be bringing together a lot of these researchers - and which will be live streamed next week - you’ll be able to access that for free on bmj.com For more on the conference: http://institute.swissre.com/events/food_for_thought_bmj.html

In December 2017, the NEJM’s national corespondent, Lisa Rosenbaum, published an article “The Less-Is-More Crusade — Are We Overmedicalizing or Oversimplifying?” The article aimed a broadside against those who are campaigning against the overuse of medicine, and the over diagnosis of treatment. This week in the BMJ we’ve published a rebuttal to that article, and in this podcast we talk to Steve Woloshin and Lisa Schwartz - both professors at the Dartmouth Institute for Health Policy and Clinical Practice. Steve and Lisa’s article carefully deconstructs some of the ideas advanced by Rosenbaum, but in this podcast we discuss how much separate camps are forming in this debate - and how to have a constructive dialogue across that divide. Read Steve and Lisa's essay https://www.bmj.com/content/361/bmj.k2035 Iona Heath's essay - The role of fear in overdiagnosis https://www.bmj.com/content/349/bmj.g6123 Stacy Carter's interview about moral shocks https://soundcloud.c

Each time you order a test for a child, do you think the population that makes up the baseline against which the results are measured? It turns out that that historically those reference intervals have been based on adults - but children, especially neonates and adolescents, are undergoing physiological changes that mean those reference intervals may not be appropriate. To get around this Khosrow Adeli, head and professor of clinical biochemistry at the Hospital for Sick Children, and the University of Toronto, and colleagues have undertaken a mission to recruit children and young people into a study of their test results. Read the full practice article: https://www.bmj.com/content/361/bmj.k1950

Patients who are depressed and prescribed antidepressants may report weight gain, but there has been limited research into the association between the two. However new observational research published on bmj.com aims to identify that association. Rafael Gafoor, a psychiatrist and researcher at Kings College London, and one of the authors of that research joins us to talk about the potential mechanism of action - is it a physiological response to the drug, is it to do with the underlying reason for the prescription; how they studied the association; and what this might mean for individual prescriptions. You can read the full research on bmj.com; https://www.bmj.com/content/361/bmj.k1951

Complexity science offers ways to change our collective mindset about healthcare systems, enabling us to improve performance that is otherwise stagnant, argues Jeffrey Braithwaite, professor of health systems research and president elect of the International Society for Quality in Health Care. Read the full analysis: https://www.bmj.com/content/361/bmj.k2014 Quality improvement series: https://www.bmj.com/quality-improvement The BMJ in partnership with and funded by The Health Foundation are launching a joint series of papers exploring how to improve the quality of healthcare delivery. The series aims to discuss the evidence for systematic quality improvement, provide knowledge and support to clinicians and ultimately to help improve care for patients.

There’s been a lot of attention given to the new antirviral drugs which target Hepatitis C - partly because of the burden of infection of the disease, and the lack of a treatment that can be made easily accessible to around the world, and partly because of the incredible cost of a course of treatment. But a new article on BMJ talks about the uncertainly of that treatment - do we know that the drugs actually clear a HepC infection, and that this will lead to a corresponding decrease in mortality and morbidity? Janus Jakobsen from the Copenhagen Clinical Trial Unit joins us to discuss what the literature proves. Read the full article: https://www.bmj.com/content/361/bmj.k1382

Worldwide, the rate of type II diabetes is estimated to be around 1 in 11 people - about 9%. For the Pima people of Arizona, 38% of the adult population have the condition - but across the border in Mexico, the rate drops down to 7%. The difference between the groups is their life experience - one side displaced, the other on their traditional lands - and their experience is being replicated elsewhere. Lauren Carruth, assistant professor at The American University, joins us to talk about the Pima people, where else displacement is changing patterns of non-communicable disease, and what this might tell us about economic migrations effect on health. Read the full editorial: https://www.bmj.com/content/361/bmj.k1795

We’re in an era of big data - and hospitals and GPs are generating an inordinate amount of it that has potential to improve everyone’s health. But only if it’s used properly. New research published on www.bmj.com this week describes another set of information, about that data, that the authors believe could be just as important as the data itself. Griffin weber, and Isaac Kohane, from the Department of Biomedical informatics at Harvard medical school join us to discuss. Read the full research: https://www.bmj.com/content/361/bmj.k1479

The array of options available to pharmaceutical companies, to advertise their drugs, is incredibly broad - and the amount that they spend is increasing, with some reports saying it’s up 60% in the last five years. In most countries, there are pretty strict rules to limit the ways in which Pharma can spend their advertising dollars - but the WHO guidelines which have informed many of those rules are now 30 years out of date. A new analysis on bmj.com “Ethical drug marketing criteria for the 21st century“ proposes some ways in which those guidelines should be updated, we're joined two of the authors - Lisa Parker and Lisa Bero - from the Charles Perkins centre at the faculty of pharmacy at the university of Sydney to discuss. Read the full analysis: https://www.bmj.com/content/361/bmj.k1809

For many people, cancer is now survivable and has become a long term condition, and depression and anxiety are more common in cancer survivors than in the general population. Despite this, 73% of patients don't receive effective psychiatric treatment. Alexandra Pitman, consultant liaison psychiatrist at St George’s University Hospitals NHS Foundation Trust, and Andrew Hodgkiss, consultant liaison psychiatrist, at the Institute of Psychiatry, Psychology &amp; Neuroscience join us to dispel some of the concern clinicians may have about the complexities of diagnosing depression in cancer - what is biopsychosocial, what is the organic result of the cancer or treatment - and some of the concern about treatment interactions. Read the two education articles: https://www.bmj.com/content/361/bmj.k1415 https://www.bmj.com/content/361/bmj.k1488

Smokers want to vape, it can help them quit, and it’s less harmful than smoking, say Paul Aveyard professor of behavioural medicine at the University of Oxford. But Kenneth C Johnson, adjunct professor at the University of Ottawa, argues that smokers who vape are generally less likely to quit and is concerned about youth vaping as a gateway to smoking, dual use, and potential harms from long term use. Read the debate: https://www.bmj.com/content/361/bmj.k1759

Harry Burns was a surgeon, who gave up his career in that discipline to become a public health doctor. Eventually that lead to him being the last Chief Medical Officer of Scotland, and now he’s professor of global public health at the University of Strathclyde. Scotland has always had a separate NHS, but since devolution, the parliament there has had much more autonomy in running the country - and Harry has seemed to manage to convince them that improving health means improving the social determinants of health. In this conversation we talk about that link, how his philosophy has affected policy up there, some of the experiments which are going on in the country, and what he thinks is the most exciting change. Read the editorial on GDP and wellness: https://www.bmj.com/content/360/bmj.k1239

We talk about financial conflicts of interest a lot atThe BMJ - and have take taken the decision that our educational content should be without them. We also talk a lot about non-financial conflicts of interest, but the choppy waters of those are much more difficult to navigate. In this podcast, we discuss whether we should, or if we could even could, make people’s intellectual positions transparent. Arguing that it’s important to tackle this issue, are Wendy Lipworth and Ian Kerridge from Sydney health Ethics at the University of Sydney - and arguing that it’s not as easy as we think is Marc Rodwin, from Suffolk University Law School in Boston. Read the full head to head: https://www.bmj.com/content/361/bmj.k1240

In 2016, from an estimated pre-war population of 22 million, the United Nations (UN) identified 13.5 million Syrians requiring humanitarian assistance, of which more than 6 million are internally displaced within Syria, and around 5 million are refugees outside of Syria. In this podcast, Aula Abarra, consultant in infectious disease from London, joins us to discuss what's happening now in Eastern Ghouta, and area of Damascus, where civilians are being held under siege, where humanitarian aid is unable to reach. Read the full editorial: https://www.bmj.com/content/360/bmj.k1368

The first digital banking in the UK was launched in 1983, Skype turns 15 this year, but 2017 finally saw panic over the impact that online consultations may have on general practices. In this podcast Martin Marshall, professor of healthcare improvement at University College London joins us to discuss whether video conference actually is a disruptor, or whether it’s actually the whole business model of general practice that needs to change. Read the full analysis: https://www.bmj.com/content/360/bmj.k1195

When a new drug reaches market, the race is on to find more indications for its use - exploratory trials are set up, and positive results can lead to the off label prescriptions (eg Pregabalin for lower back pain. However, these initial indications are rarely confirmed with further, better quality, evidence. Jonathan Kimmelman is an associate professor at MCgill University in Canada, thinks it's time to explore less, and confirm more - and joins us to explain why. Read the full analysis: http://www.bmj.com/content/360/bmj.k959

Ravi Gupta, is a resident in internal medicine at Johns Hopkins in Baltimore - and as he said has seen the influence of sudden price hikes on his patients - between 2010 and 2015 more than 300 drugs in the U.S. have seen sudden increases of over %100. Ravi and his co-authors have suggested, and tested the feasibility of, a possible answer to those price hikes - a small tweak that should protect patients from the possibility that they’ll suddenly be unable to afford their essential medication. Read the full research: http://www.bmj.com/content/360/bmj.k831

”An additional person died every seven minutes during the first 49 days of 2018 compared with what had been usual in the previous five years. Why? In this podcast, Danny Dorling, Halford Mackinder professor of geography at the university of Oxford, talks about the spike in mortality, what that means for overall life expectancy in the UK (spoiler, it’s not great) and what he thinks could be fuelling the change. Read the full editorial http://www.bmj.com/content/360/bmj.k1090 For more information, this article by Dorling and Hiam has further analysis: https://theconversation.com/rapid-rise-in-mortality-in-england-and-wales-in-early-2018-an-investigation-is-needed-93311

That’s Jo Shapiro is a surgeon and manager in Brigham and Women’s hospital, she’s also director of the Center for Professionalism and Peer Support, and has written an editorial for The BMJ on tackling unprofessional behaviour. In this discussion, she and I talked about what she thinks (beyond the illegal) are the most damaging behaviours seen around a hospital, what needs to be done to set up an environment that allows the victims of unprofessional behaviour to speak out about senior members of staff, and how she goes about confronting perpetrators about their behaviour. Read the full editorial: http://www.bmj.com/content/360/bmj.k1025

Our latest debate asks, should doctors recommend acupuncture for pain? Asbjørn Hróbjartsson from the Center for Evidence-based Medicine at University of Southern Denmark argues no - evidence show's it's no worse than placebo. Mike Cummings, medical director of the British Medical Acupuncture Society argues yes - that there is evidence of efficacy, and trials haven't been designed to accurately measure that. We also hear from Kumari Manickasamy, a GP in north London, and someone who used acupuncture to control her pain during pregnancy despite knowing the lack of evidence. Read the debate and commentary: http://www.bmj.com/content/360/bmj.k970 http://www.bmj.com/content/360/bmj.k990

In this year's Nuffield Summit round table we're asking, how can the NHS become a good employer? At the moment, there is a recruitment and retention crisis across the workforce, doctors and nurses are leaving the NHS in droves, rota gaps are prevalent. A recent BMA survey showed that the majority of junior doctors are now planning to take a career break. So against this backdrop, what can the NHS do to nurture it's employees, and make medicine an exciting proposition for the millennial, and subsequent, generations. Taking part are: Fiona Godlee (Chair), editor-in-chief, The BMJ Candace Imison, director of policy, The Nuffield Trust Bob Klaber, consultant paediatrician and associate medical director, Imperial College Healthcare NHS Trust Claire Lemer, consultant in general paediatrics and service transformation, Guys and St Thomas’s NHS Foundation Trust Nishma Manek, GP trainee in London, national medical director’s clinical fellow Clifford Mann, consultant in Emergency Med

Its now widely agreed that one of the key ways of reducing the current high level of "waste " in biomedical research is to focus it more squarely on addressing the questions that matter to patients - and the people and medical staff that care for them. In this interview, Tessa Richards - the BMJ's patient partnership editor, talks to Katherine Cowan, independent consultant and a senior advisor the the James Lind Alliance, which has pioneered patient involvement with their research priority setting partnerships. In this conversation they talk about how these work, the challenge of navigating between different groups with what are often very different views and agendas, and why she thinks healthy debate on divergent views is no bad thing

Up to $500m a year could be put to better use by stopping ineffective and potentially harmful supplementation programmes in poorer countries, argues John Mason, professor emeritus at Tulane University School of Public Health and Tropical Medicine. However Keith West, professor of infant and child nutrition at Johns Hopkins Bloomberg School of Public Health disagrees, saying that such programmes have been proved to save millions of lives and should be withdrawn only when robust evidence permits. Read the full head to head debate: http://www.bmj.com/content/360/bmj.k927

International travel is increasingly common. Between 10% and 42% of travellers to any destination, and 15%-70% of travellers to tropical settings experience ill health, either while abroad or on returning home, Malaria is the commonest specific diagnosis, accounting for 5%-29% of all individuals presenting to specialist clinic, followed by dengue, enteric fever, and rickettsial infections . In this podcast Doug Fink specialist registrar, and Victoria Johnston consultant, in infectious diseases at The Hospital for Tropical Diseases join us to discuss diagnosis, and treatment - and why the clinically most interesting diagnosis is rarely the right one. Read the full practice article: http://www.bmj.com/content/360/bmj.j5773

In a new analysis John McArthur and Krista Rasmussen, from the Global Economy and Development Program at the Brookings Institution, and Gavin Yamey from Duke University, have set out to analyse the potential for lives saved by the goals set in the Sustainable Development Goals In this conversation I talked to Gavin and John about the numbers, which countries have to accelerate their development to meet those goals - and we also address some of the criticisms of the SDGs - that they’re too wide ranging, that they lack a political dimension, and that they are unrealistic. Read the full analysis and more on the SDGs: http://www.bmj.com/content/360/bmj.k373 http://www.bmj.com/content/sustainable-development-goals

A study published by The BMJ today reports a possible association between intake of highly processed (“ultra-processed”) food in the diet and cancer. Ultra-processed foods include packaged baked goods and snacks, fizzy drinks, sugary cereals, ready meals and reconstituted meat products - often containing high levels of sugar, fat, and salt, but lacking in vitamins and fibre. They are thought to account for up to 50% of total daily energy intake in several developed countries. Mathilde Touvier, senior researcher in nutritional epidemiology and Bernard Srour, pharmacist and PhD Candidate, both at INSERM, join us to discuss what ultra processed foods actually are, why it is they could be leading to cancer, and what their cohort study tells us about that potential risk. Read the full open access research: http://www.bmj.com/content/360/bmj.k322

Sabine Netters is an oncologist in The Netherlands - where assisted dying is legal. There doctors actually administer the drugs to help their patients die (unlike proposed legislation in the UK). In this moving interview, Sabine explains what was going through her head, the first time she helped her patient die - and how in the subsequent years, the emotional toll hasn't lessened. She explains why she believes that in certain circumstances, euthanasia can be the ultimate caring act. Read her essay: http://www.bmj.com/content/360/bmj.k116

Bobbie Farsides is professor of clinical and biomedical ethics at Brighton and Sussex Medical School. She’s been described as one of the few people that is acceptable to “both sides” of the assisted dying debate. This week she joins us to talk about the way in which the debate on euthanasia has played out in the UK - and hear why she thinks it’s now time for all individual doctors to make up their own mind, and not let either camp own the argument for them. Read her commentary on the debate: http://www.bmj.com/content/360/bmj.k544

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person. It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture. Yet medical participation in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001. Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees. The 2016 release of previously classified portions of guideli

The number of people officially recorded as sleeping on the streets of England rose from 1768 in 2010 to 4751 in autumn 2017.1 Charities estimate the true figure to be more than double this. Danny Dorling, Halford Mackinder professor of geography at the University of Oxford joins us to explain what's fuelling that rise, why the true extent of the problem is far larger, and what steps need to be taken to tackle the epidemic. Read the editorial: http://www.bmj.com/content/360/bmj.k214

We have evidence on which to act, and inaction costs lives, argues Simon Capewell, Professor of Public Health and Policy, at the University of Liverpool. But Aileen Clarke, professor of public health and health services research at Warwick Medical School, says our understanding of the human behaviour that leads to unhealthy choices is still lacking Read the head to head http://www.bmj.com/content/360/bmj.k292

We know that smoking 20 cigarettes a day increases your risk of CHD and stroke - but what happens if you cut down to 1, do you have 1/20th of that risk? Allan Hackshaw, professor of epidemiology at UCL joins us to discuss a new systematic review and meta analysis published on bmj.com, examining the risk of smoking just one or two cigarettes a day. Read the full review: http://www.bmj.com/content/360/bmj.j5855

Virginia Murray, public health consultant in global disaster risk reduction at Public Health England, was instrumental in putting together the Sendai Framework for Disaster Risk Reduction - an international agreement which aims to move the world from reacting to disasters, to proactively preventing them. In this podcast, she explains what they learned in the process, and why science had to become storytelling, in order to make politicians pay attention. Read the editorial on creating a set of indicators for disaster preparedness. http://www.bmj.com/content/359/bmj.j5279

The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice. In this audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. Kate Addlington, associate editor and trainee psychiatrist is joined by Cat Chatfield, quality editor and GP. They discuss acute respiratory distress syndrome: http://www.bmj.com/content/359/bmj.j5055 Why it’s important to have early diagnosis of psychotic symptoms, and the evidence for improved outcomes: http://www.bmj.com/content/357/bmj.j4578 And finally, why it’s important to consider hearing-loss on the ward: http://www.bmj.com/content/360/bmj.k21

Many older adults have difficulty understanding speech in acute healthcare settings owing to hearing loss, but the effect on patient care is often overlooked. Jan Blustein professor of health policy and medicine at New York University, and who has also experienced the affects of hearing loss, joins us to explain what that's like, and gives some tips on making it easier to communicate. Read the full analysis: http://www.bmj.com/content/360/bmj.k21 Full transcript of the interview: https://docs.google.com/document/d/1Rp7zvRlnTG5KRVLgmR-PFt-0fVRLBqINU5EmOrT5RDU/edit?usp=sharing

Trial MVA85A - monkey trials for a booster vaccine for BCG, developed by researchers at Oxford University, is the subject of an investigation published on bmj.com. Experts warn that today’s investigation is just one example of “a systematic failure” afflicting preclinical research and call for urgent action “to make animal research more fit for purpose as a valuable and reliable forerunner to clinical research in humans.” The press conference is led by Dr Fiona Godlee, the editor-in-chief of the BMJ, who provides a background to the investigation. The panel members are: Dr Deborah Cohen, author of the investigation and associate editor at the BMJ, talking about carrying out the investigation and the difficulty to obtain basic information Professor Paul Garner from the Liverpool School of Tropical Medicine, addressing the ineffectiveness of the current TB vaccine and also talking about the backlash he experienced after publishing a systematic review concluding that the animal studi

Neoadjuvant chemotherapy for breast cancer is a new strategy that was introduced towards the end of the 20th century with the aim of reducing tumour size - rendering an otherwise inoperable tumour operable, allowing more conservative surgery, and hopefully improving overall survival. Although data indicate that the first rationale remains valid, the others have not led to the desired outcomes. More conservative surgery after neoadjuvant chemotherapy can result in a higher rate of local recurrence, and, despite the earlier initiation of systemic treatment, no improvement in survival has been seen. Jayant Vaidya, professor of surgery and oncology and consultant breast cancer surgeon at University College London, joins us to explain why he is rethinking the use of neoadjuvant chemotherapy for breast cancer. Read the full analysis: http://www.bmj.com/content/360/bmj.j5913

Winter pressures on NHS services have kicked in a little bit earlier than usual. So here to discuss that, and also the issue of how local NHS leaders can support staff in times of extreme pressure. Discussing that with Rebecca Coombes, The BMJ’s head of news and views, are Matthew Inada-Kim, a consultant in acute and general medicine at Hampshire Hospitals NHS Foundation Trust, and Joe Harrison, CEO of Milton Keynes Hospital NHS Foundation Trust.

Acute respiratory distress syndrome was first described in 1967 and has become a defining condition in critical care. Around 40% of patients with ARDS will die, and survivors experience long term sequelae. No drug treatments exist for ARDS, however good supportive management reduces harm and improves outcome. In this podcast, John Laffey, professor of anaesthesiology at St Michael’s Hospital, Toronto and Brian Kavanagh, clinician-scientist, intensive care medicine at the University of Toronto take us through the background to diagnosis and treatment of ARDS. Cheryl Misak, professor of philosophy at the University of Toronto, and survivor of ARDS, also joins us to explain how she has faired in recovery. Read the full easily missed article: http://www.bmj.com/content/359/bmj.j5055

Psychosis often emerges for the first time in adolescence and young adulthood. In around four out of five patients symptoms remit, but most experience relapses and further difficulties. Psychosis can be a frightening and bewildering experience for both patients and families. Early proactive support and intervention improves clinical outcomes, avoids costly and traumatic hospital admissions, and is preferred by patients and their families In this podcast,Sagnik Bhattacharyya, consultant psychiatrist at the Lambeth Hospital South London and Maudsley NHS Foundation Trust, and David Shiers, former GP, honorary reader in early psychosis at at Manchester University, join us to discuss early treatment - and why hope is important for both GPs and patients. Read the full practice article: http://www.bmj.com/content/357/bmj.j4578 And see the infographic on identification and management of psychotic disorders. http://www.bmj.com/content/bmj/suppl/2017/11/08/bmj.j4578.DC1/psychosis_v28.pdf

The notion that animal companionship might be linked to human health can be traced to ancient writings and, with the first population based study conducted at least four decades ago. Although some empirical evidence links animal companionship with apparent protection against a series of important health outcomes in middle aged populations, including premature mortality, obesity, hypertension, and hyperlipidaemia, systematic reviews and position statements suggest that these associations are not universal. To investigate this further, the authors of this observational study, looked at the prospective link between pet ownership and a selected range of objective biomarkers of ageing proposed for use in large scale population based studies of older people. Richard Watt, professor of dental public health at University College London joins us to discuss their results. http://www.bmj.com/content/359/bmj.j5558

Wine glasses come in a range of sizes, but the average wine glass in the UK today can hold almost ½ a litre. That wasn’t always the case - and a new analysis, on bmj.com takes a look at the changing size of wineglasses from 1700 until now. To discuss how the size of glass affects consumption we're joined by Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge and Zorana Zupan, a research associate in the Unit. We're also joined by Matthew Winterbottom, curator of decorative arts at the Ashmolean Museum in Oxford, to tell us about the history of wine drinking in the UK. Read the full analysis: http://www.bmj.com/content/359/bmj.j5623

Average body temperature is 37°C, right? That was the conclusion of Carl Wunderlich in his magnum opus, The Course of Temperature in Diseases - Wunderlich published that in 1868, following his extensive collection of body temperature readings - and 37°C stuck. But, it’s not as simple as that Philip Mackowiak, emeritus professor of medicine, and now history of medicine scholar in residence, at the University of Maryland School of Medicine, has been interested in temperature for a long time. He joins us to explain how Wunderlich measured temperature, and what he actually found. Read his editorial: http://www.bmj.com/content/359/bmj.j5697

Manflu, the phenomenon that men experience the symptoms of viral illness more than woman, is usually used with derision - but a new review, published in the Christmas edition, is asking - is there a plausible biological basis for this sex difference? Kyle Sue is a clinical assistant professor in family medicine at Memorial University of Newfoundland, and a GP in northern Canada - and has been looking at the research on sex difference in immune response. Read the full article: http://www.bmj.com/content/359/bmj.j5560

Assessing young people with possible eating disorders can be complex for a variety of reasons. Building a therapeutic relationship with a young person with a possible eating disorder and their family is key to enabling a thorough assessment and ongoing management, but it introduces difficult issues regarding confidentiality and risk. In this podcast we speak to the mother and daughter authors of a What you patient is thinking article, who describe what it's like for a family to experience a child with an eating disorder. In a linked podcast, we talk with the authors of two practice articles, which give advice on spotting and treating eating disorders in young people. Read the articles: http://www.bmj.com/content/359/bmj.j5328 http://www.bmj.com/content/359/bmj.j5378 http://www.bmj.com/content/359/bmj.j5245

Assessing young people with possible eating disorders can be complex for a variety of reasons. Building a therapeutic relationship with a young person with a possible eating disorder and their family is key to enabling a thorough assessment and ongoing management, but it introduces difficult issues regarding confidentiality and risk. In this podcast we talk with the authors of two practice articles, which give advice on spotting and treating eating disorders in young people. In a linked podcast, we speak to the mother and daughter authors of a What you patient is thinking article, who describe what it's like for a family to experience a child with an eating disorder. Read the articles: http://www.bmj.com/content/359/bmj.j5328 http://www.bmj.com/content/359/bmj.j5378 http://www.bmj.com/content/359/bmj.j5245

Our latest H2H debate asks: Is continuous electronic fetal monitoring useful for all women in labour? Peter Brocklehurst is professor of women’s health at the University of Birmingham. He argues that continuous electronic fetal monitoring during labour can lead to harm and increase the risk of caesarean section. Christoph Lees is reader in obstetrics and fetal medicine at Imperial College London. He argues that continuous electronic fetal monitoring is useful for all women in labour as it helps avoid fetal and neonatal morbidity

We have a problem in obesity research — clinical trials continue to prioritise weight loss as a primary outcome and rarely consider patients’ experience, quality of life, or adverse events - and now a new analysis article, "Challenging assumptions in obesity research" questions that focus on weight. Navjoyt Ladher discusses this thorny topic with Liz Sturgiss, GP, obesity researcher at Australian National University Medical School, and one of the authors of that paper. Read the full analysis: http://www.bmj.com/content/359/bmj.j5303

We know that adults with obesity have an increased risk of premature mortality, cardiovascular disease, some cancers, type 2 diabetes, and many other diseases. However, the effect of dieting on 3 of those outcomes (cancer, cvd, and mortality) is surprisingly little studied. However a new systematic review and meta-analysis does bring together what we know of that effect, and to explain the evidence we're joined by Alison Avenell, professor in the Health Services Research Unit, University of Aberdeen. Read the full systematic review and meta-analysis: http://www.bmj.com/content/359/bmj.j4849

In July, The BMJ published an analysis article called “The Antibiotic Course has had it’s day” - a provocative title that turned out the garner a lot of debate on our site. The article said that the convention for the length of a course of antibiotics was set by Flemming, in his Nobel Prize acceptance speech - “If you use penicillin, use enough!” - and that the evidence base hasn’t moved on since then. The article has had over 40 substantive responses, both agreeing and vehemently not - and so we thought it worth revisiting that argument, now the dust has settled. Discussing that are Martin Llewellyn, professor of infectious disease at Brighton and Sussex Medical School, and Paul Little, professor of primary care at the University of Southampton. Read the original analysis: http://www.bmj.com/content/358/bmj.j3418

Unjust discrimination against people with mental ill health should be replaced with universal rules based on decision making ability, argues George Szmukler, emeritus professor of psychiatry and society at King’s College, London. However Scott Weich, professor of mental health at the University of Sheffield, worries about legal distractions that won’t improve outcomes while services are so thinly stretched. Read the full debate: http://www.bmj.com/content/359/bmj.j5248

The Three Talk Model of shared decision is a framework to help clinicians to think about how to structure their consultation to ensure that shared decision making can most usefully take place. The model is based around 3 concepts - option talk, decision talk, and team talk - with active listening at the centre. Three Talk was first proposed in 2012, now new research published on bmj.com updates that model. Professor Glynn Elwyn, from The Dartmouth Institute for Health Policy and Clinical Practice, joins us to explain how that was done, and what it's creators learned from the process. Read the full research: http://www.bmj.com/content/359/bmj.j4891

The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice. In this new monthly audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. In this edition, GP Cat Chatfield, psychiatric trainee Kate Addlington and Gastrology trainee Robin Baddeley discuss the articles; Diagnosis and management of postpartum haemorrhage http://www.bmj.com/content/358/bmj.j3875 Indications for anticoagulant and antiplatelet combined therapy http://www.bmj.com/content/356/bmj.j1128 Safe Handover http://www.bmj.com/content/359/bmj.j4328 and why fixing the broken medical ward round is in everyone’s interests http://blogs.bmj.com/bmj/2017/10/13/robin-baddeley-fixing-the-broken-medical-ward-round-is-in-everyones-interests/

As journal editors, we’re aware of the fact that we have a role to play in scientific discourse - that’s why The BMJ has been so keen to talk about the way in which scientific knowledge is constructed, through our Evidence Manifesto. We also know that money has influence in the scientific literature - which is why we have a zero tolerance policy for financial conflicts of interest in our educational content. Where do journal editors fit into this? The first step into investigating that is to find out if journal editors receive payments from pharma and device companies - and new research, published on bmj.com does that. Jessica Liu - internist and assistant professor at the university of Toronto, and one of the authors of that study joins us to discuss. Read the full research: http://www.bmj.com/content/359/bmj.j4619

The Quality and Outcomes Framework (QOF) is one of the most ambitious pay-for-performance schemes introduced into any health system. It's now being scrapped by bits of the NHS, and is under reform elsewhere. Martin Marshall, GP and professor of Health Improvement at University College London, thinks it's time to rethink the experiment. He joins us to discuss how we got here, what we've learned, and what will replace QOF. Read the editorial: http://www.bmj.com/content/359/bmj.j4681

Half of adolescents who die by suicide have a history of self harm. And in the UK, the rates of adolescents who commit suicide jumped from 3.2, to 5.4 per 100 000 between 2010 and 2015. The national suicide prevention strategy recently expanded its scope by aiming to reduce self harm rates as a common precursor to suicide. Therefore it's important that we have an accurate measure of rates of self harm in the population, and new research published on bmj.com aims to do that. To discuss we're joined by one of the authors of that paper - Navneet Kapur, professor of psychiatry and population health at the University of Manchester. Read the full research: http://www.bmj.com/content/359/bmj.j4351