Medicine and Science from The BMJ

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 Medicine, Taunton and Somerset NHS Foundation Trust, national clinical advisor for NHS England’s Accident and Emergency Improvement Plan

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School of Public Health disagrees, saying that such programmes have been proved to save millions of lives and should be withdrawn only when robust evidence permits.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 guidelines from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers. In this podcast, Zackary Berger, associate professor at Johns Hopkins School of Medicine, joins us to discuss what those guidelines have revealed. Read the full analysis: http://www.bmj.com/content/360/bmj.k449

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 studies results had been overstated Malcolm Macleod, from the University of Edinburgh, talking about the broader public health aspect Merel Ritskes-Hoitinga from the Department for Health Evidence in The Netherlands, addressing the quality of animal studies and the need for systematic reviews and Jonathan Kimmelman, from McGill University in Canada analysing the story from the perspective of biomedical ethics.

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

There's a crisis in old age care - not just in the UK, around the world, as population demographics shift, and the proportion of older people increase - there's a worry about who's going to look after them, and how much is it going to cost? However, a new analysis on bmj.com says this picture need not be so gloomy - they say that encouraging exercise in older people could save billions - by keeping frailty at bay and increasing healthy life expectancy. We're joined by two of the authors of that analysis - Scarlett McNally, consultant orthopedic surgeon at Eastbourne District General Hospital, and Muir Gray, public health doctor. Read the full analysis: http://www.bmj.com/content/359/bmj.j4609

New research published on bmj.com has evaluated how well women surgeons operate, when compared to their male colleagues - and shows that there is a marginal improvement in patient outcomes. To discuss how that was studied, and what the findings mean, we're joined by Chris Wallis, a resident at the University of Toronto, and Raj Satkunasivam, a urologic-surgeon and assistant professor at the Houston methodist hospital in Texas. Also joining us, to contextualise that research, is Clare Marx - associate medical director of Ipswich Hospital NHS Ttrust, and former president of the Royal College of Surgeons. Read the open access research: http://www.bmj.com/content/359/bmj.j4366 and editorial: http://www.bmj.com/content/359/bmj.j4580

Last week we published some new research which showed that 2/3 of new cancer drugs approved by the European Medicines Agency - the drug regulator for Europe - didn’t have any evidence of improved life expectancy or quality of life. In this interview, Vinau Prasad, ematologist-oncologist and Assistant Professor of Medicine at the Oregon Health and Sciences University, explains how we came to accept surrogate measures in oncology trials, and how he tries to navigate the evidence for his patients. Read his editorial: http://www.bmj.com/content/359/bmj.j4528

The majority of cancer drugs approved in Europe between 2009 and 2013 entered the market without clear evidence that they improved survival or quality of life for patients, finds a study published by The BMJ today. Even where drugs did show survival gains over existing treatments, these were often marginal. To discuss that, we're joined by Huseyin Naci, assistant professor of health policy at the London School of Economics. Read the open access study: http://www.bmj.com/content/359/bmj.j4530

If you're a patient in the UK, increasingly, your first interaction with the healthcare system won't be the traditional face to fact chat with your doctor - instead you'll have a telephone consultation. The prevalence of these telephone consultations is increasing, and being promoted by CCGs and private companies who administer them - usually as a cost saving measure. Now new research published on bmj.com looks at these phone consultation - how often they happen, how patients feel about them, and how much money they actually save. In this podcast we're joined by Martin Roland, emeritus professor of health services research at Cambridge University, to find out more. Read the full research: http://www.bmj.com/content/358/bmj.j4197

Should we welcome plans to sell off NHS land? The government seems likely to back the recommendations of Robert Naylor (national adviser on NHS property and estates) to raise capital by selling off inefficiently used assets, but Kailash Chand (GP) worries that services could be threatened and that public consultation is lacking. Read the Head To Head article: https://www.bmj.com/content/358/bmj.j4290

Choosing Wisely was launched in the US, to much fanfare. Since then the movement has spread around the world, with successful chapters set up in Canada, Australia Brazil, Italy, Japan, new Zealand - and most recently the UK. The campaigns have not been without criticism – from how individual recommendations were chosen, to the way in which patients have been involved. In this podcast, we're joined by joined by 3 of Choosing Wisely UK’s steering group, professor Sue Bailey, head of the steering committee, Ramai Santhirapala, honorary consultant in anaesthesia and perioperative medicine, and, Richard Lehman, GP. http://www.choosingwisely.co.uk/

In the UK - type 2 diabetes now affects between 5-10% of the population - and accounts for around 10% of our total NHS budget. For the individuals affected, treatments are effective at helping control glucose levels - however, the sequela associated with the disease - vascular problems, and a life expectancy that’s 6 years shorter - are still an issue. However, for some, remission seems to be a possibility. To discuss we're joined by Mike Lean, professor of human nutrition at the university if Glasgow, and co-author of an analysis, published on bmj.com, which impels doctors to make sure that type to diabetes remission is coded properly. Read the full analysis: http://www.bmj.com/content/358/bmj.j4030

One of the hurdles that anyone who submits research or analysis to The BMJ has to deal with is peer review. The problems of the process, and some of the potential solutions, was a big part of the Peer Review Congress which took place last week. In this interview, Sophie Cook, The BMJ's UK research editor, talks to Lisa Bero, who’s a professor of evidence based medicine at Sydney University, and spends a lot of time investigating the integrity of health research.

A new Rapid Recommendation from The BMJ suggests that for pregnant women, they may wish to avoid certain antiviral treatments for HIV. This recommendation differs from the WHO's, and to discuss why that is, and what makes that difference important, we're joined by Reed Siemieniuk, a physician and methodologist from McMaster University, and Alice Welbourn, campaigner for gender and sexual and reproductive health rights, in the context of HIV and violence against women. Read the full rapid recommendation: http://www.bmj.com/content/358/bmj.j3961 And Alice Welborn's opinion article: http://blogs.bmj.com/bmj/2017/09/11/alice-welbourn-who-and-the-rights-of-women-living-with-hiv/

In the USA, when googling "depression" patients will be presented with a link to the PHQ-9 screening test. Google has developed this in collaboration with the National Alliance on Mental Illness - and Ken Duckworth, the alliance's medical director, debates the merits of this approach with Simon Gilbody, from the Department of Health Sciences at the University of York. Also joining this podcast is David Gilbert, mental health services user and director of InHealth Associates, who argues that it's only through patient involvement that real improvements to mental health can be obtained. Read the debate and commentary: http://www.bmj.com/content/358/bmj.j4144 http://www.bmj.com/content/358/bmj.j4207

If you google "The NHS" you'll see screaming headlines from the Daily Mail about cost and waste - debate in parliament is about how much of our GDP we should be spending - and each year, hospital trusts go cap in hand to ask for more funding. Against this backdrop, a new analysis, and a first in a series, published on bmj.com, looks at what it takes to have sustainable healthcare - and cruically, talks about this from the point of view of benefit, not cost. I'm Duncan Jarvies, and I'm Navjoyt Ladher, and today we've come to the House of Lords to speak to Baron Nigel Crisp - cross-bench peer, former NHS trust executive, and health system guru.

The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds. A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover; Why the World Bank matters to global health The World Bank’s turn to Universal health coverage How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are The Global Financing Facility - grants and loans supplied together, and finally, creating a market out of pandemic risk In this final interview, Felix Stein a postdoctoral research fellow at the University of Edinburgh describes the bank's move to create a market for pandemic insurance. Read the full analysis: http://www.bmj.com/content/358/bmj.j3397

The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds. A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover; Why the World Bank matters to global health The World Bank’s turn to Universal health coverage How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are The Global Financing Facility - grants and loans supplied together, and finally, creating a market out of pandemic risk In this fourth interview, Genevie Fernandes a PhD student at the University of Edinburgh discusses a new model of combing grants and loans in the Global Financing Facility. Read the full analysis: http://www.bmj.com/content/358/bmj.j3395