Medicine and Science from The BMJ

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, and advocate for their obsolescence Donate the the Independent Food Aid Network here: https://www.foodaidnetwork.org.uk/bmj

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 Southampton. They are joined by Charlotte Augst, Chief Executive of national voices to talk about that report; why some patients have felt abandoned; how covid has accelerated the conversation about rationing; and why now is the time to rebuild services around patient needs. www.bmj.com/coronavirus

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.bmj.com/content/370/bmj.m3379 Covid-19’s known unknowns https://www.bmj.com/content/371/bmj.m3979 Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers https://www.acpjournals.org/doi/10.7326/M20-6817

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/coronavirus

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 for pharmacy for paediatrics & neonatology with Alberta Health Services. She is based at Alberta Children’s Hospital, Calgary. Bonnie J. Kaplan is a semi-retired research psychologist, and professor emerita from the Cumming School of Medicine, Calgary.

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/content/10.1101/2020.10.15.20209817v1 Producing and using timely comparative evidence on drugs: lessons from clinical trials for covid-19 https://www.bmj.com/content/371/bmj.m3869.full

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 which provides mental health training for primary care. Marie Stella McClure, who was diagnosed with borderline personality disorder at the age of 38, is the author of ‘Borderline: a Memoir’, a book about her life and experiences of BPD.

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 Hospital.

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. She is an academic general practitioner, and a professor at the university. Jeff Kwong is a professor at the University of Toronto, and the interim director of the Centre for Vaccine Preventable Diseases at the university’s Dalla Lana School of Public Health.

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 Hospital, Margate. She has a special interest in obesity. Naveed Sattar is a professor of Metabolic Medicine at the University of Glasgow. His main research concerns investigating the prevention, causes and management of diabetes, heart disease and obesity.

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 Stein is a Family Medicine doctor at Montefiore Medical Center, and the Clinical Curriculum Manager for RHEDI – Reproductive Health Education in Family Medicine.

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 an acute disease, there is emerging consensus that it’s systemic effects lead to long term problems for some patients - but there’s a lot of uncertainty there. (38.40) Carl talks about the IMMDS review and his involvement in it - and what recommendations we’ll be covering in future Talk Evidence programmes. Reading list: Drug treatments for covid-19: living systematic review and network meta-analysis -https://www.bmj.com/content/370/bmj.m2980 Remdesivir for severe covid-19: a clinical practice guideline - https://www.bmj.com/content/370/bmj.m2924 Management of post-acute covid-19 in primary care - https://www.bmj.com/content/370/bmj.m3026