Medicine and Science from The BMJ

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-election-briefing/

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.nuffieldtrust.org.uk/news-item/is-the-number-of-gps-falling-across-the-uk

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, sigmoidoscopy or colonoscopy: a clinical practice guideline https://www.bmj.com/content/367/bmj.l5515 Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial https://www.bmj.com/content/367/bmj.l5517 Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478

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.bmj.com/content/362/bmj.k2738.abstract And search for their previous podcast - "Have we misunderstood TB's timeline?"

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 interrupted time series analysis for 2015-18 https://www.bmj.com/content/366/bmj.l5274 Design characteristics, risk of bias, and reporting of randomised controlled trials supporting approvals of cancer drugs by European Medicines Agency, 2014-16: cross sectional analysis https://www.bmj.com/content/366/bmj.l5221 Crisis in the supply of medicines https://www.bmj.com/content/367/bmj.l5841

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 https://www.bmj.com/content/366/bmj.l4363 C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations https://www.nejm.org/doi/10.1056/NEJMoa1803185 Chief Medical Officer annual report 2019: partnering for progress https://www.gov.uk/government/publications/chief-medical-officer-annual-report-2019-partnering-for-progress Advancing our health: prevention in the 2020s – consultation document https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

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 pharmaceutical companies https://www.bmj.com/content/366/bmj.l4217

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

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