Medicine and Science from The BMJ

In the UK, the prime minister has announced the disbanding of NHS England, Nigel Crisp - former chief executive of the NHS, explains why he thinks that it’s important the health service is closer to the political decision makers, and why this could be the time to really acknowledge the healthcare emergency. On the international stage, the Trump administration's withdrawal from the WHO is throwing global health into disarray - Illona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva, joins us to explain which new alliances are emerging, why the funding that has disappeared may never be replaced, and how tech will surpass pharma when it comes to industry influence. Finally, there is a triple burden of malnutrition for adolescent girls in south Asia - which creates a cycle of ill health that is hard to break. However, Zulfiqar Bhutta, chair in global child health at the Hospital for Sick Children in Toronto, thinks the region can come together to change both government and society to champion young women’s health. Reading list: Abolishing NHS England: risks and opportunities https://www.bmj.com/nhs-commission https://www.bmj.com/collections/nourishing-south-asia

We've just published a new rapid review on the safety and efficacy of physician and anaesthetic associates in the UK, which was commissioned to support the ongoing Leng review of these new roles in the NHS. Trish Greenhalgh, professor of primary care at the University of Oxford, joins us to discuss the data she found. Habib Naqvi is director of the NHS Race and Health Observatory, and is holding up a mirror to the NHS on it's support for ethnic minority patients and doctors - he joins us to talk about the work they've done, and why Reform UK's manifesto pledge to disband the Observatory is a matter of pride. Finally, our annual trip to the Nuffield Summit is not complete without a roundtable, this year we asked the question "What is stopping staff from speaking up?". Our panellists raised the usual issues of hierarchy and psychological safety, but also how the lack of positive change from senior leadership has habituated people into thinking "why bother". Our panel; Katie Bramall-Stainer, chair of the General Practice Committee of the BMA Jugdeep Dhesi, consultant in geriatric medicine at Guys and St Thomas Hopsital Henrietta Hughes, the UK's patient safety commissioner Thea Stein, chief executive of the Nuffield Trust Reading list Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research Together we can challenge the racism that persists in healthcare

From pay restoration, to making sure there are enough training posts for resident doctors, the BMA has been busy. In this podcast, Kamran Abbasi, the editor in chief of The BMJ, spoke to Phil Banfield, chair of the BMA’s council. They talk about the ongoing pay discussions, how the BMA is working with the new government - touching on both speciality training places, and the role of physician assistants. The conversation also covers the BMA's changing strategy, which aims to empower local members to take on the fights they care about, and how the organisation is linking both their trade union and professional activities.

In this episode of the BMJ's Medicine and Science podcast, editor-in-chief Kamran Abbasi discusses the urgent need to tackle disinformation in health, especially in the context of the US, with Heidi Larson and Martin McKee from the London School of Hygiene and Tropical Medicine. We also hear from Jane Ballentyne, professor of anaesthesia and pain medicine at the University of Washington, about new guidelines that strongly recommend against the use of spinal injections for chronic pain - and why that recommendation might be hard for some patients and doctors to hear. Finally, we revisit the progress made in addressing racism in UK medical schools over the past five years with Gareth Iacobucci, The BMJ's assistant news editor. Running order 01:44 Defining Misinformation and Disinformation 04:08 Vaccines and Misinformation 05:38 Strategies to Combat Disinformation 10:04 Denialism and Its Implications 16:21 BMJ Rapid Recommendations on Spinal Injections 26:27 Racism in Medical Schools: An Update Reading list Spinal interventions for chronic back pain Racism in medical schools: are things improving?

Providing quality healthcare is demanding, often stressful, and requires sustained effort. When resources are stretched and pressure mounts, compassion can slip - but compassion is an essential tool for leaders, who need to support their teams to continue delivering the best possible care. In this final episode of The BMJ’s podcast series on quality of care, Rachael Hinton, BMJ Editor, speaks to three healthcare leaders. They discuss how fostering kind and compassionate leadership and care can improve morale, combat burnout, and contribute to better patient outcomes. 01:48 Lydia Okutoyi talks compassionate leadership in Kenya 08:39 Pedro Delgado talks refocusing on the human factor and tools for kind leadership 15:02 Alexander Ansah Manu talks reaping quality of care benefits in Ghana This podcast was produced as part of the BMJ Collection on Quality of Care, developed in partnership with the World Health Organisation and the World Bank. Visit bmj.com/qualityofcare to view the full Collection. The BMJ commissioned, edited, and published this podcast. This episode edited by Brian Kennedy.

This week Rebecca Coombes is back with another big-food investigation, this time about fast-food giant MacDonalds subverting attempts to stop it opening stores near schools. Sticking with industry behaving badly, May van Schalkwyk, from the University of Edinburgh, wonders why we haven't learn lessons from the attempts to control big tobacco companies, when it comes to other industries that harm health. And finally, AI in healthcare - Karim Lekadir, from the University of Barcelona, explains new guidelines which can help evaluate which AI applications are trustworthy. Reading list McDonald’s triumphs over councils’ rejections of new branches FUTURE-AI: international consensus guideline for trustworthy and deployable artificial intelligence in healthcare

Exercise and a better diet, prior to surgery, can improve outcomes. Daniel McIsaac, a professor of anaesthesiology from the University of Ottowa and lead author of that research, joins us to talk about getting those results into practice. Julia Sinclair, professor of addiction psychiatry at the University of Southampton, explains how the NHS has lost sight of the impact alcohol consumption has on clinical care, and why we need a strategy to tackle it. Finally, Matt Morgan, consultant in intensive care and BMJ columnist, has written another book - this time about patients who are revived after cardiac arrest, and the profound effect it can have on their outlook in life. Reading list: Relative efficacy of prehabilitation interventions and their components UK needs national strategy to tackle alcohol related harms A Second Act

US President Donald Trump has signed an executive order to withdraw the US out of the WHO. This would cut funding for the UN’s medical agency by one-fifth. Will they really exit, or can a deal be made? Lawrence Gostin hopes so, and as a professor of law at Georgetown, and director of the World Health Organisation Collaborating Center on National and Global Health Law, he is working with senior US and WHO officials to try and understand what reforms could be made to WHO what would allow a such a deal to be be struck. Gostin also believes that the president cannot withdraw from the WHO with an executive order, but instead requires congressional approval - and is exploring the options for legal challenge to the move. 00:00 Intro 01:01 US history with the WHO 03:31 Executive order 06:35 WHO’s relationship with China 11:14 Funding 12:47 Benefits to US from the WHO 18:05 H5N1 threat 19:43 World benefits from US involvement 21:57 A deal to be made? 24:55 Legal action? 26:37 Administration responses Read Professor Larry Gostin’s co-written opinion piece on the dangers of a US withdrawal from the WHO here: https://www.bmj.com/content/388/bmj.r116

In the last podcast of 2024, Richard Smith, former editor of The BMJ and head of UKHACC will be making the case for being more convivial. Tina Korownyk, professor of family medicine at the University of Alberta is the ghost of Christmas past for TV doctors. Tim Feeny and Navjoyt Ladher take us through this year's Christmas research papers. And finally, Mari Martensen, a paramedic, explains what makes being a medic in Svalbard bear-able. Reading list. The dangers of industrialisation—why we need to rebuild a convivial societyTelevised medical talk shows—what they recommend and the evidence to support their recommendationsChristmas 2024: How to transport a polar bear, and other idiosyncrasies for Arctic emergency medical servicesThe full Christmas archive

Conflicts of interest harm health, and a new investigation uncovers the infiltration of big food manufacturers into UK schools. Emma Wilkinson reports on that investigation. Kamran and Rebecca Coombes, head of journalism, discuss moves to reduce industry's impact on food policy in the UK. A new research paper has identified a link between eating chocolate and lower rates of diabetes. Binkai Liu, doctoral student and Qi Sun, associate professor, at the Harvard T.H. Chan School of Public Health explain what they found. Finally, Sam Hutt is a doctor in the NHS, but is better known by his stage persona “Hank Wangford”. Hank performed a celebration of the NHS at Glastonbury this year, and has now released that song. He joins us to talk about what inspired him. Reading list Food industry has infiltrated UK children’s education: stealth marketing exposed Chocolate intake and risk of type 2 diabetes Hank Wangford

In today’s episode, new research, which has looked at the impact staff turnover is having on patient outcomes. Giuseppe Moscelli, associate professor at the University of Surrey joins Navjoyt Ladher to explain more. Also, every year the BMJ has a Christmas appeal - and this year we have chosen the International Rescue Committee as our partner. To talk more about what they do, and to give us some insight into how geopolitics are affecting health we're joined David Milliband, president and chief executive officer of the International Rescue Committee, and former UK foreign secretary. Reading list; Nurse and doctor turnover and patient outcomes in NHS acute trusts in England The BMJ Appeal 2024-25: David Miliband on hospital attacks, Trump, and the International Rescue Committee in a “flammable world”

This week we’re at the World Innovation Summit for Health, where we’re a media partner - the meeting is focussing on conflict, equity and resilience. In that vein, we’re joined by Christos Christou, international president of Médecins Sans Frontières (MSF) to talk about attacks on healthcare staff, and the difficulty and importance of maintaining neutrality in conflict zones. Ara Darzi, surgeon, executive chair of the conference, and author of the recent NHS review, joins us to talk about antimicrobial resistance, and how diagnostics and a small funding commitment could head off the problem. And finally, we change our focus to the US, and hear about new research into adverse events during surgery with authors Antoine Duclos and David Bates from Harvard Medical School. Reading list. We need to do more to keep antibiotics working WISH report - Tackling Antimicrobial Resistance: How to Keep Antibiotics Working for the Next Century Safety of inpatient care in surgical settings: cohort study

In this episode, we speak to the doctor overseeing the WHO’s emergency response for the eastern mediterranean region - including Gaza, Lebanon, Sudan and Yemen. Richard Brennan joins us to talk about protecting health services, and workers, in the escalating armed conflicts that are affecting the region. Menaka Paranathala and Emma Rourke, from The BMJ, are on to talk about improving research into women’s health. A new UK project, MESSAGE, aims to give consideration to sex and gender in life science research. Palliative care is not just for end-of-life, and rethinking how it’s integrated into every speciality is the key to improving care for patients, argue Richard Harding, Anna Peeler, and Oladayo Afolabi from the Cicely Saunders Institute. Links WISH report - Protecting Health in Armed ConflictMESSAGE (Medical Science Sex and Gender Equity) projectBMJ Opinion - Palliative care is an overlooked global health priorityWISH report - Palliative Care

It’s an often cited statistic that if healthcare was a country, it would be the fifth largest carbon emitter. At The BMJ we want to change that, and move healthcare towards a more sustainable future. In this week’s episode, we’ll hear about our annual climate edition from two of The BMJ’s editors, Sophie Cook and Juliet Dobson. We’ll be diving into Cli-Fi and asking how climate fiction can galvanise our collective response to climate change. Our panel includes Howard Frumkin, professor emeritus at University of Washington. Lakshmi Krishnan, internist and Director of Medical Humanities at Georgetown university, and Sarah Grossman, journalist and author of Fire So Wild. And Finally, Tereza Kasaeva, director of the WHO’s Global Tuberculosis Programme, explains how migration and food insecurity, exacerbated by climate change, are affecting TB - and why, despite effective treatment, there are still over a million deaths from the disease annually. Our panel's cli-fi book recommendations A Fire So WildThe Last ManThe Broken EarthOryx and CrakeThe Ministry for the FutureOlga Dies DreamingLand of Milk and HoneyDay of the Triffids Links The BMJ’s annual climate issueCli-Fi—helping us manage a crisisWriting towards a healthier future amid climate disasterWISH report - Tuberculosis Lakshmi’s references Fundamental Role of Arts and Humanities in Medical EducationCapable of being in uncertainties’: applied medical humanities in undergraduate medical educationThe introduction of medical humanities in the undergraduate curriculum of Greek medical schools: challenge and necessityThe medical humanities at United States medical schools

How science can be transformed into policy? One of the seemingly intractable issues when it comes to legislative change in the US is gun control. One reason policy change is so difficult, is the US specific evidence vacuum, but that’s beginning to change. We're joined by Louis Klarevas, an academic at the University of Colombia and author of the book “Rampage Nation, securing america from gun violence" and Shannon Watts, from Moms Demand Action which is a grassroots movement of Americans fighting for public safety measures that can protect people from gun violence. Even when there is evidence, the trade-offs needed for legislative change can still paralyse policy makers. Citizen assemblies, a form of democratic participation that asks the public for their views, has helped clarify some key healthcare issues, from assisted dying in Jersey, to abortion access in Ireland. Rebecca McKee from the Institute of Government argues they could be used to fix the NHS, and joins us to explain how. Reading list More gun regulation, less firearm harm Citizens’ assemblies, health, and health policy

Under-nutrition harms health, but so does over-nutrition. The Bill and Melinda Gate’s foundation has just released their Goalkeepers' report - highlighting the detrimental impact that poor nutrition is having on children’s health. Rasa Izadnegahdar, director of Maternal, Newborn, Child Nutrition & Health at the foundation joins us to explain how they are targeting nutritional interventions. Also this week, a new investigation in The BMJ has found that the UK government’s Scientific Advisory Committee on Nutrition - the people who help guide the UK’s nutrition policy - have competing interests with the food industry. We hear from Chris van Tulleken, University College London; Rob Percival, the Soil Association; and Alison Tedstone, chair of the Association for Nutrition. Reading list: Goalkeepers Report 2024 UK government’s nutrition advisers are paid by world’s largest food companies, BMJ analysis reveals

There's a real drive to strengthen quality of care in facilities around the world. However, no matter where you are, improving healthcare depends on quality data—and collecting and using that data can be challenging without the time and expertise. In this podcast, we explore how different healthcare systems, especially those with limited resources, are tackling the challenge of data collection and use head-on. The BMJ has partnered with the World Health Organization and the World Bank on a Collection on Quality of Care. This podcast, the second in a series exploring themes from the Collection, features researchers and implementers from Ghana, Qatar, and the US. They share insights on improving and using data in resource-constrained environments, offering valuable perspectives relevant to healthcare systems worldwide facing similar challenges. Provenance statement: This podcast is part of a Collection on Quality of Care proposed and funded by the World Health Organization and the World Bank. The BMJ commissioned, edited, and published the podcast. Emma Veitch, Rachael Hinton and Duncan Jarvis were the lead editors for The BMJ.

The news that GPs in England have voted for industrial action has spooked the healthcare system - Katie Bramall-Stainer, the chair of the BMA's General Practice Committee explains what's lead to this, and why trust in the government has gone. After the games, olympians and paralympians return to their normal lives - but what does that mean for their healthcare, especially in the US where insurance is expensive? Jonathan Finnoff, chief medical officer for the US Olympic and Paralympic committee joins us to explain how athletes are supported outside the games. Reading list; GP leader: “If general practice is the bedrock of the NHS, then the NHS is collapsing”

This week we're questioning the effectiveness of the Galleri Test for early cancer detection with investigation authors Margaret McCartney and Deborah Cohen. They delve into the decision-making and politics behind this test's introduction in the UK. The episode also covers the growing NHS waiting list crisis and how Imran Ahmed and his team at Guy's and St. Thomas' NHS Trust are using high intensity theatre (HIT) lists to increase surgical throughput - and what other teams need to know, if a national rollout of this model is to happen. Reading list Galleri promises to detect multiple cancers—but new evidence casts doubt on this much hyped blood test Are surgical HIT lists the answer to bringing down NHS waiting times?

The Paris games have just started - and France has made a concerted effort to ensure that this year's Olympics will have a legacy of physical activity for the whole population. However, mega sporting events don't always have that effect, and Fiona Bull, head of physical activity for the WHO, joins us to explain why it's increasingly important that they do. We'll also hear from Professor Sir Denis Perera Gray about how a lifetime of general practice, and why continuity needs to be at the heart of any improvement to primary care. Finally, Harry Brunjes went from being a village GP to the chair of English National Opera, and explains what the two careers have in common. Reading list Olympic Games: linking sports mega events to population physical activity