Medicine and Science from The BMJ

In this episode of podcast we explore two clinical dilemmas - unrecognised drug side effects, and the outcomes from hip and knee replacements. When an unrecognised adverse drug effect is mistaken for a new symptom, the resulting prescribing cascade can end in polypharmacy and potentially preventable patient harm. New research on nearly 2.3 million adults in Ontario, has found 24 high-priority, potentially inappropriate prescribing cascades—including laxatives after iron, pain relievers following statins, and sedatives after cholinesterase inhibitors. Paula Rochon, Jerry Gurwitz, and Antonio Cherubini, three of the study's authors join us to discuss. Over 100,000 hip and, 100,000 knee replacements are performed annually in the NHS, and health systems are investing hundreds of millions to rapidly scale robot-assisted surgery, but is this expensive new tech delivering better patient outcomes? Two target trial emulation papers, using the UK's National Joint registry aim to find out if robots are better at join replacement. Hassan Mohammad, one of the papers' authors shares their findings, and Teppo Järvinen joins the conversation to discuss challenging orthopaedic surgery standard practice. Guest List Prescribing Cascades Discussion Paula Rochon, Geriatrician, senior scientist, and professor at Sinai Health and the University of Toronto. Jerry Gurwitz, Geriatrician, researcher, and professor of Medicine at UMass Chan Medical School. Antonio Cherubini, Geriatrician and clinical eesearcher at Università Politecnica delle Marche and INRCA (Istituto Nazionale di Riposo e Cura per Anziani)  Robotic Hip & Knee Arthroplasty Discussion Hassan Mohammad, academic clinical lecturer in orthopaedics at Barts and The London School of Medicine and Dentistry Teppo Järvinen, orthopaedic surgeon and professor at the University of Helsinki, and Head of the Finnish Centre for Evidence-Based Orthopaedics (FICEBO) in Finland. BMJ.com Reading List Research Papers Exploring high priority potentially inappropriate prescribing cascades in older adults: population level retrospective cohort study Early national comparison of robotic versus conventional knee replacements for arthritis using National Joint Registry data: target trial emulation study Early national comparison of robotic versus conventional hip replacements for arthritis using National Joint Registry data: target trial emulation study Robot assisted hip and knee arthroplasty: It is high tech, but is it better?

Referrals for ADHD and autism assessments have reached unprecedented levels, leaving NHS waiting lists stretched into years and families struggling to access support. But is the rise driven by a genuine increase in neurodevelopmental conditions, increased awareness, or systemic overdiagnosis? This prompted the government to commission the Independent Review into Mental Health Conditions, ADHD, and Autism; and we're joined by vice Chair of that review, Professor Sir Simon Wessely, Regis chair of psychiatry at King’s College London. In this episode, we discuss: Community prevalence vs. administrative prevalence, the roles of underdiagnosis, misdiagnosis and overdiagnosis. Why the current focus on diagnosis is a mistake, and why environmental factors are really key to the changes we're seeing. We also cover thecore recommendations of the report.   Read the full report: https://www.gov.uk/government/publications/independent-review-into-mental-health-conditions-adhd-and-autism-final-report

Last year, in July 2025, the independent review of the physician associate and anaesthesia associate roles, carried out by professor Gillian Leng, was published. The review followed the contentious role out of PAs in the NHS - where their scope of practice differed across trusts, and GP practices, and concerns were raised about clinical safety. Some of the key recommendations were around seeing undifferentiated patients, training needs, and supervision - and we spoke to Gill at the time, and the government accepted her proposals. But questions remained about exactly how some of those recommendations might work. Today, with the publication of a draft clinical protocol - and we clarify some of those questions.

The VAERS system in the US monitors adverse events following vaccines, but a new investigation on BMJ.com has found problems with the data mining systems used to spot patterns - and more worryingly, that the agencies involved were alerted about the issues, and didn’t take steps to fix the problem. David Willman, Pulitzer Prize winning investigative journalist, joins us to explain what he found.   Also this week, while the UK parliament still seems divided on assisted dying, in Switzerland it has been allowed for over 80 years - making it an normalised part of medicine. New research has asked patients why they have decided to seek help in ending their lives, and analyses those motivations.  Two authors of this work, Claudia Gamond, a palliative care physician who leads the palliative and supportive care department at the University Hospital in Lausanne, and  Solenne Blanc, a PhD student in sociology, join us to explain what they found.   Reading list US officials knew covid vaccine safety system was flawed—but turned aside the FDA doctor who alerted them   How patients explain and make sense of their decision for assisted suicide in Switzerland (the Exit Project): qualitative exploratory study

Something different for the podcast today: a live event. It’s the inaugural BMJ lecture, in partnership with the Academy of Medical Sciences and hosted at the historic Royal Academy of Arts. We want to talk about the big issues facing healthcare professionals around the world - and we’re starting with one of the biggest: how do we make decisions in the face of real risk and genuine uncertainty? Well, who better to talk through those big questions than the man who had to try to navigate those risks and uncertainties during the pandemic? Chris Whitty is England’s Chief Medical Officer and Chief Medical Adviser to the UK Government, advising on all aspects of healthcare. He is also a professor of public health at the London School of Hygiene and Tropical Medicine, where he was director of their Malaria Centre. In his lecture, Professor Whitty argues that medical training must better prepare doctors to manage risk, highlighting that "higher risk decisions, and accountability for these, have moved to later in training", causing a "substantial and sudden step up" in risk for new consultants. He acknowledges AI’s potential to speed up clinical diagnostics, but warns against public-facing AI tools that present diagnoses with false certainty while ignoring medical risk and uncertainty. Read the related Opinion article: "We must be more systematic about risk holding throughout doctors’ careers" This recording is available to view on YouTube.

Chris Van Tulleken, UCL physician, author and ultra-processed food researcher, examines persistent financial ties between UK nutrition advisers and food companies. Alastair Denniston, an ophthalmologist and AI evaluation specialist, and Henrietta Hughes, England’s Patient Safety Commissioner, explore how healthcare AI should be regulated, monitored and held accountable when things go wrong. Topics include structural bias, risk-based oversight, rapid enforcement and real-world safety testing.

The next few months might be an inflection point for GPs in England and Wales  Our strong primary care system is often credited in the success of the NHS - But changes to how that system works are currently underway. Legislation is quietly proceeding through parliament that will reorganise the way in which local care is structured, and those changes are raising concerns for GPs. To talk about how we build a stronger primary care system, and stronger NHS we're joined by: Victoria Tzortziou Brown, president of the Royal College of General Practitioners Sam Everington, a GP in East London, and a non-executive director of NHS England Kamila Hawthorne, GP in South Wales, and chair of National Academy for Social Prescribing We also take the opportunity to hear about where social prescribing fits into this new picture, and why our panel think it's important in changing the UK's health. Reading list Building a stronger NHS: an open letter from past and present presidents and chairs of the Royal College of General Practitioners

Daniel Daneshvar, Harvard associate professor studying CTE in former NFL players. Rohan Krishnan, Delhi orthopaedic surgeon involved in India’s NEET debates. John McLachlan, medical education professor who reviews exam safety. They discuss exam failures, nationwide NEET protests after alleged paper leaks, and new research into CTE prevalence and its implications for contact sports.

Simon Clarke, cellular microbiologist explaining AI-designed bacteriophage research. Elvira Perez Vallejos, computer science and medicine researcher focused on responsible digital mental health tools. Mark Ball, public health academic working on AI governance and workforce impacts. John Tilbert, physician-ethicist on medical tech ethics. Victor Montori, clinician and evidence-based medicine advocate. They discuss risks of rapid AI rollout, lifecycle regulation, accountability, and biosecurity concerns.

Bipolar disorder affects almost 40 million people worldwide, but finding the right treatment is complex, and nearly half of patients struggle to follow their prescribed treatment plans.   In the first part of this episode, we discuss new research which aims to help patients and their doctors identify the right treatment. Michele De Prisco, psychiatrist and researcher at the Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques, joins us to discuss his team's comprehensive umbrella analysis of bipolar disorder treatment options.   Also this week, with the malaria vaccines RTS,S and R21 passing regulatory hurdles, and becoming available for populations around the world, the fight against malaria is shifting. Gillian Turner, Principal Research Associate at the Liverpool School of Tropical Medicine, explains the logistical challenges of the malaria vaccine rollout and what steps are needed next to control the disease. Reading list:   Evidence based interventions for bipolar disorder across phases and age groups   Scaling up Malaria Vaccines in Africa