Medicine and Science from The BMJ

In this Talk Evidence, Helen Macdonald, Joe Ross and Duncan Jarvies discuss what's going on in the world of EBM. Firstly, a while ago on the podcast, we concluded that excess mortality would be the best way to measure the impact of the pandemic - and now a new paper looks at different country's excess mortalitites over the past year. We're joined by author Nazrul Islam Physician-Epidemiologist at the University of Oxford (and a research editor for The BMJ) to talk about why comparisons may still not be sensible. Read the full research here - https://www.bmj.com/content/373/bmj.n1137 The Delta variant is dominating headlines, and infections in the UK now - but until recently the Alpha one was ascendent, and new research has helped characterise how the mortality rate of that variant differed from previous viruses. We discuss how that research was done. Read the full research - https://www.bmj.com/content/372/bmj.n579 GP data in the UK - the planned cut-off for granting access to your GP data for researchers has been extended, but there are still a lot of questions remaining. Helen has tried to find out some basic answers, and is still confused. Finally, the FDA has approved a new drug for treatment of dementia - and researchers (and the FDA's own panel of experts) are up in arms. Joe Ross tells us why he thinks the decision was the wrong one, and why patients may be harmed because of it. https://edition.cnn.com/2021/06/17/opinions/biogen-alzheimers-drug-opinion-ramachandra-ross/index.html

We've been bringing you stories of doctors wellbeing for a while in the podcast, but we noticed a pattern. Woman would come on and talk about their own difficulties, men would talk about other peoples - so we wanted to dive into that a bit, and called out on twitter for men who would be willing to open up to our listeners about their own mental health. This interview is with Zeshan Quereshi - registrar in paediatrics, author and TedX talker. In this conversation we talk about why it is that men are particularly disinclined to open up about their difficulties at work, and what Zeshan has done to try and support his own. Zeshan's TedX talk https://www.youtube.com/watch?v=uctoTk64GVM

Finally it seems that life might return to normal in the UK, as the vaccination efforts continue apace, and despite concern about increasingly spreading variants, our hospitals are not being overwhelmed. Because of this, we are changing our approach to covering the pandemic - and taking this second wave podcast to pastures new, but before that, in this last episode we’re going to look backwards and forwards, at the UK’s response. On the panel today are Matt Morgan, consultant in critical care, Nisreen Alwan, associate professor in public health, Partha Kar, consultant in diabetes, and Helen Salisbury, GP. www.bmj.com/coronavirus

The pandemic has wrought a lot of change, not least to doctors relationship to their careers. While still loving the patient interaction, we're increasingly hearing that doctors are disillusioned with the other aspects of medicine. If you're feeling that way, there are ways to structure your thinking to help you make sense of your career. In this podcast Claire Kaye, former portfolio GP and now coach, explains how she went about deciding medicine wasn't for her, and how she helps doctors go through that process too. You can find Claire at https://www.drclairekaye.com/ https://www.instagram.com/drclairekaye_executivecoaching/

In this week's Talk Evidence, Joe Ross, BMJ editor and professor at Yale again joins Helen Macdonald to talk about emerging evidence on Covid-19. They also welcome to the podcast Juan Franco, family physician in Buenos Aires, and professor at the Instituto Universitario Hospital Italiano, and new editor-in-chief of BMJ Evidence Based Medicine. This week, the team bring you updates on; Post-covid syndrome in individuals admitted to hospital with covid-19 - how are people with long covid faring. Finally published research from Scandinavia on the risk of thrombotic events after administration of the Oxford-AstraZeneca vaccine - how big is the risk, and what does that mean for the overall benefit of that vaccine. How difficult the UK population found it to understand and stick to the rules with our test, trace and isolate system - and some of the questions that this raises for this public health approach. and finally, research that showed non-drug interventions are as good as pharmaceuticals at treating people with depression and dementia - and the holistic effect that alleviating depression can have. Full reading list Ayoubkhani, Daniel, Kamlesh Khunti, Vahé Nafilyan, Thomas Maddox, Ben Humberstone, Ian Diamond, and Amitava Banerjee. 2021. “Post-Covid Syndrome in Individuals Admitted to Hospital with Covid-19: Retrospective Cohort Study.” BMJ 372 (March): n693. https://www.bmj.com/content/372/bmj.n693 Pottegård, Anton, Lars Christian Lund, Øystein Karlstad, Jesper Dahl, Morten Andersen, Jesper Hallas, Øjvind Lidegaard, et al. 2021. “Arterial Events, Venous Thromboembolism, Thrombocytopenia, and Bleeding after Vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: Population Based Cohort Study.” BMJ 373 (May): n1114. https://www.bmj.com/content/373/bmj.n1114 Smith, Louise E., Henry W. W. Potts, Richard Amlôt, Nicola T. Fear, Susan Michie, and G. James Rubin. 2021. “Adherence to the Test, Trace, and Isolate System in the UK: Results from 37 Nationally Representative Surveys.” BMJ 372 (March): n608. https://www.bmj.com/content/372/bmj.n608 Watt, Jennifer A., Zahra Goodarzi, Areti Angeliki Veroniki, Vera Nincic, Paul A. Khan, Marco Ghassemi, Yonda Lai, et al. 2021. “Comparative Efficacy of Interventions for Reducing Symptoms of Depression in People with Dementia: Systematic Review and Network Meta-Analysis.” BMJ 372 (March): n532. https://www.bmj.com/content/372/bmj.n532

This interview is part of our BMJ interview series, where we talk to the people who are changing medicine. The series thus far has been a bit male dominated - reflecting the leadership in medicine at the moment, if not the actual workforce. One woman who's planning to change that is Roopa Dhatt, executive director of Woman in Global Health - a new grassroots organistion which is making waves with its demand for equality of representation for woman in global health decision making. In this interview, we talk to Dr Dhatt about the genesis of Woman in Global Health, and how they've managed to cement real commitment from the WHO. We also discuss how her experience of being Indian and American has shaped her understanding of equality in medicine, and how the covid-19 pandemic has highlighted the way in which women are discounted.

In medicine, a lot of work has been done to encourage person centred care - but can that maxim be extended to the people working within the healthcare system? Subodh Dave has just been elected as dean of the Royal College of Psychiatrists, and joins us fresh from talking at the International conference on physician health to speak about his ambition to humanise medicine. In this podcast, Subodh, Abi and Cat discuss what lessons from the pandemic need to remain, why at this time it's really important to look out for your colleague with family overseas, and how ice cream trucks meant much more than a cold treat. www.bmj.com/wellbeing

On this wellbeing podcast, Abi and Cat are joined by Emma Lishman, a clinical psychologist and part of the North Bristol NHS Trust's staff wellbeing team.Emma helps doctors return to training after a break - be that for maternity leave, or covid-19. Emma describes some of the fears that doctors who have been shielding have expressed coming back onto the ward, the ways in which teams may inadvertently make those worse, and the problems with complying with risk assessments in the face of staffing pressures. Wellbeing podcasts have focused a lot on the importance of openness about mental health in the NHS, but in this podcast, you'll also hear how reluctant clinicians are to discuss physical health problems - and why the taboo around all aspects of illhealth needs to be tackled. For more wellbeing https://www.bmj.com/wellbeing

Recorded on Tuesday 13th of April, as the shops open in the UK, and England is heading to the beer gardens. The roll out of the vaccination programme has completed its first phase, and second doses have been given to the most vulnerable people - and now the under 50s are starting to get their first doses. In this podcast, Duncan Jarvies, multimedia editor for The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire. The genomicc trial Matt mentions is still recruiting - if you're interested more detail is available here https://genomicc.org/

The synergistic linking of increasing health and wealth is broadly accepted - it's an integral part of the thinking between the Sustainable Development Goals, and the World Bank's call for universal healthcare as a way of boosting a country's economy. But the quantification of that link - the extent to which a particular health intervention, has broader economic impacts, is actually pretty poorly understood. In this podcast, we hear from some economists, who have an idea about how we could - fairly easily - measure those impacts at the same time we measure clinical efficacy. Joining us are, Dean Jamison, professor emeritus of global health at the University of Washington Osondu Ogbuoji, assistant research professor at Duke Global Health Insitute. Till Bärnighausen, director of the Heidelberg Institute of Global Health Sebastian Vollmer, professor of development economics at the University of Göttingen The collection that prompted this discussion is "Health, Wealth and Profits" - https://www.bmj.com/health-wealth-profits