Medicine and Science from The BMJ

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