Medicine and Science from The BMJ

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.