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.

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) 

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.

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.

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.

Back in 2024, the BMJ revealed how more than half of the members of the UK government's Scientific Advisory Committee on Nutrition, had declared financial interests with food and drinks companies.

A tightening of the rules followed, but two years after our initial investigation, we have returned - and we found that nearly a third of nutrition advisors still have significant ties to the food industry.

Chris Van Tulleken, professor of infection and immunology at University College London, and author of the book “Ultra Processed People”, joins us to explain why he thinks ongoing industry ties are bad for the UK's health.

Also this week. We have tight regulation of medical tech in the UK, but new AI tools don’t fit neatly into that existing process - and so the government has set up a National Commission on the Regulation of AI in Healthcare, 

Alastair Denniston, and Henrietta Hughes, who headed that commission, join us to explain how AI should be monitored, how we can ensure it's safety, and who should be responsible when something goes wrong.

Reading list:

A third of UK government’s nutrition advisers are still paid by food industry, including Coca Cola and Nestlé

National Commission into the Regulation of AI in Healthcare: Recommendations for a future regulatory framework

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:

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

In this week’s podcast we’ll be hearing a lot about exams - the bane of many doctor’s training lives, exams that determine your future are scattered through medicine and can cause a huge amount of anxiety and stress…

John McLachlan, professor of medical education at the University of Lancashire, has carried out four reviews of medical exams. He explains what happens to the people who have been marked wrongly, why he thinks re-sits should be done differently, and why multiple choice questions are still in use.

Over the Summer there have been extensive protests from the young people of India, the “Cockroach Janta Party” has led demonstrations across the country, sparked by allegations of cheating in India’s “NEET” exams - the federal tests taken by applicants to India's medical training.

Rohan Krishnan, orthopaedic surgeon in Delhi, and chief of the Federation of All India Medical Association, and Kathir Karuppiah, a house surgeon in Tamil Nadu, join us to explain where India's medical admissions tests are failing students.

We’ll also hear about new research into Chronic Traumatic Encephalopathy in NFL players.  Daniel Daneshvar is associate professor at Harvard Medical School, and he and his co-authors have examined the brains of 338 former players, with the goal of determining how many of them died with CTE neurodegeneration. He joins us to explain his findings, and what it means for competitive sports players and others who play contact sports.

Reading list:

“Cockroach” victory: India’s education minister resigns over medical exam scandal linked to 12 suicides

Prevalence of chronic traumatic encephalopathy at death in National Football League players: retrospective population based cohort study, 2008-21

This week we’re focusing on how healthcare is using AI systems. The NHS is firmly set on a course of AI integration, with NHS England committing £10 billion of taxpayer funds to the cause over the next three years. The pressure to implement AI in our hospitals is intense. But, how can healthcare leaders know what makes for a good AI adoption strategy? Victor Montori and Jon Tilburt are physicians from the US’ Mayo Clinic. They join us to lay out what they are calling the ‘five red flags’ that any organisation needs to consider in its AI rollout.

The UK is already having this conversation. The National Commission into the Regulation of AI in Healthcare released its initial report in June of this year. Among its findings was a call for a ‘lifecycle-based approach’ to regulation. To explain what this means, as well as how doctors can be equipped to ‘surveil’ AI systems as conditions evolve, we’re joined by the co-authors of a new BMJ editorial - Mark Ball from the University of Derby, and Elvira Perez Vallejos from the University of Nottingham.

And lastly, we talk about a research paper from last week that sparked off some concern. Researchers at Stanford University in California have used generative AI to design novel bacteriophage viruses. But, what have these scientists actually accomplished, and how can we put the right safeguards around the technology? Simon Clarke, associate professor in cellular microbiology at the University of Reading, explains the breakthrough and lays out its real implications.

References:

We can, but should we? Red flags for hasty, low integrity AI integration into healthcare

Regulating AI in healthcare: a moving target

Developments in AI designed viruses demonstrate why such research must be done in the open

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.

Evidence based interventions for bipolar disorder across phases and age groups

Scaling up Malaria Vaccines in Africa