The BMJ Podcast

Giving staff the confidence to speak out is important in healthcare - It's a key aspect of the WHO patient safety checklist, decreasing incidence of medical error, but it's also important to stop incidents of harassment and abuse which undermine staff and increase burnout.

Creating that culture is a difficult task, but two hospitals in the southern hemisphere have been trying to do do that by putting in place ways which support staff in making complaints when they wouldn't normally feel confident to do so.

In this podcast we hear from Alex Sia, CEO of KK hospital Singapore, Jeanette Conley, medical executive at Adventist Healthcare in Sydney and Mark O”Brien, medical director of the Cognitive Institute, who talk about their challenges and successes in changing the way they work.

For more on burnout;

https://podcasts.apple.com/co/podcast/burnout-dont-try-to-make-canary-in-coal-mine-more-resilient/id283916558?i=1000446459269

http://www.bmj.com/wellbeing

The NHS Practitioner Health Programme - once only for doctors in London, now it’s being rolled out across the NHS to provide the largest, publicly funded, comprehensive physician health service, in the world.

However, while helping the individual is essential, systemic change needs to be made to support doctors in our healthcare system.

Clare Gerada, GP and medical director of NHS PHP joins us to talk about how the expanded service will work, and what role regulation and inspections should play in wellbeing.

For more on the NHS PHP

https://blogs.bmj.com/bmj/2019/10/31/clare-gerada-protecting-practitioners-health/

020 3049 4505

https://php.nhs.uk/

There has been a lot of noise made about calorie counts on labels - the idea being it’s one of those things that might nudge people to make healthier choices.

So much so that in 2018, in the USA, it became mandatory for food chains with more than 20 outlets to label the calories in their food.

But the effectiveness of that is hard to gauge - it’s relied on reporting from customers, which leads to an incomplete picture. The really killer data would be from the chains themselves, but they’re reluctant to share that widely.

That's where new research comes in - and we're joined in the podcast by Joshua Petimar, postdoctoral researcher at the Harvard T.H. Chan School of Public Health, and Jason Block, associate professor at Harvard Pilgrim Healthcare Institute & Harvard Medical School, to discuss what they've done.

Read the full research:

https://www.bmj.com/content/367/bmj.l5837

A TB infection can take two forms, active and latent. Active disease is transmissible, and causes the damage to the lungs which makes TB one of the biggest killers in the world.

In the latent form, the bacteria Mycobacterium tuberculosis is quiescent and can stay that way for years until it becomes active and causes those clinical signs.

Testing for the active version of the disease is done directly, but when it comes to latency, we use the tuberculin skin test to see if someone has an immunological response - and when that happens we consider them to have latent disease.

However, in this podcast Lalita Ramakrishnan, professor of immunology and infectious diseases at the University of Cambridge; Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania; and Marcel Behr, professor of medicine at McGill University question that conclusion.

Read their full analysis:

https://www.bmj.com/content/367/bmj.l5770/

Their previous analysis:

https://www.bmj.com/content/362/bmj.k2738.abstract

And search for their previous podcast - "Have we misunderstood TB's timeline?"

Statins are now the most commonly used drug in the UK and one of the most commonly used medicines in the world, but debate remains about their use for primary prevention for people without cardiovascular disease.

Paula Byrne from the National University of Ireland Galway, joins us to talk about the evidence of benefit for low risk individuals, and what needs to be done to finally answer the questions about efficacy and harms.

Read the full analysis:

https://www.bmj.com/content/367/bmj.l5674

Direct-to-consumer genetic tests are sold online and in shops as a way to “find out what your DNA says".

They insights into ancestry or disease risks; others claim to provide information on personality, athletic ability, and child talent. However, interpretation of genetic data is complex and context dependent, and DTC genetic tests may produce false positive and false negative results.

Rachel Horton, clinical training fellow, Anneke Lucassen, chair of British Society of Genetic Medicine, and Jude Hayward the RCGP clinical champion for genomics join us to discuss how this deluge of genetic data is affecting patients, GPs and clinical geneticists in the NHS.

Read the full article:

https://www.bmj.com/content/367/bmj.l5688

Blockchain is the digital technology that underpins cryptocurrencies such as bitcoin, and has been proposed as the digital panacea of our times.

But Leeza Osipenko, from the London School of Economics, has thought about how it could actually be used in clinical trials, and what else would need to change in our regulatory environment to make that work.

Read her full essay:

https://www.bmj.com/content/367/bmj.l5561

In quality improvement, measurement is seen as a key driver of change - how well do you know you’re doing, if you can’t actually measure it.

So, when something changes in the NHS (say a new guideline) how can you tell how quickly that’s filtering down to the front line.

Ben goldacre, from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, joins us to talk about a new proof of concept published on bmj.com, which uses NHS prescribing data to analyse how change propagated through GP practices.

Read the full open access research:

https://www.bmj.com/content/367/bmj.l5205

https://openprescribing.net/

Talk Evidence is back, with your monthly take on the world of EBM with Duncan Jarvies and GPs Carl Heneghan (also director for the Centre of Evidence Based Medicine at the University of Oxford) and Helen Macdonald (also The BMJ's UK research Editor).

This month Carl talks about evidence that restricting your diet might improve health at a population level (1.50)

Helen talks about the data on a drop in alcohol consumption amongst Scots (7.04)

A listener questions the team about their take on Tramadol (13.45)

Helen talks about the problems with the trials we use to regulate drugs (18.00)

And Carl explains why drug shortages aren't just a Brexit problem (31.30)

Reading list:

two years of calorie restriction and cardiometabolic risk (CALERIE): exploratory outcomes of a multicentre, phase 2, randomised controlled trial

https://www.sciencedirect.com/science/article/pii/S2213858719301512?via%3Dihub

Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18

https://www.bmj.com/content/366/bmj.l5274

Design characteristics, risk of bias, and reporting of randomised controlled trials supporting approvals of cancer drugs by European Medicines Agency, 2014-16: cross sectional analysis

https://www.bmj.com/content/366/bmj.l5221

Crisis in the supply of medicines

https://www.bmj.com/content/367/bmj.l5841

On the 1st of May, 2018 Scotland was the first country to try a new way of reducing alcohol consumption in its population. It introduced a minimum unit prices for alcohol.

Now new research just published on BMJ.com is looking at the effect of that price increase - and measuring how well it has achieved the goal of reducing drinking in Scots.

Peter Anderson, professor of alcohol studies at Newcastle University explains how well the result matched the expectation, and if the result targeted just lower earners, or all high volume drinkers.

Read the full research:

https://www.bmj.com/content/366/bmj.l5274