The BMJ Podcast

In this interview from Preventing Overdiagnosis 2017 (preventingoverdiagnosis.net) Stacy Carter, associate professor at Sydney Health Ethics - and the author of a recently written BMJ essay the ethical aspects of overdiagnosis, joins us to talk about how the cultural context of medicine seeps into our decision making processes and affects how people conceptualise the risks of too much medicine.

Read Stacy's full essay:

http://www.bmj.com/content/358/bmj.j3872

Mike Richards is well known in the UK - former Cancer Tzar, he now heads up the Care Quality Commission - regulator of all health and social care services, and therefore the body responsible for inspecting hospitals and GP practices.

In this interview, BMJ’s head of news and views, Rebecca Coombes went to the CQC’s headquarters in London, and spoke to Mike Richards - who defends the record of hospital inspection on his watch.

This is an edited version of the interview - read the full write up:

http://www.bmj.com/content/358/bmj.j3567

The Alzheimer’s society, in the UK, predicts that if the rates of dementia remain constant there’ll be 1.7 million people in the country living with the condition by 2050. We also know that things like improvements in cardiovascular health are changing those rates.

New research published on bmj.com attempts to model what the outcomes of those changing factors might be, and Sara Ahmadi - Abhari, a research associate in the Department of Epidemiology and Public Health at the University College London, joins us to discuss that model.

Read the open access research:

http://www.bmj.com/content/358/bmj.j2856

"Too many research studies are poorly designed or executed. Too much of the resulting research evidence is withheld or disseminated piecemeal. As the volume of clinical research activity has grown the quality of evidence has often worsened, which has compromised the ability of all health professionals to provide affordable, effective, high value care for patients.”

Evidence is in crisis, and Carl Heneghan, director for the Centre for Evidence Based Medicine, and Fiona Godlee, editor in chief of The BMJ set out the 9 points of the Evidence manifesto, which tries to set a road map for strengthening the evidence base.

1) Expand the role of patients, health professionals and policy makers in research

2) Increase the systematic use of existing evidence

3) Make research evidence relevant, replicable and accessible to end users.

4) Reduce questionable research practices, bias, and conflicts of interests

5) Ensure drug and device regulation is robust, transparent and independent

6) Produce better usable clinical guidelines.

7) Support innovation, quality improvement, and safety through the better use of real world data.

8) Educate professionals, policy makers and the public in evidence-based healthcare to make informed choices.

9) Encourage the next generation of leaders in evidence-based medicine.

http://www.bmj.com/content/357/bmj.j2973

The 2014 west African Ebola epidemic shone a harsh light on the health systems of Guinea, Liberia, and Sierra Leone. While decades of domestic and international investment had contributed to substantial progress on the Millennium Development Goals, national health systems remained weak and were unable to cope with the epidemic.

Margaret Kruk associate professor of global health at the Harvard TH Chan School of Public Health, joins us to discuss what makes a health system resilient, and how Liberia in particular has learned lessons from Ebola.

Read the full analysis:

http://www.bmj.com/content/357/bmj.j2323

The rapid changes in the global environment have led many scientists to conclude that we are living in a new geological epoch—the Anthropocene—in which human activities have become the dominant driving force transforming the Earth’s natural systems.

A recent joint publication by the World Health Organization and Convention on Biological Diversity articulated the myriad connections between biodiversity and health and the threats to both posed by environmental change.

Andy Haines, professor of public health and primary care, at the London School of Hygiene and Tropical Medicine joins us to talk about a new research platforms present an opportunity to advance understanding of how to safeguard health in the face of global environmental change.

Read more:

http://www.bmj.com/content/357/bmj.j2358

We're creating a manifesto for better evidence. The centre for Evidence Based Medicine at the University of Oxford, and the BMJ, are asking what are the problem with medical evidence, and how can we fix them?

In this third discussion we went to Scotland, to find out what the people who create policy think about the issues with evidence synthesis, and how the information they create is being used in practice.

evidencelive.org/manifesto/ - join the discussion, read, and comment on our manifesto.

Adoption of shared decision making into routine practice has been remarkably slow, despite 40 years of research and considerable policy support.

In 2010, the Health Foundation in the UK commissioned the MAGIC (Making Good Decisions in Collaboration) programme to design, test, and identify the best ways to embed shared decision making into routine primary and secondary care using quality improvement methods.

In this podcast, Natalie Joseph-Williams from Cardiff University and Richard Thomson from Newcastle University, join us to discuss how the project went, and what key lessons they learned from the pilot.

Read their full analysis:

http://www.bmj.com/content/357/bmj.j1744

For seven years, Republicans have vowed to repeal the Affordable Healthcare Act (Obamacare), and that promise took a central place in President Trump's campaign. The first major vote to replace it was due to happen last week, but was cancelled at the 11th hour.

In advance of the potential vote, The BMJ published a debate asking "Should US doctors mourn for Obamacare?". Now we're asking the authors of that debate, what next?

Joining Peter Doshi are Adam Gaffney, from Harvard Medical School and Saurabh Jha from the Hospital of the University of Pennsylvania.

Read their original debate:

http://www.bmj.com/content/356/bmj.j1441

The BMJ publishes a lot of educational articles, and in an attempt to help you with your CPD, we have put together this round-up. Our authors and editors will reflect on the key learning points in the articles we discuss, and explain how they may change their practice in light of that new understanding.

In this week's round up we're discussing:

The offer of an HIV screen for an asymptomatic adult

http://www.bmj.com/content/356/bmj.i6656

Two articles on legal highs

Novel psychoactive substances: types, mechanisms of action, and effects

http://www.bmj.com/content/356/bmj.i6848

Novel psychoactive substances: identifying and managing acute and chronic harmful use

http://www.bmj.com/content/356/bmj.i6814

and how to become better at supporting relatives and carers at the end of a patient’s life

http://www.bmj.com/content/356/bmj.j367