Our latest H2H debate asks: Is continuous electronic fetal monitoring useful for all women in labour? Peter Brocklehurst is professor of women’s health at the University of Birmingham. He argues that continuous electronic fetal monitoring during labour can lead to harm and increase the risk of caesarean section. Christoph Lees is reader in obstetrics and fetal medicine at Imperial College London. He argues that continuous electronic fetal monitoring is useful for all women in labour as it helps ...
Dec 07, 2017•29 min
We have a problem in obesity research — clinical trials continue to prioritise weight loss as a primary outcome and rarely consider patients’ experience, quality of life, or adverse events - and now a new analysis article, "Challenging assumptions in obesity research" questions that focus on weight. Navjoyt Ladher discusses this thorny topic with Liz Sturgiss, GP, obesity researcher at Australian National University Medical School, and one of the authors of that paper. Read the full analysis: ht...
Nov 24, 2017•20 min
We know that adults with obesity have an increased risk of premature mortality, cardiovascular disease, some cancers, type 2 diabetes, and many other diseases. However, the effect of dieting on 3 of those outcomes (cancer, cvd, and mortality) is surprisingly little studied. However a new systematic review and meta-analysis does bring together what we know of that effect, and to explain the evidence we're joined by Alison Avenell, professor in the Health Services Research Unit, University of Aber...
Nov 21, 2017•26 min
In July, The BMJ published an analysis article called “The Antibiotic Course has had it’s day” - a provocative title that turned out the garner a lot of debate on our site. The article said that the convention for the length of a course of antibiotics was set by Flemming, in his Nobel Prize acceptance speech - “If you use penicillin, use enough!” - and that the evidence base hasn’t moved on since then. The article has had over 40 substantive responses, both agreeing and vehemently not - and so w...
Nov 17, 2017•30 min
Unjust discrimination against people with mental ill health should be replaced with universal rules based on decision making ability, argues George Szmukler, emeritus professor of psychiatry and society at King’s College, London. However Scott Weich, professor of mental health at the University of Sheffield, worries about legal distractions that won’t improve outcomes while services are so thinly stretched. Read the full debate: http://www.bmj.com/content/359/bmj.j5248
Nov 17, 2017•26 min
The Three Talk Model of shared decision is a framework to help clinicians to think about how to structure their consultation to ensure that shared decision making can most usefully take place. The model is based around 3 concepts - option talk, decision talk, and team talk - with active listening at the centre. Three Talk was first proposed in 2012, now new research published on bmj.com updates that model. Professor Glynn Elwyn, from The Dartmouth Institute for Health Policy and Clinical Practic...
Nov 10, 2017•24 min
The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice. In this new monthly audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. In this edition, GP Cat Chatfield, psychiatric trainee Kate Addlington and Gastrology trainee Robin Baddeley discuss the articles; Diagnosis and management of postpartum haemorrh...
Oct 31, 2017•48 min
As journal editors, we’re aware of the fact that we have a role to play in scientific discourse - that’s why The BMJ has been so keen to talk about the way in which scientific knowledge is constructed, through our Evidence Manifesto. We also know that money has influence in the scientific literature - which is why we have a zero tolerance policy for financial conflicts of interest in our educational content. Where do journal editors fit into this? The first step into investigating that is to fin...
Oct 27, 2017•16 min
The Quality and Outcomes Framework (QOF) is one of the most ambitious pay-for-performance schemes introduced into any health system. It's now being scrapped by bits of the NHS, and is under reform elsewhere. Martin Marshall, GP and professor of Health Improvement at University College London, thinks it's time to rethink the experiment. He joins us to discuss how we got here, what we've learned, and what will replace QOF. Read the editorial: http://www.bmj.com/content/359/bmj.j4681
Oct 26, 2017•21 min
Half of adolescents who die by suicide have a history of self harm. And in the UK, the rates of adolescents who commit suicide jumped from 3.2, to 5.4 per 100 000 between 2010 and 2015. The national suicide prevention strategy recently expanded its scope by aiming to reduce self harm rates as a common precursor to suicide. Therefore it's important that we have an accurate measure of rates of self harm in the population, and new research published on bmj.com aims to do that. To discuss we're join...
Oct 19, 2017•24 min
There's a crisis in old age care - not just in the UK, around the world, as population demographics shift, and the proportion of older people increase - there's a worry about who's going to look after them, and how much is it going to cost? However, a new analysis on bmj.com says this picture need not be so gloomy - they say that encouraging exercise in older people could save billions - by keeping frailty at bay and increasing healthy life expectancy. We're joined by two of the authors of that ...
Oct 18, 2017•31 min
New research published on bmj.com has evaluated how well women surgeons operate, when compared to their male colleagues - and shows that there is a marginal improvement in patient outcomes. To discuss how that was studied, and what the findings mean, we're joined by Chris Wallis, a resident at the University of Toronto, and Raj Satkunasivam, a urologic-surgeon and assistant professor at the Houston methodist hospital in Texas. Also joining us, to contextualise that research, is Clare Marx - asso...
Oct 13, 2017•37 min
Last week we published some new research which showed that 2/3 of new cancer drugs approved by the European Medicines Agency - the drug regulator for Europe - didn’t have any evidence of improved life expectancy or quality of life. In this interview, Vinau Prasad, ematologist-oncologist and Assistant Professor of Medicine at the Oregon Health and Sciences University, explains how we came to accept surrogate measures in oncology trials, and how he tries to navigate the evidence for his patients. ...
Oct 13, 2017•24 min
The majority of cancer drugs approved in Europe between 2009 and 2013 entered the market without clear evidence that they improved survival or quality of life for patients, finds a study published by The BMJ today. Even where drugs did show survival gains over existing treatments, these were often marginal. To discuss that, we're joined by Huseyin Naci, assistant professor of health policy at the London School of Economics. Read the open access study: http://www.bmj.com/content/359/bmj.j4530...
Oct 05, 2017•24 min
If you're a patient in the UK, increasingly, your first interaction with the healthcare system won't be the traditional face to fact chat with your doctor - instead you'll have a telephone consultation. The prevalence of these telephone consultations is increasing, and being promoted by CCGs and private companies who administer them - usually as a cost saving measure. Now new research published on bmj.com looks at these phone consultation - how often they happen, how patients feel about them, an...
Sep 28, 2017•23 min
Should we welcome plans to sell off NHS land? The government seems likely to back the recommendations of Robert Naylor (national adviser on NHS property and estates) to raise capital by selling off inefficiently used assets, but Kailash Chand (GP) worries that services could be threatened and that public consultation is lacking. Read the Head To Head article: https://www.bmj.com/content/358/bmj.j4290
Sep 27, 2017•15 min
Choosing Wisely was launched in the US, to much fanfare. Since then the movement has spread around the world, with successful chapters set up in Canada, Australia Brazil, Italy, Japan, new Zealand - and most recently the UK. The campaigns have not been without criticism – from how individual recommendations were chosen, to the way in which patients have been involved. In this podcast, we're joined by joined by 3 of Choosing Wisely UK’s steering group, professor Sue Bailey, head of the steering c...
Sep 27, 2017•40 min
In the UK - type 2 diabetes now affects between 5-10% of the population - and accounts for around 10% of our total NHS budget. For the individuals affected, treatments are effective at helping control glucose levels - however, the sequela associated with the disease - vascular problems, and a life expectancy that’s 6 years shorter - are still an issue. However, for some, remission seems to be a possibility. To discuss we're joined by Mike Lean, professor of human nutrition at the university if G...
Sep 22, 2017•24 min
One of the hurdles that anyone who submits research or analysis to The BMJ has to deal with is peer review. The problems of the process, and some of the potential solutions, was a big part of the Peer Review Congress which took place last week. In this interview, Sophie Cook, The BMJ's UK research editor, talks to Lisa Bero, who’s a professor of evidence based medicine at Sydney University, and spends a lot of time investigating the integrity of health research.
Sep 19, 2017•14 min
A new Rapid Recommendation from The BMJ suggests that for pregnant women, they may wish to avoid certain antiviral treatments for HIV. This recommendation differs from the WHO's, and to discuss why that is, and what makes that difference important, we're joined by Reed Siemieniuk, a physician and methodologist from McMaster University, and Alice Welbourn, campaigner for gender and sexual and reproductive health rights, in the context of HIV and violence against women. Read the full rapid recomme...
Sep 15, 2017•26 min
In the USA, when googling "depression" patients will be presented with a link to the PHQ-9 screening test. Google has developed this in collaboration with the National Alliance on Mental Illness - and Ken Duckworth, the alliance's medical director, debates the merits of this approach with Simon Gilbody, from the Department of Health Sciences at the University of York. Also joining this podcast is David Gilbert, mental health services user and director of InHealth Associates, who argues that it's...
Sep 11, 2017•35 min
If you google "The NHS" you'll see screaming headlines from the Daily Mail about cost and waste - debate in parliament is about how much of our GDP we should be spending - and each year, hospital trusts go cap in hand to ask for more funding. Against this backdrop, a new analysis, and a first in a series, published on bmj.com, looks at what it takes to have sustainable healthcare - and cruically, talks about this from the point of view of benefit, not cost. I'm Duncan Jarvies, and I'm Navjoyt La...
Sep 08, 2017•26 min
The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds. A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover; Why the World Bank matters to globa...
Sep 01, 2017•22 min
The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds. A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover; Why the World Bank matters to globa...
Sep 01, 2017•13 min
The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds. A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover; Why the World Bank matters to globa...
Sep 01, 2017•19 min
The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds. A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover; Why the World Bank matters to globa...
Sep 01, 2017•17 min
The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds. A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover; Why the World Bank matters to globa...
Sep 01, 2017•17 min
In our last podcast from Preventing Overdiagnosis 2017, we convened an impromptu roundtable of clinicians who are attending the conference to see how some of the big themes that were discussed at the conference are going to impact their everyday practice. Joining us were; Jessica Otte - Family physician from Canada David Warriner - Cardiologist from the UK. Jack O’Sullivan - Junior doctor from Australia Imran Sajid - GP from the UK To read more, have a look at our Too much medicine campaign - bm...
Aug 24, 2017•24 min
This week we’re at the over diagnosis conference in Quebec Canada, Preventing overdiangosis is a forum to discuss the harms associated with using uncertain methods to look for disease in apparently healthy people - and is part of the BMJ’s too much medicine campaign. One of the ways in which the public’s attitudes and wishes around health is measured are citizen or community juries - set up in a similar way to a criminal jury - with an information gathering, and a deliberation phase - recently o...
Aug 19, 2017•15 min
The Preventing overdiagnosis conference covers how physicians, researchers and patients can implement solutions to the problems of over diagnosis and overuse in healthcare. If you’re a doctor on twitter, you’ve probably come across our guest - Vinay Prasad, assistant prof. of medicine at Oregon Health and Science University, and author of the book Ending Medical Reversal.
Aug 19, 2017•32 min
