Medicine and Science from The BMJ

In this episode, we hear about ketamine addiction. It's in the news, but the rise in addiction amongst young people in the UK has caused concern for some time.  Irene Guerrini and Nicola Kalk, both addiction psychiatrists from the National Addiction Centre, join us to explain why its become a problem. In November 2024 Wes Streeting, the UK’s health and social care minister, announced that he was planning to introduce league tables for hospitals - and would be linking managers' pay and continued employment to those outcomes.  Richard Lilford, from the University of Birmingham, Timothy Hofer, from the University of Michigan, and Ian Leistikow, an inspector at the Dutch Health and Youth Care Inspectorate, join us to explain why this is a bad idea. Non-prescribed ketamine use is rising in the UK [https://www.bmj.com/content/389/bmj.r1167] Hospital league tables, targets, and performance incentives should be used with care [https://www.bmj.com/content/389/bmj-2024-083517]

Devi Sridhar's new book  “How Not to Die  (Too Soon) - The Lies We’ve Been Sold, and the Policies That Could Save Us” is focussing on the way wellness culture ignores the societal context in which health is really created. As a trained personal trainer and professor of global public health, Devi's straddling both of those worlds, and joins us to talk about how she would tackle our lowering life expectancy. Also, John Downey, from the Centre of Health Technology at Peninsula Medical School, and Martha Lee from NHS Devon Integrated Care Board, have written about Plymouth's "Living Lab" - which has been set up to test how health tech can actually work in the real world, but also (importantly, critically) how it can be properly evaluated and integrated into the NHS and social care. Reading list How Not to Die (Too Soon) [https://www.penguin.co.uk/books/458539/how-not-to-die-too-soon-by-sridhar-devi/9780241742846] Harnessing predictive prevention to shift elderly care from hospital to community in England [https://www.bmj.com/content/389/bmj-2024-082873]

Recent escalations in the ever simmering tension between India and Pakistan brought us closer to conflict - conflict between two nuclear powers. For a long time doctors have campaigned for nuclear disarmament, and Chris Zielinski, president of the World Association of Medical Editors, makes the case for returning WHO's mandate to measure the potential impact of nuclear war. Also the militarization of the region is detrimental to the health and wellbeing of the populations in both India and Pakistan. co-chairs of The BMJ's South Asia editorial board, Sanjay Nagral and Zulfiqar Butta, explain why a focus on the daily material and health needs of citizens is the way to change political rhetoric in the region. Gordon Guyatt, distinguished professor at McMaster University, was one of the people responsible for starting GRADE - which is a structured system for assessing the quality of evidence in systematic reviews and clinical practice guideline. Gordon thinks that process has become too complicated - so he’s now championing “Core GRADE”. He joins us to explain why.   Reading list Ending nuclear weapons, before they end us [https://www.bmj.com/content/389/bmj.r881] Why Core GRADE is needed: introduction to a new series in The BMJ [https://www.bmj.com/content/389/bmj-2024-081902]

China was declared malaria free in 2021 - and we'll hear how persistence was key to their success, and what new technologies are available to help the rest of the world become malaria free, from Regina Rabinovich, director of the Malaria Elimination Initiative at the Barcelona Institute for Global Health.  Sonia Saxena, professor of primary care at Imperial College London, and Miguel O’Ryan, dean of the medical faculty of the University of Chile join Kamran to talk about what broke academic medicine, and why it's time for a revolution. New research shows that data from retracted papers is still having an alarming effect on clinical practice. Chang Xu, Hui Liu, and Fuchen Liu from the Naval Medical University in Shanghai, and Suhail Doi from Qatar University, join us to talk about their study which has maped retracted papers impact on systematic reviews and clinical guidelines.    Reading list Malaria control lessons from China [https://www.bmj.com/collections/malaria-control-china] Vision 2050: a revolution in academic medicine for better health for all [https://www.bmj.com/content/389/bmj.r561] Investigating the impact of trial retractions on the healthcare evidence ecosystem (VITALITY Study I) [https://www.bmj.com/content/389/bmj-2024-082068] - An example of the BMJ's approach to updating metaanalysis after a study retraction  [https://www.bmj.com/content/356/bmj.j138]

The UK government is debating legislation to allow assisted dying in England and Wales, which puts doctors at the forefront of deciding if their patient will be eligible for a medically assisted death - the key criteria being a 6 month prognosis. But is making a 6 month prognosis actually clinically reliable? To discuss we're joined by a panel of experts on end of life; * Scott Murray, emeritus professor of primary palliative care at the University of Edinburgh * Simon Etkind, assistant professor of palliative care at the University of Cambridge * Nancy Preston, professor of supportive and palliative care, Lancaster University * Suzanne Ost, professor of law, Lancaster University Reading list Assisted dying and the difficulties of predicting end of life [https://www.bmj.com/content/388/bmj.r490] Breaching the stalemate on assisted dying: it’s time to move beyond a medicalised approach [https://www.bmj.com/content/382/bmj.p1968]   Also in this episode, we dim the lights and raise the curtains - there is a public fascination with doctors who kill and the stage show turned podcast, ‘An Appointment with Murder’, takes a deep dive into the crimes of GPs John Bodkin-Adams and Harold Shipman. Kamran is joined by Harry Brunjes and Andrew Johns to talk medical murder. An Appointment With Murder on Apple Podcasts [https://podcasts.apple.com/gb/podcast/an-appointment-with-murder/id1810022052]