Medicine and Science from The BMJ

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:

Victoria Tzortziou Brown, president of the Royal College of General Practitioners

Sam Everington, a GP in East London, and a non-executive director of NHS England

Kamila Hawthorne, GP in South Wales, and chair of National Academy for Social Prescribing

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.

Reading list:

 

Evidence based interventions for bipolar disorder across phases and age groups

 

Scaling up Malaria Vaccines in Africa

This week we focus on the external forces that shape medicine and healthcare. 

Global health is changing, after the reduction in financing from wealthy nations, the global community are beginning to implement reforms to improve the situation. However, any change will be unsuccessful until we tackle the fundamental structures that govern outcomes, argue Daniel Bernal-Serrano and Omar Gabriel Torres Valencia from the London School of Hygiene and Tropical Medicine. They join us to explain how economic forces, wealth distribution, and market dynamics undermine health outcomes.

We also learn about the rapid rise in private equity financing of healthcare in the UK, and the dangers that poses to healthcare quality. Bernd Rechel is a researcher at the European Observatory on Health Systems and Policies, and explains how different countries are handling this drive for healthcare profit extraction.

 

Reading list:

Private equity involvement in UK healthcare

Reforming global health architecture requires confronting its political economy