Medicine and Science from The BMJ

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

In this week's podcast - the Sensitivity of Patient Questionnaires: If you've ever asked a patient to fill out a Patient Health Questionnaire (like the PHQ-9) to assess their mental health and wondered exactly how much of a change it can actually detect, new research just published on bmj.com sets out to answer that question. We're joined by Brett Thombs, Professor in the department of Psychiatry at McGill University

Also this week, Are Doctors Scared of Death? BMJ Careers Editor Abi Rimmer sits down in the studio with Richard Coker, Emeritus Professor of Public Health at LSHTM. Drawing from his early days as an HIV doctor during the onset of the AIDS epidemic, and later with infectious disease outbreaks in South East Asia. Professor Coker discusses the profound experiences of the end of his patients lives that shaped his new book, Timor Mortis: How We Live with Death.

Reading list:

Minimal detectable change of the Patient Health Questionnaire-9, Patient Health Questionnaire-8, and Patient Health Questionnaire-2`

Known for his use of devolved powers, during his tenure as Mayor of Greater Manchester, Andy Burnham now has the opportunity to bring his local blueprint to the national stage. But what does this mean for the future of health and social care?

Our panel explore the deeply rooted health inequalities tied to the social determinants of health, the disconnect between local decision-making and national infrastructure, and the urgent need to extend the ability to access social care to more of England's population.

We're joined by

Michael Marmot: Professor of Epidemiology and Public Health at University College London (UCL) and author of the landmark Marmot Review.

Sarah Woolnough: Chief Executive of the health think tank, The King's Fund.

Matt Sutton: Professor of Health Economics at the University of Manchester.

Reading List

Devolution can create new opportunities for better health

Will devolving powers to mayors close England’s health gap?

Andy Burnham’s goal of good growth could be a health-creating mission that supports environmental action

The King's Fund responds to Andy Burnham’s comments on social care

Discrimination in NHS Hiring: We examine the troubling success rates of Black and Asian doctors when applying for NHS jobs. Deputy news editor, Gareth Iacobucci speaks to Anthony Emmanushares his analysis on why discrimination persists in the medical workforce and what recent reports reveal.

The Ethnicity Data Gap in Research: While sex and gender are reported in 99% of trials, ethnicity is reported in only 48%. Bianca Brijnath, Professor of Health Communication in Society at La Trobe University, joins us to discuss a newly published framework aimed at standardizing the capture and reporting of ethnicity data in clinical trials.

The Evidence Revolution: We celebrate how evidence-based medicine (EBM) has set the gold standard for other areas of science. Mun-Keat Looi, The BMJ’s International News and Features Editor, speaks with Nature editor and science journalist Helen Pearson about her new book, Beyond Belief: How Evidence Shows What Really Works.

Reading List
Black and Asian doctors are up to 30 times less likely to be offered medical training posts in some specialties, data show 

Measurement of ethnicity in clinical trials: Delphi survey and consensus statement 

Beyond Belief: How Evidence Shows What Really Works by Helen Pearson

Who actually owns our health data once it is stored in the cloud? And how do we balance the global push for open medical research with the need to protect local populations from data extraction?
Kamran Abbasi sits down with Trudie Lang, Professor of Global Health Research at the University of Oxford and David Strain, Associate Professor of Cardiometabolic Health at the University of Exeter.
Together, they dive into the complex ethical and legal landscape of data sovereignty - unpacking the loopholes that could allow the US government access to NHS data, and how medical research in resource poorer settings can be extractive of data. They set out the case for data sovereignty, and how it could practically work while not stifling essential international research collaboration
Read the related articles on BMJ.com:
The CLOUD Act: NHS data must be safeguarded from US interests by David Strain
A commitment to act on data sharing by Kamran Abbasi
Data sharing must evolve towards data sovereignty by Trudie Lang