Measuring the carbon impact of healthcare interventions is essential if we're going to make the sector sustainable, however tracing all of the emmission from even a simple treatment can be tricky. Romi Haas, a research fellow at Monash Department of Clinical Epidemiology joins us to explain how it works, and how research could be more efficient.

New U.S. guideline on breast cancer screening  have been extended to women in their 40s -  Katy Bell, from the University of Sydney, and Stacy Carter, from the University of Wollongong explain why the good intention of that change wont be mirrored in outcomes - and may even induce harm.

 

Reading list:

Clinician and health service interventions to reduce the greenhouse gas emissions generated by healthcare: a systematic review 

Breast cancer screening from age 40 in the US

 

It's a therapeutics evidence feast this month.

We start with deprescribing in older adults - Anna Hung, assistant professor at the Duke University School of Medicine has written a summary of the evidence, and we discuss why there are so few trials on an important topic.

Metformin is typically first line for type II diabetes, but what should be next? A new cohort study emulating a comparative effectiveness trial has been published, and the team discuss using observational data for this very common problem.

Finally, a new trial on nirmaltrevir for covid 19 in those at higher risk of severe disease or those who are unvaccinated.

 

Links

BMJ - Deprescribing in older adults with polypharmacy

BMJ - Comparative effectiveness of second line oral antidiabetic treatments among people with type 2 diabetes mellitus: emulation of a target trial using routinely collected health data

NEJM - Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19

In this month’s Talk Evidence, Helen Macdonald, Juan Franco and Joseph Ross are back to talk us through some of the latest research, They’ll talk about pay-for-perfomance schemes, and whether the data they routinely collect is measuring outcomes or tickboxes. They’ll also talk about a new analysis published on bmj.com which suggests ways in which that data could be better. We’re also by Huseyin Naci, associate professor of health policy at the London School of Economics and Political Science, who will tell us about proposed changes to drug regulation in the UK - and we discuss research which has linked speedier regulatory approval to more adverse advents in post marketing studies. Finally, we talk about point of care apps. The availability of medical information in the clinic has changed practice, but how good is that information? We hear about research which has evaluated those point of care apps (including BMJ’s Best Practice app) and rates them against different criteria. Reading list Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland https://www.bmj.com/content/380/bmj-2022-072098 How can we improve the quality of data collected in general practice? https://www.bmj.com/content/380/bmj-2022-071950# UK to give “near automatic sign off” for treatments approved by “trusted” regulators https://www.bmj.com/content/380/bmj.p633 Smartphone apps for point-of-care information summaries

https://ebm.bmj.com/content/early/2023/03/14/bmjebm-2022-112146

In this episode of Talk Evidence, Helen Macdonald is joined by Juan Franco and Joe Ross, to bring you the newest evidence in The BMJ. First, chronic pain. As prescribers move away from opioids, Juan finds an overview of systematic reviews asking whether anti-depressants might help. Joe finds new research on the link between six healthy lifestyle markers and cognitive decline. Helen looks at a trial to reduce prescribing among older people with suspected urinary tract infection or UTI. Juan has a nuanced take on the updated evidence on masks to reduce the spread of respiratory viruses. Finally, an international group of researchers traced the health claims made about infant formula milk back to the evidence or lack of it Reading list: Efficacy, safety, and tolerability of antidepressants for pain in adults https://www.bmj.com/content/380/bmj-2022-072415 Association between healthy lifestyle and memory decline in older adults https://www.bmj.com/content/380/bmj-2022-072691 Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults https://www.bmj.com/content/380/bmj-2022-072319 Physical interventions to interrupt or reduce the spread of respiratory viruses https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full Health and nutrition claims for infant formula

https://www.bmj.com/content/380/bmj-2022-071075

In this week's episode, we're focusing on covid and the ongoing crisis in the NHS. Helen Macdonald, Juan Franco and Joseph Ross cast their evidence seeking eyes over research into outcomes as well as the workload of doctors. Firstly, Joe tells us about a new big data study into longer term outcomes after mild covid-19, how those ongoing symptoms relate to long covid, and how often they resolve themselves. Juan looks back to his homeland to see what Argentina which was very early to offer children vaccinations against covid-19. He tells us how a new study design can help understand how effective different combinations of vaccines were. Joe has a Danish registry paper, which links people's employment status after a MI, explains how that gives us an insight into morbidity following that event. Helen looks at a new analysis which outlines the concept of "time needed to treat" - a measure of how much time it would take a clinician to actually carry out a guideline - and you'd be surprised how much GP time would be swallowed by a "brief" intervention to reduce inactivity in their patients. Finally, the data on excess mortality in the UK has been up for debate recently - our health minister calling into question the Office of National Statistic's data. We hear from Nazrul Islam, Associate professor of medical statistics, advisor to the ONS and BMJ research editor, who has some bad news for him. Reading list: Long covid outcomes at one year after mild SARS-CoV-2 infection https://www.bmj.com/content/380/bmj-2022-072529 Effectiveness of mRNA-1273, BNT162b2, and BBIBP-CorV vaccines against infection and mortality in children in Argentina, during predominance of delta and omicron covid-19 variants https://www.bmj.com/content/379/bmj-2022-073070 Guidelines should consider clinicians’ time needed to treat https://www.bmj.com/content/380/bmj-2022-072953 Expanding the measurement of overdiagnosis in the context of disease precursors and risk factors https://ebm.bmj.com/content/early/2023/01/10/bmjebm-2022-112117 Excess deaths associated with covid-19 pandemic in 2020

https://www.bmj.com/content/373/bmj.n1137.abstract

It's almost time for the Christmas edition of the BMJ to hit your doormats, and in this festive edition of Talk Evidence we're going to be talking Christmas research. Joining Helen and Juan, we have Tim Feeney, BMJ research editor and researcher into Surgical outcomes at Boston University.

In this episode we'll be hearing about the health of footballers, and if a career in the sport predisposes Swedish players to substance use disorders. We'll hear about the performance of BMJ’s editors, when it comes to assessing the impact of a paper. We'll find out if AI algorithms can pass UK radiology exams, misinformation and a belief that everything causes cancer, and finally, some tips from BMJ’s statisticians to set the world right

In this month's episode, Helen Juan and Joe delve into the clinical - with a new review of endometriosis, and why the difficulty in diagnosis has lead to a dearth of evidence and attention on the condition. Joe tells us about a risk prediction tool that could be useful in helping to mitigate some of the problems of antihypertensive treatments. We're also having a geek out about a group of papers we've published lately, on how well evidence is created, maintained, and diseminated. Reading list; Development and external validation of a risk prediction model for falls in patients with an indication for antihypertensive treatment: retrospective cohort study https://www.bmj.com/content/379/bmj-2022-070918 Pathophysiology, diagnosis, and management of endometriosis https://www.bmj.com/content/379/bmj-2022-070750 Effective knowledge mobilisation: creating environments for quick generation, dissemination, and use of evidence https://www.bmj.com/content/379/bmj-2022-070195 Consistency of covid-19 trial preprints with published reports and impact for decision making: retrospective review https://bmjmedicine.bmj.com/content/1/1/e000309 Changing patterns in reporting and sharing of review data in systematic reviews with meta-analysis of the effects of interventions: a meta-research study from the REPRISE project

https://www.medrxiv.org/content/10.1101/2022.04.11.22273688v2

In this month's Talk Evidence, Helen Macdonald, The BMJ's research integrity editor, is joined again by Juan Franco, editor in chief of BMJ EBM, and Joe Ross, US research editor. They're straying beyond the pages of The BMJ, and discussing an NEJM paper about colonoscopy for colorectal cancer screening. We have a listener request, asking about evidence for England's " NHS Diabetes Prevention Programme" - what do we know about how lifestyle interventions work at a population level? Juan puts on his Cochrane hat to answer the query. We stay with diabetes, and Joe tells us about his research trying to see if routinely collected observational data could be used to match the outcomes of an RCT into drug treatments. Finally, Helen updates us about what she's been doing about a case of plagiarism in one of BMJ's journals - and what that means for researchers who are writing in multiple journals about their work. Reading list Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 Emulating the GRADE trial using real world data: retrospective comparative effectiveness study https://www.bmj.com/content/379/bmj-2022-070717 Expression of concern about content of which Dr Paul McCrory is a single author

https://bjsm.bmj.com/content/early/2022/10/11/bjsports-2022-106408eoc

It's October's Talk Evidence, and that means the autumn is upon us including those autumnal viruses. Here in the UK covid is on the rise, and Joe Ross is looking at some research on how good those elusive lateral flows are at detecting infection among people with symptoms of covid. Juan will give us an update on the covid inquiry, the collection of analysis articles The BMJ is publishing looking at the interface of evidence and policy in our decisions about how to handle the pandemic. Since the pandemic moral among clinicians in many health systems has fallen even further, workloads have spiralled. Coupled with other problems with workforce planning and investment in health and healthcare, this is increasing burnout - with a consequential impact on patient care. Helen will tell us about new research which is trying to put some numbers to how much clinican burnout effects patient outcomes Finally, we're turning to a very clinical topic that we don't often cover in Talk Evidence - oncology, and some interesting insights into clearance margins in cancer surgery. Reading list Diagnostic accuracy of covid-19 rapid antigen tests with unsupervised self-sampling in people with symptoms in the omicron period https://www.bmj.com/content/378/bmj-2022-071215 Guided by the science? Questions for the UK’s covid-19 public inquiry https://www.bmj.com/content/378/bmj.o2066 Associations of physician burnout with career engagement and quality of patient care https://www.bmj.com/content/378/bmj-2022-070442 Margin status and survival outcomes after breast cancer conservation surgery

https://www.bmj.com/content/378/bmj-2022-070346

In this week's episode, Joe Ross, professor of medicine at Yale, and The BMJ's US research editor, and Juan Franco, researcher at Heinrich-Heine-Universität and editor in chief of BMJ EBM are in the hot-seat. They will discuss new research on the effectiveness of antidepressants - based on all the individual patient data submitted to the FDA between 1979 and now. We'll take a look at a study of industry sponsorship of cost effectiveness analysis, and seeing similar patters of publication bias to RCTs. And finally we'll be talking about new research on the ongoing, and emergent pandemics - covid and monkeypox. Reading listResponse to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis https://www.bmj.com/content/378/bmj-2021-067606) Using individual participant data to improve network meta-analysis projects https://ebm.bmj.com/content/early/2022/08/10/bmjebm-2022-111931 Industry sponsorship bias in cost effectiveness analysis: registry based analysis https://www.bmj.com/content/377/bmj-2021-069573 Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak https://www.bmj.com/content/378/bmj-2022-072410 Effectiveness of a fourth dose of covid-19 mRNA vaccine against the omicron variant among long term care residents in Ontario, Canada:

https://www.bmj.com/content/378/bmj-2022-071502

In this episode, Juan Franco, editor in chief of BMJ EBM, and Helen Macdonald, The BMJ's research integrity editor, sit down to discuss what's new in the world of evidence. Firstly, last week they went to the first EBM Live conference for two years - and report back on what happened when the evidence community got back together. We have two research papers looking at knees and shoulders, and finding out about the balance of risks and benefits. In covid news, we're still finding new symptoms associated with infection, 2.5 years after the pandemic started. We'll also hear how complex it is to research vaccine efficacy now. Reading list: Smell and taste dysfunction after covid-19 https://www.bmj.com/content/378/bmj.o1653 Serious adverse event rates and reoperation after arthroscopic shoulder surgery https://www.bmj.com/content/378/bmj-2021-069901 Viscosupplementation for knee osteoarthritis https://www.bmj.com/content/378/bmj-2022-069722 Waning effectiveness of BNT162b2 and ChAdOx1 covid-19 vaccines over six months since second dose

https://www.bmj.com/content/378/bmj-2022-071249

In this week's episode, Helen Macdonald is joined by Joseph Ross, US research editor for The BMJ, and Juan Franco, editor of BMJ EBM. They begin by discussing a review of obesity interventions in primary care, and Joe wonders if GPs are really the best people to tackle the issue. https://www.bmj.com/content/377/bmj-2021-069719 Cervical screening in the UK now includes HPV testing, and they look at research which examines whether this could mean longer periods between screening tests. https://www.bmj.com/content/377/bmj-2021-068776 They all enjoy a new State of the Art Review into Revascularization in stable coronary artery disease. https://www.bmj.com/content/377/bmj-2021-067085 Juan and Joe look at a review into combinations of covid-19 vaccinations - and wonder whether we'll ever see more trials to fit into this meta-analysis. https://www.bmj.com/content/377/bmj-2022-069989 Finally, they find out how your political persuasion has affected mortality in the US, with new research that links Republican and Democrat voters with differential changes in mortality.

https://www.bmj.com/content/377/bmj-2021-069308

Helen Macdonald, BMJ's publication ethics and content integrity editor, and Juan Franco, editor of BMJ EBM are back with another episode of Talk Evidence.

This month, we'll be focussing on semaglutide, for managing obesity. Interviews with James Cave, editor-in-chief of Drug and Therapeutic Bulletin, and Lene Bull Christiansen, who has personal and professional experience with obesity, are featured. They discuss the history of drug therapies for obesity, and wonder if the wonderdrug semaglutide will turn out to be as disappointing. They discuss the evidence base for use of semaglutide, its effectiveness in weight management, and the broader societal issues surrounding obesity treatment.

Next, the hosts delve into undisclosed financial conflicts of interest in the DSM-5, focusing on a study led by Lisa Cosgrove and colleagues. The study reveals significant ties between DSM-5 authors and pharmaceutical companies, raising concerns about industry influence on psychiatric diagnosis and treatment recommendations.

The episode concludes with a discussion on survival rates after in-hospital cardiac arrest, based on a study using data from the Get With The Guidelines Resuscitation database. The hosts analyze the implications of the study findings for clinical practice and advanced care planning.

 

• Interview with James Cave: 00:03:15
• Interview with Lene Bull Christiansen: 00:11:07
• Interview with Lisa Cosgrove: 00:25:07
• Survival after in-hospital cardiac arrest: 00:31:25

Reading list

NEJM - Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes

DTB - Semaglutide: a new drug for the treatment of obesity

BMJ - Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis

BMJ - Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study

   

 

Helen Macdonald, The BMJ's research integrity editor is back with another episode, and this week is joined by Joe Ross, professor of medicine and public health at Yale, and US research editor for The BMJ, and Juan Franco, editor in chief of BMJ EBM, and Professor at the Instituto Universitario Hospital Italiano de Buenos Aires In this episode they discuss; The US supreme court looks set to overturn Roe v Wade, creating a patchwork of abortion provision across the U.S. We consider the role which evidence might play in documenting how health is affected by that decision, and whether medical evidence is being used at all in the debate. We'll give you a quick update on treatment for Covid-19 We know that trials are needed for new treatments, but in the face of an exponentially growing amount of observational data, is it time for a shift in that certainty? Joe tells us about his research into whether trials and observational studies of three drugs in covid produce the same answer? And finally, treatment variation - it's one of the things that helped kick-start the EBM revolution, but there's still much to learn. Juan describes some new research which examines how countries stack up when you compare their handling of and outcomes of a common condition such as a myocardial infarction. Reading list; Navigating Loss of Abortion Services — A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade https://www.nejm.org/doi/full/10.1056/NEJMp2206246. A living WHO guideline on drugs for covid-19 https://www.bmj.com/content/370/bmj.m3379 Agreement of treatment effects from observational studies and randomized controlled trials evaluating hydroxychloroquine, lopinavir-ritonavir, or dexamethasone for covid-19 https://www.bmj.com/content/377/bmj-2021-069400 Variation in revascularisation use and outcomes of patients in hospital with acute myocardial infarction across six high income countries

https://www.bmj.com/content/377/bmj-2021-069164

In this episode of Talk Evidence, Helen Macdonald, the BMJ’s research integrity editor is joined by Joe Ross, US research editor, and Juan Franco, editor in chief of BMJEBM, to talk about all things evidence. Joe gives us an update about covid, including new research on safety of the vaccine Association between covid-19 vaccination, SARS-CoV-2 infection, and risk of immune mediated neurological events https://www.bmj.com/content/376/bmj-2021-068373 Juan updates us on a potential new prophylactic for recurrent UTIs, Methenamine hippurate, which could be an alternative to antibiotics. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women https://www.bmj.com/content/376/bmj-2021-0068229 Helen tells us about some research which evaluates the way in which intersecting identities combine to make students experience of medical school more difficult. Marginalized identities, mistreatment, discrimination, and burnout among US medical students

https://www.bmj.com/content/376/bmj-2021-065984

In the first Talk Evidence of 2022, we'll be asking about the evidence for isolation - now that isolation periods are being reduced, or even stopped in the event of a negative lateral flow test, we'll find out what data that's based on, and if it's appropriate. Vaccinations and treatments for covid-19 have been the one major success story of the pandemic, but that doesn't mean we should abandon the principles of openness and transparency when it comes to scrutinising the data - we'll hear what access to the data which underlies regulatory approval could do now. Finally, the impacts of climate change were set out in a WHO report in November last year - and recent weather seems to underline their conclusions. We'll discuss new evidence linking the environment and health, and ask what clinicians can do with that. Reading list: Mitigating isolation: The use of rapid antigen testing to reduce the impact of self-isolation periods https://www.medrxiv.org/content/10.1101/2021.12.23.21268326v1.full.pdf Covid-19 vaccines and treatments: we must have raw data, now https://www.bmj.com/content/376/bmj.o102 WHO report: Climate change and health https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study https://www.bmj.com/content/375/bmj-2021-065653 Residential exposure to transportation noise in Denmark and incidence of dementia: national cohort study https://www.bmj.com/content/374/bmj.n1954 Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis

https://www.bmj.com/content/374/bmj.n1904

The BMJ has special criteria for considering Christmas research: first it should make you laugh, and then it should make you think. In this festive episode of the Talk Evidence podcast, our regular panel of Helen Macdonald and Joe Ross are again joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine.

They’ll give you a peek into what makes for good Christmas research, and why what may seem silly on the surface has a deeper meaning.

In this month’s Talk evidence, we’re going back to our roots and avoiding covid - so sit back and listen to Helen Macdonald and Joe Ross discuss a new nutrition study to prevent fractures in older adults by eating dairy, and a meta-analysis which helps you choose pain relief medications for management of osteoarthritis. We’ll hear from Steven Woloshin about the virtual Overdiagnosis conference, and why he’s so excited about a new category in the National Library of Medicine. Finally, we have a study on urinary retention and risk of cancer that has been over 25 years in the making. Reading list; Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care https://www.bmj.com/content/375/bmj.n2364 Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis https://www.bmj.com/content/375/bmj.n2321 To access the webinars Steven was talking about. https://www.preventingoverdiagnosis.net/ Acute urinary retention and risk of cancer https://www.bmj.com/content/375/bmj.n2305

Podcast listener survey. Please let us know how we could improve the podcasts for you, and your specialty - https://linktr.ee/BMJsurvey

This week our regular panelists, Helen Macdonald and Joe Ross, are joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine - to take a primary care focussed look at what's been happening in the world of evidence. On this week’s episode. As kids go back to school, winter bugs surge and pressure mounts on health services we look at two trials which aimed to use reduce antibiotic prescribing for respiratory tract infections in nursing homes and primary care Juan brings us an update on prescribing medicinal cannabis for pain, based on a recent BMJ rapid recommendation article and linked systematic review and meta-analysis And finally, in covid news, how likely are you to be admitted or die from covid after one or two SARS-CoV 2 vaccinations? Reading list Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents - https://www.bmj.com/content/374/bmj.n2198 Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care - https://www.bmj.com/content/374/bmj.n2132 Medical cannabis or cannabinoids for chronic pain - https://www.bmj.com/content/374/bmj.n2040

Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination - https://www.bmj.com/content/374/bmj.n2244

In this month's Talk Evidence, Helen Macdonald and Joe Ross are back with a wry look at the world of Evidence Based Medicine. They give us a round up of real world data emerging to address various uncertainties about vaccinations against covid Helen has an update on NHS Digital’s project to extract GP coding for planning of healthcare and research, and talks to Natalie Banner from Understanding Patient Data, to find out what the public really cares about. Finally, as routine care must go on a clinical review on cardiovascular disease in older adults introduces us to geroscience. Reading list Vaccines; Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study - https://doi.org/10.1136/bmj.n1943 Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study - https://doi.org/10.1136/bmj.n2015 Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia: prospective cohort study https://doi.org/10.1136/bmj.n1868 Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study - https://doi.org/10.1136/bmj.n1931 CVD

Cardiovascular care of older adults - https://doi.org/10.1136/bmj.n1593

The 19th of July in the UK saw the relaxation of covid rules that have been in place for 18 months - social distancing requirements in venues, mask wearing in public will no longer be legally mandated. There are a lot of questions about what this will mean for the pandemic, and in this episode of Talk Evidence Helen MacDonald, Joe Ross and Duncan Jarvies are joined by Iain Buchan, professor of public health in Liverpool, who has been involved in 2 key studies on covid transmission. Firstly, lateral flow tests - the big questions has been how well do they work in the wild - and how well do they have to work, to be useful in test trace and isolate? Iain tells us about new research into the innova test. Secondly, events - the football has shown that events can still be a big source of transmission, and the UK government put in place a number of trial events, all carefully monitored by public health researchers - Iain tells us about one nightclub test in Liverpool, and what we can glean from it. Reading list; Performance of the Innova SARS-CoV-2 antigen rapid lateral flow test in the Liverpool asymptomatic testing pilot: population based cohort study https://www.bmj.com/content/374/bmj.n1637 The UK government's events programme https://www.gov.uk/government/publications/events-research-programme-phase-i-findings/events-research-programme-phase-i-findings#findings https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/979461/S1195_Science_framework_for_opening_up_group_events.pdf Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data https://www.bmj.com/content/373/bmj.n1343 Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial https://www.bmj.com/content/374/bmj.n1585 Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis

https://www.bmj.com/content/374/bmj.n1446

In this Talk Evidence, Helen Macdonald, Joe Ross and Duncan Jarvies discuss what's going on in the world of EBM. Firstly, a while ago on the podcast, we concluded that excess mortality would be the best way to measure the impact of the pandemic - and now a new paper looks at different country's excess mortalitites over the past year. We're joined by author Nazrul Islam Physician-Epidemiologist at the University of Oxford (and a research editor for The BMJ) to talk about why comparisons may still not be sensible. Read the full research here - https://www.bmj.com/content/373/bmj.n1137 The Delta variant is dominating headlines, and infections in the UK now - but until recently the Alpha one was ascendent, and new research has helped characterise how the mortality rate of that variant differed from previous viruses. We discuss how that research was done. Read the full research - https://www.bmj.com/content/372/bmj.n579 GP data in the UK - the planned cut-off for granting access to your GP data for researchers has been extended, but there are still a lot of questions remaining. Helen has tried to find out some basic answers, and is still confused. Finally, the FDA has approved a new drug for treatment of dementia - and researchers (and the FDA's own panel of experts) are up in arms. Joe Ross tells us why he thinks the decision was the wrong one, and why patients may be harmed because of it.

https://edition.cnn.com/2021/06/17/opinions/biogen-alzheimers-drug-opinion-ramachandra-ross/index.html

In this week's Talk Evidence, Joe Ross, BMJ editor and professor at Yale again joins Helen Macdonald to talk about emerging evidence on Covid-19. They also welcome to the podcast Juan Franco, family physician in Buenos Aires, and professor at the Instituto Universitario Hospital Italiano, and new editor-in-chief of BMJ Evidence Based Medicine. This week, the team bring you updates on; Post-covid syndrome in individuals admitted to hospital with covid-19 - how are people with long covid faring. Finally published research from Scandinavia on the risk of thrombotic events after administration of the Oxford-AstraZeneca vaccine - how big is the risk, and what does that mean for the overall benefit of that vaccine. How difficult the UK population found it to understand and stick to the rules with our test, trace and isolate system - and some of the questions that this raises for this public health approach. and finally, research that showed non-drug interventions are as good as pharmaceuticals at treating people with depression and dementia - and the holistic effect that alleviating depression can have. Full reading list Ayoubkhani, Daniel, Kamlesh Khunti, Vahé Nafilyan, Thomas Maddox, Ben Humberstone, Ian Diamond, and Amitava Banerjee. 2021. “Post-Covid Syndrome in Individuals Admitted to Hospital with Covid-19: Retrospective Cohort Study.” BMJ 372 (March): n693. https://www.bmj.com/content/372/bmj.n693 Pottegård, Anton, Lars Christian Lund, Øystein Karlstad, Jesper Dahl, Morten Andersen, Jesper Hallas, Øjvind Lidegaard, et al. 2021. “Arterial Events, Venous Thromboembolism, Thrombocytopenia, and Bleeding after Vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: Population Based Cohort Study.” BMJ 373 (May): n1114. https://www.bmj.com/content/373/bmj.n1114 Smith, Louise E., Henry W. W. Potts, Richard Amlôt, Nicola T. Fear, Susan Michie, and G. James Rubin. 2021. “Adherence to the Test, Trace, and Isolate System in the UK: Results from 37 Nationally Representative Surveys.” BMJ 372 (March): n608. https://www.bmj.com/content/372/bmj.n608 Watt, Jennifer A., Zahra Goodarzi, Areti Angeliki Veroniki, Vera Nincic, Paul A. Khan, Marco Ghassemi, Yonda Lai, et al. 2021. “Comparative Efficacy of Interventions for Reducing Symptoms of Depression in People with Dementia: Systematic Review and Network Meta-Analysis.” BMJ 372 (March): n532.

https://www.bmj.com/content/372/bmj.n532

The December edition of the Talk Evidence podcast discusses the complexities of seeking consent from patients who are part of large data sets, and some new research to help patients living with diabetes in places without certain power supplies.

First patient consent and data - in the UK,  two stories that have made the public worry about the use of their health data. Firstly the news that UK biobank, who hold a lot of genomic and health data, allowed research by an insurance company, and second that the NHS has entered a contract with Palentir to do analysis on NHS data.

Natalie Banner, director of ethics at Genomics England has been thinking hard about putting patients at the centre of decision making about their data, and explains why she thinks a sole reliance on a consent model falls short.

Next, uncertain power supplies, such as in conflict or disaster zones, means uncertain refrigeration. Hard enough for most people to survive, but if you need to keep your insulin cold, it can be lifethreatening. However a new cochrane review has found good news about the thermostability of insulin at room temperature.

We ask Phillipa Boulle, MSF Intersectional NCD Working Group Leader and Cyrine Farhat,is  a global diabetes advocate based in Lebanon, how this will affect care for patients around the world.

 

Reading list

Thermal stability and storage of human insulin

 

Outline

 

00:06 introduction and overview

00:24 the challenge of seeking consent in big data sets

01:34 understanding consent issues in large datasets

01:52 the role of participant panels in data accountability

02:44 the complexity of public attitudes towards data use

04:54 the importance of transparency and engagement in data use

05:48 the impact of external factors on public trust in data use

07:49 the ethical challenges of using health data

09:17 the limitations of consent in ethical discussions

09:23 the need for more conversation about group benefits, risks, and harms

10:41 the role of governance in ethical decision making

12:05 discussion on the interview with natalie banner

14:59 the challenge of managing chronic conditions in disaster zones

15:15 the impact of temperature and storage conditions on insulin

17:32 interview with Philippa Boulle from medecins sans frontieres

29:10 interview with Cyrine Farhat, a person living with diabetes in lebanon

36:18 discussion on the interviews and the challenges of diabetes management

 

 

The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined again by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale. This week we update you on treatment - the WHO's guidelines for covid and ivermectin, and why they're not ready to recommend it's use in treatment, and prophylactic anticoagulation treatment. We hear about two papers from the UK and Switzerland which look at children and covid, and we pick up on varients of concern and long covid. Reading list. Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England https://www.bmj.com/content/372/bmj.n628 Clustering and longitudinal change in SARS-CoV-2 seroprevalence in school children in the canton of Zurich, Switzerland: prospective cohort study of 55 schools https://www.bmj.com/content/372/bmj.n616 Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study https://www.bmj.com/content/372/bmj.n579 Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study https://www.bmj.com/content/372/bmj.n311 Editorial - Prophylactic anticoagulation for patients in hospital with covid-19 https://www.bmj.com/content/372/bmj.n487 Living with Covid19 – Second review - Informative and accessible health and care research

https://evidence.nihr.ac.uk/themedreview/living-with-covid19-second-review/

In a slightly different talk evidence, Helen Macdonald and Duncan Jarvies are bringing you a couple, of in depth interviews, Firstly, Anthony Harnden, GP, academic and member of the UK's Joint Committee on Vaccination and Immunisation takes us inside their decision making, and explains what evidence they look at, how they assess it, and what the next year of vaccination may look like. Also in this episode, Gordon Guyatt, one of the founders of EBM, joins us to talk about Grade - the framework in which evidence for guidelines can be assessed - and explains why the most important thing is not the RCTs, but being very clear about what the guideline is supposed to achieve. https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation

https://www.gradeworkinggroup.org/

The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale. This week we pick up on a preprint in medRxiv, which has been attracting attention on social media - it tries to look at the longer term effects of covid hospitalisation. Joe explains why he thinks propensity matching can be summarised as "doing your best". Finally, as more and more care moves remotely, we discuss a trial on a digital intervention to help manage poorly controlled hypertension remotely. Reading list: Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study https://www.medrxiv.org/content/10.1101/2021.01.15.21249885v1.full.pdf Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

https://www.bmj.com/content/372/bmj.m4858

In this episode of Talk Evidence, Jon Deeks, professor of biostatistics at the University of Birmingham, returns to the pod with an update on lateral flow tests - and why the government plan for using them in asymptomatic screening for covid-19 doesn't follow the science. We're also joined by Allyson Pollock, clinical professor of public health at Newcastle University, and author of a recent editorial in The BMJ about asymptomatic transmission of SARS-CoV-2. She explains why she thinks supporting social isolation is the missing piece of our approach to tackling the pandemic. Covid-19 INNOVA testing in schools: don’t just test, evaluate https://blogs.bmj.com/bmj/2021/01/12/covid-19-innova-testing-in-schools-dont-just-test-evaluate/ Asymptomatic transmission of covid-19

https://www.bmj.com/content/371/bmj.m4851

As 2021 hoves into view, we look back at a year of extraordinary evidence. Helen Macdonald is joined by Joe Ross, one of The BMJ's research editors, as well as a researcher at Yale.

They discuss the way in which clinical pre-prints have become an important part of the research ecosystem, especially during the pandemic, and pick up on some of the non-coronavirus things you might have missed in the deluge of data.

If you've had time to digest this year's Christmas edition of The BMJ, you might have wondered how those papers get into The BMJ. Well in this Talk Evidence podcast, Helen Macdonald, UK research editor at The BMJ talks to two of her research team colleagues, John Fletcher and Tim Feeney, as they talk through why they chose their favourite papers. Toxicological analysis of George’s marvellous medicine https://www.bmj.com/content/371/bmj.m4467 Does medicine run in the family—evidence from three generations of physicians in Sweden https://www.bmj.com/content/371/bmj.m4453 The time to act is now

https://www.bmj.com/content/371/bmj.m4143

The vaccines are being rolled out - but approval is still on an emergency basis, and the evidence underpinning those decisions is only just becoming available for scrutiny. In this podcast we talk to Baruch Fischhoff, professor at Carnegie Mellon University and expert on public health communication about how that messaging should be done. Peter Doshi, associate editor at The BMJ, and vaccine regulation researcher also joins us to talk about the data now released on the vaccine trials - what questions does it raise, and what are the next steps for researching safety.

For more on The BMJ's covid-19 coverage www.bmj.com/coronavirus

Uncertainty abounds - even as we get better data on treatments, with the big RCTs beginning to report, and new trials on masks, the evidence remains uncertain, in both the statistical realm (confidence intervals crossing 0) and in what to do in the face of that continuing lack of clear effect. As always Helen Macdonald and Duncan Jarvies are looking at the evidence, and this week are joined by John Brodersen, professor of general practice at the University of Copenhagen. Helen talks to Bram Rochwerg, methodology lead on the WHO treatment guidelines for covid, about why their latest review has stopped recommending remdesivir for covid-19 treatment. John tells us about the Danmask study - what question it was actually trying to answer. We also discuss the ways in which there is a tendency to express certainty where there is none, and why distrusting simple solutions to complex problems is a good rule of thumb. Reading list: A living WHO guideline on drugs for covid-19 https://www.bmj.com/content/370/bmj.m3379 Covid-19’s known unknowns https://www.bmj.com/content/371/bmj.m3979 Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers

https://www.acpjournals.org/doi/10.7326/M20-6817

In this talk evidence covid-19 update, we’re taking on risk - how do you figure out your individual risk of dying from the disease? Try QCovid, but remember that it’s figuring out your risk back in April. When it comes to talking about risk, very few people actually engage with the number, so Alex Freeman from the Winton Centre for Risk and Evidence Communication at the University of Cambridge joins us to describe their research into more effective ways of presenting it. Huseyin Naci, from the London School of Economics, returns to the podcast to talk to us about the problems of pulling all the trial data together, and where covid-19 has made people work together most effectively in tackling that issue. Reading list; Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults https://www.bmj.com/content/371/bmj.m3731 Repurposed antiviral drugs for COVID-19 –interim WHO SOLIDARITY trial results https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1 Producing and using timely comparative evidence on drugs: lessons from clinical trials for covid-19

https://www.bmj.com/content/371/bmj.m3869.full

In this Talk Evidence covid-19 update, Jon Deeks, professor of biostatistics at the University of Birmingham gives us an update on testing technology. Will the point of care tests make a different to big live events, and how research and regulation need to change to tame the testing wild west.

Paul Glasziou, professor of evidence based practice at at Bond University has set up a new collaboration to try and get better at creating evidence for non-drug/vaccine control of pandemics - and ponders why we're good at drug research, but terrible at other kinds.

Each episode of Talk Evidence we take a dive into an issue or paper which is in the news, with a little help from some knowledgeable guests to help us to understand what it all means for clinical care, policy, or research. 

 

In this episode:

Helen Macdonald take a deep dive into cancer screening tests, prompted by a paper in JAMA which showed most have no effect on all cause mortality, and news that the NHS is evaluating a single test which screens for 50 common cancers - we ask Barry Kramer, former director of the Division of Cancer Prevention, at the U.S. National Cancer Institute to help explain how to hold those two pieces of knowledge.

Juan Franco has been looking into diet and obesity, prompted by new research in The BMJ and a new Cochrane review, looking at the role of low glycemic index foods in weightloss - we ask Khadidja Chekima, nutritional researcher at Taylor’s University in Malaysia, to define low GI foods, and why it’s so hard to research their role in diet and weightloss 

 

Reading list;

JAMA research - Estimated Lifetime Gained With Cancer Screening Tests; A Meta-Analysis of Randomized Clinical Trials

The BMJ news - Clinicians raise concerns over pilot of blood test for multiple cancers

The BMJ research - Association between changes in carbohydrate intake and long term weight changes: prospective cohort study

Cochrane review - Low glycaemic index or low glycaemic load diets for people with overweight or obesity

This episode was recorded on 18 September - just before the news came out about the new lockdown measures. We’ll hear Carl and Helen’s thoughts, but we also want to hear a broad range of views - so get in touch at bmj.com/podcasts. (1.15) The kids are back in school, and people are worried about the infection spreading. Helen takes us through the ISCARIC data on children's symptoms and outcomes from covid-19. (5.50) David Ludwig, professor of pediatrics at Harvard Medical School and BMJ editor, joins us to give an overview of paediatric covid. (15.30) Carl has thoughts about the spread of covid, and how it seems to be mirroring other respiratory illnesses.

(18.00) We wonder about the evidence for the "rule of six"

There are have been local lockdowns in the UK, in places such as Oldham, Birmingham, Manchester – but what is the criteria for making that decision? In the non-Covid world: does honey alleviate symptoms in upper-respiratory tract infections? When does unexpected weight-loss warrant further investigation for cancer in primary care?

Plus, in the light of findings from the Cumberlege review of safety in medical devices, the team discuss the issue of doctors’ declaration of interests.

1.00) Carl has been looking at PCR testing, and explains why it picks up both viable SARS-cov-2, but also fragments of it’s RNA - leading to potential over diagnosis. (8.50 ) What did the Living systematic review and accompanying guidelines say about treatment options for covid-19 (14.35) Helen talks to Reed Siemieniuk,  general internist from McMaster University, about creating a living network meta-analysis, to try and synthesis all the evidence on covid-19 (22.48) Helen also talks to Bram Rochwerg, associate professor at McMaster University and consultant intensivist at Hamilton Health Sciences, about turning the outcomes of a meta-analysis into guidelines, and why at the moment they’re still calling for more evidence on Remdesivir (30.08) Finally, there are worries about the uncertainty expressed in the living review - and in the way in which we communicate that. Helen goes back to Reed to find out how the review might evolve in the future. (33.50) Covid isn’t just an acute disease, there is emerging consensus that it’s systemic effects lead to long term problems for some patients - but there’s a lot of uncertainty there. (38.40) Carl talks about the IMMDS review and his involvement in it - and what recommendations we’ll be covering in future Talk Evidence programmes. Reading list: Drug treatments for covid-19: living systematic review and network meta-analysis -https://www.bmj.com/content/370/bmj.m2980 Remdesivir for severe covid-19: a clinical practice guideline - https://www.bmj.com/content/370/bmj.m2924

Management of post-acute covid-19 in primary care - https://www.bmj.com/content/370/bmj.m3026

Fresh outbreaks of covid in Europe and a wave of infections in the United States have been in the news this week, highlighting the renewed need for social distancing – but to what extent? In this edition, we explore the real-world evidence for physical distancing measures as well as the research into whether or not facemasks make us behave more recklessly.

We also discuss the non-covid themes of research transparency and a BMJ investigation into the lucrative business of orphan drugs.

Vaccines have been in the news this week - but when you dig into the stories, it turns out that the hype is about phase 1 trials. We're a long way from being sure any of the 150 possible vaccines being developed actually work. In this talk evidence we're talking to a researcher, a regulator, and a manufacturer about the way in covid-19 is upending normal vaccine development, which hurdles they'll have to reach to get onto the market, and how we'll know which one to choose when they are there. This week (1.10) We said that covid would have a knock-on effect on other treatments, and Helen looks at some research into acute coronary syndrome admissions in the UK. (6.53) Peter Doshi, assistant professor of pharmaceutical health services research at the University of Maryland School of Pharmacy and an editor for The BMJ, tells us what to watch out for in the PICO for a vaccine study. (15.20) Marco Cavaleri, head of Biological Health Threats and Vaccines Strategy at the European Medicines Agency, explains what regulators are looking for when thinking about licencing a vaccine - and how covid has made different agencies around the world align their requirements. (22.22) Philip Cruz, UK head of vaccines at GSK, explains how a manufacturer tests their vaccines, and how they use adaptive study design to past regulatory hurdles and provide information for those choosing which vaccine to use. Reading list Lancet paper - COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31356-8/fulltext ONS Data - Deaths registered weekly in England and Wales, provisional: week ending 3 July 2020 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest The BMJ editorial - Vaccines, convalescent plasma, and monoclonal antibodies for covid-19 https://www.bmj.com/content/370/bmj.m2722 WHO report - Draft landscape of COVID-19 candidate vaccines https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines Research Methods & Reporting The Adaptive designs CONSORT Extension (ACE) statement: a checklist with explanation and elaboration guideline for reporting randomised trials that use an adaptive design

https://www.bmj.com/content/369/bmj.m115

In this week's Talk Evidence we're hearing about how the death rate has dropped below average, disappointment about HIV drugs for covid-19 treatment, a trial to reduce polypharmacy, and why academic promotions matter to everyone else. 1.35 - Carl gives us one of his death updates 3.30 - Helen asks if it’s finally time to be able to do the international comparisons we’ve been waiting for? 16.10 - New research suggests that extreme PPE prevents transmission - but PPE came with a whole range of other viral suppression measures, and they all work together. 21.30 - The Recovery trial has said that  lopinavir-ritonavir isn’t effective against covid - enough for them to stop the arm of that trial. We talk about this and more treatment evidence. 24.00 - Can a digital intervention reduce poly pharmacy? A new trial on bmj.com says no, but we talk about the composite endpoint and the way the trial is powered.

36.25 - Why academic promotion matters to non academics

This week we're looking beyond the press release for dexamethasone, the long awaited review of antibody testing, and how well people are recovering after surviving acute covid-19. (2.36) The preprint for dexamethasone is finally out - considerably after the press release. Carl digs into it to find out how good the news actually is. (8.49) There are a couple of newly published systematic reviews on antibody testing, so we return to our testing guru Jon Deeks - professor of biostatistics at the University of Birmingham to give us an update. (23.52)Covid-19, it became apparent as the pandemic grew, was more than a respiratory disease - there are systemic effects on almost all organs. As people are recovering from the worst ravages of the disease, the long term consequences of those effects are becoming more clear - Lynne Turner-Stokes, professor of rehabilitation medicine at King's College London. Reading list; Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1 Cochrane review of antibody tests for covid-19 DOI: 10.1002/14651858.CD013652 British society of rehabilitation medicine guidelines for rehab after covid-19.

https://www.bsrm.org.uk/downloads/covid-19bsrmissue1-published-27-4-2020.pdf

This week, we’re asking questions about surgisphere data, and how it might have got into such high impact journals, we’re also talking about the protests around the world about structural racism - and how they intersect with the covid pandemic. (1.39) Helen and Carl talk about the data underlying the newly retracted papers on hydroxychloroquine and ace-inhibitors or ARBs and covid. (7.45) Fiona Godlee, the BMJ’s editor in chief, comes onto the pod to talk about retractions, and why they’re often called for, an rarely done. (25.10) We talk about the protests, and Carl gives us his opinion on the risk of covid transmission during them (spoiler; he thinks it’s low) (37.40) Sonia Saxena, professor of primary care at Imperial College London gives her verdict on the Public Health England report into this disproportionate effect of covid on ethnic minorities in the UK, and pushes back against it being a biological instead of a sociological determination. Reading list: Sonia’s analysis into transforming the health system for the UK’s multiethnic population https://www.bmj.com/content/368/bmj.m268  News Analysis - Covid-19: PHE review has failed ethnic minorities, leaders tell BMJ https://www.bmj.com/content/369/bmj.m2264 The PHE report into the disparate risk of covid to ethnic minorities

https://www.gov.uk/government/publications/covid-19-review-of-disparities-in-risks-and-outcomes

In this episode of Talk Evidence, we'll be finding out if second waves are inevitable (or even a thing), how the UK's failure to protect it's care homes is symbolic of a neglected part of public life, and why those papers on hydroxychloroquine were retracted. This is Talk Evidence - the podcast for evidence based medicine, where research, guidance and practice are debated and demystified. Helen Macdonald, UK research editor for The BMJ, and Carl Heneghan, professor of EBM at the University of Oxford and editor of BMJ EBM, talk about some of the latest developments in the world of evidence, and what they mean. This week: 2.00 - Helen looking into a second wave - and finds out from Tom Jefferson, an epidemiologist with the Cochrane Collaboration's acute respiratory infections group, that a "wave" might be a misnomer. 12.00 - Mary Daly, professor of sociology and social policy at the University of Oxford, tells us where the UK went wrong with care homes, and what we’d need to do to stop it happening again. 31.20 - Carl and Helen discuss those hydroxy chloroquine papers, now retracted. This was recorded before that happened, but we decided to keep this section in, because they talk about the reasons the papers should be viewed with caution, and the importance of scrutiny of the data. Reading list: The talk from Mary Daly at Green Templeton College.

https://www.gtc.ox.ac.uk/news-and-events/event/covid-19-and-care-homes-what-went-wrong-and-why/

That remdesivir study has finally been published - what does it say and is it as independant as claimed. Also, as the world's focus turned to covid, so have researchers - and they've produced over 15000 papers. How can we sift through the flood of research and know what's any good? (2.30) Helen Macdonald talks to Elizabeth Loder about the volume of research we're seeing, and why journals and peer reviewers are struggling to check it all. (8.15) The study on remdesivir has been published - the trial was stopped early, and the primary outcome switched - we talk about how that increases uncertainty over the results, and could actually delay the treatment. (26.50) We hear from a couple fo readers who wanted to correct us about averages, means, medians. Reading list: The US NIH AID study on remdesivir, published 22nd May in the New England Journal of Medicine Research - preliminary report https://www.nejm.org/doi/full/10.1056/NEJMoa2007764 NEJM - looking at the dose duration https://www.nejm.org/doi/full/10.1056/NEJMoa2015301

Editorial - an important first step https://www.nejm.org/doi/full/10.1056/NEJMe2018715

In this month's Talk Evidence, Helen and Juan are reporting from Preventing Overdiagnosis - the conference that raises issues of diagnostic accuracy, and asks if starting the process of medicalisation is always the right thing to do for patients.

 

In this episode, they talk about home testing, sustainability and screening. They're also joined by two guests to talk about the overdiagnosis of obesity - when that label is stigmatising and there seem to be few successful treatments that medicine can offer, and the need to educate students in the concepts of overdiagnosis and too much medicine, to create a culture change in medicine.

 

Links;

The Preventing Overdiagnosis conference

The BMJ EBM papers on choosing wisely.

This week we're focussing on what kind of information we need to be able to collect and use as the country transitions out of lockdown - and why local lockdowns may be here for some time. We also hear about the new antibody tests which are available in the UK - are they actually a game changer? (2.00) Helen explains what some new evidence says about hydroxychloroquine (spoiler; don’t take it for covid-19) (6.40) *Non covid alert* - Carl tells us about new research on compressions stockings for thromboprophylaxis, and the importance of doing research on non-pharmacological interventions (10.30) David Nabarro, Special Envoy of WHO Director-General on COVID19, (28.00) Helen goes back to Jon Deeks, professor of biostatistics at Birmingham, to find out more about these “accurate” tests for covid, endorsed by the government this week. Reading list: Clinical efficacy of hydroxychloroquine in patients with covid-19 https://www.bmj.com/content/369/bmj.m1844 Hydroxychloroquine in patients with mainly mild to moderate covid-19 https://www.bmj.com/content/369/bmj.m1849 David Nabarro’s website, with daily briefings https://www.4sd.info/ News Covid-19: Two antibody tests are “highly specific” but vary in sensitivity, evaluations find

https://www.bmj.com/content/369/bmj.m2066

Big data is being crunched to help us tackle some of the enormous amount of uncertainty about covid-19, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. In these podcasts, we're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week. (3.10) Calum Semple, professor of outbreak medicine at the University of Liverpool talks about the ISARIC project - predesigned research brought off the shelf and deployed during a pandemic. (14.20) Ben Goldacre, doctor, researcher and director of the EBM datalab at the University of Oxford, joins us to talk about how his team have managed to pull together records from 40% of NHS patients to look for patterns in covid-19 morbidity and mortality. Reading list OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1 Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol

https://www.medrxiv.org/content/10.1101/2020.04.23.20076042v1

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (1.20) Carl gives us an update on the England and Wales admission data. (3.00) Helen talks about ways in which spread and severity of infection amongst household contacts. (8.20) We talk natural history of covid-19, and Harlan Krumholz, cardiologist at Yale, tells us what we know, and why it's difficult to have a full picture at the moment. (15.10) Helen picks up on a study from Tim Spectre and colleagues using an app to track cases. (20.00) Henry Scowcroft, one of The BMJ's patient editor, who also works for Cancer Research UK, joins us to talk about patients who are taking part in clinical trials, and how this is affecting them. He also touches on the thin patient participation in the design of covid treatment guidelines. (24.10) Carl talks rapidity of publishing, and where researchers should most target their evidence outreach. Reading list: Reducing risks from coronavirus transmission in the home https://www.bmj.com/content/369/bmj.m1728 Rapid implementation of mobile technology for real-time epidemiology of COVID-19 https://science.sciencemag.org/content/sci/early/2020/05/04/science.abc0473.full.pdf The BMJ Public and Patient participation twitter chat

https://twitter.com/hashtag/BMJdebate

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (1.10) Carl gives us an update on the UK's figures, and how deaths outside are now being counted. (2.10) When the pandemic slows down, and normal services resume - what should we start doing first? Helen picks up some evidence on what they might be. (6.05) There's a signal that covid-19 may be causing coagulopathies in some patients, and Helen picks up on a listeners request for more information. (11.22) John Deeks, professor of Biostatistics at the University of Birmingham, is leading a Cochrane initiative into examining the evidence around testing, and rivals Carl's rant when he explains how some research is being done behind a veil of confidentiality.

(35.27) When there's a lot of uncertainty, and the stakes are very high, then tempers can flare. Vinay Prasad, hematologist-oncologist in the US, and host of Plenary Sessions podcast, joins us to talk about having a good, respectful, scientific debate.