Talk Evidence

Talk Evidence - eating less, drinking less, drug approval data

Talk Evidence is back, with your monthly take on the world of EBM with Duncan Jarvies and GPs Carl Heneghan (also director for the Centre of Evidence Based Medicine at the University of Oxford) and Helen Macdonald (also The BMJ's UK research Editor). This month Carl talks about evidence that restricting your diet might improve health at a population level (1.50) Helen talks about the data on a drop in alcohol consumption amongst Scots (7.04) A listener questions the team about their take on Tramadol (13.45) Helen talks about the problems with the trials we use to regulate drugs (18.00) And Carl explains why drug shortages aren't just a Brexit problem (31.30) Reading list: two years of calorie restriction and cardiometabolic risk (CALERIE): exploratory outcomes of a multicentre, phase 2, randomised controlled trial https://www.sciencedirect.com/science/article/pii/S2213858719301512?via%3Dihub Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18 https://www.bmj.com/content/366/bmj.l5274 Design characteristics, risk of bias, and reporting of randomised controlled trials supporting approvals of cancer drugs by European Medicines Agency, 2014-16: cross sectional analysis https://www.bmj.com/content/366/bmj.l5221 Crisis in the supply of medicines

https://www.bmj.com/content/367/bmj.l5841

Talk Evidence - Recurrent VTE, CRP testing for COPD, CMO report, and a consultation

Helen talks about new research on prevention of recurrent VTE - and Carl things the evidence goes further, and we can extend prophylaxis for a year. 13.00 - CRP testing for antibiotic prescription in COPD exacerbations, should we start doing it in primary care settings - and what will that mean. We also hear from Chris Butler, one of the trialists, who explains why being very clear about what you actually want to measure is important in study design. 26.50 - Carl wants you to read the Chief Medical Officer’s report, and we hear from Cathrine Falconer, who edited it, about how they put the recommendations together. 32.50 - Helen thinks that a new consultation from the UK government is collecting evidence in an unsystematic way, and that it’s an opportunity for listeners to submit some good evidence. Reading list: Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event https://www.bmj.com/content/366/bmj.l4363 C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations https://www.nejm.org/doi/10.1056/NEJMoa1803185 Chief Medical Officer annual report 2019: partnering for progress https://www.gov.uk/government/publications/chief-medical-officer-annual-report-2019-partnering-for-progress Advancing our health: prevention in the 2020s – consultation document

https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

Talk Evidence - Tramadol, medical harm, and alexa

Welcome back to Talk Evidence - where Helen Macdonald and Carl Heneghan take you through what's happening in the world of Evidence. This month we'll be discussing tramadol being prescripted postoperatively, and a new EBM verdict says that should change(1.36). How much preventable harm does healthcare causes (11.20. A canadian project to help policy makers get the evidence they need (16.55) One of our listeners thinks "Simple" GPs are anything but (28.30) - and we'll be asking Alexa about our health queries. Reading list Treating postoperative pain? Avoid tramadol, long-acting opioid analgesics and long-term use https://ebm.bmj.com/content/early/2019/08/16/bmjebm-2019-111236 Prevalence, severity, and nature of preventable patient harm across medical care settings https://www.bmj.com/content/366/bmj.l4185 Helen Salisbury: “Alexa, can you do my job for me?”

https://www.bmj.com/content/366/bmj.l4719

Talk Evidence - smoking, gloves and transparency

This month we have some more feedback from our listeners (2.20) Carl says it's time to start smoking cessation (or stop the reduction in funding for smoking reduction) (11.40) and marvels at how pretty Richard Doll's seminal smoking paper is. It's gloves off for infection control (22.20) Andrew George, a non-executive director of the Health Research Authority joins us to talk about their consultation on research transparency, and explains how you can get involved (27.04) And we talk about a new tool for rating the transparency of pharma companies (37.40) Reading list: Impact of the WHO Framework Convention on Tobacco Control on global cigarette consumption https://www.bmj.com/content/365/bmj.l2287 Sixty seconds on . . . gloves off https://www.bmj.com/content/366/bmj.l4498 HRA transparency consultation https://www.hra.nhs.uk/about-us/consultations/make-it-public/our-vision-research-transparency/ Sharing of clinical trial data and results reporting practices among large pharmaceutical companies

https://www.bmj.com/content/366/bmj.l4217

Talk Evidence - Z drugs, subclinical hypothyroidism and Drazen’s dozen

This week on the podcast, (2.02) a listener asks, when we suggest something to stop, should we suggest an alternative instead? (8.24) Helen tells us to stop putting people on treatment for subclinical hypothyroidism, but what does that mean for people who are already receiving thyroxine? (20.55) Carl has a black box warning about z drugs, and wonders what the alternative for sleep are. (30.11) Finally the NEJM has published Jeff Drazen's dozen most influential papers - but not a systematic review amongst them. Cue the rant. Reading list: Rapid rec on subclinical hypothyroidism https://www.bmj.com/content/365/bmj.l2006 Temporal trends in use of tests in UK primary care, 2000-15 https://www.bmj.com/content/363/bmj.k4666 Black box warning for z-drugs https://www.bmj.com/content/365/bmj.l2165 Drazen's dozen

https://cdn.nejm.org/pdf/Drazens-Dozen.pdf

Talk Evidence - cancer causing food, prostate cancer and disease definitions

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month. (1.05) Carl rants about bacon causing cancer (7.10) Helen talks about prostate cancer, and we hear from the author of the research paper which won Research Paper Of The Year at the BMJ awards. We also cover disease definition and a call to have GPs more involved in that process, (24.12)and a new call for papers into conflicts of interest (29.40) Reading list: MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. https://www.ncbi.nlm.nih.gov/pubmed/29552975?dopt=Abstract Reforming disease definitions: a new primary care led, people-centred approach https://ebm.bmj.com/content/early/2019/04/11/bmjebm-2018-111148 Commercial interests, transparency, and independence: a call for submissions

https://www.bmj.com/content/365/bmj.l1706

Talk Evidence - health checks, abx courses and p-values

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month. (1.20) Carl grinds his gears over general health checks, with an update in the Cochrane Library. (9.15) Helen is surprised by new research which looks at over prescription of antibiotics - but this time because the courses prescribed are far longer than guidelines suggest. (22.30) What is the true 99th centile of high sensitivity cardiac troponin in hospital patients? (29.02) Is it time to abandon statistical significance and be aware of the problem of the transposed conditional. Reading list: General health checks in adults for reducing morbidity and mortality from disease - https://www.ncbi.nlm.nih.gov/pubmed/30699470?dopt=Abstract Duration of antibiotic treatment for common infections in English primary care -https://www.bmj.com/content/364/bmj.l440 True 99th centile of high sensitivity cardiac troponin for hospital patients - https://www.bmj.com/content/364/bmj.l440 Significant debate - https://www.nature.com/magazine-assets/d41586-019-00874-8/d41586-019-00874-8.pdf The false positive risk: a proposal concerning what to do about p-values - https://www.youtube.com/watch?v=jZWgijUnIxI

http://www.onemol.org.uk/?page_id=456

Talk Evidence - Shoulders, statins and doctors messes

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month. They start by talking about shoulders - what does the evidence say about treating subacromial pain, and why the potential for a subgroup effect shouldn't change our views about stop surgery (for now, more research needed). (16.00) Statins - more uncertainty about statins, this is now looking at older people. Age is a big risk factor for cardiovascular disease - at what point does that risk overwhelm any potential benefit from taking statins? (20.30)Carl explains his rule-of-thumb for turning relative risks into absolute risks, in a way can help doctors talk to patients about new evidence. (25.46)What's the evidence for doctors messes? Carl's rant of the week focuses on the calls (including the BMJ's campaign) to have spaces for doctors to relax in hospitals. He asks, is that better than putting in a gym? What's the evidence for that. Reading list: Subacromial decompression surgery for adults with shoulder pain https://www.bmj.com/content/364/bmj.l294 Efficacy and safety of statin therapy in older people https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext The future of doctor's messes

https://www.bmj.com/content/364/bmj.k5367.abstract