Intended for healthcare professionals

Talk Evidence

The podcast for evidence based medicine - where research, guidance and practice are debated and demystified.

Available on Apple Podcasts, Spotify and all major podcast players.

 

The Team

(L-R) Helen MacDonald, Carl Heneghan and Duncan Jarvies

Helen Macdonald

Helen is a GP with an interest in the communication of evidence. She is the UK research editor for The BMJ, continues to develop The BMJ's Rapid Recommendations series, and champions our campaigns on Better Evidence and Too Much Medicine.

Carl Heneghan

Carl is Professor of Evidence-Based Medicine (EBM) and Director of the Centre for Evidence-Based Medicine (CEBM) at Oxford University’s Nuffield Department of Primary Care Health Sciences. He is also a practicing GP, editor of BMJ Evidence-Based Medicine, and frequently exasperated by poorly done or interpreted research.

Duncan Jarvies

Duncan is the multimedia editor for The BMJ and a former biochemist who came to the journal via TV production, and is fascinated by the world of EBM.

Episode 31: Covid-19 update - how well have physical distancing measures worked?

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.

Episode 30: Covid-19 update - how will we know if a vaccine works?

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.

(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/birthsdeathsandmarri...

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-cand...

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

Episode 29: Covid-19 update - drop in excess deaths, HIV drugs, academic promotion.

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

Episode 28: Covid-19 update - dexamethosone, testing, rehabilitation after covid.

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...

Episode 27: Covid-19 update - surgisphere data, and protests in a pandemic

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-disparitie...

Episode 26: Covid-19 update - second wave and care home failings

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.

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-w...

Episode 25: Covid-19 update - remdesivir redux, the overwhelming volume of research

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

Episode 24: Covid-19 update - strategies to end lockdown, more testing

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,

(16.30) Helen talks care homes, and interviews Mona Koshkouei, from Oxford University, about the research which shows staff are the main vector of infection.

(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

Episode 23: Covid-19 update - answering questions with big data

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.

(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

Episode 22: Covid-19 update - natural history of covid, include patients in guidelines

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.

(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.abc0...

The BMJ Public and Patient participation twitter chat - https://twitter.com/hashtag/BMJdebate

Episode 21: Covid-19 update - lack of testing transparency, how to give good debate

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.

(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.

Episode 20: Covid-19 update - covid ethics, waste and a minimum RCT size

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.

(1.00) Carl gives us an update on the UK’s covid-19 related mortality

(7.40) When the evidence is uncertain, and the outcomes so massive, then the ethical dimensions of decisions become even more apparent. Helen talks ethics in guidelines with Julian Sheather, advisor on ethics and human rights to the BMA and MSF.

(25.37) Update on covid-19 research, looking at viral particle shedding.

(29.24) We’ve mentioned the potential wasted effort in covid-19 research, and Helen speaks to Paul Glaziou, director of the Institute for Evidence Based Research at Bond University, about the waste he’s already seen, and ways in which it could be avoided.

Episode 19: Covid-19 update - Remdesivir, care homes, and death data

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.

(3.14) Jeff Aronson from Oxford University explains why remdesivir is a potential therapeutic, but is pessimistic about the quality of the studies being done on it.

(13.22) Carl explains why smoking cessation is still a key public health priority under covid-19.

(16.30) Helen talks care homes, and interviews Mona Koshkouei, from Oxford University, about the research which shows staff are the main vector of infection.

(27.20) David Spiegelhalter, professor of public understanding of risk, looks at the new data on excess deaths in the UK - and the difficulties with reporting that underlie it. Carl explains how deaths track infections, and why uncertainty there makes it hard to calcuate the case fatality rate (And why that is not a good measure to use in a pandemic).

Reading list:

Compassionate Use of Remdesivir for Patients with Severe Covid-19 - https://www.nejm.org/doi/full/10.1056/NEJMoa2007016

How can pandemic spreads be contained in care homes? - https://www.cebm.net/covid-19/how-can-pandemic-spreads-be-contained-in-c...

Covid-19: Death rate in England and Wales reaches record high because of covid-19 - https://www.bmj.com/node/1024784.full

Episode 18: Covid-19 update - hydroxy/chloroquinine, prognostic models and facemaskss

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.

(2.24) - Hydroxychloroquinine/chloroquinine - Robin Ferner, honorary professor of clinical pharmacology at the University of Birmingham explains why is it a potential therapeutic for covid-19, and why is it being hyped.

(12.45) - We use prognostic models to make treatment decisions, but they have to be well conducted. Lots of them are being created for covid-19, but their quality isn’t great. Statisticians Laure Wynants Maastricht University and Maarten van Smeden from Utrecht University have done a systematic review of these models, and explain what’s needed for them to be useful.

(26.30) PPE - specifically facemasks. What does the evidence say about their use by the public, and does the precautionary principle hold.

Reading List

COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community - https://www.nice.org.uk/guidance/ng165/chapter/4-Managing-suspected-or-c...

Chloroquine and hydroxychloroquine in covid-19 - https://www.bmj.com/content/369/bmj.m1432

Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal - https://www.bmj.com/content/369/bmj.m1328

What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff? - https://www.cebm.net/covid-19/what-is-the-efficacy-of-standard-face-mask...

Episode 17: Covid-19 update - pneumonia, guidelines, preprints and testing

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.

5.00 - Carl gives us an update about pneumonia in primary care, should you give antibiotics when you're not sure if it's bacterial or viral.

10.00 - The importance and difficulty of making guidelines now.

15.00 - We hear from guideline maker Per Vandvik, about making guidance.

21.40 - Preprint servers for medicine are showing their use in this fast changing situation. Joseph Ross from Yale School of Medicine, and one of The BMJ's research editors, talks to us about the kind of information we're seeing on medRxiv.

31.10 - Testing. What are the tests, and when do we want specificity, and when do we want sensitivity. Nick Beeching from the Liverpool School of Tropical Medicine joins us to explain.

Reading list:

www.bmj.com/coronavirus

Rapidly managing pneumonia in older people during a pandemic - https://www.cebm.net/covid-19/rapidly-managing-pneumonia-in-older-people...

https://www.medrxiv.org/

Covid-19: testing times - https://www.bmj.com/content/369/bmj.m1403

Episode 16: Covid-19 update - Confused symptoms, fatality rate uncertainty, Iceland's testing

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.

3.50 - There is a lot of confusion around symptoms, we hear what Carl's review of the case studies has found, and why he thinks fever and persistent dry cough may not be a sign of all cases.

10.30 - where are we with research into antiviral treatment.

17.30 - John Ioannidis has expressed concerns about the quality data used in modelling and therefore our pandemic response. We hear what his concerns are, and what needs to be done to answer them.

29.10 - Iceland is the only country attempting to do population level screening, we hear from Kári Stefánsson, CEO of deCODE genetics which is working with the Icelandic government to allow everyone to access testing for the virus.

Episode 15: Testing under the microscope and opioid prescription

This edition of talk evidence was recorded before the big increase in covid-19 infections in the UK, and then delayed by some self isolation. We'll be back with more evidence on the pandemic very soon.

As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence).

(1.01) Helen talks about variation in prescription of opioids - do 1% of clinician really prescribe the vast majority of the drug?

(8.45) Carl tells us that its time papers (in this case a lung screening one) really present absolute numbers.

(17.30) Carl explains how a spoonfull (less) of salt helps the blood pressure go down.

(21.25) Helen puts test results under a microscope, and finds out that they may vary.

(33.20) What do conflicts of interest in tanning papers mean for wider science?

(48.05) Carl has a "super-rant" about smartphone apps for skin cancer - and a sensitivity of 0.

Reading list:

Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study - https://www.bmj.com/content/368/bmj.l6968

Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial - https://www.nejm.org/doi/full/10.1056/NEJMoa1911793

Effect of dose and duration of reduction in dietary sodium on blood pressure levels - https://www.bmj.com/content/368/bmj.m315

Your results may vary: the imprecision of medical measurements - https://www.bmj.com/content/368/bmj.m149

Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review - https://www.bmj.com/content/368/bmj.m7

Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies - https://www.bmj.com/content/368/bmj.m127

Episode 14: Building an evidence base for covid-19

We're taking a break from the usual Talk Evidence to focus on the new corona virus that has emerged in China.

With a brand new disease, we have to build our evidence base from scratch - basic virology, epidemiology, pathogenicity, transmissibility, and ultimately treatment are all unknowns.

In this episode of Talk Evidence, we're trying to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

(8.00) Peter Openshaw, professor of experimental medicine at Imperial College London, talks to us about the pathogenicity of covid-19

(17.30) Wendy Barclay, head of the Department of Infectious Disease at Imperial College London, describes what can change the R0 of a viral disease.

(20.50) Raina MacIntyre, professor of biosecurity at the Kirby Institute at the University of New South Wales, talks to us about how effective masks are at preventing spread of viruses.

(30.00) We discuss treatment options in the face of massive uncertainty.

To read more about covid-19 and to keep up to date with the disease visit https://www.bmj.com/coronavirus where all of the information on the disease if freely available.

Episode 13: Sepsis, talc and blindsided by blinding

Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence).

(1.20) Carl tells us about new research on treating sepsis with steroids that might inform practice.

(4.58)Proscribing of prophylactic PPIs or H2-blockers for intensive care patients.

(11.00) Carl wonders if we can actually rule out an increased risk of ovarian cancer with the use of talc.

(17.46) Helen drops and EBM bombshell - is all the work needed to blind participants in a double blind randomised control trial actually worth it?

(33.00) Helen is annoyed about a press release from the department of health, and kicks of 2020 by stealing Carl's rant spot.

Reading list:

Corticosteroids for Treating Sepsis in Children and Adults - https://pubmed.ncbi.nlm.nih.gov/31808551-corticosteroids-for-treating-se...

Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline - https://www.bmj.com/content/368/bmj.l6722

Association of Powder Use in the Genital Area With Risk of Ovarian Cancer - https://www.ncbi.nlm.nih.gov/pubmed/31910280

Blinding - Fool’s gold? Why blinded trials are not always best - https://www.bmj.com/content/368/bmj.l6228

Impact of blinding on estimated treatment effects in randomised clinical trials - https://www.bmj.com/content/368/bmj.l6802

Episode 12: Talk Xmas Evidence

Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence).

(2.00) Helen look back at a Christmas article, which investigates a very common superstition in hospitals.

(7.55) Carl has his pick of the top 100 altimetric most influential papers of the year.

(12.40) We find out all about the preventing overdiagnosis conference which happened earlier in December.

(34.15) Helen has her annual rant about misogeny in medicine.

Reading list:

Q fever—the superstition of avoiding the word “quiet” as a coping mechanism - https://www.bmj.com/content/367/bmj.l6446

Altmetric Top 100 - https://www.altmetric.com/top100/2019/

Fiona Godlee’s keynote at Preventing Overdiagnosis - https://www.preventingoverdiagnosis.net/

Gender differences in how scientists present the importance of their research: observational study - https://www.bmj.com/content/367/bmj.l6573

Episode 11: Aggravating acronyms, a time to prescribe, and screening (again)

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 Helen talks about the messy business of colon cancer screening - which modality is best, and in what population is it actually effective (1.40).

The Rant: acronyms in research papers (17.45).

Mini Rant: politicisation of the NHS, and Carl pitches for yet another job (25.15).

Research in the news has talked about the importance of when drugs are taken, to maximise efficacy. Melvin Lobo, cardiologist specialising in hypertension joins us to explain that research and why we seem to have forgotten about that effect.

Reading list:

Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline - https://www.bmj.com/content/367/bmj.l5515

Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial - https://www.bmj.com/content/367/bmj.l5517

Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial - https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj...

Episode 10: 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%...

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

Episode 9: 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

Prevalence, severity, and nature of preventable patient harm across medical care settings - https://www.bmj.com/content/366/bmj.l4185

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-...

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

Episode 8: 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

Episode 7: 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-...

Sharing of clinical trial data and results reporting practices among large pharmaceutical companies - https://www.bmj.com/content/366/bmj.l4217

Episode 6: 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

Episode 5: 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

Episode 4: 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/d41586-019-008...

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

Episode 3: 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

Episode 2: Radiation, fertility, and pneumonia

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 how difficult a task it is to find evidence that's definitely practice changing, what GPs can learn from Malawian children with nonsevere fast-breathing pneumonia, how radiation dosage varies substantially - and consultant radiologist Amy Davies what that means for patients.

They also rail against add-on tests for fertility, and the lack of evidence underpinning their use - will the traffic light system suggested help patients make treatment choices.

Carl's rant this week is based on a new study by Steve Woloshin and Lisa Schwartz which documented 20 years of medical marketing in the USA.

Reading list:

Pneumonia in Malawi - https://www.ncbi.nlm.nih.gov/pubmed/30419120

Variation in radiation dose - https://www.bmj.com/content/364/bmj.k4931

Traffic light fertility tests - https://www.bmj.com/content/364/bmj.l226

Medical marketing - https://jamanetwork.com/journals/jama/fullarticle/2720029

Episode 1: Devices and facebook vaccines

In the second of our EBM round-ups, Carl Heneghan, Helen Macdonald and Duncan Jarvies are joined by Deborah Cohen, investigative journalist and scourge of device manufacturers.

We're giving our verdict on the sensitivity and specificity of ketone testing for hyperemesis, and the advice to drinking more water to prevent recurrent UTIs in women.

Deb joins us to talk about the massive, international, investigation into failing regulation for implantable devices - and shares some of the stories where these have harmed patients.

Finally, Carl is excised about antivaxer ads on facebook - but Helen has seen some pro-vaccine ones which are poor science too.

Reading list:

Diagnostic markers for hyperemesis gravidarum - https://www.ncbi.nlm.nih.gov/pubmed/24530975

Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2705079

The great implant scandle - https://www.bbc.co.uk/iplayer/episode/b0btjr55/panorama-the-great-implan...

Facebook antivaccine ads - https://www.independent.co.uk/news/uk/home-news/anti-vaccination-antivax...

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