Talk Evidence

There is a growing market of new diagnostic tests being targeted directly to consumers, often before high-quality evidence about their effectiveness is available. This is causing issues in clinical practice as patients arrive at the NHS’s front door with results that have alarmed them.   The accuracy of these tests is unknown, developed in idealised populations then released to the general public, the positive predictive value of these tests plummet in the real world - but false positives require extensive further testing to rule out problems.   But advances in technology, with real potential, and commercial and societal incentives have aligned - these tests aren’t going to go away. So how do we start grappling with the power and pitfalls of early diagnosis - define exactly how we should be evaluating and regulating this growing industry, and what changes will we need to put in place in our healthcare systems to make sure an early diagnosis is good diagnosis?   In this podcast;   Peter Donnelly, professor of public health medicine at the University of St Andrews Bethany Jenkins, professor of health economics at the University of Leeds Stuart Hogarth, researcher at the University of Cambridge Andreas Halner, co-founder of Oxford Cancer Analytics Alex Richter, director of clinical immunology services at the University of Birmingham Carl Heneghan, director of the Centre for Evidence-Based Medicine at the University of Oxford. This podcast was recorded at the Evidence Based Early Diagnosis Conference

Helen MacDonald and Juan Franco are back to examine the newest in evidence based medicine.   In this episode: gabapentinoids are medications routinely prescribed for treating epilepsy and nerve pain. But, they come with side effects; among them - dizziness, cognitive impairment, and a dent to motor coordination - as well as an increase in suicidal ideation for the patient. Seena Fazel is professor of forensic psychiatry at University of Oxford and joins Juan to discuss a new paper tracking the association of self-harm and gabapentinoids use in Sweden.   Meanwhile, GRADE is a fundamental tool for clinicians to assess the quality of evidence for medical interventions. But, the sheer number of recommendations in the GRADE series can be overwhelming. Gordon Guyatt is a distinguished professor of medicine at McMaster University in Canada, and an early figure in the rise of evidence based medicine. He joins Helen to reflect on the future of EBM, and how the new Core GRADE system can cut through the noise.   Reading list:   1. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden 2. Why Core GRADE is needed: introduction to a new series in The BMJ  

Helen MacDonald and Juan Franco are back, magnifying glasses in hand, to take a closer look at what’s happening in evidence based medicine.   In this episode: the NHS increasingly relies on physician associates to plug some of its leaks. But, what do academic studies show about the effectiveness of these newest healthcare team members? Trish Greenhalgh is professor of primary healthcare at the University of Oxford, and she tells us about her meta-study reviewing the evidence.   Meanwhile, chronic back pain can be debilitating. When it’s at its worst, patients are eager for treatments. But, what is the true effectiveness of spinal injections to alleviate pain? Jane Ballantyne is a retired professor of pain medicine. She discusses where interventions go wrong, and how new recommendations for pain management reflect the best evidence.   Finally, Helen and Juan face uncertainty. A new research methods and reporting paper published in the BMJ takes a critical look at clinical prediction models. What does the evidence tell clinicians about how to behave when outcomes can’t be exact?   Reading list: Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research. Spinal interventions for chronic back pain Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches

  Helen Macdonald and Juan Franco are back, delving into some new evidence.   Studies showing that bi-annual injection that could prevent HIV transmission sound incredible, but will the implementation research find that the tried and tested pill regime is better? Jen Manne-Goehler, Assistant Professor of Medicine at Brigham and Women's Hospital, explains all about Lenicaprovir .   And while silicon valley tells us the future is AI, how can we trust the tools they produce? FUTURE-AI is an acronym and a potential answer, Karim Lekadir, director of the University of Barcelona’s Artificial intelligence in medicine lab, join us to explain what FUTURE-AI means, and why its principles are important in both the design and evaluation of machine learning.   Reading list:   HIV: Breakthrough study raises hopes of effective prevention if drug’s costs can be lowered.  FUTURE-AI: International consensus guideline for trustworthy and deployable artificial intelligence in healthcare. 

In this first episode of 2025, hosts Helen MacDonald and Juan Franco focus on hospitals - asking how useful UTI dipstick tests really are for acutely ill patients, and what are the effects of staff turnover on patient care in NHS hospitals? 01:11 The use of dipsticks for acutely ill UTI patients 07:48 Interview with UTI paper author 17:26 Turnover of doctors and nurses and the effects on patient care 18:41 Interview with staff turnover paper author 29:34 Helen and Juan’s thoughts on the staff turnover paper Reading list:  - Diagnostic accuracy of dipsticks for urinary tract infections in acutely hospitalised patients: a prospective population-based observational cohort study.  - Nurse and doctor turnover and patient outcomes in NHS acute trusts in England: retrospective longitudinal study.

In this special festive episode, Helen MacDonald, Juan Franco, and guest Tim Feeney discuss three intriguing themes from BMJ's 2024 Christmas edition: cognitive dysfunction in careers that require spatial cognition, and in large language models; the effectiveness of heated mittens on osteoarthritis hand symptoms; and a trial exploring just-in-time training for doctors.      00:40 Cognitive dysfunction and hippocampus stimulating jobs 07:00 Cognitive testing of large language models 10:30 Warming mittens for osteoarthritis 17:11 Coaching clinicians for high-stakes procedures Reading list Alzheimer’s disease mortality among taxi and ambulance drivers Age against the machine—susceptibility of large language models to cognitive impairment Effect of heated mittens on physical hand function in people with hand osteoarthritis Coaching inexperienced clinicians before a high stakes medical procedure

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

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      

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    

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

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.

In this month's Talk Evidence, we're getting a little meta - how do we keep an eye on research to make sure it's done with integrity. Helen Macdonald is BMJ's Publication ethics and content integrity editor - and we quiz her about what that actually means on a day to day basis. Ensuring the integrity of research could be made both easier, and harder, by the ascendance of large language models, Ian Mulvany, BMJ's chief technology officer joins us to talk about how we can harness the power of this new technology.

In this episode of Talk Evidence,  Helen Macdonald, Joe Ross, and Juan Franco are back to update us on what's happening in the world of medical evidence. Firstly, the news about the end of the covid-19 pandemic was trumpeted, but the changes to research funding have been more quite - and the team discuss what this means for ongoing work to understand the effects of covid, but also in terms of preparedness for the next pandemic. Next, breast cancer screening recommendations, in the USA, have been reduced from women over the age of 50, to those over the age of 40. We discuss the modelling study which lead to that recommendation change, and what the consequence may be in terms of overdiagnosis. Finally, 40 years ago, the U.S. Orphan Drug act was passed to encourage the development of treatments for rare conditions - but new research looks at how many clinically useful drugs have come onto market, and an analysis examines the way in which the system could be gamed by narrowing disease definitions to create small populations of patients.   Reading list Is the UK losing its world leading covid surveillance network just when it needs it most? Breast cancer: US recommends women start screening at 40 FDA approval, clinical trial evidence, efficacy, epidemiology, and price for non-orphan and ultra-rare, rare, and common orphan cancer drug indications    

Helen Macdonald, Juan Franco, and Joe Ross are back with our monthly update on the world of evidence based medicine. This episode delves into new methodologies which can use observational data to emulate trial data. We discuss a new systematic review and meta-analysis of RCTs for surgical treatment of sciatica. There is elaboration and explanation of the CONSORT Harms 2022 statement - and we'll be asking if it goes far enough. Finally, the old chestnut of surrogate endpoints in cancer treatment trials - are benefits communicated to patients accurately? Reading list; Nirmatrelvir and risk of hospital admission or death in adults with covid-19: emulation of a randomized target trial using electronic health records - https://www.bmj.com/content/381/bmj-2022-073312 Surgical versus non-surgical treatment for sciatica https://www.bmj.com/content/381/bmj-2022-070730 CONSORT Harms 2022 statement, explanation, and elaboration https://www.bmj.com/content/381/bmj-2022-073725 Funders crack down on unpublished clinical trials—but is it enough? https://www.bmj.com/content/381/bmj.p840 Communication of anticancer drug benefits and related uncertainties to patients and clinicians https://www.bmj.com/content/380/bmj-2022-073711

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