Medicine and Science from The BMJ

Talk Evidence 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

Lowering the shield with Julia Marcus and Carol Liddle

The relaxation of the COVID-19 lockdown regulations is raising a lot of questions, both for doctors and for patients. This week, we discuss how the lack of clarity and coherence in public health messages over the past few months has caused anxiety and confusion for our patients, especially those who have been told to shield. We talk about GPs tailoring shielding advice to suit the individuals they treat, the politicisation of mask wearing, and the flaws of ‘abstinence-only’ health messaging. How do we balance prompting overall health, rather than just working to prevent disease, and how do we start taking baby steps towards returning to normality?
Our guests:
Julia Marcus is an infectious disease epidemiologist and Assistant Professor at Harvard Medical School’s Department of Population Medicine . She is also an HIV researcher.
Carol Liddle, a COPD patient, is a patient advocate on the panel for NACAP (National asthma and COPD audit), as well as a patient representative for the Taskforce for Lung Health, which is run by the British Lung Foundation.
Tom, Navjoyt and Jenny mentioned some resources they have found useful while looking at racism in medicine - which we have compiled into this document https://bit.ly/DBIRacismResources

David Michaels - Doubt is an industry tactic

For a long time, the BMJ has been interested in conflicts of interest and how that skews the research base.
We also heard in our podcast on "Big Tan" that science is being used to sow seeds of doubt into the association between sunbeds and skin cancer, by scrutinizing the minutiae of a research paper, but ignoring it's bigger message.
Now it's all just happening in medicine. This is an industry tactic. And to talk about that we're joined by David Michaels - who was the longest serving head of the Occupational Safety and Health Administration, and an epidemiologist and professor at the George Washington University School of Public Health.
Read The BMJ's collection - Commercial influence in health: from transparency to independence
https://www.bmj.com/commercial-influence
To find out more from David, plus his two books on the influence of industry
https://www.drdavidmichaels.com/

Covid-19 in the U.S. - returning to work in a pandemic

In the third part of our series of podcasts “Corona Virus as Seen Through a US Lens,” features editor for The BMJ, Joanne Silberner, talks to Dr. Adeline Goss about the experience of being a new mom and a hospital resident during the crisis.
In The BMJ, Dr Goss recently wrote about the challenges facing medical residents as they deal with working during the virus.
When she went on maternity leave a few months ago, nothing seemed amiss, beyond the normal stress of being a new mom. But when she returned to full time work on June 1, everything had changed. Goss kept an audio diary of her experience preparing and going back to work and we hear some of that during the podcast.
For more of The BMJ's covid-19 coverage www.bmj.com/coronavirus

Talk Evidence 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.pdf

Mala Rao on the UK’s new race in health observatory

Earlier this year, the bmj published a racism in medicine issue - the issue was guest edited by Lord Victor Adebowale, chief executive of the NHS Confederation and Professor Mala Rao, professor of public health at Imperial College London.
At the event to launch the issue, they managed to persuade Simon Stephens , chief executive of the NHS, to put money into a “race in health observatory”
Mala joins us to talk about what that observatory is going to do, how it will maintain independence, it's role in synthesising, commissioning and implementing research, and where the organisation might begin in tackling the issue.
Reading list
NHS launches Race and Health Observatory after BMJ’s call to end inequalities
https://www.bmj.com/content/369/bmj.m2191
The BMJ's racism in medicine issue (free to access)
https://www.bmj.com/racism-in-medicine
Interview with Yvonne Coghill
https://podcasts.apple.com/us/podcast/yvonne-coghill-is-trying-to-fix-racism-in-the-nhs/id283916558?i=1000466962555
Interview with David Williams
https://podcasts.apple.com/tr/podcast/david-williams-everyday-discrimination-is-independent/id283916558?i=1000465493980

Resetting General Practice with Martin Marshall, Jenny Doust and Toyin Ajayi

In this week’s episode, our focus is on what the post-COVID world of general practice might look like. The pandemic has exposed the inequalities in our social and healthcare systems, but has also given GPs some much-needed headspace to reflect on changes to make going forward. Will we be able to turn general practice off and on again, like a faulty computer? Will we just drift back to the status quo, or will we seize this opportunity to shake up the old routines in order to redefine the role of the GP and to benefit the ever-evolving needs of our patients?
Our guests:
Martin Marshall is Chair of the Royal College of General Practitioners, a professor of Healthcare Improvement at UCL, and a GP practising in East London.
Jenny Doust is a Clinical Professorial Research Fellow at the School of Public Health at the University of Queensland, and practises as a GP in Brisbane.
Toyin Ajayi is Chief Health Officer, and co-founder, of Cityblock Health, which is a New York-based health and social services company delivering personalised healthcare to marginalised communities.
Tom, Navjoyt and Jenny mentioned some resources they have found useful while looking at racism in medicine - which we have compiled into this document https://bit.ly/DBIRacismResources

The corona virus pandemic in South America

At the end of May, the WHO said that South America has become the new epicentre of the covid-19 pandemic.
The majority of those with covid are in Brazil - not entirely surprising given it is the most populous - but in neighbouring Peru, numbers are growing too.
And it’s to Peru that we turn to talk to our guest today, Valerie Paz-Soldan is a social scientist and director of the Tulane Health Office for Latin America - part of the university’s school of public health and tropical medicine.
She joins us to talk about the pattern of the virus in Peru in particular, but elsewhere in the region, and how the pandemic is overwhelming an already stressed healthcare system.
https://www.bmj.com/coronavirus

Wellbeing - the art of the staycation

n normal times, around this time we’d start thinking about weekend breaks and summer holidays abroad. More than most healthcare staff and other key workers are in dire need of time out. Given the uncertainties around foreign travel, how can we recreate in some way that holiday feeling. Simon Calder, travel correspondent for The Independent newspaper, offers his staycation tips and alternative travel advice.

Talk Evidence 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-disparities-in-risks-and-outcomes