Medicine and Science from The BMJ

17 Liam Mannix

Our latest series kicks off with Australia’s multi-award-winning health and science reporter, Liam Mannix. He joins Ray to share his insights into the role and impact of evidence, advocacy and investigative reporting in today’s ever-changing media landscape.

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

18 David Tovey

After ten years at the helm of the Cochrane Library, Dr David Tovey recently stepped down as Editor-in-Chief. This week he joins Ray to reflect on Cochrane’s past, present and future and share some of the challenges and rewards of leading one of the world’s largest and most trusted health research networks.

Minimum unit pricing in Scotland

On the 1st of May, 2018 Scotland was the first country to try a new way of reducing alcohol consumption in its population. It introduced a minimum unit prices for alcohol.
Now new research just published on BMJ.com is looking at the effect of that price increase - and measuring how well it has achieved the goal of reducing drinking in Scots.
Peter Anderson, professor of alcohol studies at Newcastle University explains how well the result matched the expectation, and if the result targeted just lower earners, or all high volume drinkers.
Read the full research:
https://www.bmj.com/content/366/bmj.l5274

Climate change will make universal health coverage precarious

The BMJ in partnership with The Harvard Global Health Institute has launched a collection of articles exploring how to achieve effective universal health coverage (UHC). The collection highlights the importance of quality in UHC, potential finance models, how best to incentivise stakeholders, and some of the barriers to true UHC.
One of those barriers, and it’s a big one, is climate change - patterns of disease will change, both communicable and non-communicable, cataclysmic weather will disrupt systems, and the economic impact is going to challenge our ability to pay for healthcare.
But even against that backdrop, Ashish Jha, and Rene Salas - aren't totally pessimistic. They join us to talk about the intersection between climate and health, and where effective change can be made.
Climate change threatens the achievement of effective universal healthcare
https://www.bmj.com/content/366/bmj.l5302
Universal health coverage collection
https://www.bmj.com/universal-health-coverage

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

Cancer drug trials used for regulatory approval are at risk of bias

Around half of trials that supported new cancer drug approvals in Europe between 2014 and 2016 were judged to be at high risk of bias, in a new study.
Huseyin Naci,assistant professor of health policy a the London School of Economics joins us to talk about why potential bias may mean potential exaggeration of treatment effects, and could be costing our health systems a great deal of money.
Read the full research:
https://www.bmj.com/content/366/bmj.l5221
Listen on apple podcasts:
https://podcasts.apple.com/gb/podcast/the-bmj-podcast/id283916558?mt=2&app=podcast

Brexit - Planning for medicine shortages

This week we saw the release of the much awaited Yellowhammer documents from the government, documents which outline some of the risks involved with Britain’s sudden departure from the EU. The documents themselves outline that there are risks to the supply of medicines - but do not set out the detail of how those risks have been mitigated, and what doctors and patients should do to plan for the possibility.
In this podcast we hear from Andrew Goddard , president of the Royal College of Physicians, and Sandra Gidley, president of the Royal Pharmaceutical Society. We also have a statement from the Royal College of Radiologists.

Vaping deaths - does this change what we think about public health messages

This week the Trump administration has banned the sale of flavoured vapes in the USA.
The reason for that is the sudden rash of cases of pulmonary disease, including deaths, linked to vaping. The mechanism by which vaping may be causing damage to the lungs is as yet unclear, and our understanding is hampered by the heterogeneous nature of the compounds involved and the mechanisms of delivery.
David Hammond, professor in the school of public health and health systems at the University of Waterloo in Canada, is author of a recent editorial about vaping and joins us to discuss what this means for public health.
Outbreak of pulmonary diseases linked to vaping
https://www.bmj.com/content/366/bmj.l5445

Extending the UK’s sugar tax to snacks

In the UK, for just over a year, we've been paying the "Soft Drinks Industry Levy" - a tax on sugary beverages intended to reduce our consumption of free sugars.
That was based on taxes that had happened in other countries, however, in the UK high sugar snacks, such as confectionery, cakes, and biscuits make a greater contribution to intakes of free sugars as well as energy than sugar sweetened beverages.
Now new research models what extending the sugar tax to those snacks would do to our energy intake, and then onto the BMI of the nation.
Pauline Scheelbeek, assistant professor in nutritional and environmental epidemiology at the London School of Hygiene and Tropical Medicine joins us to explain how they modelled that, and what the outcome might be
Read the full open access research:
https://www.bmj.com/content/366/bmj.l4786