Medicine and Science from The BMJ

Talk Evidence - 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.

David Williams - everyday discrimination is an independent predictor of mortality

There comes a tipping point in all campaigns when the evidence is overwhelming and the only way to proceed is with action. According to David Williams, it’s time to tackle the disproportionate effects of race on patients in the UK.
David Williams, from Harvard University, developed the Everyday Discrimination Scale that, in 1997, launched a new scientific approach to assessing social influences, such as racism, on health.
He’s shown that people who experience every day acts of discrimination— like getting poorer service in a bank or a restaurant, or being treated with less courtesy—will over time have worse health outcomes, including higher rates of heart disease, lower life expectancy, and greater infant mortality.
In this podcast he is interviewed by Lilian Anekwe, assistant news editor
for New Scientist.
Read Lilian's article on tackling racism in the NHS
https://www.bmj.com/content/368/bmj.m341
And all of the special issue on racism in medicine
https://www.bmj.com/racism-in-medicine

Big Tan - Is the sunbed industry targeting research?

In 2012, Eleni Linos, professor of dermatology at Stanford university, published a systematic review and meta-analysis of the link between non-melanoma cancer and sun-beds.
That bit of pretty standard research, and a particular rapid response to it, has kicked of years of work - and in this podcast I talk to Eleni and her colleagues Stanton Glantz, and Yogi Hendlin about what they’ve uncovered.
Reading list:
Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning
https://www.bmj.com/content/368/bmj.m7
Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis
https://www.bmj.com/content/345/bmj.e5909

Writing a good outpatient letter means addressing it to the patient

In many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters.
However, Hugh Rayner, consultant nephrologist, and Peter Rees, former Chair of the Academy of Medical Royal Colleges' lay patient committee, suggest that hospital doctors who have changed their practice to include writing letters directly to patients have more patient centred consultations and experience smoother handovers with other members of their multidisciplinary teams.
Read their article explaining what makes for a good outpatient letter; https://www.bmj.com/content/368/bmj.m24

QI and improvement are not synonyms

In October 2019, Mary Dixon-Woods, director of the THIS Institute, dedicated to healthcare improvement. In that she explained how she believed healthcare improvement could be improved.
The essay took the position that "Quality Improvement" isn't necessarily the best way to improve healthcare, and that more rigour needs to be brought to the field.
That paper has created a great deal of discussion, so in this podcast we wanted to go back to Mary and ask her what she thinks about improvement, and how we can practically put into place some of the things she calls for.
Read the full essay:
https://www.bmj.com/content/367/bmj.l5514
And the rest of our healthcare improvement series:
https://www.bmj.com/quality-improvement

Prevalence and treatment of precocious puberty

Precocious puberty, that is puberty that starts before age 8 in girls and 9 in boys seems to be on the rise, but whether that’s because of an increase in incidence, or greater attention is unknown - what we do know that precocious puberty in girls is commonly idiopathic, while in boys is a red flag for pathology. But either way ther first point of call is the GP.
In this podcast, Steven Bradley GP, and Neil Lawrence, paediatric trainee join us to discuss how common precocious puberty is, how GPs should respond to a family presenting with it, and if intimate examination is actually warranted in primary care.
Read the full practice pointer:
https://www.bmj.com/content/368/bmj.l6597

Talk Evidence - 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)*
This month:
(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-sepsis-in-children-and-adults/?dopt=Abstract
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
*quick note to say sorry about the sound quality on Duncan's microphone - we had a technical glitch (he was left alone to record).

Surviving childhood cancer treatment

In a British cohort, 30% of patients who had survived childhood cancer had died within 45 years of diagnosis; only 6% were expected to have died.
51% had developed a new primary cancer, but a 26% died of cardiovascular disease - thought to be caused by their treatment. Consequently, efforts to reduce long term mortality have focused on reducing exposure to the most toxic aspects of anticancer treatment, including radiotherapy.
In this podcast we’re joined by Daniel Mulrooney, associate professor in the Division of Cancer Survivorship, at St Jude Children’s Research Hospital and one of the authors of the paper Major cardiac events for adult survivors of childhood cancer diagnosed between 1970 and 1999: report from the Childhood Cancer Survivor Study cohort
Read the full research:
https://www.bmj.com/content/368/bmj.l6794

Is it possible to have fair pricing for medicines

Is it possible to have a fair price for medicines? Yes, according to a new collection just published on bmj.com.
The authors set out to evaluate how we could improve the functioning of the market for medicines, to honestly compensate industry for innovation, whilst allowing the poorest to afford them.
Suerie Moon, co-director of global health at the Graduate Institute of Geneva joins us to explain what's wrong with how we decided what to pay for medicine's now, and how we could change that.
Read the full collection:
https://www.bmj.com/fair-pricing

Michael West - GMC Report On Wellbeing

Michael West is professor of organisational psychology, at Lancaster University, and co-author of a new GMC report into the wellbeing of NHS staff.
The review he led together with the clinical psychiatrist Denise Coia, focused on primary interventions related to workplace factors and the systems that doctors work in, rather than secondary interventions such as resilience training.
In this podcast interview, he describes what he found - and talks about how low wellbeing is amongst doctors, why the command and control nature of some management teams has increased the problem, and why he has hope because of some of the good practice he sees in NHS organisations.
Read the full report:
https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf