Medicine and Science from The BMJ

Statins for primary prevention - How good is the evidence

Statins are now the most commonly used drug in the UK and one of the most commonly used medicines in the world, but debate remains about their use for primary prevention for people without cardiovascular disease.
Paula Byrne from the National University of Ireland Galway, joins us to talk about the evidence of benefit for low risk individuals, and what needs to be done to finally answer the questions about efficacy and harms.
Read the full analysis:
https://www.bmj.com/content/367/bmj.l5674

Ancestry DNA tests can over or under estimate genetic disease risk

Direct-to-consumer genetic tests are sold online and in shops as a way to “find out what your DNA says".
They insights into ancestry or disease risks; others claim to provide information on personality, athletic ability, and child talent. However, interpretation of genetic data is complex and context dependent, and DTC genetic tests may produce false positive and false negative results.
Rachel Horton, clinical training fellow, Anneke Lucassen, chair of British Society of Genetic Medicine, and Jude Hayward the RCGP clinical champion for genomics join us to discuss how this deluge of genetic data is affecting patients, GPs and clinical geneticists in the NHS.
Read the full article:
https://www.bmj.com/content/367/bmj.l5688

How Blockchain could improve clinical trial transparency

Blockchain is the digital technology that underpins cryptocurrencies such as bitcoin, and has been proposed as the digital panacea of our times.
But Leeza Osipenko, from the London School of Economics, has thought about how it could actually be used in clinical trials, and what else would need to change in our regulatory environment to make that work.
Read her full essay:
https://www.bmj.com/content/367/bmj.l5561

A new way to look at behaviour change in UK GPs

In quality improvement, measurement is seen as a key driver of change - how well do you know you’re doing, if you can’t actually measure it.
So, when something changes in the NHS (say a new guideline) how can you tell how quickly that’s filtering down to the front line.
Ben goldacre, from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, joins us to talk about a new proof of concept published on bmj.com, which uses NHS prescribing data to analyse how change propagated through GP practices.
Read the full open access research:
https://www.bmj.com/content/367/bmj.l5205
https://openprescribing.net/

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