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: 00:03:15Interview with Lene Bull Christiansen: 00:11:07Interview with Lisa Cosgrove: 00:25:07Survival 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

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

In this month's Talk Evidence, Helen Macdonald, The BMJ's research integrity editor, is joined again by Juan Franco, editor in chief of BMJ EBM, and Joe Ross, US research editor. They're straying beyond the pages of The BMJ, and discussing an NEJM paper about colonoscopy for colorectal cancer screening. We have a listener request, asking about evidence for England's " NHS Diabetes Prevention Programme" - what do we know about how lifestyle interventions work at a population level? Juan puts on his Cochrane hat to answer the query. We stay with diabetes, and Joe tells us about his research trying to see if routinely collected observational data could be used to match the outcomes of an RCT into drug treatments. Finally, Helen updates us about what she's been doing about a case of plagiarism in one of BMJ's journals - and what that means for researchers who are writing in multiple journals about their work. Reading list Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 Emulating the GRADE trial using real world data: retrospective comparative effectiveness study https://www.bmj.com/content/379/bmj-2022-070717 Expression of concern about content of which Dr Paul McCrory is a single author https://bjsm.bmj.com/content/early/2022/10/11/bjsports-2022-106408eoc

It's October's Talk Evidence, and that means the autumn is upon us including those autumnal viruses. Here in the UK covid is on the rise, and Joe Ross is looking at some research on how good those elusive lateral flows are at detecting infection among people with symptoms of covid. Juan will give us an update on the covid inquiry, the collection of analysis articles The BMJ is publishing looking at the interface of evidence and policy in our decisions about how to handle the pandemic. Since the pandemic moral among clinicians in many health systems has fallen even further, workloads have spiralled. Coupled with other problems with workforce planning and investment in health and healthcare, this is increasing burnout - with a consequential impact on patient care. Helen will tell us about new research which is trying to put some numbers to how much clinican burnout effects patient outcomes Finally, we're turning to a very clinical topic that we don't often cover in Talk Evidence - oncology, and some interesting insights into clearance margins in cancer surgery. Reading list Diagnostic accuracy of covid-19 rapid antigen tests with unsupervised self-sampling in people with symptoms in the omicron period https://www.bmj.com/content/378/bmj-2022-071215 Guided by the science? Questions for the UK’s covid-19 public inquiry https://www.bmj.com/content/378/bmj.o2066 Associations of physician burnout with career engagement and quality of patient care https://www.bmj.com/content/378/bmj-2022-070442 Margin status and survival outcomes after breast cancer conservation surgery https://www.bmj.com/content/378/bmj-2022-070346

In this week's episode, Joe Ross, professor of medicine at Yale, and The BMJ's US research editor, and Juan Franco, researcher at Heinrich-Heine-Universität and editor in chief of BMJ EBM are in the hot-seat. They will discuss new research on the effectiveness of antidepressants - based on all the individual patient data submitted to the FDA between 1979 and now. We'll take a look at a study of industry sponsorship of cost effectiveness analysis, and seeing similar patters of publication bias to RCTs. And finally we'll be talking about new research on the ongoing, and emergent pandemics - covid and monkeypox. Reading listResponse to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis https://www.bmj.com/content/378/bmj-2021-067606) Using individual participant data to improve network meta-analysis projects https://ebm.bmj.com/content/early/2022/08/10/bmjebm-2022-111931 Industry sponsorship bias in cost effectiveness analysis: registry based analysis https://www.bmj.com/content/377/bmj-2021-069573 Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak https://www.bmj.com/content/378/bmj-2022-072410 Effectiveness of a fourth dose of covid-19 mRNA vaccine against the omicron variant among long term care residents in Ontario, Canada: https://www.bmj.com/content/378/bmj-2022-071502

In this episode, Juan Franco, editor in chief of BMJ EBM, and Helen Macdonald, The BMJ's research integrity editor, sit down to discuss what's new in the world of evidence. Firstly, last week they went to the first EBM Live conference for two years - and report back on what happened when the evidence community got back together. We have two research papers looking at knees and shoulders, and finding out about the balance of risks and benefits. In covid news, we're still finding new symptoms associated with infection, 2.5 years after the pandemic started. We'll also hear how complex it is to research vaccine efficacy now. Reading list: Smell and taste dysfunction after covid-19 https://www.bmj.com/content/378/bmj.o1653 Serious adverse event rates and reoperation after arthroscopic shoulder surgery https://www.bmj.com/content/378/bmj-2021-069901 Viscosupplementation for knee osteoarthritis https://www.bmj.com/content/378/bmj-2022-069722 Waning effectiveness of BNT162b2 and ChAdOx1 covid-19 vaccines over six months since second dose https://www.bmj.com/content/378/bmj-2022-071249

In this week's episode, Helen Macdonald is joined by Joseph Ross, US research editor for The BMJ, and Juan Franco, editor of BMJ EBM. They begin by discussing a review of obesity interventions in primary care, and Joe wonders if GPs are really the best people to tackle the issue. https://www.bmj.com/content/377/bmj-2021-069719 Cervical screening in the UK now includes HPV testing, and they look at research which examines whether this could mean longer periods between screening tests. https://www.bmj.com/content/377/bmj-2021-068776 They all enjoy a new State of the Art Review into Revascularization in stable coronary artery disease. https://www.bmj.com/content/377/bmj-2021-067085 Juan and Joe look at a review into combinations of covid-19 vaccinations - and wonder whether we'll ever see more trials to fit into this meta-analysis. https://www.bmj.com/content/377/bmj-2022-069989 Finally, they find out how your political persuasion has affected mortality in the US, with new research that links Republican and Democrat voters with differential changes in mortality. https://www.bmj.com/content/377/bmj-2021-069308

Helen Macdonald, The BMJ's research integrity editor is back with another episode, and this week is joined by Joe Ross, professor of medicine and public health at Yale, and US research editor for The BMJ, and Juan Franco, editor in chief of BMJ EBM, and Professor at the Instituto Universitario Hospital Italiano de Buenos Aires In this episode they discuss; The US supreme court looks set to overturn Roe v Wade, creating a patchwork of abortion provision across the U.S. We consider the role which evidence might play in documenting how health is affected by that decision, and whether medical evidence is being used at all in the debate. We'll give you a quick update on treatment for Covid-19 We know that trials are needed for new treatments, but in the face of an exponentially growing amount of observational data, is it time for a shift in that certainty? Joe tells us about his research into whether trials and observational studies of three drugs in covid produce the same answer? And finally, treatment variation - it's one of the things that helped kick-start the EBM revolution, but there's still much to learn. Juan describes some new research which examines how countries stack up when you compare their handling of and outcomes of a common condition such as a myocardial infarction. Reading list; Navigating Loss of Abortion Services — A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade https://www.nejm.org/doi/full/10.1056/NEJMp2206246. A living WHO guideline on drugs for covid-19 https://www.bmj.com/content/370/bmj.m3379 Agreement of treatment effects from observational studies and randomized controlled trials evaluating hydroxychloroquine, lopinavir-ritonavir, or dexamethasone for covid-19 https://www.bmj.com/content/377/bmj-2021-069400 Variation in revascularisation use and outcomes of patients in hospital with acute myocardial infarction across six high income countries https://www.bmj.com/content/377/bmj-2021-069164

In this episode of Talk Evidence, Helen Macdonald, the BMJ’s research integrity editor is joined by Joe Ross, US research editor, and Juan Franco, editor in chief of BMJEBM, to talk about all things evidence. Joe gives us an update about covid, including new research on safety of the vaccine Association between covid-19 vaccination, SARS-CoV-2 infection, and risk of immune mediated neurological events https://www.bmj.com/content/376/bmj-2021-068373 Juan updates us on a potential new prophylactic for recurrent UTIs, Methenamine hippurate, which could be an alternative to antibiotics. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women https://www.bmj.com/content/376/bmj-2021-0068229 Helen tells us about some research which evaluates the way in which intersecting identities combine to make students experience of medical school more difficult. Marginalized identities, mistreatment, discrimination, and burnout among US medical students https://www.bmj.com/content/376/bmj-2021-065984