Talk Evidence

There is a growing market of new diagnostic tests being targeted directly to consumers, often before high-quality evidence about their effectiveness is available. This is causing issues in clinical practice as patients arrive at the NHS’s front door with results that have alarmed them.

The accuracy of these tests is unknown, developed in idealised populations then released to the general public, the positive predictive value of these tests plummet in the real world - but false positives require extensive further testing to rule out problems.

But advances in technology, with real potential, and commercial and societal incentives have aligned - these tests aren’t going to go away.

In this podcast;

Peter Donnelly, professor of public health medicine at the University of St Andrews

Bethany Jenkins, professor of health economics at the University of Leeds

Stuart Hogarth, researcher at the University of Cambridge

Andreas Halner, co-founder of Oxford Cancer Analytics

Alex Richter, director of clinical immunology services at the University of Birmingham

Carl Heneghan, director of the Centre for Evidence-Based Medicine at the University of Oxford.

This podcast was recorded at the Evidence Based Early Diagnosis Conference

Helen MacDonald and Juan Franco are back to examine the newest in evidence based medicine.

In this episode: gabapentinoids are medications routinely prescribed for treating epilepsy and nerve pain. But, they come with side effects; among them - dizziness, cognitive impairment, and a dent to motor coordination - as well as an increase in suicidal ideation for the patient. Seena Fazel is professor of forensic psychiatry at University of Oxford and joins Juan to discuss a new paper tracking the association of self-harm and gabapentinoids use in Sweden.

Meanwhile, GRADE is a fundamental tool for clinicians to assess the quality of evidence for medical interventions. But, the sheer number of recommendations in the GRADE series can be overwhelming. Gordon Guyatt is a distinguished professor of medicine at McMaster University in Canada, and an early figure in the rise of evidence based medicine. He joins Helen to reflect on the future of EBM, and how the new Core GRADE system can cut through the noise.

Reading list:

1. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden

2. Why Core GRADE is needed: introduction to a new series in The BMJ

Helen MacDonald and Juan Franco are back, magnifying glasses in hand, to take a closer look at what’s happening in evidence based medicine.

In this episode: the NHS increasingly relies on physician associates to plug some of its leaks. But, what do academic studies show about the effectiveness of these newest healthcare team members? Trish Greenhalgh is professor of primary healthcare at the University of Oxford, and she tells us about her meta-study reviewing the evidence.

Meanwhile, chronic back pain can be debilitating. When it’s at its worst, patients are eager for treatments. But, what is the true effectiveness of spinal injections to alleviate pain? Jane Ballantyne is a retired professor of pain medicine. She discusses where interventions go wrong, and how new recommendations for pain management reflect the best evidence.

Finally, Helen and Juan face uncertainty. A new research methods and reporting paper published in the BMJ takes a critical look at clinical prediction models. What does the evidence tell clinicians about how to behave when outcomes can’t be exact?

Reading list:

Helen Macdonald and Juan Franco are back, delving into some new evidence.

Studies showing that bi-annual injection that could prevent HIV transmission sound incredible, but will the implementation research find that the tried and tested pill regime is better? Jen Manne-Goehler, Assistant Professor of Medicine at Brigham and Women's Hospital, explains all about Lenicaprovir .

And while silicon valley tells us the future is AI, how can we trust the tools they produce? FUTURE-AI is an acronym and a potential answer, Karim Lekadir, director of the University of Barcelona’s Artificial intelligence in medicine lab, join us to explain what FUTURE-AI means, and why its principles are important in both the design and evaluation of machine learning.

Reading list:

In this first episode of 2025, hosts Helen MacDonald and Juan Franco focus on hospitals - asking how useful UTI dipstick tests really are for acutely ill patients, and what are the effects of staff turnover on patient care in NHS hospitals?

01:11 The use of dipsticks for acutely ill UTI patients

07:48 Interview with UTI paper author

17:26 Turnover of doctors and nurses and the effects on patient care

18:41 Interview with staff turnover paper author

29:34 Helen and Juan’s thoughts on the staff turnover paper

Reading list:

 - Diagnostic accuracy of dipsticks for urinary tract infections in acutely hospitalised patients: a prospective population-based observational cohort study.

 - Nurse and doctor turnover and patient outcomes in NHS acute trusts in England: retrospective longitudinal study.

Measuring the carbon impact of healthcare interventions is essential if we're going to make the sector sustainable, however tracing all of the emmission from even a simple treatment can be tricky. Romi Haas, a research fellow at Monash Department of Clinical Epidemiology joins us to explain how it works, and how research could be more efficient.

New U.S. guideline on breast cancer screening  have been extended to women in their 40s -  Katy Bell, from the University of Sydney, and Stacy Carter, from the University of Wollongong explain why the good intention of that change wont be mirrored in outcomes - and may even induce harm.

Reading list:

Clinician and health service interventions to reduce the greenhouse gas emissions generated by healthcare: a systematic review 

Breast cancer screening from age 40 in the US

It's a therapeutics evidence feast this month.

We start with deprescribing in older adults - Anna Hung, assistant professor at the Duke University School of Medicine has written a summary of the evidence, and we discuss why there are so few trials on an important topic.

Metformin is typically first line for type II diabetes, but what should be next? A new cohort study emulating a comparative effectiveness trial has been published, and the team discuss using observational data for this very common problem.

Finally, a new trial on nirmaltrevir for covid 19 in those at higher risk of severe disease or those who are unvaccinated.

Links

BMJ - Deprescribing in older adults with polypharmacy

BMJ - Comparative effectiveness of second line oral antidiabetic treatments among people with type 2 diabetes mellitus: emulation of a target trial using routinely collected health data

NEJM - Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19

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: 00:03:15

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