Talk Evidence The BMJ

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