DTB Podcast

The polypill revisited, cytisinicline for vaping cessation and a new co-host

In this podcast accompanying the May issue (https://dtb.bmj.com/content/63/5) of DTB, David Phizackerley (DTB Editor) welcomes Syba Sunny (DTB Clinical Editor) to the podcast. Syba provides an overview of her role with DTB, discusses her previous work as a Consultant Microbiologist and talks about areas of interest for future DTB articles.  The editorial (https://dtb.bmj.com/content/63/5/66) discusses a paper in The BMJ which proposed offering a polypill containing rosuvastatin, hydrochlorothiazide, amlodipine and losartan to all people in the UK over the age of 50 years to reduce the risk of heart attacks and strokes.
A DTB Select item (https://dtb.bmj.com/content/63/5/68) summarises the results of  a small study that assessed whether cytisinicline (cytisine) plus behavioural support was more effective than behavioural support alone for vaping cessation. The main article (https://dtb.bmj.com/content/63/5/74) is the first of two articles on the medical management of ADHD and there will be a longer discussion and an interview with the author in the June podcast.
 
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

Misuse of female empowerment to sell tests and treatments, triptan safety, use of ACEI or AIIRA in CKD

In this podcast recorded in early March, David Phizackerley (DTB Editor-in-Chief) and James Cave (DTB Editor-in-Chief Emeritus) provide an overview of the April 2025 issue of DTB. The editorial discusses concerns over the use of feminist empowerment messages to sell tests and treatments - https://dtb.bmj.com/content/63/4/50. A DTB Select item summarises the results of an observational study that assessed the association between initiation of a triptan and the risk of myocardial infarction or stroke - https://dtb.bmj.com/content/63/4/51. The main article provides an overview of initiating angiotensin-converting enzyme inhibitors or angiotensin-II receptor antagonists in adults with CKD, highlighting current guideline recommendations and providing a practical approach to dealing with the challenges associated with their use - https://dtb.bmj.com/content/63/4/54.
 
Links
Health Innovation Network: https://thehealthinnovationnetwork.co.uk/news/launch-of-new-game-changing-guide-to-tackle-overprescribing-and-support-governments-shifts-to-prevention-and-community/ 
 
Tackling overprescribing report: https://thehealthinnovationnetwork.co.uk//wp-content/uploads/2025/02/Health-Innovation-Network-Polypharmacy-Guide-Feb-2025.pdf 
 
GP Evidence: (https://gpevidence.org/)
 
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

Paying the price, liver problems with fezolinetant, systemic anticancer treatments

In this podcast recorded in early February, David Phizackerley and Julian Treadwell (DTB Associate Editor) provide an overview of the March 2025 issue of DTB. Julian talks about his work as an academic GP based at Bristol University. He explains why and how he developed the GP Evidence website (https://gpevidence.org/) as a resource for health professionals to use as part of a shared decision making process, and talks about the importance of providing patients with information on the absolute benefits and harms of different treatment options for long-term conditions.
 
The editorial discusses a paper published in The Lancet on the population-health impact of new drugs recommended by NICE and highlights the tension between NICE's role in ensuring that treatments are a cost-effective use of taxpayers’ money and its role in championing the for-profit life-sciences - https://dtb.bmj.com/content/63/3/34. A DTB Select item summarises safety alerts issued by the US Food and Drug Administration and the European Medicines Agency on liver problems associated with fezolinetant (▼Veoza), a drug licensed for the treatment of moderate-to-severe
vasomotor symptoms associated with the menopause - https://dtb.bmj.com/content/63/3/36. The main article provides an overview of systemic anticancer treatments and conventional cytotoxic drugs - https://dtb.bmj.com/content/63/3/37.
 
Links
GP Evidence (https://gpevidence.org/)
 
Naci H, Murphy P, Woods B, et al. Population-health impact of new drugs recommended by the National Institute for Health and Care Excellence in England during 2000–20: a retrospective analysis. The Lancet 2025;405:50–60. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02352-3/fulltext) 
 
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

Prioritising shared decision making, remission from type 2 diabetes, gefapixant for cough

In this podcast recorded in early January, David Phizackerley provides a brief overview of the February 2025 issue of DTB. The editorial discusses the importance of shared decision making and calls on guideline developers to produce patient decision aids to accompany their guidance - https://dtb.bmj.com/content/63/2/18. A DTB Select item summarises a study that evaluated implementation of NHS England’s type 2
diabetes path to remission programme -  https://dtb.bmj.com/content/63/2/19. The authors of a DTB Commentary article review a UK primary care study which reported that treatment with antihypertensive medicines in older people with complex health needs was associated with an increased risk of
acute kidney injury (AKI) and a short-term increased risk of falls - https://dtb.bmj.com/content/63/2/20. The main article explores the evidence for gefapixant in the treatment of refractory or unexplained chronic cough in adults - https://dtb.bmj.com/content/63/2/22.
 
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

PILs: all harms and no benefits, Irish College of GPs end pharma funding, Ryeqo for fibroids

In this podcast recorded in early December, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the January 2025 issue of DTB. They provide an overview of the editorial that questions whether it is time for the medicine Patient Information Leaflet (PIL) to include information on the impact of a medicine on clinical outcomes - https://dtb.bmj.com/content/63/1/2. They talk about a recent announcement from the Irish College of GPs that it is phasing out sponsorship from pharmaceutical companies as evidence suggests that ‘engagement between pharmaceutical companies and prescribers is associated with inappropriately increased prescribing rates, lower prescribing quality and increased prescription costs’ - https://dtb.bmj.com/content/63/1/3. The main article provides an overview of Ryeqo (relugolix, estradiol and norethisterone acetate) for the treatment of moderate to severe symptoms of uterine fibroids - https://dtb.bmj.com/content/63/1/6. The podcast ends with a farewell to James, who is stepping down as Editor-in-Chief after more than 12 years. James reflects on his time as a doctor, GP and Editor of DTB.
 
Other links:
Is ASCOT all it's cracked up to be? https://www.bmj.com/content/331/7523/1023.1
Don't lose your head over ASCOT https://www.bmj.com/content/331/7523/1022.1

When it comes to drugs, sex matters; menopausal HT and dementia; daridorexant for sleep

In this podcast recorded in early November, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the December issue of DTB. They provide an overview of the editorial that discusses the need to record the sex and gender of all participants in clinical trials and the importance of recognising diversity and inclusivity in clinical research - https://dtb.bmj.com/content/62/12/178. They talk about a commentary article that addresses claims made in a systematic review that menopausal HT may support neurological function and reduce the risk of Alzeheimer's disease - https://dtb.bmj.com/content/62/12/179. The main article provides an overview of daridorexant for the management of chronic sleep - https://dtb.bmj.com/content/62/12/183.
They begin by providing an update on the NICE guidance for tirzepatide and highlighting the publication of a toolkit for repeat prescribing in general practice.
 
Other related links
NICE guidance on tirzepatide: https://www.nice.org.uk/guidance/gid-ta11156/documents/html-content-10
Repeat prescribing toolkit: https://www.rpharms.com/resources/repeat-prescribing-toolkit

Supporting obesity treatment, major bleeds with anticoagulants and SSRIs, equity in COPD care

In this podcast recorded in early October, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the November issue of DTB. They provide an overview of the editorial that discusses the need to support people taking drugs to help with weight loss: "Providing the drug is only one part of the process and if the other elements are not available to support people with obesity the full benefits of these expensive treatments will not be realised" - https://dtb.bmj.com/content/62/11/162. They talk about the results of an observational study that assessed the risk of major bleeds with concomitant use of selective serotonin reuptake inhibitors (SSRIs) and oral anticoagulants -  https://dtb.bmj.com/content/62/11/164. The main article discusses equity of care in the management of COPD and that those more at risk of COPD are also more likely to
experience barriers to care - https://dtb.bmj.com/content/62/11/165. They begin by highlighting two articles* in the BMJ that consider the problem of conflicts of interest.
 
*Fabbri A, Grundy Q. Protecting early career physicians from commercial influence. BMJ. 2024 Sep 9;386:q1939.
(https://www.bmj.com/content/386/bmj.q1939)
McCartney M. Transparency as a means to conquer conflicts of interest is illusory. BMJ. 2024 Sep 24;386:q2092.
(https://www.bmj.com/content/386/bmj.q2092)
 
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

(Un)common sense in oncology, DOACs in device-detected AF, and hypertension in the elderly

In this podcast recorded in early September, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the October issue of DTB. They discuss the editorial that highlights the work of the Common Sense in Oncology movement and its aim "to counteract the trend towards irrational, industry-designed, profit-driven cancer drug development" - https://dtb.bmj.com/content/62/10/146. They talk about the results of a systematic review and meta-analysis of two randomised controlled trials that assessed the effect of treating people who have device-detected subclinical atrial fibrillation (AF) with a direct oral anticoagulant - https://dtb.bmj.com/content/62/10/147. The main article discusses the management of hypertension in older people - https://dtb.bmj.com/content/62/10/149. They begin by highlighting an article* that considers the challenges associated with the introduction of new drugs for the treatment of Alzheimer's disease.
*Walsh S, Merrick R, Milne R, et al. Considering challenges for the new Alzheimer's drugs: clinical, population, and health system perspectives. Alzheimers Dement. 2024. doi: 10.1002/alz.14108. [Epub ahead of print 4 Aug 2024].https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.14108
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

Medicines optimisation measures, warfarin-tramadol interaction and icosapent ethyl

In this podcast recorded in early August, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the September issue of DTB. They discuss the editorial (https://dtb.bmj.com/content/62/9/130) that highlights some of the challenges associated with NHS England's national medicines optimisation measures for Integrated Care Boards. They talk about the MHRA's recent safety alert on the risk of an interaction between tramadol and warfarin (https://dtb.bmj.com/content/62/9/131), which was prompted by a coroner's prevention of future deaths report (summarised in a DTB article in March https://dtb.bmj.com/content/62/3/36). The main article reviews the evidence for icosapent ethyl for cardiovascular risk reduction (https://dtb.bmj.com/content/62/9/135).
 
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

Psychotropic medicines in children, warfarin vs DOAC in old age, and fezolinetant in menopause

In this podcast recorded in early July, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) continue to ignore political and sporting events and talk about the August issue of DTB. They discuss the editorial that highlights the growth in the use of psychotropic medication in children and young people and some of the challenges associated with this trend. They talk about a study that assessed the harms of changing frail older people with AF from warfarin to a DOAC. The main article is an overview of the evidence for fezolinetant for the treatment of menopausal vasomotor symptoms.
 
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.