DTB Podcast

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.

Propranolol and its risk in overdose and managing COPD exacerbations

In this podcast recorded in early June, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) ignore the UK general election, the T20 cricket world cup and the European football championship and talk about the July 2024 issue of DTB. They discuss the editorial that highlights trial data showing that dupilumab had a modest effect on reducing COPD exacerbations, and question whether more drugs or greater investment in pulmonary rehabilitation and smoking cessation services are a better use of resources. They review a coroner's prevention of future deaths report that highlights the need to raise awareness of the dangers of propranolol overdose. The main article discusses the management of exacerbations of COPD in primary care.
 
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.
 

Diagnostic imaging and shielding, sinusitis, antibiotics and coloured snot, ritlecitinib

In this podcast recorded in early May, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the June 2024 issue of DTB. They discuss the editorial that highlights changes to the use of gonadal and fetal shielding for diagnostic imaging (see link). They review the results of a study that assessed the benefit of antibiotics for treating acute sinusitis in children aged 2-11 years.  The main article considers the evidence for ritlecitinib, a Janus kinase enzyme inhibitor that is licensed for the treatment of severe alopecia areata in adults and adolescents aged ≥12 years. They begin the podcast by discussing newspaper headlines generated by an international conference on obesity.
Link
https://www.bir.org.uk/education-and-events/patient-shielding-guidance.aspxPlease 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 (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). If you want to contact us please email dtb@bmj.com. Thank you for listening.

Medicines and global warming, donanemab for AD, and cytisine for smoking cessation

In this podcast recorded in early April, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the May 2024 issue of DTB. They discuss the editorial that highlights the effect medicines have on greenhouse gas emissions and the need to consider the environmental impact of all aspects of the patient care pathway​ (https://dtb.bmj.com/content/62/5/66). They review the results of a study that assessed the effect of donanemab on early symptomatic Alzheimer's disease​ (https://dtb.bmj.com/content/62/5/67). The main article considers the evidence for cytisine, a nicotine receptor partial agonist, that has recently been licensed to facilitate quitting smoking​ (https://dtb.bmj.com/content/62/5/71). They begin by highlighting some useful resources relating to the safe use of valproate.
 
Other links:
https://www.england.nhs.uk/patient-safety/sodium-valproate/ 
https://www.england.nhs.uk/publication/decision-support-tool-is-valproate-the-right-epilepsy-treatment-for-me/
https://www.gov.uk/government/collections/valproate-safety-measures
https://www.gov.uk/guidance/valproate-use-by-women-and-girls
 
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 (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). If you want to contact us please email dtb@bmj.com. Thank you for listening.
 

Drug safety alerts, valproate safety (again) and a new contraceptive POP

In this podcast recorded in early March, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the April 2024 issue of DTB. They discuss the editorial that questions whether drug safety alerts are effective in changing practice and whether more needs to be done to implement safety recommendations (https://dtb.bmj.com/content/62/4/50). They review the Medicines and Healthcare products Regulatory Agency's latest risk minimisation measures for using valproate, which include a guide for healthcare professionals, a guide for patients, an annual risk acknowledgement form and an information card for patients (https://dtb.bmj.com/content/62/4/53). The main article considers the evidence for a new progestogen only pill containing drospirenone (https://dtb.bmj.com/content/62/4/55). They begin by discussing recent concerns over neuropsychiatric reactions associated with montelukast.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 (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). If you want to contact us please email dtb@bmj.com. Thank you for listening.

Protecting consumers, tramadol-warfarin interaction and very low calorie diets

In this podcast recorded in early February, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the March 2024 issue of DTB. They discuss the editorial highlighting the important work that the founders of The Medical Letter, Worst Pills, Best Pills and Drug and Therapeutics Bulletin did to scrutinise the safety of medicines and the need to challenge the processes by which medicines are licensed, appraised, commissioned and promoted (https://dtb.bmj.com/content/62/3/34). They review a coroner's Prevention of Future Deaths report that highlighted an interaction between tramadol and warfarin (https://dtb.bmj.com/content/62/3/36). They also talk about a study that compared the emergency contraceptive efficacy of levonorgestrel plus piroxicam with levonorgestrel plus placebo (https://dtb.bmj.com/content/62/3/38). The main article considers the effectiveness of low or very low calorie diets in achieving remission of type 2 diabetes (https://dtb.bmj.com/content/62/3/39).
 
Link
Mathew R. Prescribing isn’t a single act—getting it right requires time and effort. BMJ 2024;384:q279 (https://www.bmj.com/content/384/bmj.q279)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 (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). If you want to contact us please email dtb@bmj.com. Thank you for listening.

ADHD medicines shortages, fluoroquinolone safety, drugs not to prescribe

In this podcast recorded in early January, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the February 2024 issue of DTB. They discuss the editorial that highlights problems associated with shortages of ADHD medicines.  They talk about two safety alerts issued by the Medicines and Healthcare products Regulatory Agency that focus on the adverse effects of fluoroquinolone antibiotics on physical and mental health.  The main article considers various NHS initiatives that have attempted to limit primary care prescribing of drugs that are deemed to have limited clinical value. They begin the podcast with sad news of the death of Dr Sidney Wolfe (1937-2024), a colleague and friend who co-founded the US Health Research Group and Public Citizen (a nonprofit consumer advocacy organisation) and who was "a towering public health leader and an unparalleled consumer champion". 
 
Links
Remembering Sid Wolfe: https://www.citizen.org/remembering-sidney-wolfe/
Mandatory disclosure of all pharmaceutical and medical device companies’ payments to healthcare providers: learning from the US: https://dtb.bmj.com/content/60/4/52
Worst Pills, Best Pills: https://www.citizen.org/topic/safe-affordable-drugs-devices/worst-pills-best-pills/
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 (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). If you want to contact us please email dtb@bmj.com. Thank you for listening.