GP sceptics podcast 7: EBM Hijacked!

 

pod7-by-kat-ritchie

by Kat Ritchie

 

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Just when you thought GP Sceptics put the E in evidence-based medicine, we pull the rug from underneath your trusting feet.

Western Australian GP Casey Parker, of Broome Docs fame, joins our twosome to become the ‘third nerd’ – a role which fits him like a cardigan and a new pair of glasses.

Casey delves into EBM’s dark recesses, where p-hackers subvert the concept of ‘significance’, and RCTs answer all the questions no one bothered asking.

Justin discusses a hot-off-the-press systematic review revealing the over-optimism of doctors.

And Liz? Liz invites us all aboard the EBM gravy train.

Bonus nerd points for any listener who comments below correctly describing when affect is a noun and effect is a verb.

This podcast is dedicated to the fond memory of the late Prof Gavin Mooney, editor of Evidence-based medicine in its place.

Thanks to Dr Kat Ritchie for her brilliant artwork.

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Does the weather affect our joints?

midsummer

Therefore the moon, the governess of floods,
Pale in her anger, washes all the air,
That rheumatic diseases do abound.

A Midsummer Night’s Dream

Long before Shakespeare, vagaries in the weather have been blamed for flare-ups of joint pain. The rheumatic curse seems to redouble on a cold, wet day…or is it a hot, dry one?

But a new study from The George Institute casts doubt that we can ever really “blame it on the weather”.

In every place I have ever worked, patients will swear their knee or back pain has eased since they moved to that town, crediting their temporary cure to the local conditions. Curiously, this remains true regardless of where I am working at the time, whether at the bottom or the top of Australia: from the windswept southern coast to the burning central deserts or humid tropics.

Are rainfall, humidity and temperature really affecting my patient’s joints, or is there a less exciting interpretation? Perhaps joint pain is a randomly relapsing condition, and we humans love attributing causation whenever two unrelated events roughly coincide.

Previously, researchers at the George Institute published a study where 345 Australians with confirmed knee osteoarthritis recorded their pain scores. No correlation whatsoever was found between pain flares and the local weather conditions (temperature, precipitation, humidity, barometric pressure).

This negative study, which countered such a long-held belief, not surprisingly copped plenty on social media. Contrarian anecdotes flew in faster than a cold southerly over Bass Strait.

So other researchers decided to see if they could replicate the findings in different circumstances. Continue reading

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GP Sceptics podcast 6: Obesity – Christmas edition

kat-red-santa

By Kat Ritchie

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Liz shines when discussing her pet PhD topic – managing obesity in general practice. Nicely timed for Christmas.

Which medications safely make us thinner, now amphetamines and tobacco have lost favour? And, if media images keep depicting Headless Fatties*, how can GPs raise the topic without adding to the stigma?

Justin reveals that one of Australia’s biggest GP education companies is boasting it can change our prescribing habits at will – for a hefty fee.

Build your own promotional campaign with Liz’s Magic Marketing, and discover the superpower Justin wishes he possessed but his family knows he doesn’t. gp_sceptics_small

*Not our term – the podcast and link below place this memorable idiom in context. We wouldn’t insult Santa.

References:

Effects on Weight Reduction and Safety of Short-Term Phentermine Administration in Korean Obese People Yonsei Medical Journal, 2006

Headless fatties by Charlotte Cooper, 2007

Treating obesity seriously: when recommendations for lifestyle change confront biological adaptations Lancet, 2015. [But note authors’ multiple conflicts of interest]

No Advertising Please campaign 2014

They wouldn’t do that, would they? The Medical Republic, 30 Nov 2016

World Obesity image bank Free usage for non-profit purposes

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Anne Deveson, who destigmatised schizophrenia

anne_deveson_2013

THE DEATH of Anne Deveson –writer, broadcaster and social justice advocate – marks the final chapter of a life that reflected the immense change in the way Australians have perceived mental health issues over the past century.

Deveson, who died from Alzheimer’s yesterday at age 86, recalled travelling home from London 40 years ago after her father referred to her mother’s bewildering mental decline in a letter. “Bea is bats,” wrote her father, unable to articulate the subtleties of what we now know was Alzheimer’s disease.

Upon Deveson’s return, her mother described the affliction more poetically: “Anne, I’ve been in a forest and I can’t find my way through.”

If Australians’ understanding of mental illness has altered dramatically since the Deveson family arrived from Malaya as refugees during World War II, their famous daughter could claim much responsibility. Continue reading

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Why ‘medicine for the rich’ is sometimes inevitable

stockmarket

The issue: Poor people can’t afford high-cost drugs privately

Player #1: The Australian PBS, which has just released this year’s list of top 10 pharmaceuticals by expense (see table below)

Player #2: The Social Medwork, a new company which imports high-end drugs, for a fee

My verdict: Sorry, that’s life. The public can’t afford to pay for everything.

THE DILEMMA posed by high-cost pharmaceuticals isn’t one likely to go away any time soon.

With hepatitis C treatments clocking up their first $1 billion in just four months, PBS budgeters must be sweating.

However, they would also be relieved that they didn’t cave in to the campaign – backed by the manufacturer but involving patient advocacy groups and some doctors – to approve the drugs earlier at an even higher cost, as happened in the US.

Coming second on the PBS expense list, at half a billion, are two macular degeneration drugs with their own cost controversies.

The manufacturer of ranibizumab (Lucentis) has been heavily criticised for purchasing the patent on its only competitor but not doing the head-to-head study that might have allowed approval for the cheaper drug. Back then, Lucentis cost 50 times the price of its competitor, and it remains the gift that keeps on giving, near the very top of this year’s PBS spending. Merry Christmas, shareholders.

At the top end of the market, where high-rollers spend public funds on the promise of clinical benefit, it is no surprise that a new player has entered the room. A Netherlands-based company has just created a new niche for those customers who can afford it. Continue reading

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GP Sceptics podcast 5: Lyme disease…don’t get sold a lemon

tick

Ten thousand miles away…Australia’s closest lyme-carrying tick

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To coincide with today’s Senate inquiry on how to catch Lyme Disease in Australia (short version – you can’t), Justin and Liz interview infectious disease expert Prof Frank Bowden, from Australian National University.

Frank swats aside a series of claims by Australian lyme disease proponents, but sounds stumped when Justin asks whether sentinel chickens or sentinel ticks are better at keeping watch.

The conversation takes a few twists, lurching from false positive US lab results to unrelated matters such as whether having sex before the game enhances or detracts from sports performance. You’ll have to listen to find out the answer.*

*Or you could always cheat and read the reference below  gp_sceptics_small

References:

Infectious: A doctor’s eye-opening insights into contagious diseases

Frank Bowden’s book, published 2016, including the chapter “Lyme is the new black”

Sexual Activity before Sports Competition: A Systematic Review

Frontiers in physiology June 2016

sentinel-chicken-neko-richiko

By Neko Richiko

 

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GP Sceptics podcast 4: Addiction

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Justin and Liz invite Dr Hester Wilson into the pod to chew on some baclofen; is it really the latest promising drug for alcohol addiction? A recent Australian Doctor article (requires login) thinks so.

Hester is a Sydney GP who specialises in drug and alcohol medicine. And she’s also a fine soprano: we don’t let her leave without singing a snippet of Cosi Fan Tutte.

Liz’s dilemma for ‘what would Justin do?’ channels one of these:wookie

 

…and Justin’s factoid concerns a mysterious case of smartphone blindness.

Liz applies the Mindspace framework for pharmaceutical marketing.

Neko Richiko, our unofficial calligrapher, sums up this podcast:

neko-richiko-learning-points

References:

“Bacloville” baclofen study  — Berlin slide presentation teaser prior to study publication. 2016

Transient Smartphone Blindness NEJM, June 2016

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Homeopathy: US mandates ‘No evidence’ labels

arnica-pills

Bottle claiming to contain one trillion trillion trillion trillion trillionth of this flower.

The US Federal Trade Commission (FTC) has just issued an enforcement policy statement requiring marketers of homeopathic products to ‘effectively communicate the lack of scientific evidence’ on product labels.

The move is being heralded as the first time that homeopathic products will legally require a label stating that they don’t work.

Numerous submissions to the FTC report cited the Australian 2015 comprehensive assessment of evidence by the NHMRC, which concluded there is no reliable evidence that homeopathy is effective for any health conditions.

Although the evidence overwhelmingly supports the new FTC policy, much of their report deals with legal issues, possibly pre-empting industry arguments that regulating advertising claims might be inconsistent with the US First Amendment around free speech.

The FTC policy does not constitute a new law, but it clarifies the minimum standards for homeopathic health claims, which until now have largely been left to self-regulation. Homeopathic products will now “be held to the same truth-in-advertising standards as other products claiming health benefits.”

But not all is rosy… Continue reading

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With Obamacare gone, how will Trumpcare affect US health?

trumpcare

The world is a less certain place than it was this time yesterday, and the health industry has not escaped waking up with that feeling of ‘what just happened?’

US President elect Donald Trump vowed through his campaign to ‘immediately repeal’ Obamacare, but it seems no one has any idea what Trumpcare will look like. The Affordable Care Act will be afforded no longer, and health analysts are scrambling to find much more than election sound bites to predict what might replace it.

To consult the modern oracles, one need never travel further than the stockmarket. As investors fled US-dollar exposed shares yesterday, health insurance stocks were caught in the maelstrom.

Repealing Obamacare entirely would leave 20 million without health insurance, and although few believe the Republicans will go so far, Trump is predictably unpredictable. That’s enough to spook health insurers and owners of private hospitals. Continue reading

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Mothers, don’t plan on early delivery unless it’s medically necessary.

1. pregnancy

Important new findings today suggest that planning to have your child born before 39 weeks’ gestation may be associated with worse brain developmental outcomes, once your child reaches school age.

 

SOMETIMES there is no choice in having to pre-book an early birth. If your pregnancy is high-risk or complicated by a particular medical condition, then planning an early delivery, by C-section or going to the hospital for induction, may be the safest option.

However, increasingly the delivery of babies is pre-planned without necessarily a pressing medical need. In fact, in Australia, planned births now account for around half of all deliveries at 37 and 38 weeks’ gestation. Today’s news it that your child may be more likely to have unforeseen complications down the track.

What is this new study?

A study published today in Paediatrics linked the birth records of 153,730 children born in NSW in 2002-7 with the child’s performance some years later, as graded by their teacher in the triennial Australian Early Development Census (AEDC).

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