Orphan drugs, allopurinol and CVD, mavacamten for obstructive hypertrophic cardiomyopathy

In this podcast accompanying the October issue of DTB (https://dtb.bmj.com/content/63/10) David Phizackerley (DTB Editor) is joined by Julian Treadwell (DTB Associate Editor). David and Julian discuss the editorial that highlights a few of the challenges associated with the introduction of an orphan medicine into clinical practice (https://dtb.bmj.com/content/63/10/146). They talk about a DTB Select article that summarises a randomised clinical trial that assessed the effect of allopurinol on cardiovascular outcomes in people with ischaemic heart disease who did not have gout (https://dtb.bmj.com/content/63/10/147). They finish by discussing the main article that provides an overview of the evidence for mavacamten (▼Camzyos) for the treatment of symptomatic obstructive hypertrophic cardiomyopathy in adults (https://dtb.bmj.com/content/63/10/150).   Links GP Evidence: https://gpevidence.org/ Preventing Overdiagnosis 2025 International Conference: https://www.cebm.ox.ac.uk/preventing-overdiagnosis   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 [email protected]. Thank you for listening.

In this podcast accompanying the September issue of DTB (https://dtb.bmj.com/content/63/9), David Phizackerley (DTB Editor) is joined by Syba Sunny (DTB Clinical Editor). David and Syba discuss the editorial that highlights changes to antibiotic susceptibility reports, and in particular, the change to the 'I' classification from 'intermediate' to 'susceptible, increased exposure’ (https://dtb.bmj.com/content/63/9/130). They talk about a DTB Select article that summarises an evidence review of deprescribing interventions in primary care and the importance of collaborative multidisciplinary teams, education and training, and shared-decision making (https://dtb.bmj.com/content/63/9/131). They finish by discussing the main article that provides an overview of pharmacological management of chronic heart failure with reduced ejection fraction and the four main groups of drugs that form the four pillars of treatment (https://dtb.bmj.com/content/63/9/133).   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 [email protected]. Thank you for listening.

In this podcast accompanying the August issue of DTB (https://dtb.bmj.com/content/63/8), David Phizackerley (DTB Editor) is joined by James Cave (former DTB Editor-in-Chief). David and James discuss an editorial generated by artificial intelligence (AI) (https://dtb.bmj.com/content/63/8/114) which looks at the role of AI in publishing. They talk about a DTB Forum article (https://dtb.bmj.com/content/63/8/115) that explores some of the practical problems of implementing drug safety alerts.  A DTB Select article (https://dtb.bmj.com/content/63/8/117) provides an overview of a double-blind, randomised, placebo-controlled trial of tirzepatide for weight reduction in people without diabetes. They finish by reviewing the main article (https://dtb.bmj.com/content/63/8/118) that provides an overview of the evidence for lecanemab for the treatment of mild cognitive impairment and mild dementia due to Alzheimer’s disease.   Link BMJ policy on AI use: https://www.bmj.com/content/ai-use    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 [email protected]. Thank you for listening.

In this podcast accompanying the July issue of DTB  (https://dtb.bmj.com/content/63/7), David Phizackerley (DTB Editor) is joined by Syba Sunny (Clinical Editor). David and Syba discuss the editorial (https://dtb.bmj.com/content/63/7/98) which focuses on some key changes in the new national asthma guideline and the implications for patients and healthcare professionals. A DTB Select article (https://dtb.bmj.com/content/63/7/99) provides an overview of a double-blind randomised placebo-controlled trial that assessed whether bisoprolol reduced the number of exacerbations in people with COPD. The main article (https://dtb.bmj.com/content/63/7/103) is an overview of abaloparatide, which is licensed for the treatment of osteoporosis in postmenopausal women at increased risk of fracture.   The podcast begins with a discussion about ideas for new articles for DTB and the therapeutic areas currently under consideration. If you have a suggestion for an article that you would like DTB to cover, please email details to [email protected].   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 [email protected]. Thank you for listening.

In this podcast accompanying the June issue of DTB, David Phizackerley (DTB Editor) is joined by Julian Treadwell (DTB Associate Editor) and Laurence Leaver (GP). David and Julian start by discussing the editorial - https://dtb.bmj.com/content/63/6/82 - which highlights some of the challenges in preventing VTE in early pregnancy. They also talk about a cohort study - https://dtb.bmj.com/content/63/6/84 - that assessed whether gabapentinoid use was associated with severe exacerbations among patients aged >55 years with chronic obstructive pulmonary disease (COPD). In the second half of the podcast, Julian talks to Laurence about two articles - https://dtb.bmj.com/content/63/5/74 and https://dtb.bmj.com/content/63/6/85 - he wrote on managing ADHD in adults.   Their discussion includes issues relating to diagnosis, effectiveness of medication, starting and titrating medication and some of the common adverse effects associated with medication. Both articles are currently free to access on the DTB website.   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 [email protected]. Thank you for listening.

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 [email protected]. Thank you for listening.

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 [email protected]. Thank you for listening.

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 [email protected]. Thank you for listening.

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 [email protected]. Thank you for listening.

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