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The great swapthon: why the vouchers don't add up to much

Carl Heneghan
Last edited 3rd January 2011

The great swapthon

The BBC 'Great Swapathon' voucher bid to boost healthy living
A child eating a healthy lunch Families are being urged to swap the sugary snacks for strawberries or other healthy options

Families in England are to be offered £250m in vouchers in a bid to encourage them to eat healthily and exercise.

Apparently 4 million £50 voucher books will be on offer through the News of the World and Asda stores.

Health Secretary Andrew Lansley said: "It's a great example of how government, the media, industry and retailers can work together to help families to be healthy.

Is there any evidence-base for this?

Basically the money could go to 5 million familes if you give them £50. Therefore of the 16.5 million families in the UK about one in every three could get the money. see familes in Britain publication.

I filled in the questionnaire for me and my two kids, and this is the sort of advice I got

'Swap Fizzy drinks (and drinks with added sugars) for water, unsweetened juicds or milk',

'Swap fry up for grill-ups',

Swap creamy indian dishes for tomat-based sauces or grilled dishes

They then ask you to:

Tell us how it went?

Once you’ve tried your swap for a week, it’s time to share how it went. Your experiences and ideas are a valuable part of the Swapathon. Your shared tips help support everyone taking part, and encourage others on to make their own changes. See what our Swapathon community are saying.

The website annoying, it is slow, and its pretty one dimensional and repetitive. If I tried this for a week I'd be swapping my computer. In fact save your breath and swap this site for some exercise instead.

Are we surprized or do they think the public is stupid. Food policy experts have previously questioned the wisdom of allowing big brands to become involved in telling the public how to eat more healthily.

I say give the money to schools, they could do something useful with £250 million. I'll let you know when the adverts start to my email address

Highlights of the year in Evidence-Based Medicine

Carl Heneghan
Last edited 1st January 2011

The 1st of January saw the year start with a retweet from @david_colquhoun on a scary story on Big Pharma and US healthcare. We learnt authors of BMJ articles are reluctant to respond to criticisms. Reluctant in medical speak, to cebmblog, translates in to ‘can’t be bothered’. A linked editorial highlighted ‘that all aspects of post-publication review are wanting in medical research.’ Whislt the peer review process continued to create fuss, and may finally be broken.

Shriger and Altman in a linked editorial state ‘the majority of research articles receive no critique, and, for the minority that do, authors often do not reply or reply but do not respond to the criticism.’ Will we see more criticism in 2011, probably not.

In May, Isabelle Boutron, highlighted in JAMA the reporting and interpretation of randomized controlled trials with statistically nonsignificant results for primary outcomes. Guess what? Previous studies indicate the interpretation of trial results can be distorted by authors of published reports. Spin was identified in the conclusions sections for 58% of reports. Hold your hand up if you are guilty.

In terms of what drives health costs? You are twice as likely to have an x-ray, ultrasound or imaging after seeing a self-employed urologist as opposed to a salaried urologist Staying on the diagnostic theme, we learnt we should not be pooling diagnostic likelihood ratios in systematic reviews.

Small studies gave us the wrong answers, and Docs suggested women were hitting the pause button on osteoporosis drugs, which sounded very much like the HRT story.

On the drug front, we managed to give out 300,000 prescriptions for sibutramine in the UK in the last yr. Put me in charge of the drug budget, I’ll show you some cuts. Yet, nearly 1 in 10 prescribed meds were not taken by hospital inpatients. Hard to know what is the point of being in hospital but one of the major reasons was drugs were not available.

A pretty sobering statistic from 2010 is one-third of world's population is without access to surgical services

In contrast, a 10-year stroke prevention study after successful carotid endarterectomy had no surrogate, no early stopping, proper research for a change. But, bad news in that adherence statistics showed ¼ of stroke patients stopped taking their meds within 3 months and useful stroke studies remained unpublished: 1 in 5 studies were not published.

Jamie Oliver waded into the health debate @jamie_oliver: "not a day goes by I dont see a patient who could stop one med if they ate healthier." He needs to get out more, as he doesn’t see enough patients. Although his TED Prize wish: Teach every child about food was a great watch for Easter.

However, good news arrived by Xmas, despite all the snow, the FDA was aiming to keep us safe from harmful diet supplements which contain deceptively labeled ingredients, whilst the media was easily fooled by the Xmas BMJ edition. The BBC, at times, continued to produce shocking maths –why most research findings are false and, highlights for cebmblog were the prostate 'magic drug', the case of the changing headline

It’s a good job NHS choices continued to make sense of the news in 2010 : Put your feet up to slim down?

Oh, and Docs continue to be outed @ProPublicafor being paid by pharma despite government sanctions. However, they take fewer freebies, but disclosure is poor: really, 71% still accept gifts.

In addition, we learnt a bit more about ghost writers from @bengoldacre: Worst of all is the complicity of the academics And we became aware we had to be careful what you tweet ; when Bad Science clashed with Gillian McKeith.

Whilst the biggest problem may be consumer organizations: in 2010 2/3rds working with European Medicines Agency (the drug regulators) received partial or significant funding. Or is it Drug company study results are the major problem: drug company studies 85% positive, Government 50% positive. Must do more drug trials, if I want to get ahead. Or should I join the WHO: WHO admits to "inconsistencies" in its policy on conflicts of interest, whillt the BMJ editor pulled no punches WHO leadership may need to resign.

Finally the biggest change of the year saw the Avandia saga come to an end, well nearly, and four years to late. The recorded meeting between GSK and Dr Nissen in 2007 was published due to a subpoena, whilst Panorama ran the Avandia story asking why a million prescriptions were still issued in the UK.

And, after 16 yrs cebmblog thought he knew everything on calculating NNTs. Read this neat piece by Smeeth, I don't. Still more EBM to learn then for 2011, and my final thought for 2010 is: you better watch out, you better not lie. Here’s the reason I’m telling you why

Cheers cebmblog

Why Kings shouldn’t mess with clinical trials

Carl Heneghan
Last edited 14th September 2012

The best teaching scenarios often come from other teachers or their presentations. The King Gustav example and why Kings shouldn’t mess with clinical trials is a great example of this. I pinched this off, C. Wanner I have no idea who he is, but thanks, I’m using it again in the morning as an opener and thought I’d share it with a wider audience.

An early Clinical Trial
In the late 18th century, King Gustav III of Sweden decided that coffee was poison and ordered a clinical trial.
J Int Med, October 1991:289, Reprinted in Ann Intern Med 1992;117:30

Study design
- The king condemned a convicted
murderer to drink coffee every day.
- Control: another murderer was
condemned to drink tea daily.
- Outcome: death.
- Two physicians were appointed to
determine the outcome.

Results
- The two doctors died first.
- The king was murdered.
- Both convicts enjoyed long life until the
tea drinker died at age 83 (no age was given for the coffee drinker).

Discussion
One should not rely on such a small sample size. Perhaps the end point was too harsh.
The outcome of the trial had no effect on the decision makers. Coffee was forbidden in Sweden in 1794 and again in 1822.

Conclusions
None possible.
External events and other biases may have confounded the result.
Kings should not mess with clinical trials.

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