The effects of wearables in depression
It’s probably not cool to admit to having a favourite fallacy, but mine is the McNamara fallacy. This is where we fall into the trap of measuring whatever can be easily measured, to disregard anything that can’t easily be measured, and to presume that what can’t be measured easily isn’t important (https://en.wikipedia.org/wiki/McNamara_fallacy). It comes to mind when reading a review of wearable technology in clinical practice for depressive disorder, which starts with an ominous vision of the future of the consultation. At the start of the consultation, a patient tells their psychiatrist that they’re feeling “much better,” have been “much more active and social,” and are “sleeping great.” The doctor then shows the patient data from their wearable device revealing that their sleep has actually been very disrupted and offers to talk more about how they can improve their sleep. The consultation becomes about the thing you can measure, not the things that you cannot.
The article describes how there are no randomised controlled trials to confirm that access to data from wearables leads to improved care or outcomes, but argues that wearables can augment the information we get by talking to patients to help reduce inaccuracies from recall bias—like forgetting that your only good night’s sleep lately was last night. As well as recording sleep, wearables can track movement, heart rate, phone use, location, and payments—and researchers are devising sophisticated ways to analyse all this raw data to assist diagnosis and progress. But whether these will turn out to be as important to people with depression as the things we can’t measure remains to be seen.
N Engl J Med doi:10.1056/NEJMra2215898
Downstream effects of lung cancer screening
NHS England’s targeted lung cancer screening programme is being rolled out, with a target of 100% national coverage by 2025. The landmark trial in this area is the 2011 US National Lung Screening Trial (NLST), which found a reduction in all-cause mortality in high risk people allocated to screening with low dose computed tomography versus controls. A new retrospective cohort study has looked at the rates of downstream complications in people screened for lung cancer. It found that major complications occurred in 20.6% of those who had a positive screening scan and went on to have invasive tests, compared with just 9.4% in the NLST study. Complications occurred mainly in those who turned out to have lung cancer (and stand to benefit from earlier diagnosis), but the study reminds us of the need to monitor the balance between risks and benefits of lung cancer screening.
Ann Intern Med doi:10.7326/M23-0653
Thiazides and hyponatraemia
We’re used to thinking of hyponatraemia when reviewing thiazide diuretics, but how common is it? Hyponatraemia (defined as sodium levels <130 mmol/L) occurred within two years in 3.83% of those prescribed bendroflumethiazide in a retrospective cohort study set in Denmark. That’s 1.35% higher than in a matched group of people prescribed a calcium channel blocker. Results were similar when comparing hydrochlorothiazide plus a renin-angiotensin system inhibitor with a renin-angiotensin system inhibitor alone.
Ann Intern Med doi:10.7326/M23-1989
The weight is over for tirzepatide
The dramatic weight loss seen with tirzepatide (a glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) agonist) doesn’t last once treatment is stopped, according to a new study. The trial randomised 670 adults with obesity who had been taking tirzepatide for 36 weeks (losing an average of 20.9 kg from a baseline of 107.3 kg) to either continue the weekly injections or have a placebo for a further 52 weeks. Those in the placebo arm gained weight by an average of 14.0%, and those who continued taking tirzepatide lost on average a further 5.5%. It’s worth noting that the study author group included six employees of Eli Lilly, which manufactures tirzepatide, and another employee acknowledged for writing and editorial assistance. Hopefully, more independent research is also under way to see if these findings are reproduced.
JAMA doi:10.1001/jama.2023.24945
Motivation for dry January
For those looking for an incentive to stick to dry January, here’s a study from the International Agency for Research on Cancer (IARC), which last year convened a group of 15 scientists to take a look at the evidence of the link between alcohol consumption and cancer and see what we know—and don’t know. Alcohol is classified as a group 1 carcinogen on the basis of evidence of a causal link between it and seven different cancers, and each year over 700 000 cancers occur that are attributable to alcohol. The IARC’s report concludes that “alcohol reduction or cessation decreases the risk of oral cancer and esophageal cancer,” but a lot of gaps in knowledge remain, including how long you need to stop taking alcohol to see a reduction in risk (perhaps there’s still hope for dry January folk), the effect of reduced consumption, and how different patterns of consumption over a lifetime of drinking affect risk.
N Engl J Med doi:10.1056/NEJMsr2306723