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10 Sep, 10 tweets, 7 min read
@RaoMala @GraceOkoli and I write in @JHHypertension: nature.com/articles/s4137…

🧵 THREAD on why we need to seriously re-consider race in the @NICEComms hypertension guidance: Image
1️⃣ There is a small difference in ACE inhibitor blood pressure response between Afro-Caribbean and White people.

bmcnephrol.biomedcentral.com/articles/10.11…

bmj.com/content/371/bm… Image
2️⃣ Stereotyping all Afro-Caribbean people as being low renin responders is not based in science:

nature.com/articles/10011… Image
3️⃣ No one can tell if they do/not have Afro-Caribbean ancestry, so who decides if they should have a treatment over the other?

academic.oup.com/genetics/artic…

cell.com/ajhg/fulltext/…

onlinelibrary.wiley.com/doi/10.1111/14… Image
4️⃣ Why is race important at the beginning of the guidance but not after initial treatment ineffective?

pathways.nice.org.uk/pathways/hyper… Image
5️⃣ Race is not important in use other guidance with the use of ACE inhibitors in other guidance, e.g. heart failure

nice.org.uk/guidance/ng106

nice.org.uk/guidance/qs99
6️⃣ Some say ACE inhibitor associated angioedema is much higher in Afro-Caribbeans. Is it? A 2006 meta-analysis with mostly US data found the rate was 0.43% compared to 0.18% for White people. Is it relevant esp later in the guidance?

bmj.com/content/332/75… Image
7️⃣ Some say that ACE inhibitor/ARB are associated with an increased stroke risk from a 2018 meta-analysis with mostly US data, without including trials that measured relevant confounders such as discrimination or poverty.

onlinelibrary.wiley.com/doi/epdf/10.11… ImageImage
It's not about moral or some anti-racist virtue signal.

It's about questioning the science behind race and whether it serves our patients well.

@NICEComms - does it?

\\ ENDS //
@NICEComms @threadreaderapp unroll please, thank you 🙏🏽

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More from @DipeshGopal

Dipesh Gopal Profile picture
30 Aug
Going through @dylanwiliam's plenary and pulling out the nuggets!

1⃣ There are no perfect solutions to anything. There are trade-offs. You need to decide which trade-offs you are willing to accept from new/old solutions. (Chesterton's fence)

#AMEE2021 #FOAMed
2⃣ Time spent on one thing means you miss out time on another thing.

Which things are worthy of inclusion and exclusion in the curriculum?

#AMEE2021
3⃣ Teaching is a wicked learning environment. Where students learn things is NOT where they apply them.

This makes working out what is effective teaching, a nightmare!

From Hogarth et al, 2015: journals.sagepub.com/doi/abs/10.117…

#AMEE2021
Read 21 tweets
Dipesh Gopal Profile picture
30 Aug
Excited to be at @AMEE_Online at this workshop on teaching students during remote consultations @RoaaUK @Dr_UmarChaudhry

#AMEE2021
Interesting discussion about what students felt about remote consultations: @AcademicGP

ethics of consenting patients
usefulness for OSCEs
higher clinical risk so less exposure to them
⬆️ growth of verbal cues
⬇️ growth of gut feeling

#AMEE2021
Unsurprisingly @trishgreenhalgh @ejosipcar @bmj_latest paper about remote consultations in primary care was mentioned: bmj.com/content/368/bm…

#AMEE2021
Read 9 tweets
Dipesh Gopal Profile picture
25 Jul
I read all 288 pages @food_strategy, and this is what I learnt

🧵 THREAD

1/
TL;DR - our food system needs multi-level intervention to improve our health, healthcare systems, biodiversity and climate emergency

14 recommendations and the govt has 6 mths to respond.
2/
Deforestation, climate change and overfishing is all linked...to food production.

Food production contributes to 33% and 20% of UK of global greenhouse gas emissions.

(air travel = 3.5% global emissions)

There is a huge biomass of farm animals for food production.
3/
Diet has huge implications for human health.

In 1980, on average, 57% of a household’s grocery budget was spent on ingredients for home-cooked food.

By 2000, this had fallen to 35%, while the share of processed foods which required little preparation rose from 26% to 45%.
Read 17 tweets
Dipesh Gopal Profile picture
21 Jul
🧵 THREAD on @TheBMA report on medical staffing in England which did not get much airtime last week:

bma.org.uk/advice-and-sup…

Whilst the numbers are increasing, we just don't have enough doctors, esp GPs. #NHS #medtwitter

Here's the evidence:

@sbattrawden
@ShaunLintern
2/
We have some the lowest number of doctors per population in Europe. Image
3/
Whilst the number of hospital doctors is rising, the numbers of GPs has not despite record numbers of new trainees.

With more and more work being diverted to primary care without resourcing and funding, can we be surprised? Image
Read 18 tweets
Dipesh Gopal Profile picture
2 May
1/
🧵 THREAD on critiquing lifestyle medicine from

article from @dnunan79 @dnblane @mgtmccartney just published in @BJGPjournal: bjgp.org/content/71/706…
2/
🗣️ "... we focus on the unintended consequences of uncritical endorsement and application of lifestyle medicine including the infiltration of pseudoscience, profiteering, and the potential for widening health inequalities by a continued focus on the ‘individual’."
3/
🗣️ "We have two main concerns here:

1⃣ the opportunity taken by some to link alternative medicine practices to lifestyle medicine

2⃣ the association of some ‘lifestyle medicine practitioners’ with commercial opportunities" Image
Read 11 tweets
Dipesh Gopal Profile picture
21 Mar
🧵 THREAD on BIAS in MEDICINE #MedTwitter #FOAMed

1a/

BIAS:

➡️ is integral to how we see people/make diagnoses: can't be removed

➡️ affects research questions that get asked, who gets funded, what gets published and in which journal

@FutureHealthJ: rcpjournals.org/content/future…
1b/

Bias training:

➡️ increases bias awareness

➡️ doesn't decrease biases (no evidence base)

➡️ bias training ignores communication, provides no debiasing interventions, doesn't measure motivation

➡️ doesn't address structural problems

Read: ncbi.nlm.nih.gov/pmc/articles/P…
2/
Shoutout to the amazing team:

@UlaChetty

@patrickod9

@returnofcam

@jodieblackadder

And Prof @damienridge who shaped the manuscript.

Hundreds of papers, hours of lectures/books, many drafts to get here.

Thank you 🙏🏽
Read 26 tweets

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