{"id":1797,"date":"2018-08-31T08:23:09","date_gmt":"2018-08-31T08:23:09","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=1797"},"modified":"2018-09-12T14:37:23","modified_gmt":"2018-09-12T14:37:23","slug":"bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/","title":{"rendered":"Bronchial Thermoplasty – evidence does not back up NICE approval"},"content":{"rendered":"

 <\/p>\n

We\u2019ve been here before with devices, the studies are small, biased, there is lots of uncertainty about who, if anyone, benefits from this treatment and the adverse events including admissions are higher.<\/em><\/p>\n

Carl Heneghan<\/p>\n

\n

\"\"Bronchial Thermoplasty is all over the news today: The BBC reports<\/a><\/u> that the New asthma treatment is set for wider NHS distribution:<\/p>\n

\u201cThe procedure, bronchial thermoplasty, “melts” away excess muscle tissue in the lungs using radio frequency, making breathing easier. Previously there were strict criteria about who was eligible to receive it. But the National Institute for Health and Care Excellence (Nice)<\/a><\/u><\/strong> says it can be offered more routinely, after it was proved to be safe and effective.\u201d\u00a0\u00a0<\/em>Source BBC<\/a><\/u><\/em><\/p>\n

The NICE consultation document is here<\/a><\/u>. It sets out that the current evidence on the safety and efficacy of bronchial thermoplasty for severe asthma is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.<\/p>\n

NICE\u2019s <\/a><\/u>evidence summary is where this approval gets concerning.<\/p>\n

It is based on an AHRQ\u2019s systematic review of the Effectiveness and Safety of Bronchial Thermoplasty in Management of Asthma.\u00a0 <\/a><\/u>The evidence is limited,\u00a0 the adverse events are concerning and it turns out the treatment is no better than a sham.\u00a0 The systematic review<\/a><\/u> found fifteen studies, but only three of these were randomised trials including 432 participants.<\/p>\n

The Asthma Quality of Life Questionnaire (AQLQ) showed a small difference in patients who had bronchial thermoplasty (mean difference 0.28, 95% confidence interval 0.07 to 0.5). \u00a0A change in score of 0.5<\/a><\/u> on the 7-point scale is the smallest change that can be considered clinically important and would justify a change in the patient\u2019s treatment.\u00a0 There was also no difference in hospital admissions and reduction in steroids across the three trials.<\/p>\n

Admission to hospital during the treatment period, however, was higher in thermoplasty patients (RR 3.5, 95% CI 1.26 to 9.68), along with respiratory adverse events: thermoplasty\u00a0 (407 events) compared with SMC or sham (106 events).<\/p>\n

In the one trial that used a sham procedure asthma control, hospitalizations for respiratory symptoms, use of rescue medications, pulmonary physiology measures, or AQLQ scores showed no improvement. So while the quality of life measures show a small statistic difference in two nonblinded studies, these measures did not improve in the sham-controlled study.<\/p>\n

We\u2019ve been here before with devices, the studies are small and biased; there is lots of uncertainty about who, if anyone, benefits from this treatment and the adverse events including admissions are higher in the treated group. Approval of devices based on a very low bar of evidence often adds costs, leads to patients harms and waste scarce healthcare resources – be warned.<\/p>\n

\n

References<\/p>\n

Effectiveness and Safety of Bronchial Thermoplasty in Management of Asthma [Internet].\u00a0<\/a>D\u2019Anci KE, et al.\u00a0 Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Dec.<\/p>\n

\n

\u00a0<\/em>BMJ\u00a0Evidence-Based Medicine<\/a>\u00a0\u2013\u00a0original evidence-based research, insights and opinion<\/p>\n

Read more in the\u00a0Welcome to BMJ Evidence-Based Medicine Editorial<\/a>.<\/p>\n

\"\"<\/p>\n

\n

Competing interests<\/b><\/p>\n

Carl has received expenses and fees for his media work including BBC Inside Health. He holds grant funding from the NIHR, the NIHR School of Primary Care Research, The NIHR Oxford BRC\u00a0 and the WHO. He has also received income from the publication of a series of toolkit books. CEBM jointly runs the\u00a0EvidenceLive<\/a>\u00a0Conference with the BMJ and the\u00a0Overdiagnosis Conference<\/a>\u00a0with some international partners which are based on a\u00a0 non-profit model.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

  We\u2019ve been here before with devices, the studies are small, biased, there is lots of uncertainty about who, if anyone, benefits from this treatment and the adverse events including admissions are higher. Carl Heneghan Bronchial Thermoplasty is all over the news today: The BBC reports that the New asthma treatment is set for wider […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":1798,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14374,14388],"tags":[],"class_list":["post-1797","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-carl-heneghan","category-evidence-watch"],"yoast_head":"\nBronchial Thermoplasty - evidence does not back up NICE approval - BMJ EBM Spotlight<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Bronchial Thermoplasty - evidence does not back up NICE approval - BMJ EBM Spotlight\" \/>\n<meta property=\"og:description\" content=\"  We\u2019ve been here before with devices, the studies are small, biased, there is lots of uncertainty about who, if anyone, benefits from this treatment and the adverse events including admissions are higher. Carl Heneghan Bronchial Thermoplasty is all over the news today: The BBC reports that the New asthma treatment is set for wider [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/\" \/>\n<meta property=\"og:site_name\" content=\"BMJ EBM Spotlight\" \/>\n<meta property=\"article:published_time\" content=\"2018-08-31T08:23:09+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2018-09-12T14:37:23+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/08\/asthma.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"612\" \/>\n\t<meta property=\"og:image:height\" content=\"397\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Bronchial Thermoplasty – evidence does not back up NICE approval\",\"datePublished\":\"2018-08-31T08:23:09+00:00\",\"dateModified\":\"2018-09-12T14:37:23+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/\"},\"wordCount\":575,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/files\\\/2018\\\/08\\\/asthma.jpg\",\"articleSection\":[\"Carl Heneghan\",\"Evidence Watch\"],\"inLanguage\":\"en-GB\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/\",\"name\":\"Bronchial Thermoplasty - evidence does not back up NICE approval - BMJ EBM Spotlight\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/files\\\/2018\\\/08\\\/asthma.jpg\",\"datePublished\":\"2018-08-31T08:23:09+00:00\",\"dateModified\":\"2018-09-12T14:37:23+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/files\\\/2018\\\/08\\\/asthma.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/files\\\/2018\\\/08\\\/asthma.jpg\",\"width\":612,\"height\":397},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/08\\\/31\\\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Bronchial Thermoplasty – evidence does not back up NICE approval\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/\",\"name\":\"BMJ EBM Spotlight\",\"description\":\"The new blog for the journal BMJ Evidence-Based Medicine, edited by Carl Heneghan\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-GB\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#organization\",\"name\":\"BMJ EBM Spotlight\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/files\\\/2017\\\/10\\\/admin-ajax.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/files\\\/2017\\\/10\\\/admin-ajax.png\",\"width\":300,\"height\":34,\"caption\":\"BMJ EBM Spotlight\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Bronchial Thermoplasty - evidence does not back up NICE approval - BMJ EBM Spotlight","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/","og_locale":"en_GB","og_type":"article","og_title":"Bronchial Thermoplasty - evidence does not back up NICE approval - BMJ EBM Spotlight","og_description":"  We\u2019ve been here before with devices, the studies are small, biased, there is lots of uncertainty about who, if anyone, benefits from this treatment and the adverse events including admissions are higher. Carl Heneghan Bronchial Thermoplasty is all over the news today: The BBC reports that the New asthma treatment is set for wider [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/","og_site_name":"BMJ EBM Spotlight","article_published_time":"2018-08-31T08:23:09+00:00","article_modified_time":"2018-09-12T14:37:23+00:00","og_image":[{"width":612,"height":397,"url":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/08\/asthma.jpg","type":"image\/jpeg"}],"author":"BMJ","twitter_card":"summary_large_image","twitter_misc":{"Written by":"BMJ","Estimated reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Bronchial Thermoplasty – evidence does not back up NICE approval","datePublished":"2018-08-31T08:23:09+00:00","dateModified":"2018-09-12T14:37:23+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/"},"wordCount":575,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/08\/asthma.jpg","articleSection":["Carl Heneghan","Evidence Watch"],"inLanguage":"en-GB"},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/","url":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/","name":"Bronchial Thermoplasty - evidence does not back up NICE approval - BMJ EBM Spotlight","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/08\/asthma.jpg","datePublished":"2018-08-31T08:23:09+00:00","dateModified":"2018-09-12T14:37:23+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/#breadcrumb"},"inLanguage":"en-GB","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/"]}]},{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/08\/asthma.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/08\/asthma.jpg","width":612,"height":397},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/31\/bronchial-thermoplasty-evidence-does-not-back-up-nice-approval-be-warned\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/"},{"@type":"ListItem","position":2,"name":"Bronchial Thermoplasty – evidence does not back up NICE approval"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/#website","url":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/","name":"BMJ EBM Spotlight","description":"The new blog for the journal BMJ Evidence-Based Medicine, edited by Carl Heneghan","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-GB"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/#organization","name":"BMJ EBM Spotlight","url":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/","logo":{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2017\/10\/admin-ajax.png","contentUrl":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2017\/10\/admin-ajax.png","width":300,"height":34,"caption":"BMJ EBM Spotlight"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1797","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=1797"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1797\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media\/1798"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=1797"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=1797"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=1797"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}