In episode 127, Mike and James attempt to answer questions about topical NSAIDs, bleeds on NSAIDs and SSRIs, Strep throat, statins in the UK, and NSAIDs and CVD risk. They smish and smash all the available data into partly coherent answers, yet give definitive and dogmatic answers with the conviction of a dog with a bone or a cardiologist with a statin.

Show notes

1) SSRIs and bleeds

Alimentary Pharmacology & Therapeutics 2008;27:31-40

Arch Intern Med 2003;163:59-64

2) Dipstick urinalysis

In women with dysuria, frequency, and no vaginal discharge the probability of UTI is 96%

JAMA 2002;287:2701-10

In episode 126, James and Mike discuss how to do a drugectomy and why one needs to consider evidence, efficacy, side effects, cost, patient preference and that as clinicians we need to do many “n of 1” trials. We then discuss the concerns around dabigatran and what to do about bleeding on this agent and why the FDA made the 150 mg dose the chosen one. We also provide commentary on how long we need to give antibiotics and if you really need to take them until they are “all gone”. At the end we advise listeners to only listen to the podcasts until they feel better and then stop before they get any side effects like annoyance or frustration.

Show notes

1) Dabigatran and the FDA – why 150 mg?

NEJM 2011;364:1788-90

In episode 125, Mike and James get back to the listener questions and discuss calcium, probiotics, and clopidogrel. By the end of the podcast Mike threatens to jump out of a 17 story building unless he gets a high fat meal with some caffeine. Out of respect for Mike’s surrogate markers James steals Mike’s Egg McMuffin and coffee and eats it himself. 

Show notes

1) Calcium and MI

BMJ 2011;342:d2040

2) Probiotics for acute infectious diarrhea

Cochrane review

2) Clopidogrel

N Engl J Med 2010;362:1374-82

N Engl J Med 2010;362:1441-3

Ann Pharmacother 2008;42:550-7

Arch Intern Med 2007;167:1593-9

N Engl J Med 2007;357:2001-15

3) Clopidogrel Guidelines

NHS 2007 Northwest London Cardiac Network:

Bare Metal: 1 month

Drug Eluting Stent: 12 month

American College of Chest Physicians (2008)

No stent: 12 months

Bare-metal: 12 months

DES: 12 months (or more with no contraindications)

Veterans Affairs (August 2009)

Bare Metal: 1 month minimum, up to 12 months

DES: 12 months – or longer duration if

No bleeding risk and “complex anatomy” 

Stent thrombosis indefinite unless bleed risk

4) Prasugrel

N Engl J Med 2007;357:2001-15

5) High fat followed by caffeine

No comment!!!!

In episode, 124 James and Mike go all PREMIUM on the podcast and provide our wonderful PREMIUM subscribers with information that will make them much better health care practitioners than those listeners who are not PREMIUM podcast subscribers. They discuss definitive studies on childhood asthma, COPD and calcium yet at the end they still do not come up with definitive answers and question the PREMIUM nature of this podcast.

Show notes

1) In children with asthma – can you stop inhaled corticosteroids?

Lancet 2011;377:650-7

2) Calcium – yet another study showing maybe it isn’t all it was cracked up to be

BMJ 2011; 342:d2040 

3) Tiotropium or salmeterol for COPD?

N Engl J Med 2011;364:1093-1103

In episode 123, Mike and James chew on and regurgitate all the diet data that’s fit for consumption. They figure out that all diets have similar average effects on weight but that only the Mediterranean diet has any evidence of benefit in reducing cardiovascular outcomes. To celebrate this new found knowledge we both celebrate by eating 4 pounds of bacon (tofu bacon for James) dipped in olive oil.

1) Tools for Practice

Is any diet better for weight loss or preventing negative health outcomes?

2) Low glycaemic index or low glycaemic load diets for overweight and obesity 

Cochrane Library

3) Low fat, low carb vs Mediterranean

N Engl J Med 2008;359:229-41

4) 4 different diets (varying concentrations of carbohydrate, protein and fat)

N Engl J Med 2009;360:859-73

5) Cohort data – increased mortality with low carb diets especially if protein and fat from animal sources

Eur J Clin Nutr 2007;61:575-81

Ann Intern Med 2010;153:289-98

6) Very low calorie diets

Obesity 2006;14:1283-93

Obesity 2008;16:2456–61

7) Mediterranean diet evidence

Lancet 1994;343:1454-59

Ann Intern Med 2009;151:306-14

Lancet 2002;360:1455–61

BMJ 2008;337:a1344