TEC: Evidence Based Therapeutics
Therapeutics Education Collaboration
Medication Mythbusters – Home of the Best Science (BS) Medicine Podcast

Episode 129: PREMIUM – New studies on old and new diuretics

In episode 129, we get back to giving our listeners PREMIUM content and we end up spending the entire time talking about drugs that, in theory, make you pee – and you wonder why we call this a PREMIUM podcast. We discuss a synopsis of an old drug hydrochlorothiazide and then we discuss the most recent clinical trial of the new aldosterone antagonist eplerenone. The podcast comes to an abrupt end when, because of either the topic or the coffee, both Mike and James have to leave to leave to attend to more important matters.

Show notes

1) Hydrochlorothiazide – what is the evidence for its use?

J Am Coll Cardiol 2011;57:590-600

2) Eplerenone – EMPHASIS-HF study

N Engl J Med 2011;364:11-21

3) Aldosterone antagonist systematic review

Euro H J 2009;30,469–77

Episode 128: Questions from near and far and answers from way out – Part IV

In episode 128, James and Mike finally get to the last of the listener questions We discuss codeine and cough, Vapor Rub; we talk about the PREMIUM podcast, otitis media and antibiotics, atrial fibrillation and low dose statins. We then both collapse from exhaustion yet promise to get back to making premium podcasts as soon as possible.

Show notes

Codeine and cough

Can Fam Phys 2010;56:1293-4

Cochrane Library

Episode 127: Questions from near and far and answers from way out – Part III

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

Episode 126: Questions from near and far and answers from way out – Part II

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

Episode 125: Questions from near and far and answers from way out

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!!!!



Episode 124: PREMIUM – Two pulmonary studies with useful results and yet again more data on calcium

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

Episode 123: Eat what you want as long as it comes from the Mediterranean

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

Episode 122: The evolution of an evidence-based doctor


In episode 122, James and Mike welcome to the podcast a good friend and colleague Mark McConnell, an internist from Lacrosse, Wisconsin. We discuss how Mark became interested in evidence and how his practice has evolved, for the better, by incorporating the concepts of evidence and shared-informed decision making. At the end we get a very special message from Reverend Lovejoy’s identical twin who really provides us with the most insightful comment of the whole podcast.

Episode 121: An atraumatic way to break down the evidence around bone density measurements

In episode 121, Mike, James and Tina tackle the issue of who needs a bone density measurement and describe a simple tool that will help you with that decision.

However, at the end, Mike threatens to jump out of his building and James and Tina talk him down by promising not to measure his BMD more than once.

Show notes

1) Tools for Practice

Screening for Osteoporosis – Who Should Receive Bone Mineral Density Testing?

2) Osteoporosis Self Assessment Tool (OST)

Simple application of OST:

Age – Weight (kg)

If greater than minus 5, increased risk of osteoporosis and BMD is warranted

A cut-off of greater than positive 5 should be used for Asian patients.

Episode 120: PREMIUM – Two interesting studies for your patients with coughs and colds

In Episode 120, Mike and James, in an attempt to truly make this a PREMIUM podcast, elicit Tina Korownyk to yet again help us unravel the mysteries of medicines. In this podcast, we report on two new studies that look at two old therapies for cough and cold symptoms (Vapor Rub and Zinc). We learn that despite coughs and colds being a very common condition, effective therapies are definitely not common.

Show notes

1) Vapor Rub for children with nocturnal cough and cold symptoms

Pediatrics 2010;126:1092-9 

2) Zinc systematic review

Cochrane Library



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