In episode 492, Mike and James delve into a couple of potentially practice-changing results. The first trial looked at the effect of different shoes for knee osteoarthritis. You might be surprised by the results. The second trial is the first ever look at a salt substitute and what it does, believe it or not, to cardiovascular events and death. Yeah! You might also be surprised by the results. Check out what was found in this PREMIUM podcast.

Show Notes

1) The Effect of Flat Flexible Versus Stable Supportive Shoes on Knee Osteoarthritis Symptoms: A Randomized Trial

Ann Intern Med. 2021 Apr 174:462-71

2) Effect of Salt Substitution on Cardiovascular Events and Death

N Engl J Med 2021; 385:1067-1077 DOI: 10.1056/NEJMoa2105675

In episode 484, Mike and James go PREMIUM on two topics that annoy them – Vitamin D and interpretation of tests. We find there is no value to using Vitamin D to prevent acute respiratory infections and that as health care providers we overestimate the probability of diagnoses before and after testing.

Show notes

1) Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials 

Lancet Diabetes Endocrinol 2021; 9: 276–92 

2) Accuracy of Practitioner Estimates of Probability of Diagnosis Before and After Testing 

JAMA Intern Med. doi:10.1001/jamainternmed.2021.0269 

In episode 473, Mike and James invite Samantha Moe yet again to talk about a recent Tools for Practice that looked at treatments for osteoporosis. Sam helps us put all the evidence into perspective for bisphosphonates and denosumab when it comes to fractures. We discuss the numbers and help explain why secondary prevention in osteoporosis is not really secondary prevention.

Show notes

Tools for Practice

Osteoporosis treatment for post-menopausal women

In episode 472, Mike and James invite Samantha Moe in to talk about a recent Tools for Practice that looks at the evidence for glucosamine and chondroitin in osteoarthritis. Sam does a great job of showing why you have to look at publicly funded trials and responder analyses to really get the whole picture of the evidence around these products.

Show notes

1) Tools for practice

Glucosamine & Chondroitin: Natural remedies for osteoarthritis? 

2) PEER simplified decision aid: osteoarthritis treatment options in primary care

3) Pain calculator

In episode 471, Mike and James get back to being PREMIUM and discuss 2 studies that should impact what you do today in your practice. Is Vitamin C needed when you take iron? What does the evidence really show about the SGLT-2 and the GLP-1s for diabetes and is one better than the other?

Show notes

1) The Efficacy and Safety of Vitamin C for Iron Supplementation in Adult Patients With Iron Deficiency Anemia

JAMA Network Open. 2020;3(11):e2023644. doi:10.1001/jamanetworkopen.2020.23644

2) Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials 

BMJ 2021;372:m4573 http://dx.doi.org/10.1136/bmj.m4573

In episode 470, Mike and James finish their discussion about misinterpretation and misdirection in medicine by looking at some of the evidence about how we incorporate new information and whether or not we change our minds. We also talk about competence versus experience vs knowledge.

In episode 469, Mike and James continue their discussion about misinterpretation and misdirection and how much of it starts with a narrative/story. We bring up a number of specific “stories” that are examples of how we were initially mislead into making bad treatment decisions.

In episode 468, Mike and James start on a multi-podcast rant and talk about how misinterpretation and misdirection can lead us all down rabbit holes in many ways, not just in medicine.

In episode 467, Mike and James finish off talking with Jamie Falk about COPD/inhalers. We go over the some of the latest trials for the triple therapies and then wrap up all the evidence into a nice package and put a bow on it.

At the end we finally get to the issue of eosinophils and let you know if you need to know this number.

Show notes 

1) COPD handout + eosinophil stuff

In episode 466, Mike and James continue talking with Jamie Falk about everything COPD/inhalers. We go over the evidence for the steroid component of inhalers and then we start going over the triple therapies. But all Mike really wants to talk about are eosinophils – but that is PART III.

Show notes 

1) COPD handout