In episode 491, Mike and James invite Mike Kolber to talk about Pink Ladies and White Knights. In medical terms we are referring to whether or not it makes sense to add lidocaine and antispasmodics to antacids in patients who present to an emergency room with dyspepsia. Please ignore the parts when both Mikes battle it out for a place at King Arthur’s Round Table and when one of them wears a pink dress for effect.

Show Notes

Tools for Practice

Keeping it Simple for Emergency Room Dyspepsia 

In episode 490, Mike and James invite Tony and Mike to go over the best available evidence for ivermectin. Overall the evidence shows that ivermectin does not improve clinically important outcomes. Unfortunately, much of the evidence for ivermectin is unpublished and some has even been retracted.

Show Notes

Tools for Practice

Opening a can of helminths: Ivermectin for COVID-19

In episode 489, Mike and James invite Adrienne to go over the evidence for weight loss with semaglutide. We find the evidence shows that weight loss is on average roughly 10 kg over the effect of placebo, however this comes at the expense and inconvenience (injection) of the medication and roughly 25% of people (over placebo) will have GI adverse effects.

Show Notes

Tools for Practice

Mission Slimpossible: Semaglutide for weight loss

CFPCLearn

In episode 488, Mike and James invite Mike Kolber back again to chat about what the best evidence says around COVID vaccine adverse effects. We discuss all the numbers around common post-dose side effects, anaphylaxis, thrombotic thrombocytopenia and myocarditis.

Show Notes

Tools for Practice

COVID-19 Vaccine Adverse Events

In episode 487, Mike and James invite Mike Kolber in to chat about the real-world evidence we have for the COVID vaccine. We find the effectiveness of the COVID vaccines pretty much mirrors what the original clinical trials show. There is also effectiveness evidence the vaccine works for the variants of concern and we even have safety evidence in pregnancy.

Show Notes

Tools for Practice
Real World Evidence for COVID-19 Vaccines

In episode 486, Mike and James go over the evidence we have for acupuncture in chronic low back pain. We find out that some evidence shows acupuncture will improve chronic low back pain in one in 6 patients. However, the magnitude of the effect seen is importantly less when you look at trials that actually use a sham control or those that are of higher quality or longer duration.

Show Notes

Tools for Practice

Needle in a Pain-Stack: Acupuncture for Chronic Low Back Pain

CFPC Learn

In episode 485, Mike and James go over a couple of COVID trials that show two different anti-inflammatories – colchicine and inhaled budesonide – seem to have an effect on reducing hospitalizations or urgent care visits.

Show Notes

1) Colchicine for community-treated patients with COVID-19 (COLCORONA): a phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial

Lancet Respir Med. 2021 May 27;S2213-2600(21)00222-8.doi: 10.1016/S2213-2600(21)00222-8.

2) Inhaled budesonide in the treatment of early COVID-19(STOIC): a phase 2, open-label, randomised controlled trial

Lancet Respir Med. 2021 Jul;9(7):763-772. doi: 10.1016/S2213-2600(21)00160-0.Epub 2021 Apr 9.

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 483, James and Mike invite Tina to the podcast to talk about the aducanumab (Aduhelm) FDA approval story. We look at all the latest evidence, we talk about how people analyzed the data, whether or not the findings were clinically important, the side effects and finally the cost. And no matter how we looked at it we were still puzzled it got FDA approval. What do you think?

Show notes

1) Effect of reductions in amyloid levels on cognitive change in randomized trials: instrumental variable meta-analysis.

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n156 (Published 25 February 2021)

2) Failure to demonstrate efficacy of aducanumab: An analysis of the EMERGE and ENGAGE trials as reported by Biogen, December 2019

Alzheimers Dement. 2021 Apr;17(4):696-701.  doi: 10.1002/alz.12213.  Epub 2020 Nov 1.

3) Institute for Clinical and Economic Review

Aducanumab for Alzheimer’s Disease: Effectiveness and Value

In episode 482, Mike and James take a look into all the evidence for baths for atopic dermatitis. The evidence is fairly clear that more frequent bathing has a reasonable effect in people with moderate to severe atopic dermatitis. However, adding bleach or anything else to the bath doesn’t seem to do much at all.

Show notes

Tools for Practice

Bath Time: Atopic Dermatitis and Bathing