In episode 293, Mike and James continue to discuss the evidence behind the evidence for inhalers for COPD. We discuss the evidence and studies that look at the important outcomes behind the multitude of different puffers. At the end we discuss how we would use about these agents in practice.

Show notes

FOR COPD

See episode #292

OTHER

Simplified lipid guidelines – Prevention and management of cardiovascular disease in primary care

Can Fam Phy 2015;61:857-67

In episode 292, Mike and James delve into COPD – we briefly discuss smoking cessation and then all the evidence behind the multitude of different puffers. At the end we leave the audience hanging as we plan to discuss how to actually use these agents in the next podcast.

Show notes

COPD handout

In episode 291, James and Mike welcome back the smoking hot Mike Kolber to talk about the role of electronic cigarettes in helping smokers decrease smoking. We find out that e-cigarettes do seem to help some smokers quit smoking but the long-term adverse effects are unknown. At the end of the podcast all three of us, in the name of science, decide to take up smoking to do an n-of-3 trial of e-cigarettes but our attempt goes out the windows when the fire alarms go off.

Show notes

Tools For Practice

Electronic Cigarettes – Hoot that helps, hurts, or just hype?

In episode 290, James and Mike address listener demands for a discussion on the latest diabetes outcomes trial that looked at empagliflozin, a new class of medications for type-2 diabetes. This study actually showed the group who received this new drug had a reduction in CVD events and other clinically important outcomes. While this is a good finding, upcoming trials of other medications in this class will help put this drug into a context.

Show notes

1) EMPA-REG OUTCOME

Empagliflozin, Cardiovascular Outcomes, and Mortality in Type-2 Diabetes

NEJM 2015 DOI: 10.1056/NEJMoa1504720 

In episode 289, James and Mike slip into the quagmire of moisturizers and anti-aging creams. We look at what ingredients are in moisturizers and the evidence behind the anti-aging products. At the end they both feel like they’ve aged 5 years and there’s not a cream on the market that will save them.

Show notes

1) Use Cream That’s Cheaper – a parody of the Blue Oyster Cult song Don’t Fear the Reaper

2) Deception in cosmetics advertising

J Glob Fas Mark 2015:6:194-206

3) Consumer Reports April 2012

4) Which? August 2009

5) Ingredients essential to all moisturizers

80% WATER

10-30% Oils/lipids/fats (emollients) – Decreases Evaporation

Typically from plants and animals – PETROLATUM (petroleum jelly), beeswax, lanolin, mineral oil, shea butter, cocoa butter, olive oil, coconut oil, sesame oil, squalene

5% Emulsifiers – Allows Oils to Mix with Water

Beeswax/borax, cetearyl alcohol, polysorbate 60, PEG-150 stearate, steareth-20, lecithin, glyceryl monostearate

0.5% Preservatives  

Parabens, phenoxyethanol, MCI/MI

5% Humectants – Attracts Water

GLYCEROL (glycerin), propylene glycol, butylene glycol, alpha-hydroxy acids (glycolic acid, lactic acid), urea

1% Silicones

DIMETHICONE

2% Herbal extracts – Most added with no clinical evidence they do anything and often the reason for allergic reactions

0.2% Fragrance – 100s used

Often the reason for allergic reactions

6) Interventions for photodamaged skin

CD001782

In episode 288, James and Mike continue discussing their experiences evaluating and interacting with the media. We talk about a few examples of spin – UKPDS spin, Dr Oz/The Doctors spin and so on. At the end we quote Jon Stewart who said “The best defence against bullshit is vigilance. So if you smell something, say something.” We implore you to not complain about the media, but rather become the media by writing and publishing.

Show notes

1) Press Releases by Academic Medical Centers: Not So Academic?

Ann Intern Med 2009;150:613-18

2) Seeing what you want to see in randomised controlled trials: versions and perversions of UKPDS data. United Kingdom prospective diabetes study.

BMJ 2000;320:1720-3

3) Televised medical talk shows -what they recommend and the evidence to support their recommendations: a prospective observational study

Brit Med J 2014;349:g7346 doi: 10.1136/bmj.g7346

In episode 287, James and Mike discuss their experiences evaluating and interacting with the media. We talk about the stories, the spin, the science and especially the BS. At the end, to make a point, we put a whirlwind of spin on all our research and send it off to the Land of Oz.

Show notes

1) Jon Stewart  – BS is everywhere

Starting at 32.26

“The best defense against bullshit is vigilance. So if you smell something, say something.”

2) Drugs in the news: an analysis of Canadian newspaper coverage of new prescription drugs. 

CMAJ 2003;168:1133-7

3) Translation of highly promising basic science research into clinical applications

Am J Med 2003;114:477-84

4) Misrepresentation of Randomized Controlled Trials in Press Releases and News Coverage: A Cohort Study

PLoS Med 2012 9(9): e1001308. doi:10.1371/journal.pmed.1001308

5) The association between exaggeration in health related science news and academic press releases: retrospective observational study

BMJ 2014;349:g7015 doi: 10.1136/bmj.g7015

In episode 286, James and Mike let it all hang out, metaphorically speaking, and do a premium-like podcast without the premium price. We look at two recent publications and discuss whether or not we have to bridge when you stop anticoagulants in afib and if we should prescribe marijuana to ourselves and all our patients.  For some reason we laugh throughout the entire podcast.

Show notes

1) BRIDGE – Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

June 22, 2015DOI: 10.1056/NEJMoa1501035

2) Cannabinoids for Medical Use – A Systematic Review and Meta-analysis

JAMA. 2015;313(24):2456-2473. doi:10.1001/jama.2015.6358.

In episode 285, James and Mike look at the evidence around the use of a very old drug, cyclobenzaprine (Flexeril), for acute back pain. We find it does have some effect but it also produces sedation etc as would be expected from a tricyclic antidepressant. We remind listeners to use low doses and not to give it three times a day.

Show notes

1) Tools for Practice

Acute Back Pain: Is Cyclobenzaprine a reasonable option?

In episode 284, the Mikes and James discuss the evidence for the FODMAP diet and irritable bowel syndrome.  There is some evidence, but the gut feeling is that a low FODMAP diet may improve symptoms for patients with primarily diarrhea subtype irritable bowel syndrome. The bottom line (HA HA bottom) is that most of the studies were low quality and more high quality studies are needed. 

Show notes

1) Tools for Practice

The Low FODMAP Diet: Food for thought or just an irritable idea?

2) Stanford FODMAP guide