In episode 297, Mike, James and Tina chat about a treatment that takes 2-5 minutes and has an NNT of 2-3 – it doesn’t get much better than that. While there isn’t a lot of evidence around the Epley maneuver for benign paroxysmal vertigo, what there is is fairly impressive – in fact it made our heads spin.
Show notes
Evaluating the Epley maneuver
In episode 296, Mike and James invite Alan Cassels to help us discuss a deprescribing resource we created called MedStopper which you can find at medstopper.com. We talk about where the idea came from and how we created the database for MedStopper. We would love it if you would check out the site and let us know what you think.
Show notes
1) The MedStopper Site
2) The Med Stopper SONG – a parody of the Beatles song Day Tripper
In episode 295, Mike and James discuss the latest blood pressure target trial in an impressive PREMIUM way. We also discuss the most recent meta-analysis that looked at all of the studies (except SPRINT) that have evaluated intensive blood pressure lowering. At the end we put the entire process into a perfect perspective that some have called earth shattering; and you can only find out what we think by becoming a PREMIUM member.
Show notes
1) The SPRINT trial
N Engl J Med 2015; 373:2103-16
2) Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis
November 6, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)00805-3
In episode 294, Mike and James put the nail in the coffin on the evidence around inhalers for COPD. We discuss the evidence and studies around combination inhalers and the treatment of acute exacerbations of COPD. The bottom line is never, ever, ever, smoke.
Show notes
FOR COPD
See episode #292
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
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
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
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
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
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.
3) Televised medical talk shows -what they recommend and the evidence to support their recommendations: a prospective observational study
THE NUTRITION PROPOSITION BOOK
Check it out at nutritionproposition.com and think about picking up a copy on Amazon. All the evidence you ever wanted about nutrition and the only nutrition book that won’t tell you what to eat.
This pragmatic trial is now recruiting in BC. Make a difference and get involved with pragmatic trials (www.pragmatictrials.ca)
