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
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
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
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
In episode 481, James and Mike invite Paul Fritsch to go through all the evidence for the benzoyl peroxide/adapalene and benzoyl peroxide/clindamycin combinations that we use for acne. Call us crazy, but we focus on the important outcome of whether or not the patient thinks the treatment worked. We provide all the info and very simple numbers that will help you with shared-decision making for your patients who are trying to figure out which product to use.
Show notes
Tools for Practice
Clearing up the evidence for topical acne combination products
In episode 480, James and Mike talk about two recent meta-analyses that have done a solid job of looking at the impact of lowering blood pressure and using SGLT-2s and GLP-1s to reduce risk. Both publications lend credence to the concept of focusing much more on risk reduction goals than blood pressure or glucose thresholds.
Show notes
1) Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis
Lancet. 2021 May 1;397(10285):1625-1636.
2) Decisions about antihypertensive treatment should focus on reducing cardiovascular risk
Lancet. 2021 May 1;397(10285):1598-1599
3) 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
In episode 479, Mike and James update the latest information around cannabinoids for chronic pain. Unfortunately, there is not a lot of new information but we talk about what there is and then try and put all the evidence into context and then how to think about the information we have.
Show notes
1) Allan GM, Finley CR, Ton J, Perry D, Ramji J, Crawford K, et al. Systematic review of systematic reviews for medical cannabinoids: Pain, nausea and vomiting, spasticity, and harms.
Can Fam Physician. 2018;64(2):e78-e94.
2) Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults.
Cochrane Database Syst Rev. 2018 Mar 7;3(3):CD012182.
3) Wong SSC, Chan WS, Cheung CW. Analgesic Effects of Cannabinoids for Chronic Non-cancer Pain: a Systematic Review and Meta-Analysis with Meta-Regression.
J Neuroimmune Pharmacol. 2020 Dec;15(4):801-829
4) Johal H, Devji T, Chang Y, Simone J, Vannabouathong C, Bhandari M. Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis.
Clin Med Insights Arthritis Musculoskelet Disord. 2020 Feb 19;13:1179544120906461.
5) Fitzcharles MA, Baerwald C, Ablin J, Häuser W. Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis): a systematic review of randomized controlled trials.
In episode 478, James and Mike invite Jen Potter to the podcast yet again to talk about whether or not NSAIDs are effective for reducing menstrual bleeding. While the quality of the evidence is not great, there does appear to be some evidence that NSAIDs have an effect over placebo.
Show notes
Tools for Practice
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)
