In episode 391, Mike and James have yet again a PREMIUM moment that will leave you short of breath. We go over 2 new studies that looked at asthma action plans and does increasing doses of inhaled corticosteroids work. In the last study we go over a comparison of vaginal estradiol, vaginal moisturizer or placebo for perimenopausal vulvovaginal symptoms, and placebo ends up working as well as anything else.

Show notes

1) Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations

N Engl J Med 2018;378:891-901

2) Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations

N Engl J Med 2018;378:902-910

3) Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms

JAMA Intern Med. doi:10.1001/jamainternmed.2018.0116

In episode 390, James and Mike have a discussion about how a shared-decision may be the only real outcome to measure if one is doing, or evaluating, evidence-based practice. Do our arguments convince you? Have we missed something important? Is this the best podcast ever on shared-decision making? Do you think we should be locked up? We would love feedback.

Show notes

Shared decision is the only outcome that matters when it comes to evaluating evidence-based practice

BMJ Evid Based Med 2018 Jul 12

In episode 389, Mike and James go over with Adrienne Lindblad the evidence for a simple treatment for beast engorgement. Who knew that cabbage leaves worked for breast engorgement? At the end of the podcast we decide to attach cabbage leaves to all our microphones all the time, just in case – see last podcast description for context.

Show notes

Tools for Practice

Is that cabbage in your bra? Cabbage leaves for breast engorgement

In episode 388, Mike and James go over with Adrienne Lindblad the evidence for a simple treatment for nausea and vomiting in the ER. Who knew that inhaling isopropyl alcohol worked for nausea and vomiting? – possibly as good as the medications we have used in the past. At the end of the podcast we decide to attach isopropyl alcohol swabs to all our microphones all the time, just in case.

Show notes

Tools for Practice

Smell This: Isopropyl alcohol for nausea/vomiting in the emergency department

In episode 387, Mike and James go over the best available evidence for opioids in neuropathic pain. As with many pain treatments the evidence suggests there is some benefit and also some harm.  Overall, it seems a reasonable approach would be to only use opioids in patients with refractory pain after multiple therapeutic trials with other agents.

Show notes

1) Tools For Practice

Nerve-ous About Opioids? Treatment of neuropathic pain with opioids

2) Comparing Treatment Options for Pain: The C-TOP Tool

In episode 386, James and Mike talk about the latest low fat low carb weight loss study and then put it all into context of the more global evidence for low carbs vs low fats. The bottom line is, the evidence is even lower than the carbohydrates in a ketogenic diet – which is pretty low – or in other words nobody can really say what is the best diet – except maybe the one to which you will adhere.

Show notes

1) Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial

JAMA. 2018 Feb 20;319(7):667-679

2) Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials

Br J Nutr. 2016 Feb 14;115(3):466-79

3) Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study

J Intern Med. 2007 Apr;261(4):366-74

4) Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates

N Engl J Med. 2009 Feb 26;360(9):859-73

In episode 385, James and Mike invite Tim Caulfield (author, professor and lawyer) yet again to talk about the marketing and evidence around stem cell therapies. Low and behold the evidence pales in comparison to the hype. At the end Tim states – “science is hard” – enough said.

1) Is Gwenyth Paltrow wrong about everything?

2) A user’s guide to cheating death

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

BMJ. 2014 Dec 17;349:g7346. doi: 10.1136/bmj.g7346

4) The evolution of policy issues in stem cell research: an international survey

Stem Cell Rev. 2012 Dec;8(4):1037-42. doi: 10.1007/s12015-012-9404-5

5) Reassessing direct-to-consumer portrayals of unproven stem cell therapies: is it getting better?

Regen Med. 2013 May;8(3):361-9. doi: 10.2217/rme.13.15

6) International Society for Stem Cell Research

7) Polar Extremes in the Clinical Use of Stem Cells

N Engl J Med. 2017 Mar 16;376(11):1075-1077. doi: 10.1056/NEJMe1701379

8) How Anecdotal Evidence Can Undermine Scientific Results

9) Exploiting science? A systematic analysis of complementary and alternative medicine clinic websites’ marketing of stem cell therapies

BMJ Open 2018;8:e019414. doi:10.1136/ bmjopen-2017-019414

In episode 384, James and Mike invite Tim Caulfield (author, professor and lawyer) to talk about the marketing of personalized medicine. We find out that most of the marketing is absurd. We also figure out that personalized medicine is being done all the time but it rarely if ever requires knowledge of any genetic testing results.

1) Is Gwenyth Paltrow wrong about everything?

2) A user’s guide to cheating death

3) Shattuck lecture–medical and societal consequences of the Human Genome Project

N Engl J Med 1999;341:28-37

4) Representing a “revolution”: how the popular press has portrayed personalized medicine

Genet Med 2018 Jan 4. doi: 10.1038/gim.2017.217

5) Personalized genetic risk counseling to motivate diabetes prevention: a randomized trial

Diabetes Care 2013 Jan;36(1):13-9. doi: 10.2337/dc12-0884

6) Genetic determinants of common obesity and their value in prediction.

Best Pract Res Clin Endocrinol Metab. 2012 Apr;26(2):211-26. doi: 10.1016/j.beem.2011.11.003.

7) Effectiveness of testing for genetic susceptibility to smoking-related diseases on smoking cessation outcomes: a systematic review and meta-analysis

Tob Control 2012 May;21(3):347-54. doi: 10.1136/tc.2011.042739

8) Differences in Weight Loss Between Persons on Standard Balanced vs Nutrigenetic Diets in a Randomized Controlled Trial

Clin Gastroenterol Hepatol. 2015 Sep;13(9):1625-1632.e1. doi: 10.1016/j.cgh.2015.02.044

9) Gene Environment Risk Assessment and Colorectal Cancer Screening in an Average Risk Population: A Randomized, Controlled Trial

Ann Intern Med. 2014 Oct 21; 161(8): 537–545.

10) Lifestyle Advice Combined with Personalized Estimates of Genetic or Phenotypic Risk of Type 2 Diabetes, and Objectively Measured Physical Activity: A Randomized Controlled Trial

PLoS Med. 2016 Nov 29;13(11):e1002185. doi: 10.1371/journal.pmed.1002185. eCollection 2016 Nov

11) Born Fat: The Relations Between Weight Changeability Beliefs and Health Behaviors and Physical Health

Health Educ Behav. 2016 Jun;43(3):337-46. doi: 10.1177/1090198115602266. Epub 2015 Sep 8

12) The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis

BMJ. 2016 Mar 15;352:i1102. doi: 10.1136/bmj.i1102

13) Gene-lifestyle interaction and type 2 diabetes: the EPIC interact case-cohort study

PLoS Med. 2014 May 20;11(5):e1001647. doi: 10.1371/journal.pmed.1001647. eCollection 2014 May

14) Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? The Role of Individual Agency

PLoS Med. 2016 Apr 5;13(4):e1001990. doi: 10.1371/journal.pmed.1001990. eCollection 2016 Apr

In episode 383, James and Mike go over the IMPACT trial that looks at triple inhaler therapy for patients with COPD. We talk about how, unfortunately, the impact is not that impactful and then put all the results into context with the issues of placebo, patents and cost. 

Show Notes

1) Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD 

N Engl J Med 2018;378:1671-80

2) Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta 2018

Cost document

In episode 382, Mike and James and Gary Bloch decide to try to solve the problem of poverty. While we get somewhere, it becomes clear that it might take more than just doing a 30-minute podcast. Who would have thought? Nonetheless, we hope that some of the things we discuss will inspire others to continue the battle against this extremely important health issue.

Show notes

1) Butler-Jones  D. Chief Public Health Officer’s report on the state of public health in Canada. Addressing health inequalities. Ottawa, ON: Government of Canada; 2008. 

2) The Clinical Tool on Poverty

CFPC Poverty Tools

3) A novel income security intervention to address poverty in a primary care setting: a retrospective chart review

BMJ Open 2017;7:e014270

4) Building a Foundation to Reduce Health Inequities: Routine Collection of Sociodemographic Data in Primary Care. 

J Am Board Fam Med 2016;29:348-55

5) Framework for building primary care capacity to address the social determinants of health

Can Fam Physician 2017;63:e476-e482

6) What is the impact on individual health of services in general practice settings which offer welfare benefits advice?

Health Soc Care Community 2006;14:1–8

7) UK Social Prescribing – evidence 

8) Taking action on the social determinants of health in clinical practice: a framework for health professionals

CMAJ 2016;188:E474–83