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

In episode 283, Mike and James discuss the latest T2DM study showing that sitagliptin at least doesn’t cause much harm. We then veer off to discuss everything you need to know about diastolic and systolic blood pressure and how are they associated with CVD. Finally we discuss an n-of-1 study looking at statin-related myalgia. Bottom line – this was clearly a PREMIUM podcast.

Show notes

1) TECOS – Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes

N Engl J Med 2015; 373:232-242

2) Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people

Lancet 2014;383:1899-1911

3) N-of-1 (Single-Patient) Trials for Statin-Related Myalgia

Ann Intern Med 2014;160:301-310

In episode 282, James and the Mikes discuss the use of digoxin for systolic heart failure and atrial fibrillation. At the end we realize that if people would just use low doses and occasionally re-evaluate they would get into a lot less trouble with digoxin and maybe a few patients would benefit.

Show notes

1) Tools for Practice

Digoxin: Old friend or best left on the shelf?

2) Evidence Network

evidencenetwork.ca

In episode 281, James and Mike welcome back our friend and colleague Bruce Arroll to talk about a great study he and his colleagues recently completed looking at simple bedtime restriction for the treatment of primary insomnia – and the results were pretty impressive. So much so that Bruce had to wake us both up at the end of the podcast.

Show notes

1) Development, validation (diagnostic accuracy) and audit of the Auckland Sleep Questionnaire: a new tool for diagnosing causes of sleep disorders in primary care

2) A double-blind randomised controlled study of a brief intervention of bedtime restriction for adult patients with primary insomnia 

In episode 280, James and Mike continue on with Jon Ference about information mastery. Jon talks about hunting and foraging tools and how you can access tools that will work best for your practice. And at the end we all go out and hunt and forage and have a delicious evidence-based meal.

Show notes

Information Mastery Handout