In episode 233, Mike and James continue on with how to deal with a failing heart. We talk about nitrates, digoxin and the aldosterone antagonists. We then talk about the approach to using these medications and how we don’t need to get to everybody to high doses of every drug and in fact that this causes considerable harm unless it is done carefully.

Show notes

1) Nitrates

NEJM 2004;351:2049-57

2) DIG trial

NEJM 1997; 336:525-33

3) Aldosterone antagonists

Tools For Practice

Aldosterone antagonists in systolic heart failure – no longer an afterthought

4) Target dose evidence

Network – ACE doses

Eur Heart J 1998;19:481-9

ATLAS – ACE doses

Circ 1999;100:2312-8

Carvedilol doses

Circulation 1996;94:2807-16

Beta-blocker doses

Ann Intern Med 2009;150:784-94

Getting to carvedilol doses

QJM 2004;97:133-9

HEAAL – losartan

Lancet 2009;374;1840-8

In episode 232, Mike and James get to all the evidence around drugs for heart failure. We talk about furosemide, ACE inhibitors, beta-blockers and ARBs. The bottom line is that we have good evidence for reduction in mortality and heart failure admissions however the evidence for symptomatic control is surprisingly absent and both our hearts fail a little bit because of that news. 

Show notes

1) Diuretics

Cochrane CD003838

2) ACE inhibitors

Lancet 2000;355:1575-81

3) Aldosterone antagonists in systolic heart failure – no longer an afterthought  

Tools For Practice 

4) Beta-blockers

Ann Intern Med 2001;134:550-60

5) ARBs

PLOS 1 2010

6) Carvedilol vs metoprolol

Lancet 2003;362:7-13

In episode 231, Mike and James finally get to the end of their discussion of the CMAJ article “Prevention and Treatment of the Common Cold: making sense of the evidence” that was written by Mike and Bruce Arroll. We discuss all the evidence surrounding the use of alternative and non-drug treatments for the common cold and find out that not much, as with the medication side, really works – although if you like honey and you are a kid you are in luck.

Show notes

1) Prevention and Treatment of the Common Cold: making sense of the evidence


CMAJ January 27, 2014cmaj.121442 

This is not actually a podcast but a quick audio note to let you know about a video I just released entitled “Tom Hanks and Type 2 Diabetes – an evidence-based discussion I would like to have with Mr. Hanks”.
You can find it on YouTube at

or at 

In episode 230, Mike and James get back to discussing the CMAJ article “Prevention and Treatment of the Common Cold: making sense of the evidence”. We discuss all the evidence surrounding the use of drugs for the treatment of the common cold and find out that not much really works.

 Show notes

1) Prevention and Treatment of the Common Cold: making sense of the evidence


CMAJ CMAJ January 27, 2014cmaj.121442 

In episode 229, Mike and James start a short podcast series based on the CMAJ article “Prevention and Treatment of the Common Cold: making sense of the evidence”. The article was written by Mike and Bruce Arroll and in this first episode we briefly discuss the basics of the common cold and then delve into the evidence for cold prevention. At the end, we realize there is very little that works and therefore we fall back on common sense recommendations and suggest hand washing and avoiding people with colds.

Show notes

1) Prevention and Treatment of the Common Cold: making sense of the evidence

CMAJ January 27, 2014cmaj.121442 

In episode 228, Mike and James deconstruct the most recent JNC 8 high blood pressure guidelines. We discuss what is good and bad and we debate the issues and what the changes might mean for practice. At the end we decide that it really isn’t a guideline but really a useful synopsis of the evidence around a number of key issues and questions that surround the management of elevated blood pressure.

Show notes

1) 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
Report From the Panel Members Appointed 
to the Eighth Joint National Committee (JNC 8)

JAMA December 18, 2013. doi:10.1001/jama.2013.284427

In episode 227, James and the Mikes finish off vaccines. We discuss why people do or don’t take vaccines, the evidence around the pneumococcal vaccine, the zoster vaccine and pertussis vaccine. Ironically, one of the Mike’s got the flu a few days after this podcast – life is amazing.

Show notes

1) Pneumococcal Vaccine

Cochrane 2013 – CD000422

CMAJ 2009;180:48-58

Lancet 1998;351:399–403

Cochrane 2010 – CD001390

2) Confusing Confidence intervals

3) Alberta medication costs

In episode 226, James and the Mikes continue on their merry way down influenza vaccine lane. We finish up by talking about its use in healthy adults and then look to the most recent information on its impact on cardiovascular disease. We give you all the numbers, now you go and make up your mind. 

Show notes

1) Meta-analysis of the influenza vaccine in healthy adults

Cochrane CD001269

2) Best RCT on influenza vaccine in Healthy Adults

JAMA 2000;284:1655-63

3) Does the influenza vaccine decrease cardiovascular events

JAMA 2013;310:1711-20

In episode 225, James and the Mikes talk about vaccines for adults. In part one of this series, we discuss the effectiveness of the influenza vaccine, the benefit seen in the elderly and what happens when we vaccinate health care providers.  We find that the evidence is not bad, but it is not overwhelming either, and so at the end we all make different decisions as to what to do and we are all correct. You have to love informed decision making.

Show notes

 1) Tools for practice

Effectiveness of seasonal influenza vaccine for healthy, working age adults

Will the flu shot help my Grandma and Grandpa?

2) Vaccines for preventing influenza in the elderly

Cochrane – CD004876

JAMA 1994;272:1661-5

3) Vaccinating health care providers

Cochrane – CD005187