In episode 236, Mike and James discuss the latest listener questions. We cover the flu shot, cardiovascular calculations and as always we deal with the never-ending questions about statins. At the end Mike, who has a cold decides to take a statin for his cold and the results will astound you.

Show notes

1) The best CVD risk calculator

2) What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice

European Journal of Preventive Cardiology 2014;21:464

In episode 235, Mike and James welcome Adrienne Lindblad who helps us sort out the issue of how many antiplatelets do you need after a stroke. We come to the conclusion that the evidence is really difficult to unclog, the answering is as clear as a plugged drain and if you get the title of this podcast you are very old.

Show notes

1) Tools For Practice

Anti-platelets after stroke: Are two better than one? 

2) Surgery 101 – very clever audio/video podcast from a surgery gang from Edmonton, Alberta

In episode 234, Mike and James go PREMIUM all over again and discuss three new studies that were recently in the news. These studies looked at the link between fatty acids and coronary heart disease and acetaminophen use in pregnancy and ADHD. At the end of the podcast we decide to go out and eat a delicious meal and we forgot that we talked about an acetaminophen study.

Show notes

1) The Health Food Delusion 

Vancouver Sun Podcast

2) Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk

Ann Intern Med 2014;160:398-406

3) Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis

BMJ 2013 Feb 4;346:e8707

4) Acetaminophen Use During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders

JAMA Pediatr. doi:10.1001/jamapediatrics.2013.4914

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