In episode 206, James and Mike start to tackle the holy gospel of blood pressure measurements and interestingly feel under pressure the entire way due to the trickiness of the evidence. We discuss office measurements, automated measurements, home measurements, 24-ambulatory measurements and at the end realize we have likely raised the blood pressure of our listeners but on principle we refuse to measure it.

 Show notes

1) Screening

Canadian Task Force on Preventive Health Care and the Canadian
Hypertension Education Program

2) Automated blood pressures

BMJ 2011;342:bmj.d286 

3) MAPEC study

Chronobiol Int 2010;27:1629-51

4) Waste and Harm in the Treatment of Mild
Hypertension     

JAMA Intern Med. 2013;():1-2. doi:10.1001/jamainternmed.2013.970.
doi:10:1001/jama.2010.920

5) Mild hypertension – effect of propranolol in mild hypertension

Lancet 1966;2:1148–50

In episode 205, Mike and James continue with their discussion on the use of A1c levels in type-2 diabetes. We discuss the variability in the measurement of A1c and given this, how tricky it is to use the A1c once therapy has been started. We also discuss the magnitude of the vascular benefit of therapies that change A1c and come to the conclusion that with all this confusion “minimally disruptive medicine” seems to make a lot of sense.

Show notes

1) The variability of the A1c test

http://diabetes.niddk.nih.gov/dm/pubs/A1CTest/#11

2) Calculators for converting glucose to A1c and vice versa

Diabetic Med 2006;23:1151–4

In episode 204, James and Mike get into a discussion about the use of A1c levels for diagnosing and treating type-2 diabetes. We discuss screening recommendations and the impact an elevated A1c has on cardiovascular disease and other outcomes. At the end we realize the key message is that we have to let patients know that having an elevated A1c does not indicate impending doom.

Show notes

1) Impact of screening for type-2 diabetes

Lancet 2012;380:1741-8

2) Recommendations on screening for type 2 diabetes in
adults

CMAJ 2012;184 no.15 doi:10.1503/cmaj.120732

3) Hemoglobin A1c for the diagnosis of Type II Diabetes

Tools for practice

4) Lifetime risk of dialysis and blindness

Estimated benefits of glycemic control in microvascular complications
in type 2 diabetes

Ann Intern Med 1997;127:788-95

5) UKPDS risk engine

For the risks calculated in the podcast we used a version of
the UKPDS risk engine that is not presently publically available – UKPDS risk
engine v3.0b2

6) Risk of dialysis in type 2 diabetes

Diabetes Care 2003;26:2353-8

In episode 203, James and Mike go all PREMIUM and discuss three new studies. Vitamin D for the common cold, chelation therapy post-MI and the link between obesity and mortality. If you are reading this and you are a non-PREMIUM member, boy are you missing something.

 Show notes

1) Vitamin D for the cold

JAMA 2012;308:1333-9

2) Chelation post-MI RCT

JAMA 2013; 309: 1241-50

3) Obesity and mortality

JAMA 2013;309:71-82

In episode 202, Mike and James continue their testing deconstruction process. This week they take on bone mineral densities and discuss when (almost never) and when not to get these measurements. The podcast clocks in at a dense 44 minutes but the result is a real gem (mineral).

Show notes

1) OST – Osteoporosis Self-assessment Tool

Mayo Clin Proc 2003;78:723-7

Mayo Clin Proc. 2002;77:629-637

The Singapore Family Physician Jul-Sep 2003;29:12

MOH Osteoporosis clinical practice guidelines – Singapore
Mar 2002

Tools for practice – Screening for
Osteoporosis – Who Should Receive Bone Mineral Density Testing?

2) BMD plus age to get fracture risk

CMAJ 2002 167: S1-S34

Ost Int 2001 12:989-95

3) Remeasuring for risk assessment

Arch Intern Med 2007;167:155-60

4) Simpler tools for risk assessment

Arch Intern Med 2009;169:2087-94

5) Follow-up bone density after treatment

BMJ 2009;338;b2266

Tools for practice – Bone Mineral Density
– Too much of a good thing?

In episode 201, James and Mike continue on with deconstructing the concept of cholesterol measuring and lowering. We talk about various scenarios as to when one could measure cholesterol but quickly come to the realization that if one looks at the best science and uses a logical thought process, the whole concept of cholesterol measurement for individual patients is unfortunately built upon a house of cards.

Show notes

1) Meta-Analysis Comparing Mediterranean to Low-Fat Diets for Modification of Cardiovascular Risk Factors

Amer J Med 2011;124:841-51

In episode 200, James and Mike unveil the new BS Medicine Podcast. For their first topic they rant on and on about why most cholesterol measurements are pretty much a waste of time. We talk about how the breakpoints are arbitrary and lack any specific logic and that given the within-person variation, annual measurements really don’t have any value. At the end we brilliantly segue to a discussion on cranberry juice for UTIs.

Show notes

1) AACE Cholesterol Guidelines  

Endocr Pract 2012;18:1-78

2) 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult

Can J Cardiol 2013;29:151-67

3) The SANDS Randomised Trial

JAMA 2008;299:1678-89

4) Monitoring cholesterol levels: Measurement Error or True Change?

Ann Intern Med 2008;148:656-61

5) Do you need to know cholesterol to assess risk?

Arch Intern Med 2012;172:1766-8

5) When to remeasure cardiovascular risk in untreated people at low and intermediate risk:observational study

BMJ 2013;346:f1895

Hi Everyone: Well, after 5 years, 199 episodes, ~ 120 hours of content = 24 hours a day for 5 days, James and Mike have decided to pull the plug on the TEC podcast. We want to thank all the listeners – some who have listened to them all – for trusting in the content that we provide.

BUT DON’T YOU WORRY.

We are coming back with more of the same and maybe a little bit more. We’ve never really liked the name “TEC podcast” so we’ve decided to make a name change and a logo change.

From now on the podcast will be known as

The Best Science (BS) Medicine Podcast – BS without the BS

Hope you like the change and let us know what you think.

In episode 199, Mike, James and Adil finish off the ADHD series by talking about the side effects and concerns for the stimulants and the evidence behind the use of non-stimulant medications. At the end Mike and James are so excited about the upcoming 200th episode they can hardly sit still so Adil starts a stat stimulant infusion on both of them.

Show notes

1) Cardiovascular Effects of Methylphenidate, Amphetamines and Atomoxetine in 
the Treatment of Attention-Deficit Hyperactivity Disorder

Drug Saf 2010; 33: 821-842

In episode 198, we bring back Adil Virani yet again to help us work through the evidence for stimulants, which one to choose, what dose to start with, what to monitor, and how long to stay on the medications. We pay very close attention to the very end.

Show notes

1) Multimodal treatment of ADHD

Arch Gen Psychiatry 1999;56:1073-86

J Am Acad Child Adolesc Psychiatry 2001;40:168

2) What is the evidence for using CNS stimulants to treat ADHD in children?

TI Letter