In episode 166, James and Mike battle the issue of low dose statins, high dose statins and also traffic noise to try to figure if we should consider high doses of statins. We discover that bigger is better but that a lot bigger ends up being just a little bit better.
Show notes
1) Tools For Practice
How does high dose statin compare to low dose in people with heart disease?
In episode 165, Mike and James talk about how should we diagnose type 2 diabetes and should we use A1c, FPG or OGTT or a magic crystal ball. At the end we come to the conclusion that you need to realize the vagueness of the diagnosis so you can be specific in your recommendations.
Show notes
1) Tools For Practice
Hemoglobin A1c for the diagnosis of Type II Diabetes
2) ESRD and Blindness risk
In episode 164, Mike and James finally get to another PREMIUM episode and boy is it ever premium. We discuss the latest HDL raising drugs, ASA after a DVT, and a new meta-analysis of metformin. With our usual skill, alacrity and boyish charm we give all our premium listeners their monies worth with practice changing evidence.
Show notes
1) Dalcetrapib (HDL raising) study stopped due to no benefit
2) Genetic HDL – no reduction in heart disease
Lancet doi:10.1016/S0140-6736(12)60312-2
3) WARFASA – Aspirin for Preventing the Recurrence of Venous Thromboembolism
4) A new metformin meta-analysis – is it good or bad?
PLoS Med 9(4): e1001204. doi:10.1371/journal.pmed.1001204
In episode 163, Mike and James race to the end of their in-depth look at critical appraisal and as they get to the end their final kick is at some of the problems seen with meta-analyses. We discuss examples of how meta-analyses sometime go wrong and we do our best to make them right – with varying degrees of success.
Show notes
1) Glucose lowering meta-analysis
Ann Intern Med 2009;151:394-403
2) Beta-blocker meta-analysis
3) PSA screening
BMJ 2010;341:c4543 doi:10.1136/bmj.c4543
3) Statin meta-analyses on mortality effect in primary prevention
RR 0.88 (0.81-0.96)
Arch Intern Med 2010;170:1024-31
RR 0.91 (0.83-1.01)
Arch Intern Med 2005;165:725-30
RR 0.86 (0.76 -0.99)
Arch Intern Med 2006;166:2307-13
RR 0.92 (0.84-1.01)
J Am Coll Cardiol 2008;52:1769-81
RR 0.93 (0.87-0.99)
4) Back pain meta-analysis
In episode 162, Mike and James decide to tackle the whole concept of meta-analyses and try their very best to shine a clear light on this important concept. By the end they have brought up so many different valuable points that they decide to add them all together to make their own misleading and deceptive meta-analysis.
I just realised (thanks listeners) that the last podcast posted (Episode 161) was missing Mike’s vocal track. AHHGG. I’ve reposted the podcast and I think the problem is fixed. The irony is at the beginning of the podcast I mention that because of Skype the quaity of Mike’s audio is a little bit off in a few spots. In a case of double irony, many people felt the podcast without Mike’s track was the best one we have done so far. Just kidding Mike 🙂
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In episode 161, James and Mike finally get to the end of a very long series about how do a quick critical appraisal of an RCT. We talk about evaluating the harms found in the study and then discuss how to put the findings into context for an individual patient. At the end we conclude that the only well done and important studies to ever be published are the ones we have done and we leave it at that.
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In episode 160, Mike and James continue to tackle the issue of critical appraisal head on with an even more common-sense approach than the last episode. We talk about ignoring much of the text in the study, how to look at baseline characteristics and how to decipher the information provided in the outcomes table.
Show notes
The ACCORD study
N Engl J Med 2008; 358:2545-59
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In episode 159, Mike and James decide to tackle the issue of critical appraisal head on with a common-sense approach. We talk about why we need to do critical appraisal, how to save time by doing a quick scan of the abstract and how to search, identify, and deal with potential sources of bias. At the end we critique each other and find out that we are both packed full of bias but also loaded with high quality outcomes.
Show notes
1) The ACCORD study
In this second very special episode our good friend Bruce Arroll comes back to discuss all sorts of issues around insomnia. We learn all about the evidence and an interesting and very effective treatment that uses the concept of restriction of time in bed. Both of us fall asleep during the podcast but at the end realize it in no way interfered with the content.
THE NUTRITION PROPOSITION BOOK
Check it out at nutritionproposition.com and think about picking up a copy on Amazon. All the evidence you ever wanted about nutrition and the only nutrition book that won’t tell you what to eat.
