In episode 130, Mike and James run directly into the face of the evidence around exercise and really sweat out the weightiness of the results. We actively find out that it’s primarily all about quality of life, and that Mike bikes and James rollerblades to keep themselves as close to perfect physical specimens as possible. At the end we find out they also both take medications for delusions of grandeur.

Show notes

1) Activity-related benefits

Cochrane 2002;(4):CD003404

J Gerontol A Biol Sci Med Sci 2008;63:997-1004

J Sports Med Phys Fitness 2007 Dec;47:462-7

Cochrane 2008 Oct 8;(4):CD004366

Cochrane 2008 Oct 8;(4):CD004376

Arch Intern Med 2007;167:2453-60

JAMA 2003;289:2379-86

NEJM 2002; 347 (10): 716-25

JAMA 1995; 273 (14): 1093-8

Circulation 2008;117: 614-22

PLOS 2008; 5(1): e12

2) Quality of life and dose response

Arch Intern Med 2009;169:269-78

Circulation 2010;122:743-752

Br J Sports Med 2008;42:238–43

NEJM 1999;341:650-8

Eur J Epidemiol 2009;24:181–192

3) Exercise for overall benefit not on surrogate markers

J Appl Physiol 2008;105:766–8

4) RCT evidence on exercise

Circulation 2004;109:1371-8

Am J Med 2004;116:682–92

5) Motivating patients

JAMA 2007;298:2296-304

Res Q Exerc Sport 2009;80:648-55

Int J Behav Nutr Phys Act 2008;5:44

Diabetes Care 2009;32:1404-10

Arch Intern Med 2007;167:2453-60

JAMA 1995;273:1093-8

Ann Fam Med 2008;6:69-77

Am J Public Health 1998;88:288-91

In episode 129, we get back to giving our listeners PREMIUM content and we end up spending the entire time talking about drugs that, in theory, make you pee – and you wonder why we call this a PREMIUM podcast. We discuss a synopsis of an old drug hydrochlorothiazide and then we discuss the most recent clinical trial of the new aldosterone antagonist eplerenone. The podcast comes to an abrupt end when, because of either the topic or the coffee, both Mike and James have to leave to leave to attend to more important matters.

Show notes

1) Hydrochlorothiazide – what is the evidence for its use?

J Am Coll Cardiol 2011;57:590-600

2) Eplerenone – EMPHASIS-HF study

N Engl J Med 2011;364:11-21

3) Aldosterone antagonist systematic review

Euro H J 2009;30,469–77

In episode 128, James and Mike finally get to the last of the listener questions We discuss codeine and cough, Vapor Rub; we talk about the PREMIUM podcast, otitis media and antibiotics, atrial fibrillation and low dose statins. We then both collapse from exhaustion yet promise to get back to making premium podcasts as soon as possible.

Show notes

Codeine and cough

Can Fam Phys 2010;56:1293-4

Cochrane Library

In episode 127, Mike and James attempt to answer questions about topical NSAIDs, bleeds on NSAIDs and SSRIs, Strep throat, statins in the UK, and NSAIDs and CVD risk. They smish and smash all the available data into partly coherent answers, yet give definitive and dogmatic answers with the conviction of a dog with a bone or a cardiologist with a statin.

Show notes

1) SSRIs and bleeds

Alimentary Pharmacology & Therapeutics 2008;27:31-40

Arch Intern Med 2003;163:59-64

2) Dipstick urinalysis

In women with dysuria, frequency, and no vaginal discharge the probability of UTI is 96%

JAMA 2002;287:2701-10

In episode 126, James and Mike discuss how to do a drugectomy and why one needs to consider evidence, efficacy, side effects, cost, patient preference and that as clinicians we need to do many “n of 1” trials. We then discuss the concerns around dabigatran and what to do about bleeding on this agent and why the FDA made the 150 mg dose the chosen one. We also provide commentary on how long we need to give antibiotics and if you really need to take them until they are “all gone”. At the end we advise listeners to only listen to the podcasts until they feel better and then stop before they get any side effects like annoyance or frustration.

Show notes

1) Dabigatran and the FDA – why 150 mg?

NEJM 2011;364:1788-90

In episode 125, Mike and James get back to the listener questions and discuss calcium, probiotics, and clopidogrel. By the end of the podcast Mike threatens to jump out of a 17 story building unless he gets a high fat meal with some caffeine. Out of respect for Mike’s surrogate markers James steals Mike’s Egg McMuffin and coffee and eats it himself. 

Show notes

1) Calcium and MI

BMJ 2011;342:d2040

2) Probiotics for acute infectious diarrhea

Cochrane review

2) Clopidogrel

N Engl J Med 2010;362:1374-82

N Engl J Med 2010;362:1441-3

Ann Pharmacother 2008;42:550-7

Arch Intern Med 2007;167:1593-9

N Engl J Med 2007;357:2001-15

3) Clopidogrel Guidelines

NHS 2007 Northwest London Cardiac Network:

Bare Metal: 1 month

Drug Eluting Stent: 12 month

American College of Chest Physicians (2008)

No stent: 12 months

Bare-metal: 12 months

DES: 12 months (or more with no contraindications)

Veterans Affairs (August 2009)

Bare Metal: 1 month minimum, up to 12 months

DES: 12 months – or longer duration if

No bleeding risk and “complex anatomy” 

Stent thrombosis indefinite unless bleed risk

4) Prasugrel

N Engl J Med 2007;357:2001-15

5) High fat followed by caffeine

No comment!!!!

In episode, 124 James and Mike go all PREMIUM on the podcast and provide our wonderful PREMIUM subscribers with information that will make them much better health care practitioners than those listeners who are not PREMIUM podcast subscribers. They discuss definitive studies on childhood asthma, COPD and calcium yet at the end they still do not come up with definitive answers and question the PREMIUM nature of this podcast.

Show notes

1) In children with asthma – can you stop inhaled corticosteroids?

Lancet 2011;377:650-7

2) Calcium – yet another study showing maybe it isn’t all it was cracked up to be

BMJ 2011; 342:d2040 

3) Tiotropium or salmeterol for COPD?

N Engl J Med 2011;364:1093-1103

In episode 123, Mike and James chew on and regurgitate all the diet data that’s fit for consumption. They figure out that all diets have similar average effects on weight but that only the Mediterranean diet has any evidence of benefit in reducing cardiovascular outcomes. To celebrate this new found knowledge we both celebrate by eating 4 pounds of bacon (tofu bacon for James) dipped in olive oil.

1) Tools for Practice

Is any diet better for weight loss or preventing negative health outcomes?

2) Low glycaemic index or low glycaemic load diets for overweight and obesity 

Cochrane Library

3) Low fat, low carb vs Mediterranean

N Engl J Med 2008;359:229-41

4) 4 different diets (varying concentrations of carbohydrate, protein and fat)

N Engl J Med 2009;360:859-73

5) Cohort data – increased mortality with low carb diets especially if protein and fat from animal sources

Eur J Clin Nutr 2007;61:575-81

Ann Intern Med 2010;153:289-98

6) Very low calorie diets

Obesity 2006;14:1283-93

Obesity 2008;16:2456–61

7) Mediterranean diet evidence

Lancet 1994;343:1454-59

Ann Intern Med 2009;151:306-14

Lancet 2002;360:1455–61

BMJ 2008;337:a1344

Hi Everyone: Well we tried to get back the “lost” recordings but the cost of doing so would have offset the debt of a small country. Mike and I will be back in the luxurious TEC studies next Monday so we should be able to put out a new podcast sometime next week. Thanks for you patience.

Hi Everyone. Mike and I recorded a couple of podcasts 4-5 days ago and 2 hours after recording them the computer we used had a major hard drive failure. So far we have been unable to recover the recordings. We have a few more tricks up our sleeve to recover the files but we can’t do anything until after the Easter holidays. Hopefully we’ll get the next latest and greatest (at least in our minds) podcasts posted next week sometime. If we can’t recover the data, we’ll have to re-record them and so it may take a little longer. Thanks and both of us hope you have a good time with family and friends over this long weekend and as always thanks for listening.