TEC: Evidence Based Therapeutics
Therapeutics Education Collaboration
Medication Mythbusters – Home of the Best Science (BS) Medicine Podcast

The BS Medicine Podcast episodes are presented by James McCormack and Michael Allan. We try to promote healthy skepticism and critical thinking and most of the podcasts are presented in a case-based approach. We also try to inject some humour into the whole process to make the learning more interesting. Occasionally we have great guests like Mike Kolber, Tina Korownyk and Bruce Arroll help us out.

Most podcast episodes are available for free until they become archived after about 1-2 months. Every 4th episode or so is a “New Studies You Need to Know About” podcast and these will only be available to our Premium Podcast members. Premium members will also be able to listen to all archived episodes since episode #1.

Episode 51: More useful clinical trials – with a gentler touch – Part II

In episode 51, we again bring in the charming Dr. Tina Korownyk to help us work through 4 more recent studies that hopefully will have relevance to your practice. We find out that Vitamin B12 works for apthous ulcers, inhaled corticosteroids should be continued in pregnancy, that NSAID risks can be reduced – but not to zero, and an ARB (telmisartan) provides no benefit when given to stroke patients. Finally, it is revealed that Mike and James have very limited absolute charm.

Show Notes
1) Apthous ulcers – sublingual Vitamin B12

J Am Board Fam Med 2009;22:9 –16

2) GI protection for NSAIDs

Am J Gastroenterol  2009; 104:728-38

3) Asthma control in pregnancy – OK to use inhaled corticosteroids

Ann Allergy Asthma Immunol 2008;101:137–43

4) Telmisartan for stroke – no benefit

N Engl J Med 2008;359:1225-37

Episode 50: More useful clinical trials – with a gentler touch

In episode 50, we talk about 4 more clinical trials that might help you in your practice. We cover topics ranging from fever control with acetaminophen or ibuprofen, injections for rotator cuff injuries, diabetes, and osteoarthritis. Mike and James finally bring in a much needed female flavour to the show, by asking Dr. Tina Korownyk to help out with the evaluation of these studies. Unfortunately we quickly realise that the past 49 shows have, much to our chagrin, lacked any significant sex appeal.

Show Notes

1) Treatment of fever with acetaminophen, ibuprofen or both

BMJ 2008;337:a1302

Arch Pediatr Adolesc Med 2004;158:521-6

Lancet 1997;350:704-9

J Pediatr 1989;114:1045-8

2) Rotator cuff injections – do they need to go in the shoulder

BMJ 2009;338;a3112

3) Diabetes is NOT a CHD risk equivalent

Diabet Med 2009;26,142–8

4) Resistance/strength training for osteoarthritis

Arthritis Care Res 2008;59:1488–94

Episode 49: Becoming less anxious about anxiety disorders – Part II

In episode 49, we continue on from the previous anxiety ladened podcast, and cautiously delve into the whole area of treatment options for anxiety disorders. Mike and James do this by once again cautiously delving into the complex mind of our psychiatry colleague, Dr. Adil Virani. We end up with great advice but get no further insight into how men’s brains work – if in fact they do.

Episode 48: Becoming less anxious about anxiety disorders

In episode 48, we again invite our psychiatry colleague Adi Virani to talk about the important area of anxiety disorders. Mike and Adil talk about the 6 most common conditions and we find out 25% of the population have some sort of an anxiety disorder. Fortunately, there were only three of us on the podcast so James decides the one who must have an anxiety disorder is our good friend Bob Rangno.

Episode 47: The April Fools’/Happy 1st Anniversary Podcast

Mike and James celebrate their first anniversary by inviting a good friend and colleague Bob Rangno back to the podcast. We talk about things in medicine that drive us crazy and at the end we come to the conclusion laughter is the best medicine. We then write a Laughter Guideline and outline exactly how patients should laugh, when they should laugh and how often they should laugh.

Show Notes

1) The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years?

J Urology 2004;172:1297-1301

2) Do you need sterile gloves when suturing a wound?

Ann Emerg Med 2004;43:362-70

3) Using tap water to irrigate a wound

Cochrane Library 2008

4) Lubricating a speculum is OK

Obstet Gynecol 2002;100:889-92

5) Reassessment of Clinical Practice Guidelines – Go Gently Into That Good Night

JAMA 2009;301:868-9

6) The evidence behind the guidelines

JAMA 2009;301:831-41

Episode 46: High quality information on drug safety – Special Guest Dr. Bruce Psaty

In episode 46 we speak with one of the gurus of drug safety, Dr. Bruce Psaty, to get some insight on the whole issue of identifying the good and bad things that drugs can do. We come to the conclusion that high quality information is ultimately what is needed if we are to understand what drugs can and cannot do. Both Mike and James lament on their ability to produce high quality information.

Episode 45: Practice Changing Articles – with Double the Mikes Part II

In our 45th episode, we review a few more practice changing studies with Dr Mike Kolber. We go through the renal outcomes of a large trial of ACE or ARB or together, the benefits of medical therapy to pass of renal stones and then we journey into another evidence void to review the most recent antibiotic prophylactic guidelines from NICE (UK) and the US. At the end James tries to sort out which Mike is the expert and which one is just opinion, and he can’t so he enrolls them both in an RCT without their consent.

Show Notes

1) Renal outcomes with ACE & ARB (alone or combined).

Lancet 2008;372:547-53.

Canadian Hypertension Education Program (CHEP) urges physicians NOT to combine ACE & ARB

2) Medical therapy for renal stone passage.

Ann Emerg Med 2007;50:552-63

Lancet 2006;368:1171-9

3) Antibiotic Prophylaxis for Infective Endocarditis

J Am Coll Cardio 2008;52:676-85

Heart 2008;94;930-1

Who gets prophylaxis

  • US: dental procedures with manipulation of either gingival tissue, the periapical region of teeth or perforation of the oral mucosa
    1. Prosthetic cardiac valves or prosthetic material used for cardiac valve repair
    2. Previous infective endocarditis.
    3. Congenital heart disease (CHD – see below for clarity)
    4. Cardiac transplant recipients with valve regurgitation due to a structurally abnormal valve.
  • “Patients with CHD. (Level of Evidence: B)
  • Unrepaired cyanotic CHD, including palliative shunts and conduits. (Level of Evidence: B)
  • Completely repaired congenital heart defect repaired with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure. (Level of Evidence: B)
  • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (both of which inhibit endothelialization). (Level of Evidence: B)”

Episode 44: Practice Changing Articles – with Double the Mikes

In Episode 44, we review another collection of practice changing articles and are joined by Dr. Mike Kolber. The first case and study considers the use of metformin in gestational diabetes and the trial leads to a longer discussion of the challenges of prescribing in pregnancy. The second case and study concerns the use of ondansetron for vomiting in pediatric patients. James interrupts the two Mikes frequently but never knows which one.

Show Notes

1) Metformin for gestational diabetes

NEJM 2008;358:2003-15

2) Glyburide for gestational diabetes

NEJM 2000;343:1134-8

3) Persistent pulmonary hypertension of the newborn

NEJM 2006;354:579-87

4) Risk of depression relapse in pregnancy

JAMA 2006;295:499-507

Lancet 2003;361:653–51

5) Vomiting in kids and ondansetron

Arch Pediatr Adolesc Med 2008;162: 858-65

Dosing: Ondansetron usually 1 dose: IV 0.15-0.3 mg/kg or oral 2-8 mg (range based on weight) or 1.6-4 mg (range based on age)

Episode 43: Obesity – what’s the big deal? – Part III

In episode 43, we take our last run/jog at the problem of obesity by exercising our right to talk about the benefits of increasing activity. James tells the listening audience that Mike is 5’ 6” and weighs 250 lbs and Mike demonstrates to James how to become more active by chasing him around the studio with a hockey stick – but only metaphorically speaking, as Mike lives in Edmonton and James lives in Vancouver.

Show Notes

1) Latest NEJM paper on different “diets”

NEJM 2009;369:859-73

2) Activity-related benefits – morbidity and mortality

Arch Intern Med 2007;167:2453-60

JAMA 1995; 273:1093-8

Circulation 2008;117:614-22

JAMA 2003;289:2379-86

NEJM 2002;347:716-25

3) Other activity benefits

Cochrane Database SystRev 2002:CD003404

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

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

Cochrane Database SystRev. 2008;CD004366

Cochrane Database SystRev. 2008;CD004376

4) Impact of exercise on weight

JAMA 2003;290:1323-30 JAMA 2003;289:323-30

5) Exercise versus angioplasty

Circulation 2004;109:1371-8

6) Do patients adhere?

NEJM 2002;346:393-403

7) Write a prescription for lifestyle – reminders etc

J Fam Pract 2000;49:158-68

Am J Public Health 1998;88:288-91

8) Pedometers

JAMA 2007;298:2296-2304

Episode 42: Obesity – what’s the big deal? – Part II

In episode 42, we continue to take a bite out of the big problem of obesity by getting down and dirty with “diets” and drugs. As usual, lifestyle issues win out and James and Mike celebrate this news by pigging out – but it’s OK because we used small plates.

Show Notes

1) Lifestyle beats out drugs

Stopping patients with IGT going to DM

Metformin, acarbose, rosiglitazone: NNT = 7-14 (?)1-4

Lifestyle NNT= 4-9 1,5,6

Developing the metabolic syndrome 7

Metformin vs Lifestyle NNT: Resolve = 20 vs 5

IGT to DM long-term

7 years 8 (3 yrs without intervention): NNT = 32/yr

20 years 9 (14 yrs without intervention): NNT 7 (or 140/yr) with 93% vs 80% DM

References for the above

1. NEJM 2002;346:393-403

2. Lancet 2002;359:2072-7

3. Diabetes Care 2006;29:2095-101

4. Lancet 2006;368:1096-105

5. Diabetes Care 1997;20:537-44

6. NEJM 2001;344:1343-50

7. Ann Intern Med 2005;142:611-19

8. Lancet 2006;368:1673-79

9. Lancet 2008;371:1783–89

2) Little evidence for any one commercial diet over another

Ann Intern Med 2005;142:56-66

Am J Med 2005;118:991-7

Obesity 2007;15:421-9

JAMA 2004;292:2482-90

Int J Obes 2004;28:1349-52

3) No difference if you eat fat or protein or carbs

Int J Obes 2006;30:552-60

Arch Intern Med 2006;166:1466-75

Am J Clin Nutr 2005;81:1298-306

Arch Intern Med 2004;164:210-7

J Int Med 2007;261:366-74

Am J Clin Nutr 2006;84:813-21

JAMA 2003; 289:1837-50

Cochrane 2002;2:CD003640

JAMA 2007;297:969-77

Int J Obes 2004;28:1283-90

Ann Intern Med 2004;140:778-85

N Engl J Med 2008;359:229-41

4) Top 10 tips for weight loss

Int J Obesity 2008;32:700–7

5) Smaller plates

Arch Intern Med 2007;167:1277-83

6) Drugs for weight loss Sibutramine and orlistat

Diabetes Care 2007;30:27-32

JAMA 2001;286:1331-9

J Intern Med 2000;248:245-54

Fluoxetine vs sibutramine or orlistat

Arch Intern Med 2004;164:1395-404

Cochrane 2004;3:CD004094

Ann Intern Med 2005;142:532-46

7) Surgery for weight loss

Ann Intern Med 2005;142:547-59

Int J Obes 2006;30:129-33

Ann Intern Med 2006;144:625-33

Cochrane 2003;2:CD003641

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