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 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

Episode 41: Obesity – what’s the big deal?

In episode 41, we start to tackle the big problem of obesity by getting the advice of 2 Mikes for the price of one. We discuss how classification is more useful from an epidemiologic perspective than it is from an individual patient perspective – which is often the case in medicine. In the end, the team heads to a local fast food restaurant to verify the evidence for caloric binging.

Show Notes

1) Depression and obesity

Synopsis of the 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children.

CMAJ 2007;176(8 suppl):S1-13

2) Obesity and increased mortality

Ann Intern Med 2003;138:24-32

3) Being a little bit overweight is OK

JAMA 2007;298:2028-2037

Lancet 2006;368:666-78

J Am Geriatr Soc 2005;53:2112-8

4) Metabolic syndrome – who cares?

Metabolic syndrome classification predicts CVD risk no better than just using the regular CVD factors like age, sex, cholesterol, blood pressure, diabetes etc.

Diabetes Care 2006;29:1693

Framingham risk score was a better predictor of CHD and stroke than the metabolic syndrome

Arch Intern Med 2005;165:2644-50

Episode 40: Keeping up with the medical literature – 101

In episode 40 we discuss 4-5 different and fairly simple ways to keep up with the medical literature and we both come to the conclusion that the best way to keep up is to listen to these podcasts. Unfortunately we were unable to find any evidence to support such a belief. Mike critically appraises James and finds a number of fatal flaws in his design.

Show Notes

1) InfoPOEMS http://www.essentialevidenceplus.com/product/features_dailyip.cfm

2) ACP journal club http://www.acpjc.org

3) Evidence-based medicine http://ebm.bmj.com

4) Quickscan reviews http://www.cmeonly.com/QSR/qsrdemo.html

5) NetNewsWire – RSS reader for Mac users http://www.newsgator.com/INDIVIDUALS/NETNEWSWIRE

6) Amedeo http://www.amedeo.com

Episode 39: New trials you need to know about – Part II

In episode 39 we get to the 4 studies we didn’t get to in the previous podcast. We discuss evidence that BMI is as useful as cholesterol when it comes to estimating cardiovascular risk, inhaled corticosteroids increase risk of pneumonia in patients with COPD – but don’t worry just put them on daily erythromycin – and finally we discuss yet another antihypertensive trial. Mike demonstrates some sensitivity approaches to medicine in general and James ignores him.

Show Notes

1) BMI predicts risk as well as knowing a patient’s cholesterol

Lancet 2008;371:923-31

2) Meta-analysis of inhaled corticosteroids in COPD – no difference in mortality, reduction in exacerbations but pneumonia was increased by 4% (absolute) over a period of a year

JAMA 2008;300:2407-16

3) Erythromycin 250 mg BID for one year compared to placebo – exacerbations reduced to a similar degree as to that seen with inhalers

Am J Respir Crit Care Med 2008;178:1139–47

4) ACCOMPLISH – Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients

N Engl J Med 2008;359:2417-28

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