Recent comments

  • Episode 274: Two new drugs that follow all our rules   5 days 12 hours ago

    Hi guys, I appreciate the podcast as always. I have become very familiar with your philosophy on new drugs since I've been a Premium Member for 7 weeks and 4 days now, and trying to listen to every single one of the podcasts. I'm on number 50 now. Anyway, I was wondering what your thoughts are on the new insulin inhaler Afrezza? I'm a bit biased because I have invested in it, but I think it could be a great option for many patients. Thanks. -Jake

  • Episode 269: The ins and outs of the HPV vaccine   2 weeks 3 days ago

    Initially I thought: "Just another ploy by industry to make money".   Finding drugs for sick people makes a little money.  FInding drugs for non-sick people (HTN, lipids) makes more money.  Finding drugs (vaccines) for EVERYONE must make TONS of money.

    But that was my bias in looking at this.  You've change my mind to thinking:  "If I'm going to use ANY vaccine, this one ought to be at the top of the list".   Thanks.

  • Episode 247: How the new anticoagulants compare to warfarin in DVTs and PEs   5 weeks 11 min ago
    TFP

    Hi guys, I can seem to access the TFP for this podcast?

  • Episode 267: PREMIUM – Guidelines, blood pressure and antiplatelets   12 weeks 4 days ago

    Hi
    Sometimes I need to stop listening to podcasts and when I try again, the program always goes back to the beginning. Is there some way to restart where last played? To go back to listen again to an important point?
    Nichole R

  • Episode 266: Questions, questions, questions PART IV   13 weeks 4 days ago

    Do you have a link to the study you mentioned that compared pt outcomes to providers' feelings on efficacy of treatment? 

  • Episode 247: How the new anticoagulants compare to warfarin in DVTs and PEs   24 weeks 6 days ago

    Link #1 is dead, FYI. 

  • Episode 258: IMPROVE-IT – ezetimibe, what it does and doesn’t do   27 weeks 22 hours ago

    Thanks for so quickly having a podcast on this!!!

    Jim

  • Episode 258: IMPROVE-IT – ezetimibe, what it does and doesn’t do   27 weeks 1 day ago

    Hey Guys,

     

    Thank you for sharing the AHA meeting slides!  Keep up the great work. 

    The one ND who listens to you guys in Issaquah,WA

  • Episode 254: Food and You – the evidence conundrum – PART III   33 weeks 2 days ago

    This is a tad belated, but congratulations are in order to both you guys for this trio of long and comprehensive podcasts. I can only imagine the amount of reading and other work which must have gone into them. It's great to have these reference lists available too.

    Now I will be much more comfortable eating poutine, Twinkies and ketchup, though not necessarily together. Looking forward to your next podcast.

     

    Paul

  • Episode 252: Food and You – the evidence conundrum   36 weeks 6 days ago

    What do you think of this doctor's site/podcasts?: http://nutritionfacts.org/

  • Episode 251: PREMIUM – a new heart failure study and much, much more   36 weeks 6 days ago

    James,

    Many hospitals are measured on % of patients with LV dysfunction that are discharged on ACE inhibitors and b blockers.  This may be why they are all added in house.

    Jim

  • Episode 250: New Studies – two podcasts for the price of one   39 weeks 11 hours ago

    Discussing the new recommendations from AMerican College of Physicians against routine screening pelvic examinations in adult, asymptomatic, average risk, non-pregnant women. THis has causd quite an uproar by gynecologists. Don't know if Canadian docs can participate in Sermo.com but the discussion is quite ugly with talk of missed ovarian cancers, missed fibroids, missed PID, etc. For example: 

    As an ob/gyn, I don't go around telling internists to not bother to listen to hearts and lungs because most of the time, you don't find anything wrong. I mean, the patient's breathing normally right?

    All this is going to do is keep my field busy in the next 15 years. Because in general, women don't know if they're asymptomatic because they aren't educated on what is normal or abnormal...

     

    There will be a small lull, then we are going to start seeing the horendiomas that I used to see when I was a young pup. You know,, fibroid uteri as big as a 20 week uterus, Ovarian "cysts" that weigh 40 pounds. 

    We had a patient when I was a resident who hadn't seen anyone for years. She had vague abdominal symptoms. Work-up finally got her to one of my attendings. Her ovarian tumor (fortunately benigh) weighed in the 20 pound range. When she was walking around the nursing station on post op day 4 (!) someone said to her that she looked like she had lost weight. Her reply? "I've been jogging>

     

    Ovarian cancer is a silent disease. Without either exam or ultrasound it can't be detected usually until it is too late. So if an ovary becomes cancerous how long does it take to spread and be fatal? Exam frequency my take this into account and prevent deaths from ovarian cancer.

    Of course there are all the other diseases and problems.

    Anything short of year visits (meaning pelvic exam and/or US) I feel is inadequate care.

     

    Without that annual exam and a little getting used to the exam and talking about all that "embarrassing stuff", us women probably wouldn't be ready to bring up the weird stuff that really IS a problem. 
    Internists don't know everything!

     

    I wonder how valid is it. Patient of mine, had some changes in her menstrual cycle and some intense cramping ith it too, by the way, she is on BCPs. In December goes to her OB for her yearly but doesn't mention anything. 
    Normal exam. In April, goes and tells him evrything. He does vaginal ultrasound which is painful. The end result is fibroid(s) and they need to be removed.

    Thanks for considering it.

  • Episode 238: PREMIUM – two new cardiovascular studies and a bit about cough   41 weeks 1 day ago

    URTI duration is something that isn't taught at all in residency. I think most residents like myself just based our estimates on personal experience and what we think sounds right. This definitely gives me a more solid foundation to stand on and say to patients, "This is still probably a virus and the week-long cough is totally normal".  Thanks!

  • Episode 210: An explosive look at probiotics for the prevention of C.difficile associated diarrhea   1 year 6 days ago

    No , that is cool, I have been supporting my patients who are offered probiotics by the local chemist recently, I can now back to me default position of encouraging them not to buy anything in a chemist's shop apart from combs and perfume. My patients need combs and perfume.

  • Episode 234: PREMIUM – Fatty acids and should you eat acetaminophen during pregnancy   1 year 8 weeks ago

    Hi there,

    nice podcast as usual!

    Please give some notes/links for your comments about specialist and their approach to studies of their field. Thanks!

    And I'd still like to hear more about medical problems in hospital, e.g. anticoagulation for venous thromboembolism (just look at this one: http://www.thennt.com/nnt/anticoagulation-for-venous-thromboembolism/ - amazing, but true?)

    Greetings from Germany

    Fabian

  • Episode 234: PREMIUM – Fatty acids and should you eat acetaminophen during pregnancy   1 year 8 weeks ago

    Thanks - the link is fixed!!

  • Episode 234: PREMIUM – Fatty acids and should you eat acetaminophen during pregnancy   1 year 8 weeks ago

    takes to annals article

  • Episode 228: PREMIUM – The new JNC8 high blood pressure guidelines dissected and exposed   1 year 16 weeks ago

    I do inform my patients of the 160 cutoff being real, but I also tell them that I don't mind that the recommendations are lower because as a parent, if I wanted my kids home at midnight I told them to be home at 11:30. 

  • Episode 228: PREMIUM – The new JNC8 high blood pressure guidelines dissected and exposed   1 year 17 weeks ago

    I was disappointed that the updated guidelines had no comment on taking blood pressure medications at bedtime.

  • Episode 227: Vaccines - how many pricks do you really need? Part III   1 year 18 weeks ago

    Hi James and Mike, (proper order of salutation): my wife recently "won" a new line of work at our hospital that involves working days, evenings and nights. She is a poor sleeper at the best of times and is worried about recovering/living through the evening shifts, any new material, pharmaceutical and non-pharmaceutical, on treating insomnia or sleep deprivation.... especially in shift workers?

    Cheers,

    Ian

  • Episode 227: Vaccines - how many pricks do you really need? Part III   1 year 18 weeks ago

     I hope that other health practioners in British Columbia don't think, from this article, that pharmacists in B.C. get this kind of reimbursement for prescritions.... Oh!, to be allowed to have mark-ups and sliding scale dispensing fees on prescriptions!! Also, be aware that the "BC" used in this article refers to (Alberta) Blue Cross, and not to Brithish Columbia.

  • Episode 195: PREMIUM – The Mediterranean cuisine cruises to another win   1 year 19 weeks ago

    Hi folks!

    I've listened to the podcast episode but am puzzled by skepticism of the combined niacin study results.

    407 subjects were culled from 4 studies with established vascular disease who had no diabetesmellitus diagnosis; had baseline fasting glucose of less than 100 mg/dL; 90% were male; mean age 58.7; BMI 27.4; 197 received ~2 g niacin daily, 210 received no niacin. Some niacin subjects received time release; some received immediate release. The onset of impaired fasting gluvose, diabetes mellitus, changes in mean proximal coronary stenosis and major cardiovascular events (including death, MI, stroke and revascularization) were measured after three years.

    While the niacin group had a higher increase in IFG vs non-niacin (9.9 vs 4.1 mg/dL), there was no statistical difference in insulin levels or progression to DM between the groups. In other words, a marker change but no harm outcome change.

    For changes in coronary stenosis, the niacin group showed no change in 3 yrs whereas the non-niacin group worsened (0.1% vs 2%). This is a positive health outcome for the niacin group.

    For major coronary events, the niacin group experienced 8% vs 21% for the non-niacin. This again is a postivie health outcome for the niacin group.

    Doesn't this suggest that, for patients not wishing to use a statin, that niacin should, in fact, be encouraged? And that further studies would be worth pursuing?

    Thanks,
    Alexander Inglis
    In Toronto 

  • Episode 220: Confusing confidence intervals   1 year 20 weeks ago

    After listening to you discuss results that fall very close to significance or not, and how do we interpret this, I thought this recent comment in Nature's Spinal Cord might be of interest:

    http://www.nature.com/sc/journal/v52/n1/full/sc2013117a.html?WT.ec_id=SC...

    Cheers,

    James Telfer

  • Episode 217: Shining a bright light on the Vitamin D evidence   1 year 24 weeks ago

    Any comments on Vit D levels and supplementation in pts with MS? Specifically reducing exacerbations and slowing dz progression?

  • Episode 221: Finally getting the cholesterol guidelines right – almost   1 year 26 weeks ago

    Hi guys,

    Thanks for the nice update of the new American guidelines. Glad to hear that evidence is starting to prevail. I do want to take slight issue with your discussion of one of the subgroups recommended for statin therapy by the guidelines, i.e. those with high LDL levels. Mike made the point of using global risk stratification as opposed to just the LDL level (which James rightly pointed out isn't part of our standard calculators), however my impression is that the guidelines are targeting those with familial hypercholesterolemia, who may have isolated high LDL without any other obvious risk factors, and for whom the risk calculators are probably underestimating their lifetime risk. (According to the 2006 CMAJ review of FH linked below, risk of CAD by age 60 is 30-60%.) That said, without a positive family history or tendon xanthomas (or other weird and wonderful clinical signs), I agree that it's tough to justify treatment based on LDL level alone. 

     

    Also, thanks for pointing out the variability in the outcomes being predicted by various CV risk calculators. When I started using my EMR and its built-in "Framingham calculator," I was surprised at how high the predicted 10 year risk was for some of my patients. After a little digging, it turned out the calculator included a lot more than just the usual "hard" outcomes. I'd urge everyone using a similar EMR-based calculator to either look into what you're actually calculating, or use a specific calculator that you trust. 

     

    Ed

     

    1. Yuan et al. CMAJ - 2006 - http://www.cmaj.ca/content/174/8/1124.full.pdf.