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Hi there .

Love your podcasts.

I am interested whether Mike's statement that caffeine is a bladder irritant is valid though? What is the evidence base for this? Is the urinary frequency simply indicative of the volume of liquid taken when drinking coffee or is it the fairy dust effect of coffee on the transitional epithelium of the bladder?

Many Thanks,
Mick Tarry

Hi Jim or James :) - It is great to here that something we have done has got you excited about evidence again - we hear from so many people that incorporating evidence and patient preferences into practice brings back the art of medicine. It's a heck of a lot more rewarding.

James and Mike (or Mike and James?)

Thanks for the way you tackle the trials. You got me excited about evidence based medicine again and I am glad I am now a premium member. I saw you guys in Illinois a couple of years ago at VA program and have been listening to podcasts since.

Thanks!!! Jim

Hi Melanie - sorry I missed that one. The reference is

BMJ 2010;341:c6273

Vitamin B for 4.7 years lowered homocysteine and had no effect on overall cardiovascular events. It actually increased mortality by 2.2%.

Hi Lea - our pleasure - it comes easy - except the irreverent part which we really have to work at. :)

Hi Karen - according to the study "more bread, more root vegetables and green vegetables, more fish, less meat (beef, lamb, and pork to be replaced with poultry), no day without fruit, and butter and cream to be replaced with margarine supplied by the study. Because the patients would not accept olive oil-traditional to the Mediterranean diet-as the only fat, a rapeseed (canola) oil-based margarine was supplied free. The oils recommended for salads and food preparation were rapeseed and olive oils exclusively. Moderate alcohol consumption in the form of wine was allowed at meals"

Sounds very tasty to me - except I like butter.

Making sure our students are educated and competent is our primary role as teachers.  We try to pass on the core elements of the topics and we try hard to provide appropriate knowledge and skills. We ultimately do this not just for our students, but for the public our students will ultimately care for. Captivating students to enhance their learning, without distracting from the content, can often be a useful tool. There are all sorts of ways to captivate students - they range from fear of exams to humour and all in between. In these circumstances, many programs have found games, educational exercises and at times humour, to be helpful. Hope that helps and we just try to do the best we can.

Have you heard of spacing the time of the ACEI and the beta blocker by 2 hours.

Particularly in pain and insomnia placebo often has a success-rate of upwards of 20% and in other fields a NNT of 5 would be quite spectacular. But we are not supposed to lie to patients and therefore the use of placebo is frowned upon.
Is it ethically better to prescribe a (possibly expensive) medication with possible side effects in the full knowledge that it will probably work no better than placebo, rather than a cheap and harmless placebo tablet? And yes, I know that placebos have side effects too.
Please discuss

Love the show
Ralf

Hi Sue - thanks - glad you enjoy the podcast - I'll fire this off to Mike and add it to our "evidence" pile 

Hi Mike & James,

Love the podcast...find it great listening in the car on the way to work!

Sure you've come across this study already (http://www.npc.nhs.uk/rapidreview/?p=4119), would seem that patient pain is definitely worth close consideration in terms of the potential positive impact of its treatment on adverse behavioural aspects of dementia and the fact that paracetamol, one of the relatively safer drug interventions in the patient population most affected (the frail elderly), can be effective!