Recent comments

Hi James (and Mike, although this question is probably just for James)At the end of episode 187 (Part III of the neuropathic pain segments) you mentioned a book I can access on my iPad that talks about evaluating studies. What is the title of that book? Thanks!Stacy Jardine BSc.Pharm R.PhPeace River, AB

Hi guys- I don't have an ipad- but would love access to this book...is there a PC version available?? thankyou

A Calgary CME course I attended last year suggested the use of Proferrin (heme iron) for iron replacement instead of ferrous sulphate or gluconate. The tablets are 11 mg and are better tolerated (ie. less constipation) and although they are harder to obtain (only one pharmacy I checked had them), and more expensive, patients seem to prefer them and are more compliant. 

I am a nurse practitioner working in Northern Ontario and I have been listening to your podcasts for 14 months. It has changed my practice a great deal. I have enjoyed successes in removing medications that have poor evidence for long term mortality benefit, the effectiveness and safety of low dosing, strategies in how to interpret the soundness of research literature, ways of breaking down impact and effectiveness of vaccines like Zostavax in a way that patients can make an informed choice. There is such a plethora of therapeutics topics and treatments to discuss, but you fellows consistantly select the ones that are relevant. Thanks for taking the time and sharing. I also enjoy the quirky humour and do listen to most of your podcasts while jogging and recently while weigbt lifting and never while playing soccer.

Thanks you, since I started quoting you guys and pulling out my ipad and looking at My Studies when people start talking to me about HDL and LDL levels, the drug reps have stopped bothering the receptionists, and I no longer have to look at their charts detailing drops in surrogate markers for disease. The food they brought was always pretty crappy anyway, but my lunchtimes are now gloriously free for me to do stuff that really matters like listening to another podcast whilst chewing on my fish oil capsules, taking my homepathic brain enhacing drops and polishing the bowls in my cupping equipment !  

Hello!I was just trying to get to the .pdf but it looks like the think is down again. :( Wondering if you could re-post it, once again. Thanks!

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Hello gents,Long time listener, occasional commenter. Of all the sources of medical information, yours in the most impactful and practice-changing, so BIG THANK YOU for that. My patients and residents appreciate it too!Question: My typical first-line agent for uncomplicated bacterial cystitis (aka UTI) is TMP/SMX for short course and nitrofurantoin for long course. Cipro is my 3rd or 4th line. That's about along the lines of IDSA guidelines and works for our local resistance patterns. My typical first-line agent for pyelo, however, is ciprofloxacin. All the evidence suggests that we are treating the same bug - E. coli. So why the difference in prefered first-line agents in cystitis vs pyelo? Shouldn't TMP/SMX be our go-to for both? The only explanation I've heard against nitrofurantoin is that it has "poor renal tissue penetration" so shouldn't be used in pyelo. Inquiring minds want to know!~CaseyLos Angeles, CA

Thanks this was a good podcast! More areas that would be helpful for you to wade into: use of hormonal contraceptive with women with migraine/migraine with aura and their risk of stroke! this one is totally muddy. Also, a podcast to expose the (non)risks of IUDs (ie myths around risks of infertility and how you're not supposed to use an IUD unless you've had one baby - like, because if you already have one then it's ok to become infertile ...).

Did we say actually Canada wasn't on board? Maybe it was something about it takes a while to change an entire way in which we diagnose a "chronic" condition. If I had my druthers I wouldn't call it diabetes I would just use the UKPDS risk engine to provide a wough estimate of risk associated with an Aic - for instance I would say 

You are a 42 y/o male, asymptomatic, BMI 32, SBP 130 mmHg, total Chol 5 mmoles/L, HDL 1 mmoles/L, non-smoker, newly diagnosed (1 year) diabetes - for every 1% increase in A1c your 10 year CVD risk goes up 1%.

That seems fairly clear and simple to me. Hope that helps.