Episode 79: Listener comments and questions with an attempt at answers
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In episode 79, Mike and James get back to trying to answer questions posed by our wonderful listeners. We both, in our own minds, give wonderful, thoughtful and sensitive answers to issues associated with diabetes, statins, metformin, strep throat etc. Unfortunately, our producer Chris edited all these out and you are left with a lot of ranting and raving from the duo.
Comments
I too listen to the podcasts
I too listen to the podcasts while jogging, although today I listened during my time at the dental hygienist - which was more excruciating, you might ask?! Seriously, I find them very practical and relevant to our day to day decisions in family medicine, so thank you! It seems a no-brainer to learn from non-industry funded routes. Although I know the statin numbers for primary prevention, from your excellent reviews, I find myself trying to determine an individual's likely benefit from statins by reviewing their cardiac risk factors. If a fat smoker with a strong family history of heart disease comes in, I am more likely to encourage a statin than for someone in a lower risk group. Are there any studies that look at CVD outcomes by using (dare I say) a common sense approach like this, rather than chasing the numbers/lab tests? Is this a reasonable approach? Thanks.
Low doses vs Evidence for higher dose statin
I really enjoy the podcast. You two make an interesting team and I appreciate the sense of humor.
I have to say though, I think James sometimes overemphasizes the low dose thing. Please correct the following if I have misunderstood this in any way:
On this podcast in particular, there was a discussion about a particular statin which was found to be beneficial in a certain trial at 80mg. I fully agree that most of the benefit comes from starting that initial 10mg dose and working up and avoiding any side effects along the way. The trick in this trial though is that the "evidence" shows most benefit at the 80mg dose. My feeling would be that if a patient can tolerate an increasing dose of this statin after starting at 10mg, the best evidence shows that the goal is 80mg. James made a comment about how the difference in effect between a mid dose of 40mg and the 80mg dose would likely be minimal, and that if he were in the position to start on a statin he would start low and end on a mid dose (which I assume he meant 40mg). That is a reasonable personal statement to make that fits with his philosophy of low doses, but the evidence was for 80mg, and not the mid dose (40mg?) that he recommended. I find this a bit at odds with the whole philosophy of EBM because there is clearly evidence for the 80mg dose and yet he decides that a dose somewhere in the middle is what he would actually work with in clinical practice.
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