Therapeutics Education Collaboration

Episode 78: The frail elderly – treat symptoms first, last and in the middle – Part III

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Tue, 09 Mar 2010 20:54:37 +0000

In episode 78, the final one on the frail elderly, Mike and James, with John Sloan, deal with what is really important to the frail elderly, and that is symptom control. We discuss pain and opioids, sleep and benzos, and combativeness and whatever seems to work – but all in very low doses. To cap [...]

Episode 77: The frail elderly – blood pressure is good – Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Tue, 02 Mar 2010 16:14:42 +0000

In episode 77, Mike and James stop waxing philosophically and get specific about therapeutics and the frail elderly. Once again we get our friend and colleague John Sloan to help us navigate through this evidence-free zone. We specifically talk about how to deal with the patient on 47 drugs and what to do about blood [...]

Episode 76: The frail elderly – “philosophy first” – Part I

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 24 Feb 2010 18:42:41 +0000

In episode 76, Mike and James explore the topic of the treatment of the frail elderly. To do this properly, we bring in an “expert”, Dr John Sloan, who has spent the majority of his practice driving to the homes of the frail elderly and taking care of them. In the first of three episodes [...]

Episode 75: Starting insulin and stopping pain or is it stopping insulin and starting pain?

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Tue, 16 Feb 2010 22:43:45 +0000

In episode 75, Mike and James get together with Tina one more time to talk about two topics that have nothing to do with each other (starting insulin in type II diabetics and treating acute musculoskeletal pain in children). However, through the magic of podcasts we transition seamlessly from one topic to the other without [...]

Episode 74: Vitamin A, B, C, NOT D, and E – not all letters are created equal

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 10 Feb 2010 08:11:09 +0000

In episode 74, Mike (Bert) and James (Ernie), along with Tina (Betty Lou) continue their stroll down medical Sesame Street and take a look at the evidence behind Vitamins (Letters) A,B,C, and E. Lo and behold, they find that not all letters are created equal and some are even quite bad. At the end, both [...]

Episode 73: Vitamin D – dose, diet and dermatologists – Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Tue, 02 Feb 2010 21:10:29 +0000

In episode 73, we try to put Vitamin D levels into context and Tina Korownyk once again is here to help us decipher the evidence for Vitamin D supplementation when it comes to fractures, falls and overall mortality. At the end of the podcast Mike, James and Tina don their swim gear and go outside [...]

Episode 72: WE’RE BACK with Vitamin D, vim, and vigor

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 28 Jan 2010 05:58:14 +0000

In episode 72, we find out what Mike has really been doing for the last 3 months by testing his Vitamin D level and finding it to be abnormally high. This leads us, along with our always charming guest Dr. Tina Korownyk, to a discussion of the proper use of Vitamin D levels and what [...]

An update, some gingerbread, drug levels, and more “wineing” please!

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Fri, 18 Dec 2009 07:24:55 +0000

In this pseudopodcast, James let’s you know what is likely going to be happening with the podcasts and Bob and James, with limited success, make pharmacokinetics and drug levels interesting. Show Notes 1) Aminoglycoside levels and the lack of evidence Clin Inf Dis 1992;14:320-9 Pharmacotherapy 2000;20:1524-7 2) Alcohol and PK J Phar Exp Ther 1971 178:567-79 Br J Clin Pharmacol 1981;12:667-73 3) A [...]

Episode 71: PBS, PSA and YOU – a plea, a pledge and a prostate

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 21 Oct 2009 20:00:11 +0000

In episode 71, James starts off with a plea for a pledge and then the “Two Mikes” discuss the whole issue of what to do with the new evidence around PSA screening. We find out that if you believed in it before you’ll likely continue believing and if you didn’t believe in it you will [...]

Episode 70: More studies you need to know about – Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 14 Oct 2009 20:08:58 +0000

In episode 70, we continue with the “Two Mikes” and discuss a number of issues surrounding asthma treatment. We debate back and forth on the use of LABAs and their use alone or in combination and then come to complete agreement on the duration of prednisone for acute exacerbations. During the podcast James tries to [...]

Episode 69: More studies you need to know about

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 07 Oct 2009 20:46:21 +0000

In episode 69, the “Two Mikes” are back at it and they use their mics to dispense some really great prescriptive advice for patients with asthma and no heart burn pain and backs and knees which do have pain. James sits back and goes along for the ride but develops back and knee pain by [...]

Episode 68: The “heart of the matter” for stroke prevention in atrial fibrillation

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 30 Sep 2009 18:22:29 +0000

In episode 68, we get to the “heart of the matter” of stroke prevention for atrial fibrillation. We find out from Peter Loewen, that it is all a numbers game, and he gives us the tools to deal with this issue. We talk about warfarin and ASA and clopidogrel with respect to their benefits and [...]

Episode 67: A clot, a clot, I want it not – secondary stroke prevention with antiplatelets

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 24 Sep 2009 00:04:55 +0000

In episode 67, we address ischemic stroke of arterial origin and go over some core therapies (ASA, dipyridamole, clopidogrel and warfarin). We also discuss complications of anti-thrombotics and the options for patients with a GI bleed on ASA. Although Peter attempts to guide us through the maze of evidence, all three of us get lost [...]

Episode 66: A clot, a clot, I want it not – secondary prevention with antiplatelets

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 16 Sep 2009 20:00:33 +0000

In episode 66, we embark on a journey of epic proportions; at least relative to our understanding. With the help of Peter Loewen, we outline the anti-platelet options in secondary prevention of heart disease. We discuss at length the use ASA and clopidogrel but also touch on additional agents like warfarin, dipyridamole and others. Where [...]

Episode 65: A clot, a clot, I want it not – primary prevention with antiplatelets

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 09 Sep 2009 20:10:19 +0000

In episode 65, we start back at it with a discussion of using antiplatelets to decrease the chance of MIs and strokes. In this podcast, we cover the whole primary prevention aspect of these agents and we bring in our good friend and colleague Peter Loewen to help us with the numbers. Mike claims he, as [...]

A two week break – but don’t despair

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 26 Aug 2009 16:29:53 +0000

The No-show Notes Listen to the panel discussion from last year’s 20th Annual Drug Therapy Course You can listen to it directly or download the mp3 file and listen to it at your leisure. Learn more about the Annual Drug Therapy Course Next year’s Annual Drug Therapy Course is in Vancouver on April 9/10, 2010 – we would love [...]

Episode 64: More listener questions with answers leaving more questions – Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 19 Aug 2009 17:03:16 +0000

In episode 64, we finish off the listener questions and comments and clarify the murkiness, or murkify the clariness, around a number of cardiovascular issues. By the end of the podcast, both Mike and James are heavier because they eat up all the “sweet” comments made by their listeners. Show Notes 1) BMJ hypertension meta-analysis BMJ 2009;338:b1665 2) Atenolol [...]

Episode 63: More listener questions with answers leaving more questions

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 12 Aug 2009 20:04:01 +0000

In episode 63, we again let the listeners take control as we try to deal with the excellent questions and comments that come our way. We get into a heavy discussion around issues of weight and weight loss. Mike asks James a number of questions that make him squirm and James thanks him because fidgeting [...]

Episode 62: Type 2 Diabetes – how sweet it isn’t – THE END

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 05 Aug 2009 20:00:36 +0000

In episode 62, the eighth and final podcast in our tome on the treatment of type-2 diabetes, we talk about cholesterol and ASA. Statins have evidence of benefit, around 3-4% absolute risk reductions over 5 years, other drugs for cholesterol have little if any evidence of benefit, and there is evidence of no benefit from [...]

Episode 61: Type 2 Diabetes – how sweet it isn’t – Part VII

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 29 Jul 2009 20:00:33 +0000

In the 61st episode, the seventh podcast in our thesis on type-2 diabetes, we get off the topic of glucose and talk about STENO and blood pressure treatments. We decide the bottom line is control of blood pressure with low doses of thiazides and ACE inhibitors with no tolerance for side effects. Mike’s blood pressure [...]

Episode 60: Type 2 Diabetes – how sweet it isn’t – Part VI

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 22 Jul 2009 20:00:19 +0000

In episode 60, the sixth podcast in our saga on type-2 diabetes, we talk about what to do when metformin is not enough and get to the evidence surrounding other blood glucose lowering treatments. We fumble around in a pretty much evidence-free zone. James develops a bad case of hypoglycemia during the podcast because he [...]

Episode 59: Type 2 Diabetes – how sweet it isn’t – Part V

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 15 Jul 2009 20:00:22 +0000

In episode 59, the fifth podcast in our diatribe on type-2 diabetes, we finally get to the evidence surrounding specific treatments. The importance of lifestyle is discussed and then the rest of the time is spent talking about the who, what, why, where, and when’s of metformin. James asks lots of rhetorical questions and Mike [...]

Episode 58: Type 2 Diabetes – how sweet it isn’t – Part IV

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 08 Jul 2009 20:00:30 +0000

In episode 58, the fourth in our installment of podcasts on diabetes, we briefly talk about the evidence surrounding intensive glucose lowering (ACCORD, ADVANCE, VADT and UKPDS trials) – podcasts #9 and #38 did this in more detail. At the end of the podcast, Mike identifies many of James’ flaws, but does it with compassion [...]

Episode 57: Type 2 Diabetes – how sweet it isn’t – Part III

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 01 Jul 2009 20:00:36 +0000

In episode 57, we continue yet again with the topic of type 2 diabetes. In this podcast, we talk about monitoring HbA1C, self-monitoring of blood glucose and, diabetes education in general. We hear Jillian Popel suggest not only is self-monitoring of glucose not really useful when it comes to overall glucose control, it in fact [...]

Episode 56: Type 2 Diabetes – how sweet it isn’t – Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 24 Jun 2009 20:00:25 +0000

Episode 56 continues from where we left off last time with type 2 diabetes. In this podcast, we bring out the numbers and put the risks of diabetes into context by discussing the absolute cardiovascular risks associated with different levels of HbA1c. In addition, we talk about other things to look at in the evaluation [...]

Episode 55: Type 2 Diabetes – how sweet it isn’t

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 17 Jun 2009 20:00:34 +0000

Episode 55 starts off a “sweet” new topic – type 2 diabetes. In the first podcast on this topic we talk about the whole issue of the diagnosis of diabetes, how to make the diagnosis and to some degree what the diagnosis means. To do this we get some great help from a 1st year [...]

Episode 54: CRP – An important part of a Comprehensive Risk Profile or a Completely Ridiculous Practice- Part III

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 10 Jun 2009 20:00:54 +0000

Episode 54 finishes off the whole issue of CRP measurement by looking at the evidence we have about what happens to patients when they take drugs that lower CRP – glitazones, COX-2s, fibrates, vitamin E, niacin, ezetimibe, and statins. Other than statins and maybe niacin, it doesn’t look good – in contrast to Mike and James of course [...]

Episode 53: CRP – An important part of a Comprehensive Risk Profile or a Completely Ridiculous Practice- Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 03 Jun 2009 20:00:11 +0000

Episode 53 continues where we left with the whole CRP measurement or no measurement discussion. James and Mike start with the Reynolds Risk Score and show how even at the extremes of CRP, absolute risks only change by around +/- 2% or so. Far more interesting is that there are now 2 studies showing clearly [...]

Episode 52: CRP – An important part of a Comprehensive Risk Profile or a Completely Ridiculous Practice

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 28 May 2009 20:44:40 +0000

Episode 52 goes back in time to look in more detail at what we talked about in episode 30; the whole issue of CRP measurement. Mike and James start at the “large” issue of intra-subject variability, then focus on the “small” impact CRP has on absolute risk assessment, and briefly discuss how “accurate” risk assessments [...]

What is happening with the podcast

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 28 May 2009 17:48:19 +0000

Dear Listener, Some changes have been made to where the podcast resides. Please listen to this brief blurb to hear what is going on. If you have any questions or comments please leave us a note below. You will have to register to make a comment but that only takes a second and will allow you to receive [...]

Episode 51: More useful clinical trials – with a gentler touch – Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 13 May 2009 18:38:43 +0000

In episode 51, we again bring in the charming Dr. Tina Korownyk to help us work through 4 more recent studies that hopefully will have relevance to your practice. We find out that Vitamin B12 works for apthous ulcers, inhaled corticosteroids should be continued in pregnancy, that NSAID risks can be reduced – but not [...]

Episode 50: More useful clinical trials – with a gentler touch

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 06 May 2009 18:37:24 +0000

In episode 50, we talk about 4 more clinical trials that might help you in your practice. We cover topics ranging from fever control with acetaminophen or ibuprofen, injections for rotator cuff injuries, diabetes, and osteoarthritis. Mike and James finally bring in a much needed female flavour to the show, by asking Dr. Tina Korownyk [...]

Episode 49: Becoming less anxious about anxiety disorders – Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 30 Apr 2009 18:36:30 +0000

In episode 49, we continue on from the previous anxiety ladened podcast, and cautiously delve into the whole area of treatment options for anxiety disorders. Mike and James do this by once again cautiously delving into the complex mind of our psychiatry colleague, Dr. Adil Virani. We end up with great advice but get no [...]

Episode 48: Becoming less anxious about anxiety disorders

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 22 Apr 2009 18:29:44 +0000

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 [...]

Episode 47: The April Fools’/Happy 1st Anniversary Podcast

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 01 Apr 2009 08:00:57 +0000

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 [...]

Episode 46: High quality information on drug safety – Special Guest Dr. Bruce Psaty

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 26 Mar 2009 02:19:31 +0000

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 [...]

Episode 45: Practice Changing Articles – with Double the Mikes Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 19 Mar 2009 02:18:16 +0000

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 [...]

Episode 44: Practice Changing Articles – with Double the Mikes

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 12 Mar 2009 02:17:17 +0000

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 [...]

Episode 43: Obesity – what’s the big deal? – Part III

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 05 Mar 2009 02:16:18 +0000

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 [...]

Episode 42: Obesity – what’s the big deal? – Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 26 Feb 2009 02:15:09 +0000

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 [...]

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

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 19 Feb 2009 02:13:48 +0000

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 [...]

Episode 40: Keeping up with the medical literature – 101

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 12 Feb 2009 02:12:54 +0000

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 [...]

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

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 05 Feb 2009 02:11:47 +0000

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 – [...]

Episode 38: New trials you need to know about

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 29 Jan 2009 02:08:43 +0000

In episode 38 we try to go over 8 new studies in one podcast but only get half-way there. We cover 2 inhaled anticholinergic studies, one new glucose lowering trial and the latest smoking cessation RCT. Mike and James wax poetically about a variety of issues and demonstrate clearly their well-honed technique of [...]

Episode 37: Diverse listener questions and comments – Q & A with no QA

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Fri, 23 Jan 2009 02:07:46 +0000

In Episode 37, we again review listener questions and comments around such diverse topics as Bell’s Palsy, viruses that break bones, glucose monitoring, glitazones and COPD. Both James and Mike give diverse answers with diverse meanings that even they don’t really understand. Show Notes 1) The third study showing either no benefit or harm from aggressively lowering [...]

Episode 36: Information on older drugs from an even older doctor – Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 15 Jan 2009 02:05:56 +0000

In episode 36, we take up where we left off in episode 35 by reviewing eight more (not ten) old drugs that hopefully you are still using – if not, get with the progam – in your day-to-day practice. Dr Bob joins us yet again for this episode and provides us with some great clinical [...]

Episode 35: Information on older drugs from an even older doctor

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 08 Jan 2009 02:04:26 +0000

In this first episode of the New Year (Episode #35) we review nine (not ten) old drugs that should, in most circumstances, still likely play an important role in your day-to-day prescribing and recommendations. Dr Robert Rangno again joins us for this episode and provides us with some great clinical experience and some mediocre humour. [...]

Episode 34: Holiday Extravaganza: Confirming or dispelling myths and beliefs?

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 18 Dec 2008 02:02:58 +0000

In Episode 34, we review some of the myths and beliefs common in many cultures. A renowned and profound guest joins us (Dr Robert Rangno). We start with a study of Santa Claus and then move on to a variety of myths like the need for bed rest, cold exposure causing infective illness, [...]

Episode 33: NSAIDS: Considering the Risks and Benefits

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 11 Dec 2008 02:01:52 +0000

In our 33rd episode we follow-up our discussion of osteoarthritis by examining the risks and benefits of oral anti-inflammatories including Cox-2 inhibitors. We review the effects on pain relief and the theory of anti-inflammation. We discuss the possible gastrointestinal effects and possible approaches to reduce the risk. We consider the cardiovascular risks [...]

Episode 32: Aches and Pains: An Overview of Osteoarthritis Treatment

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 04 Dec 2008 01:56:43 +0000

In our 32nd episode we review the therapeutic options for the treatment of osteoarthritis. We first deal with lifestyle interventions for osteoarthritis. We consider the pain pharmaceuticals like acetaminophen, topical or oral NSAIDs, and opiates as well as some of the other osteoarthritis therapies such as glucosamine or steroid injections. We also [...]

Episode 31: Old Ideas for Coping with New Drugs

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 27 Nov 2008 01:55:16 +0000

In our 31st episode we offer an approach to new drugs. We look at the last five years of new product introduction and consider the frequency of new drugs being truly novel and a substantial addition. We examine how medicines termed “new” are frequently modifications that make no measurable change in the product. [...]

Episode 30: A New Far-Out Trial: Welcome to Jupiter

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 20 Nov 2008 01:54:09 +0000

The topic for our 30th episode is stolen from the headlines. We look at the much publicized Jupiter trial of C-Reactive Protein (CRP) and the use of a statin. We review the details, strengths and weakness of the trial. From there we look at related questions of risk assessment with CRP, reducing [...]

Episode 29: Creating Confusion or Clarity: Q&A of Listener Mail Part II

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 12 Nov 2008 02:22:03 +0000

In Episode 29, we review questions around informed decision-making, risk-benefits of statins across different populations (women, chronic kidney disease, etc), and comparisons of calculated risks and trial results. We also talk about prescribing of new antimicrobials, differentiating typical from atypical pneumonias and then attempt to clarify a few trials including HOPE. James desperately searches [...]

Episode 28: Creating Confusion or Clarity: Q&A of Listener Mail

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 06 Nov 2008 01:48:47 +0000

In Episode 28, we review questions around osteoporosis including: bone density testing and the limits of medical tests in general; the risks (including osteoporosis) and benefits of proton pump inhibitors for heartburn; and assessing calcium intake and the possible risks of calcium. We also briefly discuss topics of risk assessors of CVD, an approach to [...]

Episode 27: COPD: Breathing Life into Effective (& some not) COPD Treatments

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 30 Oct 2008 01:47:46 +0000

In episode 27, we examine the management of COPD Exacerbation and adjunctive treatments. We review the relatively good evidence for antibiotics and steroids in Exacerbations including the options in choice, dosing, and mode of administration. We briefly examination some of the other treatment options in chronic COPD with combination puffers, immunizations, theophyline, and [...]

Episode 26: COPD: Confusing Overwhelming Puffer Data leaving us Breathless

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 23 Oct 2008 01:46:35 +0000

In episode 26, we examine the initial management of COPD. We first discuss the diagnosis of COPD and if screening is recommended. We encourage an initial focus on smoking cessation and then episodic, symptom control. We then review long acting puffers and the large body of confusing research with underwhelming and at [...]

Episode 25: De-Bugging the Approaches to Sinusitis and Bronchitis

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 16 Oct 2008 01:45:18 +0000

In episode 25, we finish (for now) the discussion of in-office infectious disease management. We first review a case of sinusitis including the challenges of diagnosis and the benefit of antibiotics and/or nasal steroids. We then discuss a case of bronchitis with the concerns of diagnosis and the benefits of antibiotics. We [...]

Episode 24: De-Bugging the Approaches to Ear Infections and Strep Throat

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 09 Oct 2008 01:43:50 +0000

In episode 24, we continue the discussion of in-office infectious disease management. We discuss a case of AOM in an 8 year old child including the signs/symptoms important in making the diagnosis, pain control and the utility of antibiotics. We then discuss a case of sore throat in a 17 year old woman [...]

Episode 23: De-Bugging the Approach to Pneumonia

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 02 Oct 2008 01:42:22 +0000

In episode 23, we begin the discussion of antibiotic prescribing in common respiratory tract infections with a focus on pneumonia. We talk about the limited evidence for the clinical exam in diagnosing pneumonia. We review the variability in antibiotics suggested in guidelines and evidence for coverage of atypical pneumonia. We also discuss [...]

Episode 22: The Down-Low on Low Dose: The How-To

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 25 Sep 2008 01:41:17 +0000

In our 22nd episode we continue our low dose discussion. We talk about the concept of n-of-1 trials and allowing patients to determine their dose. We review some of the benefits of low-dose prescribing, such as low side-effect risk and reduced costs, but emphasize the medical conditions in which low doses are inappropriate. [...]

Episode 21: The Down-Low on Low Dose: The Logic

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 18 Sep 2008 01:40:15 +0000

In our 21st episode we jump into our ongoing debate about low and very low dose of medication. We present the reason why initial doses of new drugs are often too high and the logic for trialing lower doses in patients. We also review over 10 examples of medications proven in randomized control [...]

Episode 20: Mysteries within Enigmas: Answering Listener Mail

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 11 Sep 2008 01:39:08 +0000

In our 20th episode we try to answer our accumulating listener mail. We review questions around cardiovascular disease risk-benefits and try to demystify the calculators. Listeners question antidepressants: when they should start to work, when to change dose/type and their use for chronic pain. Other issues include stopping bisphosphonates, addressing the placebo [...]

Episode 19: Osteoporosis: Treating for Fracture Reduction

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 04 Sep 2008 01:37:18 +0000

ptions in treatment, which ones have evidence of non-vertebral fracture and the absolute benefits of those treatments. We discuss reliability of monitoring bone density of patients on therapy and the duration of therapy. Show Notes 1) Evidence for fracture reduction There is good evidence from randomized controlled trials (RCTs) that alendronate, etidronate, ibandronate, risedronate, calcitonin, 1-34 PTH, and [...]

Episode 18: Osteoporosis: The Initial Approach to Bone-Density

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 28 Aug 2008 01:35:44 +0000

In episode 18 we consider the approach to questions of bone density and fracture risk. We use a series of cases to work through the risk of osteoporosis (using a simple tool) and help us decide on bone mineral density testing. We discuss initial options in the prevention of fractures including weight-bearing exercise, Calcium and [...]

Episode 17: Anti-Depressants: Some Issues in Managing Depression

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 21 Aug 2008 01:34:32 +0000

In episode 17 we look at managing the treatment of depression once we’ve started a medication. We discuss the patient conversations necessary for initiating treatment including the patient perception of the illness, expectations and potential side-effects. We debate the quandaries around starting doses, when or if to increase, duration of therapy and relapse prevention. [...]

Episode 16: Anti-Depressants: Is there a Drug of Choice?

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 14 Aug 2008 01:33:09 +0000

In episode 16 we look at initiating treatment for depression. We briefly review screening and the diagnosis of depression before discussing the non-drug treatment options (therapy, exercise, sleep hygiene). We search for the anti-depressant of choice (being any) and end up deciding to tailor the choice based on factors such as side-effect profile, targeted [...]

Episode 15: Treating Depression: The Recent Sad News about Anti-Depressants

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 07 Aug 2008 01:31:23 +0000

In episode 15 a guest assists us in addressing the evidence suggesting anti-depressants are not as effective as believed. We review some biases in the anti-depressant research including publication bias (how good studies are published more than bad studies). We discuss how the benefits of anti-depressants over placebo increase as the severity of depression worsens. [...]

Episode 14: Listener Mail: Addressing the Questions and Confusion

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 31 Jul 2008 01:29:00 +0000

In episode 14 we attempt to answer some of the mail received from listeners. We talk about using the evidence to promote shared decision-making. We review calculating risk, the limitations of risk calculators and presenting the data in the positive (chance of not having an event). We address heart disease as [...]

Episode 13: Butt-Out:Silencing “The Smoking Gun” in Health

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 24 Jul 2008 01:25:06 +0000

In our 13th episode, we discuss smoking cessation. We present the impressive benefits in hard outcomes when people stop smoking. We then go through the list of interventions, from brief advice to the pharmaceutical options of nicotine replacement, two anti-depressants (Buproprion or Nortiriptyline) and the newest agent, Varenicline. Dosing, cessation rates and [...]

Episode 12: Getting Hyper Tense about Monitoring

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 17 Jul 2008 01:23:33 +0000

In our 12th episode, we divide and conquer the remaining points around hypertension. In section A, we talk about monitoring blood pressure: frequency, reliability and home monitoring are all discussed. In section B, we talk about the potential side-effects of different hypertension therapies and the need to monitor for biochemical-metabolic effects. In [...]

Episode 11: Taking the Pressure off: Other Drugs

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 10 Jul 2008 01:21:37 +0000

In our 11th episode, we discuss the laundry list of the remaining hypertensive medications and their evidence. The issue of blood pressure as a surrogate marker is discussed and we encourage clinicians to focus on hypertensive agents that effect patient oriented outcomes. While the evidence is reasonable for Ca+ Blocker, we put Beta-blockers [...]

Episode 10: Taking the Pressure Off: ACE Inhibitors

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 03 Jul 2008 01:19:40 +0000

In our tenth episode, we discuss our second choice of hyperåtensive medication agent, the ACE inhibitor. We review dosing and renal protection (briefly) before agreeing our choice is based mostly on once a day adminstration and costs. We look at substituting with ARBs but not combining with ARBs (with possible exception of co-morbid [...]

Episode 9: News Flash: Aggressive Blood Sugar Control Not All Sweet

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 26 Jun 2008 01:17:32 +0000

In our ninth episode, we interrupt our regularly scheduled podcast to talk about the recently released ACCORD and ADVANCE trials which focus on intensive glucose control (reduction) in diabetes. We discuss the patient-oriented outcomes and harms, ranging from mortality to hypoglycemia, as well as the potential benefits such as preventing microalbuminuria. Evidence regarding patient blood [...]

Episode 8: Taking the Pressure Off: Hypertension Drugs

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 19 Jun 2008 01:14:32 +0000

In our eighth installment, we discuss the initiation of hypertensive drug therapy. In recommending thiazide diuretics, we outline the evidence (e.g. ALLHAT trial) showing equivalence and the significantly lower yearly cost. We debate (politely this time) dosing and attempt to dispel the smokescreen of thiazide metabolic issues (e.g. blood glucose). The usual [...]

Episode 7: Hypertension: Taking the Pressure Off

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Thu, 12 Jun 2008 01:11:08 +0000

In our seventh installment, we discuss the options for blood pressure reduction before adding medications. We first talk about medicines, drug use and dietary factors that may increase blood pressure. We review the approach and potential benefits of varying lifestyle interventions like Exercise (e.g. pedometers), Diet (e.g. DASH) and Salt Reduction. The [...]

Episode 6: Hypertension: Coping with the Pressure

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 04 Jun 2008 23:07:23 +0000

In our sixth installment, we begin to discuss hypertension. We review the principles of making the diagnosis of hypertension and confounders in the office. Although the identification of an elevated blood pressure for a certain patient may be new, the hypertension itself is likely not and rarely an emergency. The risks of [...]

Episode 5: Swiss Cheese & The Evidence Holes in the Lipid Hypothesis

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 28 May 2008 22:58:45 +0000

In our fifth installment, we end our discussion of cholesterol outlining some of the remaining evidence gaps. Areas discussed are primary prevention for women, the use of other cholesterol reducing medicines, and the need for follow-up cholesterol testing for patients on statins. We avoid filling the evidence gaps with theory-based assumptions and close [...]

Episode 4: De-constructing Risk (or Benefit)

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 14 May 2008 22:52:36 +0000

In our fourth installment, we apply the absolute benefit for statin therapy to our patient. We discuss the absolute benefits in context of the individual risk and acknowledge that when translating pooled literature numbers to individual patients an element of mysterious uncertainty always remains (except for James who knows but won’t tell and Mike [...]

Episode 3: The Risky Business of CVD Risk Assessment

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 30 Apr 2008 22:40:22 +0000

In the third session, we discuss the advantages and disadvantages of three methods to present “benefit”: changes in risk calculators, using relative risk, or the absolute benefit. We review the challenges of absolute vs relative risk (or relative vs absolute truth) and discuss patient expectations in regards to the medical miracle of prevention. [...]

Episode 2: Evidence does not equal decision-making

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 16 Apr 2008 22:35:26 +0000

In our second session we discuss the philosophy of calculating risk and the many factors that influence the application of these numbers. We each calculate risk using our personal preference for risk estimators and discuss the mystery of why these numbers are not the same. “Treating” asymptomatic patients and instituting preventive interventions taken [...]

Episode 1: Philosophy, guidelines and the truth

podcast@therapeuticseducation.com (Dr. James McCormack and Dr. Michael Allan) — Wed, 02 Apr 2008 17:44:15 +0000

In this first session we offer a slightly long introduction (but not long enough to reach REM sleep). We present Mr. Guy Lines, a 45 year old male with a number of risks for cardiovascular, who we will consider over the next number of sessions on primary prevention. We lay the rocky groundwork of future [...]