Best Science Medicine Podcast - BS without the BS

THE CASE Dr Ashville is training to be a family physician and gets a phone call from a disgruntled patient called Jane Brown. She got a message saying “As your Cardiovascular risk is now 10% it is recommended you take a statin medication”. She is a bit cross she didn't get a proper conversation about […]

THE CASE Nurse J and advanced nurse practitioner and Dr A are taking a short coffee break and discussing the management of lifestyle issues in their mixed practice. Many of their patients are living in poverty, with a lot of patients having Long Term Conditions. They feel under pressure from health service management to push […]

In episode 601, James and Mike invite Jennifer Young back to the podcast to go over all the evidence we have for pregabalin and gabapentin in patients with fibromyalgia. During the discussion we find out how many people actually get a ≥30% reduction in pain compared to placebo. We even look at some information about […]

Show notes THE CASE Dr P works in a busy inner-city practice. One day a cancer patient bemoans the fact that she “never sees the same doctor twice” at the hospital, and asks “can I see you again doctor, you have been so helpful and understanding today?” Like many practices Dr P's workplace uses a […]

In episode 600, James and Mike invite Jamie Falk back to the podcast again and we talk about if exercise helps movement in Parkinson's disease. You might be surprised by the size of the effect so have a listen and get all the evidence and numbers you need. Show Notes Tools For Practice Exercise for […]

Show notes THE CASE M is a hard-working clinician in primary care aiming for high professional standards; they passed all their exams at medical school and post grad training, and continue to engage in regular CPD. To their surprise, medicine in practice seems to get more and more difficult as time goes on. Many patients […]

Show notes THE CASE M is a hard-working clinician in primary care aiming for high professional standards; they passed all their exams at medical school and post grad training, and continue to engage in regular CPD. To their surprise, medicine in practice seems to get more and more difficult as time goes on. Many patients […]

In episode 599, James and Mike invite Roni Kraut to the podcast for the first time to talk about a common problem that has a simple answer. What route and/or duration of antifungals is needed when treating uncomplicated vulvovaginal candidiasis in non-pregnant women. Tune in to find out all the simple details. Show Notes Tools […]

THE CASE Mrs P is aged 56 and has Type 2 Diabetes. Her HBA1c has reduced from 69 (8.5) to 58 (7.5) and her SBP has been reduced from 150 to 135. Her GP gets this discharge summary: Mrs P had surgery for a bowel obstruction caused by adhesions from a previous hysterectomy 5 years […]

THE CASE A 40 y/o, or so, primary health care provider who enjoys taking care of patients and has been working hard for the last 12 years they want to make their practice less frustrating, more interesting, more rewarding. Welcome to the premiere episode of The Contented Clinician Podcast! We’re excited to introduce you to […]

In episode 598, James and Mike continue to talk with David Gardner about the issue of insomnia. We discuss his latest, very cool, Your Answers When Needing Sleep (YAWNS NB) randomized clinical trial. YAWNS was a pragmatic, open-label, minimum-contact, RCT where people with long-term use of benzodiazepines and current or past insomnia were randomly allocated […]

In episode 597, James and Mike invite David Gardner to talk in depth about the issue of insomnia. We talk about triggers, precipitating factors, acute and chronic insomnia, and chronic use of sleeping pills. We discuss Cognitive Behavioral Therapy for Insomnia (CBT-I) and how his team has developed a comprehensive website, Sleepwell, that provides patients […]

In episode 595, Mike and James invite Jennifer Young back to talk about the use of combined oral contraceptives for heavy menstrual bleeding (benign etiology) and see if they improve patient outcomes. They do! Have a listen to get all the numbers and see how they compare to using levonorgestrel-containing intrauterine devices or NSAIDs. Show […]

In episode 594, Mike and James invite Samantha Moe back to talk about the use of the RSV vaccine in pregnancy. The only way to have an informed conversation around this vaccine is to know the numbers. If you listen to the whole podcast, you'll get all the numbers available to date. Show notes Tools […]

In episode 593, Mike and James invite Samantha Moe back to talk about a newer agent for osteoporosis. So, if you want to know all the evidence for romosozumab, tune in and all will be revealed about the benefits and harms. Show notes 1) Tools for Practice Tony Romo-sozumab: Winning touchdown in osteoporosis or interception […]

In episode 592, Mike and James invite Jennifer Young back to the podcast to review the evidence around the use of antidepressants in the challenging pain condition of fibromyalgia. We find there is an effect but, if you are going to help people make decisions, what you really need to know are the numbers for […]

In episode 591, Mike and James invite Samantha Moe back to the podcast to review the evidence for using testosterone in older men. We talk about the impact testosterone supplementation has on sexual function, strength, fatigue, cognition, quality of life, and harms. There are 16 systematic reviews so we do have pretty good evidence – […]

In episode 590, Mike and James talk in a PREMIUM way about a new trial that looked at the question, does depression screening provide any benefit in primary care? We also go over a case-finding publication on screening for asthma/COPD. At the end we look at, does implementing guideline care improve outcomes for CKD? The […]

In episode 589, Mike and James invite Jennifer Young back to the podcast again to talk about a topic that Mike absolutely loves – Vitamin D for everyone. Tune in to hear about all the latest, and the older, evidence. Do you agree we should remove the question mark from the podcast title? Show notes […]

In episode 588, Mike and James invite Émélie Braschi back to the podcast to discuss another tricky area – insulin in type 2 diabetes and how to use it. Do we need to give it once a day, twice a day or maybe no times a day? Tune in to hear about all the evidence. […]

In episode 587, Mike and James invite Adrienne Lindblad back to the podcast to go over all the evidence we have for the oral GLP-1 weight loss medications. You know you are going to get lots of questions about these medications so tune in to find out all the numbers around the benefit and potential […]

In episode 585, Mike and James invite Émélie Braschi back to the podcast to talk about the tricky issue of how to deal with a potential penicillin allergy. Believe it or not there are a couple of RCTs looking at this issue. These two trials compared oral challenge alone to skin testing followed (if negative) […]

In episode 584, Mike and James invite Tina Korownyk back to the podcast to talk about the evidence for amyloid-targeting monoclonal antibodies in mild cognitive impairment or Alzheimer's dementia. Unfortunately, the evidence shows these medications don't seem to have a clinically important effect and do have some harms. Have a listen as we give you […]

In episode 583, Mike and James continue to go over the issues associated with using CVD risk calculators. We talk about some of the limitations, how to think about the results and explain the risks and benefits to patients. Show notes PEER Simplified Cardiovascular Decision Aid Incorporation of Shared Decision-Making in International Cardiovascular Guidelines, 2012-2022 […]

In episode 582, Mike and James go over the issues associated with using CVD risk calculators. We talk about where the numbers come from, what they mean, what their limitations are, how to think about them and how to use them. So have a listen as it may decrease your risk but it will definitely […]

In episode 581, Mike and James invite Mike Kolber back to the podcast for the umpteenth time – this time we talk about a topic we haven't discussed before – acute diverticulitis. Historically, if a person has diverticulitis they were given antibiotics BUT do they really do anything? We look at all the evidence and […]

In episode 580, Mike and James invite Jennifer Young to talk about the treatment of pityriasis rosea. Believe it or not there are 2 simple treatments that seem to work really quite well. Tune in to hear what works and how well they work. Show notes Tools for Practice (A)dressing the Christmas Tree? Therapies for […]

In episode 579, Mike and James invite Nicholas Dugré back to the podcast to talk about the evidence around the benefits and harms of a new class of medications for the acute treatment of episodic migraines. Ubrogepant is an oral calcitonin gene-related peptide antagonist. In this case, amazing as it may sound, there are triple […]

In episode 578, Mike, James and Jennifer Potter try to answer the question, in patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy? We look at the evidence for methylphenidate, antipsychotics, and antidepressants so tune in to find out if any of these treatments have any sort of effect […]

In episode 577, Mike and James invite Jennifer Young to join us to go over all the evidence around how best to close punch biopsies, lacerations and incisions. We go over all the evidence for sutures (absorbable/nonabsorbable), skin glue, and tape. We look at cosmesis, patient satisfaction, and infection rates so have a listen and […]

In episode 576, James, Mike, and Jamie continue to review the evidence for acne treatments. In this podcast, we examine if antibiotics work and we find they do have an effect. Check out the podcast for all the numbers. Show notes Tools for Practice Facing the Evidence in Acne, Part II: Oral Antibiotics Tools for […]

In episode 575, James and Mike invite Jamie Falk back to the podcast to help us sift through all the evidence for using oral contraceptives and spironolactone to treat acne. We find that they actually do work. We go over all the numbers for the benefits and harms. Have a listen. Show notes Tools for […]

In episode 574, James and Mike invite Jennifer Young back to the podcast to help us yet again look at the evidence for cranberries and the prevention of UTI's. Unfortunately, there is a problem with the evidence as there is a high risk-of-bias from potential publication bias, small studies, and unblinding. However, if we look […]

In episode 573, James and Mike invite Jamie Falk back to the podcast to help us simplify all the evidence around using antipsychotics for difficult to treat depression. They do seem to “work”, but you really need to know the numbers around what “work” means. At the end of the podcast, you will! Show notes […]

In episode 572, James and Mike invite Samantha Moe back to the podcast to go over the evidence around the safety and effectiveness of the monoclonal antibodies used to reduce the risk of respiratory syncytial virus (RSV) infections in infants. We go over all the numbers for hospitalizations and death so you can make evidence-informed […]

In episode 570, James and Mike finish their trilogy on statistics. We take what we discussed in the previous podcasts and go through a couple of examples that will hopefully solidify what all the terms and numbers really mean. Show Notes 1) Sensible Medicine Doing statistics can be difficult but understanding them can be fairly […]

In episode 569, James and Mike continue to go over what statistics really show – we focus on what inferential statistics can and cannot do, what a p value means and more importantly what it doesn't mean. And yes we try to keep all this stat stuff on a realistic and practical level – easier […]

In episode 568, James and Mike go over what statistics really show – and importantly what they don't show. We go over the terms and nuances and hopefully put them all into a simple context. Statistics are not just in medicine – they are in much of what you do every day – so you […]

In episode 567, Mike and James revisit the old topic of industry influence on health care providers. We go over the issues, the nuances and some of the latest evidence around the interactions, the influence, and patient perceptions. Show Notes 1) Industry Evidence Handout 2) MAKING EVIDENCE MATTER for EVERYONE CONFERENCE Vancouver May 24/25, 2024 […]

In episode 566, Mike and James invite Émélie back yet again to the podcast and the topic is the balance of benefits to harms of using corticosteroids in adults or children for atopic dermatitis. We come to the realization, as always, that how to use topical corticosteroids is based on knowing the best available evidence […]

In episode 565, Mike and James invite Émélie Braschi back to the podcast to talk about do-it-yourself hearing aids. We find some very interesting information about how direct-to-consumer self-fitted hearing aids compare to conventional hearing aids fitted via audiogram. You really need to listen to this podcast – your patients will thank you. Show notes […]

Episode 564: Can non-hormonal drugs improve vasomotor symptoms in menopause? In episode 564, Mike and James invite Samantha Moe back to the podcast to talk about the benefits and harms of non-hormonal medications for vasomotor symptoms in menopause. We find they do have an effect over placebo but also people in the placebo group improve, […]

In episode 563, Mike and James go over all the RCT evidence for the Respiratory Syncytial Virus (RSV) vaccine in older adults. You need to know the vaccine works, but you really need to know the baseline risk of RSV before anyone can really make an informed decision about this vaccine. We'll do our best […]

In episode 562, Mike and James continue to discuss our recently revised 2023 simplified lipid guidelines with Adrienne and Mike. We talk about all the medications used for cardiovascular risk reduction. We go over all the evidence and all the numbers for the benefits (and sometimes lack of benefit) and the harms. We also specifically […]

In episode 561, Mike and James invite Adrienne Lindblad and Mike Kolber to discuss our recently revised 2023 simplified lipid guidelines. We talk about the guideline process, the best available evidence, and discuss some of the rationale we used to recommend the simpler approaches outlined in our guideline. As always, the focus was on shared […]

In episode 560, Mike and James finish their discussion around the use of hallucinogens/psychedelics by going over the psilocybin evidence. As with ketamine we cover the many limitations of the evidence around psilocybin and also talk about the side effects, costs and inconvenience. So now you know all we know for what that is worth. […]

In episode 559, Mike and James continue to discuss the best available evidence around ketamine and severe depression. We go over the many limitations of the evidence and at the end we wrap it all up by going over the side effects, costs and inconvenience. Show notes HANDOUT Psychodelics Podcast From Hallucinations to Healing?

In episode 558, Mike and James decide to start to tackle the ketamine for depression story. Mike talks about what the media says about ketamine and then he delves into what the guidelines say. Then as always, we discuss the best available evidence. Have a listen so that you can be in the know about […]

Episode 557: Fancy Creams for Scaly Skin: Topical calcineurin inhibitors for atopic dermatitis In episode 557, Mike and James invite Emelie Braschi back to the podcast to talk about how effective topical calcineurin inhibitors are for atopic dermatitis. We'll give you all the numbers so have a listen and learn what they are. Show notes […]

In episode 556, Mike and James have Betsy Thomas back to podcast to talk about how effective are artificial tears for people with dry eyes. Both of us cry halfway through the podcast because of the craziness and inconsistency of the evidence. Have a listen and see what we found. Show notes Tools for Practice […]

In episode 555, James and Mike invite Jamie Falk back to the podcast to talk about the best available evidence for acetylsalicylic acid and its potential impact on reducing the risk of complications in women at risk of preeclampsia. The evidence is pretty clear and we are able to give decent estimates of the benefits […]