Drugs (Sometimes) Work

In this second part of the 2-part episode "Vitamania," we dig in to the clinical trial data behind vitamins as dietary supplements. In Part 1 of this episode, we met a patient with Scurvy....and said that if you have Scurvy, Vitamin C definitely works. But what if you are generally nutritionally replete? What does the data say about the role of vitamins as dietary supplements in the > 99% of people who do NOT have any diseases of vitamin deficiency? And how much clinical trial data is there? And are the outcomes different for people with diabetes or established cardiovascular disease? We'll address all these questions....and then conclude by briefly addressing how commercial vitamins are made and why that accounts for the most common adverse effects that we see with vitamins.

Vitamins are widely used in the U.S., to the tune of between $15-20 billion dollars per year. But what are vitamins and what do they do? How are they regulated by the FDA and does the clinical trial data on vitamin supplementation justify our consumer appetite for them? Over this two part episode we'll discuss all of that. The goal, as always is to simply inform so that we can all make up our own minds about the role that vitamins might play in our general good health.

Before we ask a patient to take any drug we should be confident that the benefits outweigh the risks. This involves considerations like duration of therapy and whether the drug is being used to treat a disease versus prevent it. But even more important is an understanding of how the pharmacology of the drug matches up to the pathophysiology of the disease. The better we understand both, the better we'll be at deciding when to use any drug for any disease. In todays episode we apply these tenets of drug therapy to a common question, "does my patient with diabetes need to be on an ACEi or ARB?" To answer that question, we'll discuss the merits of drugs for disease prevention versus disease treatment. The use of risk factors for disease may or may not be sufficient to justify drug therapy. An LDL cholesterol of 220 is sufficient to initiate cholesterol lowering therapy. But is diabetes a sufficient reason to initiate an ACEi or ARB? We'll figure that out....and whether or not the answer surprises you, we'll learn things along the way that will be useful in virtually all settings of applied pharmacotherapy.

As we finish up we focus on the contemporary management of systolic heart failure or so called heart failure with reduced ejection fraction. Our focus in this episode is on RAAS blockade which includes the aldosterone antagonists along with a new kid on the block, Entresto. How does Entresto compare and where does it fit in to our contemporary management of systolic heart failure? We'll discuss that, along with the reason why we dont see much Digoxin anymore. When we're done, we'll have a very complete contemporary approach to how best to use pharmacotherapy in our patients with heart failure.

In this continuation of "Medicating the Failing Heart" we pick up the theme of systolic heart failure and how good beta blockers are or aren't compared to our newest agent for systolic heart failure - vericiguat. As we discuss, beta blockers hold their own quite well. But beware. Having a patient on a beta blocker is not the same thing as having them appropriately medically beta blocked. We'll discuss what that means and explain that while it's been said that the difference between a drug and a poison is dose, it is also true that dose determines when something is a drug at all.

When it comes to treating symptomatic heart failure, many things have changed but many have not. Some things that haven't changed maybe should change - that depends on who you listen to. In this multi-part episode, we'll discuss the past and present of drug therapy for both common types of heart failure. By the end, you'll know a bit of history, you'll know a lot about how well different drugs work for heart failure and you'll even know where the American College of Cardiology held one of it's annual meetings in the early 2000's.

The cephalosporin antibiotics are a confusing class of medications. We talk about them in "generations" like a pharmacologic family tree. And while there is a general rule regarding which bugs are covered by the different generations, the exceptions to that rule are numerous and just as important as the rule itself. In this 2-part episode, we'll unpack the cephalosporins a bit. We'll explain what it means for one agent to be "better" than another at treating a particular bacteria and why the 4th and 5th generations only have one drug each. In the end, we wont be infectious disease experts but you also wont have to call them the "Ceph-a-somethings" ever again.

The cephalosporin antibiotics are a confusing class of medications. We talk about them in "generations" like a pharmacologic family tree. And while there is a general rule regarding which bugs are covered by the different generations, the exceptions to that rule are numerous and just as important as the rule itself. In this 2-part episode, we'll unpack the cephalosporins a bit. We'll explain what it means for one agent to be "better" than another at treating a particular bacteria and why the 4th and 5th generations only have one drug each. In the end, we wont be infectious disease experts but you also wont have to call them the "Ceph-a-somethings" ever again.

Electrolytes are among the drugs we use in the hospital setting. And like any drug, we're better when we truly understand what we are using them to treat. In this episode, we tackle one of the most common electrolyte abnormalities in hospitalized patients....hypokalemia, and we discuss why it makes no sense to say that we treated our patients hypokalemia with 40 mEq of potassium. Understanding why requires understanding how our body shifts around and stores potassium. Join me in this podcast as we figure it out and learn why it makes no sense to say, "I repleted my hypokalemic patient with 40 mEq of potassium."

Learning which antibiotics treat which bacteria and how to dose those antibiotics is like trying to learn a foreign language. Words sound weird and are difficult to pronounce. At first, nothing really makes any sense and what we all need is more practice. In this episode, we'll start talking about some of the basics. Just like in previous episodes we'll use concrete examples to support the points that we make. One 16 minute podcast wont make you an expert at bugs and drugs but we can begin to lay an important foundation that we can build upon in future episodes. So join me as we work on the foreign language that we call "Bugs and Drugs."

In this second part of a 2-part episode on Correlation vs. Causation, we explore two relevant examples of where someone got it exactly wrong. Often times, the lay press and media coverage - especially social media coverage - make it difficult to figure out what's really going on. It's not our fault when social media gets something wrong but we do have control over how we react to it. As Dr. Daniel Kahneman describes, "fast thinking" about what we see and read isn't very helpful but it is very prevalent. In this episode, we'll slow down, carefully consider our examples and discuss what is really going on.

Understanding correlation versus causation is important. It is important in clinical drug trials and it is important in making public policy. If we dont really understand what the underlying cause of a problem is, we cannot fix that problem. In this 2-part episode, we'll explore this concept a bit and use relevant examples to highlight what is correlated and what is truly cause-and-effect.

In this second part of our 2 part series on aspirin, we focus in on what aspirin does and what both the FDA and clinical guidelines say about who should take it for primary prevention. Then, to make sense of the conflicting advice, we briefly discuss the clinical trials themselves so we can make up our own minds about "Who should take a daily aspirin?"

Aspirin is complicated. Advice on who should take it is conflicting and always changing. In this 2-part episode we'll explore why that is. We'll learn a bit about atherosclerosis - the disease that aspirin can treat. We'll explore what the FDA says about aspirin and what as well as what is recommended by a couple of the commonly used guidelines. Last, we'll summarize what was found in the clinical trials and how those finding led to some much conflicting advice. Then we'll make up our own minds about "Who should take a daily aspirin."

Drugs - the legal kind that we get with a prescription, are fascinating. How do they work? Why to they work? Why do they sometimes not work very well? Why are some of them so expensive? In this podcast, we'll explore some of that. I've been teaching the science of drug therapy to medical and pharmacy students for 25 years and I've learned a few things along the way. Join me as we explore why Drugs (Sometimes) Work.