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On this episode of the CMAJ Podcast, hosts Dr. Mojola Omole and Dr. Blair Bigham speak with two authors of the latest “Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care”

The discussion reflects a shared urgency: despite past successes, Canada’s hypertension control rates are declining. The new guidelines aim to reverse this trend by simplifying diagnosis and treatment for frontline clinicians.

Dr. Rémi Goupil, a nephrologist and clinician researcher at Sacré-Cœur Hospital in Montreal, and Dr. Greg Hundemer, a nephrologist and clinician scientist at The Ottawa Hospital, explain that the updated guideline is deliberately designed for primary care providers. They highlight key shifts: lowering the diagnostic threshold for hypertension to ≥ 130/80 mm Hg, simplifying blood pressure targets, and emphasizing accurate, standardized measurement techniques both in clinic and at home. The guidelines were created with input from a majority-primary care committee—including family physicians, nurses, pharmacists, and patient partners—to ensure clinical applicability.

Together, the panel outlines a streamlined nine-step treatment algorithm, emphasizing combination therapy as first-line pharmacologic management. They explain the evidence supporting ARB–thiazide combinations, discuss cost considerations for drug selection, and address adherence challenges. They also explore red flags for secondary hypertension and how the algorithm supports—but does not replace—clinical judgment.

For physicians, this guideline offers a clear and practical roadmap: measure blood pressure correctly, aim for systolic pressure below 130 mm Hg, and use the simplified treatment sequence to improve adherence and outcomes. Designed to be easy to implement, the new approach aims to empower primary care providers to act with confidence.

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The rising global burden of mosquito-borne viral infections has important implications for Canadian clinicians—particularly those assessing febrile patients returning from tropical and subtropical regions. On this episode of the CMAJ Podcast, infectious diseases specialists Dr. Maxime Billick and Dr. Stephen Vaughan explain what clinicians need to watch for as these viruses expand their geographic reach. Dr. Billick is the lead author of Five things to know about dengue, and Dr. Vaughan is the lead author of Five things to know about Oropouche virus, both published in CMAJ.

Dr. Maxime Billick describes the dramatic surge in dengue cases in 2024 and outlines the major drivers behind the virus’s global spread. She explains the urban-dwelling mosquito vectors that make dengue difficult to contain, discusses the virus’s four serotypes, and emphasizes the risk of antibody-dependent enhancement with reinfection. She reviews key clinical warning signs, diagnostic tests, and why identifying dengue—despite limited treatment options—still matters for patient counselling and care.

Dr. Stephen Vaughan introduces the less common but emerging Oropouche virus. He explains its current geographic range, including recent Canadian travel-related cases, and the role of biting midges in its transmission. Vaughan highlights early evidence of possible sexual transmission and the potential risks for fetal neurological complications if infection occurs during pregnancy. He also discusses symptom recurrence and what physicians should consider when counselling patients who may have been exposed.

Physicians should consider dengue and Oropouche virus in febrile returned travellers and prioritize preventive counselling before travel. Identifying the virus may not change treatment, but it can shape long-term risk awareness and help prevent future complications.

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This two-part episode of the CMAJ Podcast explores the roots and repercussions of medical mistrust. It begins with a historical lens, revealing echoes of today’s strained relationships between patients and the medical system, then narrows the scope to focus on a pressing clinical example.

In part one, Dr. Kenneth Pinnow, a historian of Soviet medicine at Allegheny College and author of the article in CMAJ entitled Soviet medicine and the problem of public trust: 1921–1929, walks through the fraught relationship between physicians and the public in the early Soviet era. He explains how underfunding, class tensions, and unrealistic expectations resulted in widespread hostility toward physicians and fractured trust that proved difficult to repair.

Part two narrows in on vaccine hesitancy, a timely example of medical distrust made more urgent by recent measles outbreaks. Dr. Noni MacDonald, a pediatric infectious disease specialist at Dalhousie University and former member of the WHO’s Strategic Advisory Group of Experts on Immunization, describes how trust is built—or lost—between patients and clinicians. She outlines practical strategies for frontline providers, from using presumptive language to engaging in motivational interviewing, and offers tips for addressing vaccine concerns efficiently, even in short appointments.

For physicians, this episode is a reminder that trust must be earned repeatedly—through expertise, empathy, and systems that allow both to be seen.

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On this episode of the CMAJ Podcast, hosts Dr. Mojola Omole and Dr. Blair Bigham explore how changes to mifepristone regulation have reshaped abortion access in Ontario. Unlike most other countries, Canada allows the drug to be prescribed by any physician or nurse practitioner and dispensed by any community pharmacy, without additional restrictions or special certifications. The discussion draws on the article Changes in local access to mifepristone dispensed by community pharmacies for medication abortion in Ontario: a population-based repeated cross-sectional study, recently published in CMAJ.

Dr. Laura Schummers, reproductive epidemiologist and lead author of the study, explains how the 2017 policy change contributed to a significant shift in abortion access. Before mifepristone, abortion care in Ontario was concentrated in fewer than 100 clinics, most of them in urban centres. Within five years of the regulatory change, the percentage of Ontario abortion service users with local access rose from 37% to 91%. Dr. Schummers also notes that this shift happened even though only one in five pharmacies dispensed the drug. She describes how earlier work demonstrating the safety of medication abortion helped support these policy changes.

Dr. Wendy Norman, a professor of family practice at UBC and co-author on the CMAJ study, outlines what clinicians need to know about prescribing mifepristone. She explains that it can be safely offered without ultrasound or lab testing in many cases, and that virtual care is a viable model for appropriate patients. Dr. Norman also provides practical advice on gestational age limits, follow-up requirements, and how to identify patients at risk for ectopic pregnancy.

This episode offers physicians a clear picture of how a regulatory approach that treats mifepristone like any other prescription medication has expanded abortion access across Ontario—and what it takes to incorporate this care into practice.

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This episode of the CMAJ Podcast examines how recent changes to U.S. federal research funding are affecting the global scientific landscape—and what they could mean for Canada. The discussion focuses on indirect costs, talent retention, and whether Canada is positioned to step into any gaps left behind. The hosts speak with two guests who have written recent articles in CMAJ offering insight into how policymakers and institutions in Canada might respond.

Dr. William Ghali, vice president of research at the University of Calgary, outlines how indirect research costs are funded in both countries and explains why the proposed U.S. cuts—though now on hold—would have had severe consequences for American institutions. He also discusses the strength of Canadian research infrastructure, recent federal budget commitments, and the challenges of recruiting U.S.-based researchers without stronger domestic supports.

Dr. Kirsten Patrick, editor-in-chief of CMAJ, expands on the policy shifts required to improve Canadian research capacity. She calls for reforms to indirect cost funding and a reassessment of how Canada prioritizes health research—highlighting the gap between identifying systemic problems and investing in studies that offer practical solutions. She also reflects on the broader implications of editorial independence in a politically pressured environment.

The episode raises timely questions for policymakers: Is Canada prepared to fill the gap left by a potential U.S. withdrawal from medical research leadership? Are we investing strategically in infrastructure, talent, and funding priorities to meet this moment? And what will it take to ensure Canadian research moves from identifying problems to generating meaningful solutions?

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It’s been nearly two decades since the last Canadian clinical practice guideline on managing obesity in children. In that time, the science has advanced, treatment options have expanded, and the need for updated guidance has grown increasingly urgent. On this episode of the CMAJ Podcast, hosts Dr. Mojola Omole and Dr. Blair Bigham speak with three guests who contributed to or were impacted by the new guideline published in CMAJ. Together, they explore how the recommendations address the complexity of pediatric obesity and what it takes to implement them in real-world settings.

Dr. Geoff Ball, chair of the guideline steering committee, explains how the recommendations were shaped by evidence as well as the meaningful participation of parents and youth at every stage of development. He discusses how the panel weighed the benefits and risks of pharmacotherapy and bariatric surgery in the context of limited pediatric data and a rapidly evolving treatment landscape.

Dr. Michelle Jackman, a pediatrician and clinical lead at the Pediatric Centre for Wellness and Health in Calgary, shares how her team delivers multi-component behavioural interventions, often in the absence of system-wide supports. She reflects on how the new guideline has prompted her to reconsider referral pathways for bariatric surgery and advocate more strongly for patients.

Brenndon Goodman, a long-time patient advocate, offers his own experience navigating childhood obesity, including the emotional dimensions of eating, the impact of stigma, and the life-changing outcome of bariatric surgery. He calls for improved access to care and a stronger commitment to children and youth living with obesity.

This episode highlights both the progress and the persistent barriers in treating childhood obesity. The new guideline affirms that obesity is a complex chronic condition and provides much-needed support for physicians caring for children and youth living with it.

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A recent article in CMAJ entitled Effect of emergency department opioid prescribing on health outcomes examines a key concern facing many clinicians: can a single opioid prescription for acute pain lead to long-term harm? This study aimed to clarify the risks and inform safer prescribing practices.

Dr. Grant Innes, the study’s senior author, analyzed more than a decade of data from Alberta emergency departments to compare outcomes between patients who did and did not receive an opioid prescription. The study found no significant difference in rates of overdose, opioid use disorder, or death—challenging widely held fears about short-term opioid use. Innes notes that older and opioid-naive patients may be more vulnerable to adverse outcomes and encourages a balanced approach to pain management.

Dr. Hance Clarke, director of pain services at Toronto General Hospital, emphasizes the importance of structured follow-up and monitoring, especially for patients at higher risk of persistent use. He outlines practical strategies for safe prescribing and highlights underused and emerging alternatives, including ketamine, IV lidocaine, nerve blocks, and sodium channel blockers now in development. Clarke warns against “opioid phobia” and calls for individualized care supported by systems that can detect early warning signs.

The guests encourage physicians to not avoid prescribing opioids when clinically indicated, particularly in cases of severe acute pain. With thoughtful screening and mechanisms for follow-up, opioids can be relatively safe and effective. The goal is not zero prescribing, but safer, smarter prescribing.

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A research article in CMAJ examines mortality risk among people hospitalized for hallucinogen use. The study found that individuals who required acute hospital care for hallucinogen-related issues had a nearly fivefold increase in mortality risk compared to the general population.

Dr. Daniel Myran, a public health and preventive medicine physician, family physician, and researcher at the University of Ottawa, discusses the study’s findings and why the growing perception of psychedelics as therapeutic may be influencing increased use. He explains how individuals hospitalized for hallucinogen-related issues often have additional risk factors, including other substance use and underlying health conditions, which may contribute to their elevated mortality risk.

Dr. Ishrat Husain, a senior scientist and the scientific head of the clinical trials unit at CAMH in Toronto, explores the controlled medical use of hallucinogens in treatment-resistant depression. He outlines the intensive screening and psychological support involved in clinical trials and compares psilocybin therapy to other treatments such as electroconvulsive therapy (ECT) and ketamine. While early evidence is promising, Husain cautions that psilocybin remains experimental and requires significant resources, raising questions about its future accessibility.

The findings highlight the need for clear public health messaging and policy decisions that distinguish between medical and recreational use of hallucinogens.

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Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

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The CMAJ Podcast is produced by PodCraft Productions