CMAJ Podcasts

Spinal and bulbar muscular atrophy (SBMA), also known as Kennedy’s disease, is a rare, progressive neuromuscular disorder that is often misdiagnosed and diagnosed late. A new CMAJ guideline offers Canadian-specific recommendations for its recognition and management.On this episode we hear from Richard Paul, a former bus driver from Saskatoon, who recalls how his symptoms began suddenly with an inability to bite into a sandwich and, over the years, progressed so gradually he barely noticed the loss of strength. His experience captures both the slow, inexorable progression of SBMA and the uncertainty of living without a diagnosis for decades.Mr. Paul was finally diagnosed by Dr. Kerri Schellenberg, a neuromuscular neurologist at the University of Saskatchewan and lead author of the guideline. She explains the clinical hallmarks of SBMA, its overlap with conditions such as ALS, and the non-motor manifestations that require attention. She also discusses the higher prevalence among Indigenous populations in Canada and how her team worked with a community Guiding Circle to ensure the recommendations reflect culturally appropriate care.For physicians, the guideline provides practical direction to support earlier recognition, timely referral, and multidisciplinary management. While there is no cure, coordinated care can significantly improve quality of life for people living with SBMA.For more information from our sponsor, go to md.ca/md-differenceComments or questions? Text us.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.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

Homelessness among pregnant and parenting people in Canada is rising, with grave consequences for both parents and children. On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham explore the scope of the problem and the supports that can improve outcomes for parents and children.Dr. Stéphanie Manoni-Millar, co-author of the CMAJ commentary Tackling the crisis of homelessness amongst pregnant and parenting people in Canada, explains who is most affected and what risks they face. She describes a predominantly young population, many of whom are homeless or experiencing precarious housing. She highlights the health consequences for children, including developmental delays, infections, and increased rates of anxiety and depression, and stresses the importance of affordable housing and integrated services to support families.Nerina Chiodo, a social worker in Toronto with MotherCraft Breaking the Cycle, shares insights from more than two decades of supporting pregnant people who are homeless. She describes what stability can look like when housing, addiction treatment, mental health services, and social supports are coordinated, an approach often described as wraparound care. Chiodo also reflects on the stigma many of her clients face in medical settings and underscores the importance of small acts of validation and compassion from clinicians.Both guests emphasized that people experiencing homelessness during pregnancy often want to parent and demonstrate resilience despite immense challenges. They urged clinicians to approach this population without stigma, to recognize the risks faced by children, and to understand how even brief, supportive interactions can influence whether patients return for care.Comments or questions? Text us.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.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

Smoking remains the leading cause of preventable disease and death in Canada. A new clinical practice guideline published in CMAJ on tobacco smoking cessation outlines evidence-based behavioural and pharmacological interventions to help patients quit. On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham speak with Dr. Eddy Lang, co-author of the guideline, and Dr. Andrew Pipe, a pioneer in smoking cessation research and practice, about how clinicians can better support patients ready to stop smoking.Dr. Eddy Lang, an emergency physician and professor at the Cumming School of Medicine, describes how the Canadian Task Force on Preventive Health  assessed a wide range of interventions to make sense of a complex evidence base. He outlines the strong recommendations in favour of pharmacological therapies such as nicotine replacement therapy, bupropion, varenicline, and cytosine, as well as behavioural interventions including counselling, group therapy, and quit lines. He also explains the conditional recommendation against e-cigarettes, citing limited long-term safety data and concerns about normalizing their use among youth.Dr. Andrew Pipe, professor of medicine at the Ottawa Heart Institute and co-creator of the Ottawa Model of Smoking Cessation, offers practical guidance for everyday practice. He highlights how a state-of-the-art smoking cessation intervention can be delivered in as little as 26 seconds. This brief approach is non-judgemental, empathetic, and emphasizes that help is available whenever the patient is ready.He also stresses that clinicians should treat cessation pharmacotherapy like any other chronic disease medication—titrated to patient response and continued as long as needed. Pipe emphasizes that nicotine replacement therapy is often underdosed, which undermines its effectiveness. He encourages physicians to combine long-acting patches with rapid-acting forms such as gum or lozenges, and to adjust dosing based on patient comfort, allowing individuals to guide their own titration.This episode underscores that even brief encounters can open the door to meaningful change for patients ready to stop smoking. Asking about smoking status, offering practical, evidence-based assistance, and prescribing cessation therapies in sufficient doses can effectively help patients quit.For more information from our sponsor, go to md.ca/md-differenceComments or questions? Text us.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.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

—This is an encore presentation of an episode previously published June 30—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.Comments or questions? Text us.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.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

Michelle Scholzberg, a hematologist dedicated to reducing gender bias in medical testing, and Rita Selby, an expert in laboratory medicine, discuss the critical issue of iron deficiency diagnosis. They highlight how outdated ferritin standards contribute to underdiagnosis, particularly among women. The conversation reveals their collaborative effort to implement province-wide changes in Ontario's labs, allowing for better identification of subclinical iron deficiency. The guests passionately advocate for structural changes that improve patient care and tackle systemic obstacles.

Measles is resurging in Canada, with particularly serious implications for pregnant patients and newborns. A recent CMAJ article, Five things to know about measles in pregnancy, outlines the risks and clinical considerations. On this episode of the CMAJ Podcast, we speak with one of the article’s co-authors, Dr. Michelle Barton-Forbes, about what physicians need to know when caring for pregnant patients during a measles outbreak. We also get an update on the current state of the outbreak in Canada from Dr. Marina Salvadori.Dr. Michelle Barton-Forbes, division chief of infectious disease at the Children’s Hospital at London Health Sciences Centre, highlights the risks of measles in pregnancy, including atypical presentations, preterm labour, and rare but severe complications like subacute sclerosing panencephalitis. She discusses the limitations of existing research, current guidance on immunoglobulin use in newborns, and the use of vaccines during pregnancy.Dr. Marina Salvadori, senior medical advisor at the Public Health Agency of Canada, describes the scope of the ongoing measles outbreaks and their concentration in undervaccinated communities. She explains the public health challenges of engaging with vaccine-hesitant populations and outlines practical steps physicians can take to support informed vaccination decisions and to prevent further spread of the virus.This episode offers physicians clinical guidance on recognizing measles in pregnancy, managing exposures and complications, and navigating conversations about vaccination during an ongoing outbreak.Comments or questions? Text us.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.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

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.Comments or questions? Text us.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.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

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.For more information from our sponsor, go to MedicusPensionPlan.comComments or questions? Text us.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.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

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.Comments or questions? Text us.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.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

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.For more information from our sponsor, go to MedicusPensionPlan.comComments or questions? Text us.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.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions