CMAJ Podcasts: Exploring the latest in Canadian medicine from coast to coast to coast with your hosts, Drs. Mojola Omole and Blair Bigham. CMAJ Podcasts delves into the scientific and social health advances on the cutting edge of Canadian health care. Episodes include real stories of patients, clinicians, and others who are impacted by our health care system.
The narrow promise of lecanemab for Alzheimer disease
Lecanemab arrived in Canada in January 2026 as an anti-amyloid therapy meant to slow Alzheimer disease. A new practice article in CMAJ , " Lecanemab use for early Alzheimer disease in Canada ," lays out key challenges with the drug including narrow eligibility, a modest effect that may not be clinically meaningful, and a resource-intensive path to treatment. Dr. Sophie Weiss, a co-author of the article and a third-year internal medicine resident at the University of Toronto, walks through eligibility and effect size of this novel treatment. Qualifying is a multi-step process of confirmed amyloid on a PET scan or lumbar puncture, genetic testing and a baseline MRI. However, the Clarity AD trial slowed decline by 0.45 points on a standard dementia scale, short of the roughly 1-point difference considered clinically meaningful. Patients eligible and interested in pursuing the therapy, in spite of its modest benefit, will need to pay $35,000 to $40,000 a year which presents one more barrier to treatment. Dr. Vivian Ewa, a care of the elderly physician in Calgary and a clinical associate professor at the University of Calgary, describes the drug's limited role in her practice. She is unable to prescribe it as this is restricted to a small number of specialized prescribers. She says biweekly infusions and urban-only diagnostics put it out of reach for rural and remote patients. For the many who will not qualify, she points to the 2024 Lancet Commission finding that 45% of dementia cases are potentially preventable by modifying 14 risk factors, through such interventions as physical activity, socialization, vascular risk management and hearing correction. For some patients, lecanemab may offer hope for a devastating condition lacking effective disease-modifying treatments. Physicians should be clear about the potential barriers, modest effect size and significant cost. At the same time, primary care physicians should emphasize the impact of reducing identified risk factors. 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
A contrast allergy note on the chart can trigger delays, unnecessary steroids and avoided scans, yet often these labels are not clinically justified. A new practice article in CMAJ , “ Hypersensitivity reactions to iodinated contrast media ,” examines how the labels arise and why the standard premedication rests on contrast agents that are no longer used. Dr. Samira Jeimy, an associate professor and program director of the division of clinical immunology and allergy at Western University and an author of the article, separates adverse reactions into Type A, the dose-dependent flushing, nausea and vasovagal symptoms anyone can get, and Type B, the bizarre ones from anaphylaxis to delayed reactions such as Stevens-Johnson syndrome. She notes the weak literature behind corticosteroid premedication is based on older high-osmolality agents that modern imaging has left behind. Dr. Amit Katyan, a radiologist at the Ottawa Hospital and its lead for CT, has built a protocol that works back through the history for signs the reaction affected airway, breathing or circulation, or required epinephrine, an emergency visit or admission. For mild and moderate reactions his team skips steroids and switches to a contrast agent the patient has not had before, an approach he says the guidelines favour. For physicians, the first move is to reverse-engineer the label rather than act on it, since many notes describe an expected physiological reaction rather than a true allergy. A necessary contrast study should not be delayed for steroid premedication when the history points to a mild reaction and another agent can be substituted. For more information from our sponsor, go to md.ca/lifeplan 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
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. For more information from our sponsor, go to HaleonHealthPartner.com 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
Urinary incontinence affects about a third of adult women in Canada, yet many never receive a diagnosis or treatment. On this episode, Dr. Blair Bigham and Dr. Mojola Omole discuss the CMAJ review “ Diagnosis and management of urinary incontinence in females ,” which outlines how physicians can identify common forms of incontinence and begin management in primary care. The episode opens with Sharon Roman, who shares her experience living with bladder dysfunction related to multiple sclerosis. Her story highlights the embarrassment, health consequences and barriers to care that can come with urinary incontinence, as well as the frustration of being told to simply keep living with symptoms that profoundly affect quality of life. Dr. Louise-Helene Gagnon, an author of the review, a urogynecologist at Sunnybrook Hospital and assistant professor at the University of Toronto, explains the distinction between stress urinary incontinence and urge incontinence. She reviews common risk factors, including childbirth, menopause and pelvic floor injury, and walks through treatment options including pelvic floor physiotherapy, pessaries, mirabegron, vaginal estrogen and specialist referral. For physicians, the central message is simple: patients may not raise urinary incontinence on their own. Asking about it directly can open the door to practical treatments that reduce isolation, embarrassment and daily disruption. For more information from our sponsor, go to md.ca/lifeplan 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
Near-death experiences (NDE) are often described in spiritual, personal or even supernatural terms. But a new CMAJ article offers physicians a clinical entry point into understanding them as a distinct phenomenon that patients may report after cardiac arrest, critical illness or other life-threatening events. Dr. Blair Bigham and Dr. Mojola Omole speak with Dr. Andrés Delgado-Ron, a senior data analyst at Simon Fraser University’s Faculty of Health Sciences and author of “ Five things to know about near-death experiences ”. He explains how NDEs differ from delirium or hallucinations, why they are often described as highly organized and vivid, and how veridical perceptions, where patients report details that can later be verified, raise important questions for researchers and clinicians. They also speak with Dr. Marieta Pehlivanova, research assistant professor of psychiatry and neurobehavioural science at the University of Virginia Division of Perceptual Studies, about how physicians respond when patients disclose these experiences. She explains why dismissive reactions can be harmful, how they may prevent patients from processing an event that feels profound, and why clinicians can validate the experience without needing to explain or endorse every aspect of it. For physicians, the message is practical: stay curious, listen without judgement and avoid automatically pathologizing or brushing aside a patient’s account. Patients may need space to talk about what happened, and clinicians can offer that space while still maintaining scientific rigour. Lancet article discussed. 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
Endometriosis and the devastating risks of untreated disease
Two articles in CMAJ look at endometriosis from sharply different angles. One shows how devastating delayed recognition can be, following a patient whose deep infiltrating endometriosis led to renal atrophy, bowel obstruction, sciatic nerve impingement and a permanent ostomy. The other offers a more reassuring picture, finding only a small increased risk of congenital anomalies among infants born to patients with endometriosis. Together, they show why endometriosis deserves earlier recognition, better imaging and more serious clinical attention. Dr. Sony Singh, chair of the Department of Obstetrics and Gynecology at the University of Ottawa and head of the Department of Obstetrics, Gynecology and Newborn Care at The Ottawa Hospital, discusses the CMAJ practice article, “ Renal atrophy, bowel obstruction, and sciatic nerve impingement secondary to endometriosis ”. He explains how deep infiltrating endometriosis can invade adjacent organs and cause severe fibrosis when left untreated. Bailey Milne, a PhD candidate in epidemiology at Queen’s University, discusses the CMAJ article, Risk of congenital anomalies for infants born to patients with endometriosis: a population-based cohort study . She emphasizes that although the study found a small increased risk of congenital anomalies, the overall risk remains low. For physicians, the episode highlights the importance of considering endometriosis in patients with cyclical pelvic, abdominal, bowel, urinary or sexual pain, even when initial imaging is normal. For more information from our sponsor, go to md.ca/lifeplan 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
While overall cancer rates in Canada continue to decline, reflecting decades of progress in screening and treatment, younger survivors face troubling gaps in their follow-up care. In the research article “ Projected estimates of cancer in Canada in 2026 ” overall cancer incidence and mortality rates continue to decline when adjusted for population size, reflecting advances in screening, early detection, and treatment. But for adolescents and young adults, surviving cancer may mark the start of a more complex and less coordinated phase of care. Dr. Darren Brenner, a molecular cancer epidemiologist at the University of Calgary, reports that more than 250,000 Canadians are expected to be diagnosed with cancer in 2026, with rates per 100,000 continuing to fall. Mortality has declined for several major cancers, though increases in pancreatic and uterine cancers highlight uneven progress. Brenner notes that a growing number of survivors are now living with elevated risk of second primary cancers and will require long-term follow-up. Dr. Miranda Fidler-Benaoudia, a cancer epidemiologist at Cancer Care Alberta and co-author of the article, article “ Subsequent primary neoplasm risk among survivors of cancer in adolescence and young adulthood: a population-based study from Alberta, Canada, ” examines what happens after treatment for patients diagnosed between ages 15 and 39. Her study finds these survivors are twice as likely to develop a second primary cancer as their peers, often at younger ages than current screening programmes anticipate. Despite this, survivorship care is inconsistent. Patients treated in paediatric settings often receive lifelong, specialized follow-up, while those treated in adult systems may be discharged within a few years to primary care without standardized guidance or documentation. Many lack access to a family physician, and clinicians may not be equipped to manage the long-term risks associated with early cancer treatment. For clinicians, these findings raise questions about how to manage a growing population of younger cancer survivors who face elevated risks over decades. Earlier onset of second cancers and the absence of clear follow-up pathways suggest current screening frameworks and transition practices may not be sufficient for this group. 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
Toward a cure for sickle cell disease
Transformative therapies for sickle cell disease are redefining what is possible for patients, offering the potential for cure alongside substantial risks. In CMAJ , the article Transformative therapies for sickle cell disease outlines how stem cell transplant and emerging gene therapies are changing the trajectory of a condition long defined by recurrent crises, shortened life expectancy, and inequities in care. Dr. Kareem Jamani, a haematologist and clinical associate professor at the University of Calgary, explains how stem cell transplant replaces a patient’s blood-forming system to eliminate sickling haemoglobin, offering what can reasonably be considered a cure. Outcomes are generally favourable, particularly with matched sibling donors, but risks remain, including graft-versus-host disease, infertility, rejection, and mortality that can reach 5–7% with less well-matched donors. He also outlines the role of gene therapy, which modifies a patient’s own stem cells to increase fetal haemoglobin production, resulting in a functional cure with similar improvements in quality of life. The episode is grounded in the experience of Ufuoma Muwhen, who underwent a stem cell transplant as a teenager after years of frequent hospitalizations and functional limitations. She describes the toll of both the disease and the treatment process, as well as the shift in her daily life following transplant, including her ability to travel, exercise, and live without recurrent crises. Her account highlights the importance of wraparound supports and trust in the healthcare system. For physicians, these therapies require balancing meaningful benefit against real risk, often early in life and under uncertainty. The discussion also underscores persistent inequities, including delayed acute care, limited access to fertility preservation, and the challenges of delivering advanced therapies within systems designed around oncology rather than chronic genetic disease. For more information from our sponsor, go to medicuspensionplan.com 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
Two research articles in CMAJ examine gaps in how maternal risk is captured and how it varies across populations in Canada. One study shows that extending surveillance beyond delivery reveals a higher burden of severe maternal morbidity, particularly in the postpartum period. A second examines obstetric trauma, identifying differences across racial and immigration groups and pointing to structural and sociocultural factors that shape risk during delivery. Dr. Giulia Muraca, an obstetrician-gynecologist at McMaster University and principal investigator on the first study, explains that extending surveillance beyond delivery increases estimated rates of severe maternal morbidity from 1.7% to 2.7%, representing nearly 10 000 affected pregnancies annually in Canada. Maya Rajasingham, a perinatal epidemiologist at McMaster and co-author, notes that 29% of these events occur postpartum, with sepsis emerging as a key contributor. Muraca adds that postpartum sepsis rates are substantially higher than previously reported, with most cases occurring in the first week after discharge. She also identifies acute appendicitis as the most frequent severe maternal morbidity in the antepartum period, a finding that remains underexplored in the Canadian literature. The findings suggest current surveillance windows underestimate the true burden of maternal morbidity. In a second CMAJ study on obstetric trauma, Muraca again serves as principal investigator alongside Irina Oltean, a PhD candidate at McMaster and co-author. The study finds that obstetric trauma affects 5.5% of vaginal births, with substantial variation across racial groups. Oltean reports higher rates among Asian patients and lower rates among Black patients compared with White patients, even after adjusting for clinical factors. Among immigrants, risk declines with increasing time in Canada. The authors suggest this pattern reflects differences in communication, access to care, and familiarity with the health system rather than biological factors. For clinicians, these studies suggest the need to expand the window of concern beyond delivery and to account for how social and structural factors shape risk across populations. 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
Treatment of adult ADHD is on the rise. Why?
New prescriptions for stimulant medications used to treat attention-deficit/hyperactivity disorder (ADHD) doubled during the COVID-19 pandemic compared with the years before it, with the largest increases among adults aged 18 to 34 and among women. Dr. Tara Gomes, a professor at the University of Toronto and principal investigator of the Ontario Drug Policy Research Network, discusses findings from the CMAJ research article Patterns of prescription stimulant initiation before and during the COVID-19 pandemic . Her team found that the number of Ontarian adults newly starting stimulants rose rapidly after an initial drop early in the pandemic. The interval between a first ADHD-related health care encounter and a stimulant prescription also fell from about seven years before the pandemic to less than one year during it. Gomes suggests the increase likely reflects both improved recognition of ADHD in adults and easier access through virtual care, which may be shortening the pathway from first expression of concern by a patient to prescription. Dr. Ashley White, a family physician who treats many patients with ADHD and received her own diagnosis in adulthood, reflects on how the condition can go unrecognized in high-performing adults. While she explored her own diagnosis through an online clinic, she emphasizes the importance of careful assessment that accounts for overlapping conditions such as anxiety or trauma, which can benefit from different treatment. The episode highlights a genuine tension: better recognition of adult ADHD is overdue, but the speed of the shift raises real questions about diagnostic rigour. For more information from our sponsor, go to medicuspensionplan.com 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
High stakes: Online gambling and the rise in harm
Ontario’s expansion of online gambling and legalization of single-event sports betting were followed by a sharp rise in help-seeking for gambling problems, particularly among young men. A new CMAJ study, Help seeking for gambling problems following expansion of Ontario's online gambling market and legalization of single event sports betting , analyzes calls to Ontario's 24-hour mental health and addiction hotline before and after the 2022 policy changes. The findings suggest that increased accessibility, private-sector expansion, and in-play betting may be amplifying gambling-related harm. Dr. Daniel Myran, a family physician, research chair in family and community medicine at North York General Hospital, and co-author of the study, reports that hotline contacts among males aged 15 to 24 tripled after the market opened to private operators. By the end of the study period, more than 70% of callers cited online gambling. He describes how legalization of single-event sports betting and in-play betting reduced friction and increased immediacy, features linked to higher addiction risk. Dr. Daniela Lobo, medical lead of the Problem Gambling and Tech Use Clinic at CAMH and an assistant professor of psychiatry at the University of Toronto, describes seeing younger patients since the introduction of iGaming, including individuals in their late teens and early twenties. She explains how in-play betting mirrors other high-risk formats by offering rapid, repeated opportunities to wager. Gambling disorder shares features with substance use disorders, including tolerance, withdrawal symptoms, concealment, financial strain, and suicidal ideation. She also highlights medication-related risk, noting that dopamine agonists and certain atypical antipsychotics have been linked to new gambling behaviours. Clinicians should consider gambling when patients present with unexplained financial stress, relationship conflict, mood symptoms, or suicidality, and remain alert to medication-induced behavioural change. Resources like ConnexOntario offer anonymous referral support for patients and providers. For more information from our sponsor, go to HaleonHealthPartner.com 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
Sentinel injuries and severe maltreatment in young children
Child physical abuse often presents first with injuries that appear minor, but missing these early warning signs can have devastating consequences. Two recent CMAJ papers examine how sentinel injuries in infants may signal escalating risk and how patterns of severe maltreatment shifted during the COVID-19 pandemic. Together, they offer practical guidance on when clinicians should escalate concerns and highlight system factors that shape risk for vulnerable children. Dr. Megan Cooney, a child maltreatment pediatrician at Health Sciences Centre Winnipeg and co-author of “ Five things to know about sentinel injuries and indicators of child physical abuse ”, explains why medically minor injuries in pre-cruising infants require careful scrutiny. She notes that more than one quarter of children who experience catastrophic abuse had previously been seen for minor injuries. Any unexplained or poorly explained injury in a non-cruising infant should raise concern. She also reviews the validated TEN-4-FACESp clinical decision rule to help clinicians identify bruising patterns that warrant further action. Dr. Matthew Carwana, a pediatrician at BC Children’s Hospital and clinical investigator at the BC Children’s Hospital Research Institute, discusses findings from “Hospital admissions for maltreatment among children younger than 2 years during the COVID-19 pandemic in Canada ”. He describes an early drop in maltreatment hospitalizations during the first 16 weeks of the pandemic, followed by a return to expected levels. However, ICU admissions rose above baseline for roughly the following year, raising concern that children may have been presenting with more serious injuries. Carwana suggests reduced early detection and loss of family and community supports during periods of isolation may have contributed. For physicians, the message is to remain objective and act early. Injuries in pre-cruising infants should be treated as potential red flags, validated tools such as TEN-4-FACESp can support clinical judgment, and concerning cases should prompt timely reporting to child welfare agencies rather than waiting for certainty. For more information from our sponsor, go to medicuspensionplan.com 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham explore new evidence suggesting that rates of psychotic disorders are increasing in younger generations in Canada. Drawing on population-level data and broader psychiatric research, the episode examines how generational trends in psychosis intersect with substance use, social change, and the ongoing youth mental health crisis. Dr. Daniel Myran, a family physician and public health researcher at North York General Hospital, discusses findings from his CMAJ study, Incidence of psychotic disorders by birth cohort: a population-based cohort study in Ontario, Canada. He explains how overall rates of psychosis appear stable when populations are viewed as a whole, but mask a substantial rise among people born in the 1980s, 1990s, and early 2000s. Dr. Myran outlines possible contributors, including substance exposure, changes in diagnostic practices, and social determinants, and emphasizes the implications for early intervention psychosis programs and frontline care. The conversation then widens with Dr. Dafna Kahana, an associate professor of psychiatry at the University of Toronto and staff psychiatrist at CAMH, who draws on her article in the Journal of Psychiatry and Neuroscience , Are the kids alright? Making sense of the current youth mental health crisis in Canada through heuristic and data. She unpacks how social media use, sleep disruption, physical inactivity, pandemic-related isolation, and exposure to global crises may interact to affect youth mental health, while cautioning against oversimplified explanations or single-factor solutions. For clinicians, the takeaway is twofold: emerging generational shifts in psychosis warrant attention in both primary care and mental health planning, and addressing youth mental health requires a coordinated, multi-pronged approach that spans early identification, family support, and system-level investment rather than reliance on any single intervention. 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
World Cup exposes vulnerabilities in Canada’s health care system
On this episode of the CMAJ Podcast , Dr. Mojola Omole and Dr. Blair Bigham examine how large-scale events expose weaknesses in Canada’s health care capacity. The discussion draws on the CMAJ editorial Mass gathering events underscore serious vulnerabilities in health care capacity in Canada , which argues that Canada’s hospitals lack the flexibility to absorb even modest surges in demand. With the FIFA World Cup approaching, the episode asks how prepared the system really is. Dr. Catherine Varner, deputy editor of CMAJ and an emergency physician, explains why she wrote the editorial now. Drawing on her frontline experience during major events in Toronto, she describes hospitals that routinely operate over capacity, with little ability to create space when demand rises. She distinguishes between mass casualty events and mass gatherings, noting that while catastrophic incidents are rare, sustained influxes of visitors predictably increase emergency department use. Varner also describes how prolonged overcrowding worsens patient outcomes and contributes to moral distress among clinicians forced to triage care daily. The conversation then turns to national surge planning with Dr. Rob Fowler, chief of the trauma program at Sunnybrook Hospital and director of critical care at the University of Toronto. Fowler describes insights from tabletop exercises, including Canada Paratus, which examined how civilian and military health systems might respond to a large influx of casualties. He explains how hospitals already operating at or near capacity struggle to respond to sudden surges, particularly when care depends on moving patients across the system. For physicians, the takeaway is stark: Canada’s health care system is already operating at or beyond its limits. Without meaningful capacity to flex or coordinated mechanisms to redistribute patients, even predictable increases in demand risk tipping routine strain into crisis. For more information from our sponsor, go to medicuspensionplan.com 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
Moral distress and the ethics of involuntary treatment
On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham examine the issues raised in a recent CMAJ commentary on Alberta’s Compassionate Intervention Act , which explores the ethical and clinical implications of this approach to involuntary treatment. As governments across Canada turn to coercive measures in response to the overdose crisis, the episode considers what these policies mean for patient autonomy, clinical practice, and the role of physicians in enforcing care. Dr. Bonnie Larson, a family physician and addictions medicine specialist at the University of Calgary, joins the conversation to unpack the legislation. She explains how the Act allows individuals to be detained and treated even when they are deemed capable of making their own medical decisions. Dr. Larson describes how this represents a substantial departure from established principles of consent and autonomy, placing physicians in ethically complex positions and reshaping their role in care. The discussion then turns to Massachusetts, where involuntary treatment for substance use has existed for decades under Section 35. Dr. Keren Ladin, a bioethicist and health services researcher at Tufts University, reveals the experiences of clinicians working within this framework. Drawing on her research, she describes how Section 35 has shaped clinical practice, contributed to moral distress among healthcare providers, and often resulted in people being treated in carceral rather than therapeutic settings. Together, the guests reflect on what these policies reveal about how societies respond to addiction, the limits of coercive care, and the risks of prioritizing control over evidence-based, patient-centred treatment. 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
ENCORE: New guidelines for managing hypertension in primary care
On this ENCORE of our most popular episode of 2025, 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
Despite a range of effective prevention tools, HIV incidence continues to rise in Canada, with stark disparities across ethnicity, gender, Indigeneity and geography. Updated Canadian guidelines on HIV pre- and post-exposure prophylaxis reflect scientific advances since 2017 and address both new formulations and persistent barriers to equitable access. Dr. Darrell Tan, lead author and clinician scientist at St. Michael’s Hospital, outlines several prophylaxis options now available. Daily oral tenofovir disoproxil fumarate with emtricitabine is close to 100 per cent effective with perfect adherence and remains forgiving of occasional missed doses. Long-acting injectable cabotegravir, administered every two months, shows even greater effectiveness in trials largely because it reduces the adherence challenges associated with daily pills, though cost and availability continue to limit uptake. Natasha Lawrence, a community health worker at Women’s Health in Women’s Hands Community Health Centre in Toronto, reports that most women she serves have never heard of pre-exposure prophylaxis. Many people perceive their HIV risk as low until discussions explore relationship dynamics, including uncertainty about partner fidelity or difficulty negotiating condom use. She highlights how power imbalances and gender-based violence shape women’s risk and may limit the practicality of daily pills. Long-acting injectables can offer greater privacy and autonomy for some women, reducing the risk of partner detection. Public health messaging, she stresses, must be co-designed with communities to ensure cultural relevance and avoid stigma. Clinicians should initiate sexual health conversations routinely, not only when patients raise concerns. Pre-exposure prophylaxis can be discussed during visits for contraception, mental health or other routine care. When patients express interest, access should not be limited by rigid criteria. Long-acting options may be especially helpful for women who face safety or privacy concerns in their relationships. For more information from our sponsor, go to medicuspensionplan.com 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
Celiac disease affects between one and two percent of Canadians, yet many patients wait years before receiving a clear diagnosis. On this episode of the CMAJ Podcast, the hosts speak with two contributors to the CMAJ review article Diagnosis and management of celiac disease about the condition’s diverse clinical presentations, appropriate testing strategies, and the practical realities of long-term dietary management. Jedid-Jah Blom, a registered dietitian at the McMaster Celiac Disease Clinic and researcher at the Farncombe Family Digestive Health Research Unit at McMaster University, shares her own experience being diagnosed and living with celiac. She explains how patients must identify hidden gluten sources in ingredients like dextrin and malt, and why cornmeal or corn flour products may be contaminated. Blom outlines the risks of cross-contamination and dining out challenges, emphasizing whole gluten-free grains over processed products that lack fortification. Dr. Maria Ines Pinto-Sánchez, a gastroenterologist at Hamilton Health Sciences and director of the Celiac Clinic at McMaster University, explains why celiac is called a chameleon disease. She notes that about 30 percent of patients present with gastrointestinal symptoms, while others may have brain fog, fatigue, or anemia. She describes how TTG antibodies plus total IgA are used for screening, with positive results requiring endoscopy and biopsies for confirmation. Dr. Pinto-Sánchez emphasizes that patients should not start a gluten-free diet before testing. She discusses ongoing monitoring including TTG levels, bone density, and nutrient deficiencies. For physicians, the discussion highlights the need for a low threshold when testing TTG antibodies in patients with unexplained fatigue, brain fog, or gastrointestinal symptoms. Both guests stress the importance of completing diagnostic testing before patients begin a gluten-free diet and arranging early dietitian referral. 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
This episode of the CMAJ Podcast explores how physician identity can influence patient expectations, and how those expectations may contribute to gender, race, and immigration status pay gaps. The discussion builds on the CMAJ article “ Family physician pay inequality: a qualitative study exploring how physician responses to perceived patient expectations may explain gender, race, and immigration status pay differences ”. Dr. Monika Dutt, a family physician, public health and preventive medicine specialist, and PhD candidate in health policy at McMaster University, explains how the study’s interviews with 55 family physicians across Ontario revealed patterns linking patient expectations to physician identity. She describes how gender and cultural background influence the types of visits physicians are asked to provide, and how these interactions may affect their earnings under fee-for-service models. Dr. Meredith Vanstone, professor in the Department of Family Medicine at McMaster University, outlines how physicians adapt to explicit and inferred patient expectations and the income implications that follow. She discusses how these expectations are shaped by identity and why the resulting adjustments in care can lead to financial penalties for some physicians while improving patient relationships and trust. The guests highlight how remuneration structures can either amplify or mitigate these inequities. They suggest that moving toward salary or time-based models could help reduce the impact of physician identity on income while supporting equitable, patient-centred care. For more information from our sponsor, go to medicuspensionplan.com 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
A recent article in CMAJ , Mental health service use among Black adolescents in Ontario by sex and stress level: a cross-sectional study , reveals how patterns of mental health service use among Black youth shift with the level of psychological distress. Lead author Mercedes Sobers, a PhD candidate in epidemiology at the Dalla Lana School of Public Health and research coordinator at the Centre for Addiction and Mental Health, joins the podcast to unpack the findings and their implications. The study found that Black male youth had higher odds of accessing services than white male youth when at low levels of distress but lower odds of accessing services at high levels. Black female youth had lower odds of service use than white female youth at both low and high distress levels. Mercedes explains how these patterns may reflect how behaviour is interpreted: Black boys may be referred to services more often at lower distress levels but steered toward more punitive responses when distress rises. For Black girls, she points to adultification and cultural mismatches in care. Dr. Amy Gajaria, a psychiatrist at the Centre for Addiction and Mental Health and associate scientist in the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, describes how programs like AMANI aim to provide culturally adapted care and build trust with Black youth. She shares how early encounters with the system can shape future engagement with care. For physicians, the discussion underscores the importance of culturally sensitive care that embraces and reflects the experiences of Black youth, creating more meaningful and effective pathways to support. 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 @Drmojolaomole X (in English): @CMAJ X (en français): @JAMC Facebook Instagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions
