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

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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.

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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.

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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.

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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.

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Rates of depression in Canada are rising, but a new CMAJ guideline advises against universal screening in primary care. The Canadian Task Force on Preventive Health Care found no evidence that routinely administering depression questionnaires to all adults improves outcomes and raised concerns about false positives, overdiagnosis, and strain on limited mental health resources.

Dr. Eddy Lang, lead author of the guideline and professor of emergency medicine at the Cumming School of Medicine, University of Calgary, explains the rationale behind the Task Force’s recommendation. He describes how the review found no benefit from universal screening in improving depressive symptoms or quality of life and that commonly used questionnaires frequently misidentify patients, generating false positives and false negatives. Lang emphasizes that while physicians should remain attentive to patients’ mental health, questionnaires are not the answer to identifying depression in the general population.

Dr. Jennifer Young, a family physician in Collingwood, Ontario, and past president of the Ontario College of Family Physicians, reflects on what this recommendation means for everyday practice. She agrees that routine screening would add little value, pointing out that vigilance and continuity of care already allow family doctors to identify depression through clinical judgment and patient relationships. She underscores that time spent on universal questionnaires could displace care for patients with other pressing needs.

For physicians, the key takeaway is clear: be alert to signs of depression, especially in vulnerable patients, but don’t rely on blanket screening tools. Thoughtful conversation, familiarity with patients, and clinical intuition remain the best ways to identify those who need help.

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Evidence is mounting that cannabis use can trigger first episode psychosis, particularly among young people. On this episode of the CMAJ Podcast, hosts Dr. Mojola Omole and Dr. Blair Bigham speak with researchers and a patient with lived experience about what the data show, who is most at risk, and how clinicians should respond.

Bailey Peterson, a 26-year-old student from Mississauga, Ontario, describes how her cannabis consumption progressed from casual use to daily, all-day use of high-potency products. She recounts her experience with psychosis, the challenges of her hospitalization, and what she wishes she and her clinicians had known earlier.

Sophie Li, a fourth-year medical student at the University of Ottawa and an author of the CMAJ article Cannabis and psychosis, explains how rates of schizophrenia associated with cannabis use disorder have risen sharply in recent years and notes that young men in their late teens and early 20s are most at risk. For women, the highest risk tends to occur later, in their late 20s and 30s. Dr. Marco Solmi, psychiatrist and medical director of On Track: The Champlain First Episode Psychosis Program, reviews the evidence supporting a causal link between cannabis and psychosis and discusses how clinicians can distinguish cannabis-induced psychosis from schizophrenia, as well as approaches to treatment and patient education.

For physicians, the takeaway is clear: cannabis use—particularly before age 25—carries worrisome psychiatric risks, and psychosis can occur even without very high levels of consumption. Detailed cannabis histories, psychoeducation, and early counseling should be part of routine care for patients at risk of psychosis.

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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.

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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.

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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.

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—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.

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Iron deficiency affects as many as 40% of women of reproductive age, yet the problem often goes undetected—even when patients have symptoms and complications. On this episode, Dr. Blair Bigham and Dr. Mojola Omole speak with hematologists Dr. Michelle Sholzberg and Dr. Rita Selby about their structural solution to this pervasive problem: a province-wide change to how laboratories flag ferritin results. Their article, “Diagnosis and management of iron deficiency in females”, is published in CMAJ.

Dr. Michelle Scholzberg, a hematologist and clinician scientist at St. Michael’s Hospital and division director of Hematology at the University of Toronto, explains why iron deficiency without anemia is clinically important, how flawed reference standards and stigma around menstruation have contributed to underdiagnosis, why screening based on hemoglobin alone misses many patients and how structural barriers within medicine have long impeded timely detection and treatment. She outlines the evidence that drove a change to the clinical decision threshold for ferritin in Ontario laboratories and describes the movement that led to the change

Dr. Rita Selby, an academic hematologist and medical director of the Ontario Laboratory Medicine Program at Ontario Health, describes how change was implemented across Ontario’s major private labs. She clarifies the distinction between reference ranges and clinical decision limits, and how the shift helps clinicians identify subclinical iron deficiency earlier. She also discusses anticipated challenges, such as increased demand for treatment and the need for accessible knowledge translation tools.

This episode exemplifies how making structural change in Canadian medicine can be difficult, but is possible with  grassroots advocacy and inter-institutional collaboration.

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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.

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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.

Comments or questions? Text us.

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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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A new CMAJ study has found that alcohol-related hospitalizations and deaths in Canada surged during the COVID-19 pandemic. While overall alcohol consumption increased only modestly, the toll on the healthcare system was severe, with a 14% rise in hospitalizations and a 24% increase in deaths during the first two years of the pandemic. Researchers suggest that increased access to alcohol—through expanded retail hours and home delivery—contributed to these harms, particularly among heavier drinkers.

Dr. Tim Stockwell, a scientist at the Canadian Institute for Substance Use Research and an emeritus professor at the University of Victoria, discusses the study’s findings and why even a small rise in alcohol consumption can lead to a disproportionate increase in harm. He explains how heavier drinkers, already at risk, were pushed beyond critical health thresholds, contributing to the sharp rise in hospitalizations and deaths.

Dr. Adam Sherk, a senior scientist at the Canadian Centre on Substance Use and Addiction, examines the policy decisions that shaped alcohol access during the pandemic. While economic considerations played a role, he notes that governments were also reluctant to introduce new restrictions on alcohol at a time when the public was already under significant strain. He argues that a more balanced approach is needed in future public health crises—one that allows reasonable access to alcohol but uses measures like increased pricing and decreased availability to moderate its impact on the healthcare system.

The findings underscore the need to rethink how alcohol policy is handled during public health emergencies—not just in terms of balancing health and economic interests, but also in managing public willingness to accept restrictions in times of crisis.

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An article in CMAJ, "Move more, age well: prescribing physical activity for older adults," found that regular physical activity can reduce all-cause mortality by 31%. As Canada’s population ages, maintaining physical activity is becoming an increasingly critical factor in healthy aging. 

On this episode, Dr. Samir Sinha, a geriatrician at Sinai Health and the University Health Network and co-author of the CMAJ article, explains the evidence supporting exercise as a tool for preventing frailty, cognitive decline, and chronic disease in older adults. He addresses common misconceptions about aging and physical activity, emphasizing that even small, progressive increases in movement can help people stay independent longer.

Physiotherapist Steve Di Ciacca, program manager at the Canadian Centre for Activity and Aging at Western University, outlines practical ways clinicians can help older patients build movement into their daily routines. He discusses the role of social engagement, personalized goal-setting, and structured exercise programs in improving adherence. He also highlights evidence showing that a simple written prescription for physical activity can increase adherence by up to 10%.

This episode provides evidence-based insights to help clinicians encourage physical activity in older patients, promoting better long-term health outcomes.

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Medicine remains frequently inaccessible to people with disabilities, despite their higher-than-average need for healthcare services. On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole tackle the systemic barriers that patients with disabilities face, from inaccessible clinic spaces to discriminatory attitudes.

The discussion is inspired by the CMAJ practice article, "Five ways to support people who use wheelchairs," authored by Dr. Lisa Freeman. Dr. Freeman, a public health and preventative medicine physician who uses a wheelchair, shares her lived experiences navigating a healthcare system riddled with obstacles. She introduces practical steps that physicians can take to make their practices more inclusive, such as improving communication, ensuring referrals are effective, and addressing physical accessibility.

David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance, explains the legal obligations that healthcare providers must meet to comply with human rights and accessibility laws. He offers actionable guidance on how physicians can reduce barriers, from small changes like posting signage to long-term planning for accessible infrastructure.

This episode underscores that accessibility is both a legal requirement and a fundamental part of equitable patient care. It challenges physicians to take immediate steps toward making their practices more inclusive for patients with disabilities.

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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham discuss necrotizing fasciitis, a diagnosis that can strike fear into the hearts of clinicians due to its rapid progression and devastating consequences. The discussion builds on insights from the CMAJ practice article, “Necrotizing soft tissue infections caused by invasive group A Streptococcus,” co-authored by Dr. Saswata Deb and Dr. Stephanie Mason.

Dr. Deb, an emergency physician and clinician scientist at Sunnybrook Health Sciences Centre in Toronto, outlines the key clinical signs of necrotizing fasciitis, including pain out of proportion to physical findings and rapid hemodynamic deterioration. He emphasizes the importance of considering NSTI in the differential diagnosis for cellulitis and the need for prompt surgical consultation when red flags arise. Crucially, Dr. Deb explains that no imaging or laboratory tests can definitively rule in or rule out the diagnosis—only surgical exploration can confirm it.

Dr. Mason, a burn and general surgeon at Sunnybrook’s Ross Tilley Burn Centre, provides a surgeon’s perspective on managing these infections. She addresses common missteps in diagnosis, the need for aggressive surgical debridement, and the role of multidisciplinary care in saving patients’ lives. She also discusses how surgeons can overcome their fear of creating extensive wounds, reassuring listeners that reconstruction is possible once the patient is stabilized.

Together, the guests and hosts explore practical solutions to reduce delays in care, including the potential for institutional protocols—possibly a "code nec fasc"—to streamline decision-making and improve outcomes.

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