Adverse drug events cause 5-15% of admissions to hospital and drug-drug interactions make up about a fifth of these. Most common are pharmacodynamic situations where two drugs have a similar outcome thereby overdoing the intended outcome. Pharmacokinetic interactions are more complicated to understand as they’re more indirect. For example, while medications are cleared by oxidative metabolism in the liver and gut, there are many drugs that interfere with the function of the cytochrome enzymes responsible. This can result in clearance of the first drug at too fast or too slow a rate.

Polypharmacy has become more frequent over the decades with more than half of people over the age of 75 on five or more prescriptions. This episode examines some of the systems that have led to current rates of polypharmacy, and strategies for deprescribing safely in a given patient. We're REWINDing it nine years after it was first published to celebrate the career of Professor Ric Day who has just retired after sixty years of service at St Vincent’s Hospital, Sydney. He has been a much-appreciated clinician and prolific research academic with several hundred published papers that have been cited more than forty thousand times.

Chapters
0:50 Prevalence of drug interactions
5:52 Pharmacodynamic vs pharmacokinetic interactions
9:25 Cytochrome enzymes
17:33 ACE inhibitors and more
26:48 Strategies for deprescribing

Guests
Professor Richard Day AM MBBS, FRACP (St Vincent’s Hospital; UNSW),
Professor Sarah Hilmer AM PhD FRACP FAAHMS (Royal North Shore Hospital; Kolling Institute/ USyd).
 
Production
Produced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes ‘Flying Pea’ and ‘Cherry Blossom’ by Daddy Scrabble and “Manly Nunn Steps Out” by Doctor Turtle. Music licenced from Epidemic Sound includes ‘Train Ride’ (Instrumental) by Alex Kehm and ‘Yellow Leaf’ by Autohacker. Image adapted for RACP

Add educational activity to MyCPD as educational activity or visit web page for a transcript and references.

Key References
Life-threatening drug interactions: what the physician needs to know [Internal Medicine Journal]
Polypharmacy in older people: when should you deprescribe? [Medicine Today]

Syphilis is often thought of as a disease from the historic literature, but in August last year, it was declared a Communicable Disease Incident of National Significance by Australia’s Chief Medical Officer. Case numbers have grown year on year since it became a notifiable disease in 2004, peaking at around six and a half thousand in 2023. 

Syphilis is sometimes described as ‘the great imitator’ because it can have so many different presentations. And it can hide away for years before revealing itself in one system of the body or other. In this podcast we’ll go over the neurologic, ophthalmic and nephrotic symptoms that can eventuate, and also some worrying examples of congenital transmission seen today. Today’s podcast will expand your library of differential diagnoses and give you confidence to go down the pathway of testing, treatment and contact tracing. It has been disseminated with assistance from ASHM.

Guests
Clinical Professor Louise Owen FRACGP FAChSHM MBBS(Hons) (Statewide Sexual Health Service in Tasmania, Director; University of Tasmania)
Dr Janet Towns FRACP FRACGP AChSHM PhD (Melbourne Sexual Health Centre; Monash University)
Dr Nele Legge FRACP PhD (Liverpool Hospital)

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘A Forest Melody’, ‘Time Traveller’ by Tellsonic, ‘Reconstruct’ by Amaranth Cove and ‘Beat Street’ by VV Campos. Music courtesy of FreeMusicArchive includes ‘Namaste’ by Jason Shaw. Historic poster courtesy of the US Library of Congress Archive.

Editorial feedback kindly provided by members of the Doctors Aidan Tan, Courtney Dowd, Marion Leighton, Lauren Gomes, Rahul Barmanray and Rachel Murdoch. Dissemination of this podcast was supported by ASHM and campaign to Stop Syphilis.

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Contagious Conversations is a new series brought to you by ASID, the Australasian Society for Infectious Diseases. Once a month, these podcasts will explore evolving evidence and real-world challenges for the practice of ID medicine. The hope is that you’ll come away with practical knowledge to support your clinical confidence and continuous learning. 
 
Expert guests in this series will come from right across the interface of research, clinical care, and public health. Today we start with a paediatrician from Melbourne and a clinical nurse from the Sunshine Coast, who both make an important contribution to Australia’s National Immunisation Program. As we’ll hear today, public adherence to the NIP has been declining in recent years. In today’s conversation we hear about some of the reasons for vaccine hesitancy in parents and ways to reinspire confidence. 

Guests
Professor Margie Danchin FRACP, PhD (University of Melbourne; the Royal Children’s Hospital; Murdoch Children’s Research Institute)
Wendy Tout (Public Health Unit, Sunshine Coast Health Service)

Host
Associate Professor Sanjaya Senanayake FRACP (Canberra Hospital; Australian National University; University of New South Wales)

Production
Production supported by Mic Cavazzini DPhil, the ASID Vaccine Special Interest Group chaired by Dr Archana Koirala and staff support from Inge Meggitt. Music licenced from Epidemic Sound includes ‘Exploring the Lake’ by View Points and ‘Emerlyn’ by Valante. Image copyright with ASID (2026).

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In Pomegranate <> we go back to some classic episodes from the last ten years that have stood the test of time. The first throwback takes us back to 2017 with episodes 20 and 21 titled “Genomics for the Generalist.” While there’s been a flood of genomic discoveries since this story was first published, it’s still a good primer on fundamental concepts and everyday challenges for the physician advising a patient. The expert guests include a genetic pathologist, a clinical geneticist, a genetic counsellor and a medical oncologist.

The podcast covers the different roles for single gene tests and whole genome sequencing, which has become much more accessible. We tackle question of disease risk and how to present uncertain predictive diagnoses to consumers. This is particularly relevant to using genome-wide association studies, which re finding more and more markers with very small associated risks of disease. This increases the likelihood of picking up diagnoses incidental to the ones a clinician might be looking for. The ethics of consenting patients to genome screening and informing them of incidental findings are also discussed.

Chapters
3:04 Mendelian vs multi-gene diseases
6:42 Whole genome sequencing
10:09 Prenatal testing
12:38 What do physicians need to know?
17:07 Pharmacogenomics
19:52 Genetic counselling
22:40 Funding of genetic tests
33:46 Incidental findings
39:13 Consent and privacy issues

Guests (2026 affiliations)
Professor Leslie Burnett FRCPA, FHGSA, FCAP (University of New South Wales; Virtus Health)
Professor Michael Gabbett FRACP (Queensland University of Technolgy; Mendel Genetics)
Associate Professor Kristine Barlowe-Stewart FHGSA (University of Sydney; Children’s Cancer Institute)
Prof David Thomas FRACP PhD (University of New South Wales; Omico)

Production
Produced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes, 'Cloud Line' by Blue Dot Sessions, 'Is That You or Are You You?' by Chris Zabriskie, First Holes’ by Cory Gray, ‘Brand New World’ by Kai Engel. Music licenced from Epidemic Sound includes ‘Abyss’ by Luwaks. Image customised for RACP. 

Editorial feedback for 2017 podcast provided by members of the podcast editorial group Dr Pavan Chandrala, Dr Tessa Davis, Dr Rebecca Grainger, Dr Michael Herd, Dr Paul Jauncey, Dr Joseph Lee, Dr Marion Leighton, Dr Anutosh Shee and Dr Ellen Taylor, and Advanced Trainee Dr Katrina Gibson.

Add educational activity to MyCPD as educational activity or visit web page for a transcript and references. 

While waiting for COVID-19 vaccines to be rolled out, Australian jurisdictions adopted strong social restrictions to minimise community transmission of the virus. It’s estimated that together, these public health measures spared around 50,000 lives up to December 2022 and that vaccines saved three times as many again. While this public health response the pandemic is described as one of the most effective in the world it did cause unintended social harms and lingering resentment. Our leaders and community need some sober reflection on how to we might respond to the next such pandemic respiratory virus. 

 Over two podcasts we look carefully at the how the cost-benefit calculation stacks up for each of the major interventions.  In Part 1 we discuss the international borders closures and overcooked parochialism between state jurisdictions, and also how messaging around vaccine risks and mandates could be improved. In Part 2 we look at the controversial stay-at-home orders and interruptions to in-person schooling and even the evidence for faces-masks. Ultimately, there are some questions that can’t be answered scientifically, and it is for politicians and the public to decide what the cost of freedom and dignity against human lives left exposed. 

Chapters Part 2
3:38 Social restrictions
16:39 Facemasks
21:19 Missing behavioural and epidemiological data
30:35 Psychological morbidity from social restrictions
39:39 Human rights and moral preparedness

Guests
Professor Paul Kelly FRACP (Australia’s Chief Medical Officer during the pandemic)
Professor Catherine Bennett PhD GAICD (Deakin University; co-author of the “COVID-19 Response Inquiry” )
Professor James McCaw PhD (The University of Melbourne; modeler for the Federal government’s “National Plan”)
Lorraine Finlay PhD (Australian Human Rights Commissioner; co-author of the "Collateral Damage" report)

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Organic Textures 2’ by Johannes Bornlöf, ‘RGBA’ by Chill Cole, ‘Axon Terminal’ by Out to the World, ‘Soundbed’ by Blue Saga, and ‘Echo (Kerstin Ljungstrom Remix)’ by Bonsaye. Music courtesy of FreeMusicArchive includes ‘Namaste’ by Jason Shaw. Image by Westend61 licenced from GettyImages. Editorial feedback kindly provided by members of the podcast editorial group Dr Rahul Barmanray, Dr Zac Fuller, Dr Aidan Tan, Dr Maansi Dr Arora, Joseph Lee and Fionnuala Fagan.

Add Part 2 to MyCPD as educational activity or visit web page for a transcript and references. 

While waiting for COVID-19 vaccines to be rolled out, Australian jurisdictions adopted strong social restrictions to minimise community transmission of the virus. It’s estimated that together, these public health measures spared around 50,000 lives up to December 2022 and that vaccines saved three times as many again. While this public health response the pandemic is described as one of the most effective in the world it did cause unintended social harms and lingering resentment. Our leaders and community need some sober reflection on how to we might respond to the next such pandemic respiratory virus. 

Over two podcasts we look carefully at the how the cost-benefit calculation stacks up for each of the major interventions. In Part 1 we discuss the international borders closures and overcooked parochialism between state jurisdictions, and also how messaging around vaccine risks and mandates could be improved. In Part 2 we look at the controversial stay-at-home orders and interruptions to in-person schooling and even the evidence for faces-masks. Ultimately, there are some questions that can’t be answered scientifically, and it is for politicians and the public to decide what the cost of freedom and dignity against human lives left exposed.

Part 1 Chapters
6:46 Border Closures
35:04 Vaccine Hesitancy

Guests
Professor Paul Kelly FRACP (Australia’s Chief Medical Officer during the pandemic)
Professor Catherine Bennett PhD GAICD (Deakin University; co-author of the “COVID-19 Response Inquiry” )
Professor James McCaw PhD (The University of Melbourne; modeler for the Federal government’s “National Plan”) Lorraine Finlay PhD (Australian Human Rights Commissioner; lead author of the "Collateral Damage" report)

Production 
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘End of the Ocean’ and ‘Raised by Wolves' by Tellsonic, ‘RGBA’ by Chill Cole, ‘Organic Textures 1’ by Johannes Bornlöf and ‘Echo (Kerstin Ljungstrom Remix)’ by Bonsaye. Image by mrs licenced from GettyImages. Editorial feedback kindly provided by members of the podcast editorial group Dr Rahul Barmanray, Dr Zac Fuller, Dr Aidan Tan, Dr Maansi Dr Arora, Joseph Lee and Fionnuala Fagan.

Add Part 1 to MyCPD as educational activity or visit web page for a transcript and references. 

A 62‐year-old man is undergoing a CT‐guided core biopsy of a lung nodule when he develops an iatrogenic pneumothorax. After admission to the Royal Adelaide hospital he has ongoing dyspnoea, oxygen desaturation, and chest pain not helped by a preexisting Chronic Obstructive Pulmonary Disease. The treatment for the patient’s symptoms doesn’t immediately go to plan but his care team apply a combination of recent technologies to bring the condition under control. Pomegranate [Case Reports] have been developed to help Trainees rehearse diagnostic problem solving and case presentation.

Guests
Associate Professor Arash Badiei FRACP (Royal Adelaide Hospital; Adelaide University)

Hosts
Associate Professor Stephen Bacchi FRACP (Northern Adelaide Local Health Network; Adelaide University)
Dr Brandon Stretton (Central Adelaide Local Health Network;)

Production
Produced by Dr Stephen Bacchi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Desert Whispers’ by Tellsonic and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and med students Srishti Sharma, Prakriti Sharma and Cindy Shi. 

Key Reference (Spoiler Alert)

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Persistent air leak successfully treated with endobronchial valves and digital drainage system [Altree, Respirol Case Rep. 2018]

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app. 

Médecins Sans Frontières has projects in more than 70 countries that might be affected by natural disasters, armed conflict or disease outbreaks. Its clinics see over two million emergency room admissions a year and another 16 million outpatient consults. Emergency Paediatrics consultant Josephine Goodyer and ID consultant Tasnim Hasan are two of more than a hundred Australians and New Zealanders who contributed to MSF’s missions last year. Between them they have covered practice settings as varied as Kiribati, South Sudan and Gaza. In this interview they describe the experience shipping out with MSF on their first assignment and then the kinds of responsibilities one is given with more experience. We’ll also hear how gaps of six months or more affect career progression and financial stability back home.

Chapters
3:05 Starting out with MSF
15:04 Practicing in a conflict zone
50:53 Career impacts

Guests
Dr Josephine Goodyer FRACP (Canberra Hospital; Australian National University)
Dr Tasnim Hasan FRACP (Western Sydney LHD; University of Sydney)
Dr Aidan Tan (Sydney Children’s Hospital Network)
 

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Intimacy’ by Alex Kehm, ‘At the end of nothing’ by Silver Maple, ‘Below the Horizon’ by Dawn, Dawn, Dawn and ‘Nagba Algooah’ by Ebo Krdum. Image by Pablo Tosco ©2018 used with permission by MSF. Editorial feedback kindly provided by members of the podcast editorial group Dr Aidan Tan, Dr Stephen Bacchi, Dr Rahul Barmanray, Dr Maansi Arora and Dr Leon Li. 

Add educational activity to MyCPD or visit web page for a transcript and references.

A 75 year-old man with severe aortic stenosis is deemed unsuitable for surgery on the basis of a porcelain aorta detected with cross-sectional imaging. The patient had, a decade earlier, been diagnosed with hypertrophic cardiomyopathy after presenting with cardiac arrhythmia. A dual chamber ICD was implanted at the time for secondary prevention and other comorbidities were managed. 

The patient is now being considered for staged alcohol septal ablation (for the HCM) and transcatheter aortic valve replacement (for the aortic stenosis), however, additional complications force an experimental two-in-one procedure.

Guest
Professor Ross Roberts-Thomson FRACP (Central Adelaide Local Health Network; University of Adelaide)

Hosts
Associate Professor Stephen Bacchi FRACP (Northern Adelaide Local Health Network; University of Adelaide)
Dr Alistair Leslie (Central Adelaide Local Health Network;)

Key Reference (Spoiler Alert)

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Two-in-one: Combined transcatheter therapy for hypertrophic cardiomyopathy and aortic stenosis [IHJ Cardiovascular Case Reports (CVCR). 2020]
 
 

Production
Produced by Stephen Bacchi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Desert Whispers’ by Tellsonic and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPDto record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

The record for the longest space-flight is held by physician-cosmonaut Valeri Polyakov. Back in 1994-95, he spent 437 days on the Mir space station and grew 4 centimetres in height through elongation of his spine in micro-gravity. Polyakov had an uncomfortable ride back to Earth in the very precisely customised descent module. 

Microgravity also causes demineralization of weight-bearing bones that is faster than age-related decline. But the cosmonaut had worked out religiously for the entire mission and after his capsule parachuted to the ground he made a point of walking from it relatively unassisted. One of the main objectives of the marathon flight had been to prove that walking proudly onto the Martian surface after a 9-month journey might be possible, given it only has 37 percent the gravitational force that Earth does.
 
Microgravity additionally results in adaptive plasticity of the vestibular and sensorimotor networks and deconditioning of the cardiovascular system. Indeed, several years ago there was a medical emergency aboard the international space station when an ultrasound investigation revealed thrombosis of the internal jugular vein in one astronaut. In this podcast we discuss how management of cases like this has many parallels with remote medicine on earth. Part 1 of this series examined the risks of cosmic radiation and spaceflight-associated neuro-ocular syndrome among other things.  

Guests
Professor Gordon Cable (Australian National University; Co-founder, Human Aerospace)
Dr Alicia Tucker FACEM, FAWM (Royal Hobart Hospital; University of Tasmania)
Dr John Cherry PhD FACRRM (Deputy CMO, Australian Antarctic Division)

Chapters
1:08 Bone mineral density
 15:35 Circulation and a case study in remote medicine
35:04 Historic medevacs from space

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Spring Water’ By Chill Cole, ‘At the End of Nothing’ by Silver Maple and ‘Mega Woman IV’ by ELFL. Music courtesy of Free Music Archive includes ‘Snowfall’ by Kai Engel. Graphic is AI-generated and shared online with a Creative Commons licence. 

Editorial feedback kindly provided by members of the podcast editorial group Paul Cooper PhD, Dr Aidan Tan, Dr Rahul Barmanray, Dr Simeon Wong, Dr Fionnuala Fagan, Dr Maansi Arora, Dr Jia-Wen Chong, Dr Aafreen Khalid and Associate Professor Dr Stephen Bacchi.
 
Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.