CMAJ Podcasts

A new bill moving through Parliament aims to reduce the harms from social media for children under the age of 16. Bill C-34, the Safe Social Media Act, advances a multipronged framework for regulation. It includes restrictions on social media for children under 16 unless social media companies implement a suite of safe practices. An analysis in CMAJ examines the strengths of the Canadian model in comparison to efforts in other countries.Dr. Charlotte Moore Hepburn, co-author of the CMAJ analysis The Safe Social Media Act: lessons from international online safety policies for protecting child health in Canada, describes the online environment as the largest unregulated experiment on child development in history. She describes real harms pediatricians see in their patients. Children admitted after suicide attempts and with advanced eating disorders, harms linked directly to what those children encountered online. She says the bill is an “elegant and nuanced” response to the issue.Australia has enacted one of the more high-profile strategies towards social media regulation. Dr. Courtney Barnes, a research fellow with the National Centre for Implementation Science at the University of Newcastle, led a study published in the BMJ on the early effects of Australia’s Social Media Minimum Age Act. Three months in, more than 86% of adolescents under 16 still used at least one restricted platform each week, mostly through their own accounts. One of the weaknesses of the Act was that it allowed social media companies to design the access barriers. Most implemented self-declared age as the main obstacle, something that was easy for children to bypass. Dr. Barnes does not see the Act as a policy failure, and notes Australia has since strengthened its regulator’s enforcement powers and is drafting a Digital Duty of Care Act targeting platform design.Both researchers emphasize the need for a broad spectrum of strategies. The Canadian bill remains at the early stages of the parliamentary process, offering physicians the chance to participate in the development of effective legislation.For more information from our sponsor, go to CMPA Physician Well-Being Index.Comments or questions? Text us.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X  @BlairBigham and @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

One in 20 practising physicians in Canada report a disability always or often, a figure that rises to 17% when intermittent disability is included. These findings come from Prevalence and characteristics of disabilities in physicians in Canada: an analysis of Canadian Census data, a new study in CMAJ. The study is the first nationally representative estimate of disability among practising physicians, drawn from Census data. The findings should inform efforts to improve accessibility and sustainability in the physician workforce.Dr. Michael Quon, a general internist at The Ottawa Hospital and lead author of the study, says the true figure is likely higher, given stigma within the profession and the exclusion of physicians who have already left practice. He shares his own experiences trying to reenter medicine after a brain injury and finding there were no resources or systems to help accommodate him or ease his return to hospital work.Dr. Kendra Hebert’s article, Challenging norms: the history and future of physicians with disabilities in Canada, was published in CMAJ earlier this year. She is an internal medicine resident at Dalhousie in Saint John, New Brunswick, and she shares her experience as a wheelchair user navigating medical school and residency. She describes a general willingness to support her but a system that largely expected her to do the work of organizing her own accommodations.With up to one in six physicians living with a disability, medical institutions need structural change, not individual goodwill, to keep these colleagues in practice. Hospitals and training programs can start by adopting clear accommodation policies and providing contacts for support.For more information from our sponsor, Scotiabank Healthcare+ Physician Banking Program, go to md.ca/lifeplan.For more information from our sponsor, Physician Well-Being Index, go to CMPA Physician Well-Being Index.Comments or questions? Text us.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X  @BlairBigham and @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

Polycystic ovary syndrome, or PCOS, is shifting to a new name: polyendocrine metabolic ovarian syndrome, or PMOS. A CMAJ commentary, Polyendocrine metabolic ovarian syndrome: A new name to support better treatment, argues that the old name was framed too narrowly around fertility. The new moniker aims to place metabolic syndrome at the centre of the diagnosis.Dr. Ginevra Mills, a reproductive endocrinologist in Victoria and author of the commentary, says PMOS is driven by systemic insulin resistance. Historically, PCOS was overly focused on ovarian dysfunction, although the condition can appear without irregular periods. About a third of patients do not have obesity. Symptoms such as hirsutism, acne and dyslipidemia were frequently downplayed. The new term widens the lens to the full suite of symptoms. Treatment is targeted at addressing the root metabolic cause.Sarah Chambers experienced this narrow emphasis on irregular periods and fertility when she was 16. She says no physician ever discussed her metabolic health, and symptoms such as her persistent weight gain and hair on her face were largely ignored. She believes the new name would have streamlined her journey to diagnosis and would have given her a better understanding of what she was experiencing.When a patient presents with irregular cycles, hirsutism or unexplained weight gain, physicians should screen for insulin resistance, dyslipidemia and hypertension rather than stopping at cycle control. Treatment should prioritize empathetic management of the underlying metabolic condition.For more information from our sponsor, go to CMPA Physician Well-Being Index.Comments or questions? Text us.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X  @BlairBigham and @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

On January 31, 2023, the government of British Columbia implemented a temporary, three-year drug decriminalization policy. Under the policy, adults (18 and older) could possess up to a combined 2.5 grams of specified illegal drugs—including opioids, cocaine, methamphetamine, and MDMA—for personal use without criminal charges, prosecution, or confiscation. The policy was intended to reduce the health and social harms of illicit substance use.A new study in CMAJ evaluated changes in drug-related hospitalizations and deaths alongside police interactions such as arrests during and after the period of decriminalization. Dr. Blair Bigham and Dr. Mojola Omole speak with coauthor Dr. Daniel Myran about the study, "Impact of drug decriminalization and recriminalization on drug-related crime and health outcomes in British Columbia: a population-level time-series analysis." He explains that the policy had no impact on hospitalizations and deaths but significantly reduced police interactions.The hosts then speak with Dr. Alexis Crabtree, coauthor of an accompanying commentary, "What decriminalization in British Columbia could and could not achieve." She explains that one goal was to reduce stigma and, in turn, increase interaction with substance use supports. Instead, she says, the policy may have increased stigma—though the reduction in police interactions alone may justify it.Together, the authors argue there is no silver bullet for reducing the harms of substance use. Any solution will need to be multipronged and long lasting.For more information from our sponsor, go to md.ca/lifeplanComments or questions? Text us.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X  @BlairBigham and @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

On this episode of the CMAJ Podcast, 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 @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @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 md.ca/lifeplanComments or questions? Text us.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X  @BlairBigham and @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

Emergency departments across Canada are seeing record patient volumes, bed shortages and overcrowding. A new longitudinal study in CMAJ, "Emergency physician burnout and attrition in Canada: a longitudinal study," finds physician burnout now above pandemic-era levels and driving reduced hours and departures from the specialty.Dr. Kerstin de Wit, the study's lead author, an emergency physician and Tier 1 Canada Research Chair at Queen's University, reports that 65% of respondents to the January 2025 survey had high burnout levels, slightly higher than at the pandemic peak in December 2020, a  statistically significant difference. Participants described the health care system as broken, with chronic overcrowding forcing physicians to examine patients in corridors and waiting rooms as quality of care slips. Half the cohort had reduced shifts, 20% had stepped away from emergency medicine for a time, and 10% had left and not returned. She also describes physicians coping by detaching from responsibility for a situation they feel powerless to change.Dr. Jillian Horton, associate chair of internal medicine at the University of Manitoba and author of We Are All Perfectly Fine, teaches an evidence-based program for physicians in distress. She argues that organizational factors drive 80% to 90% of burnout and individual factors closer to 10%, and that wellness efforts fail when they focus on individual-level solutions. Physicians now reject the language of resilience, she says, so she focuses on meaning, citing research that physicians who spend at least 20% of their time on the work they find most meaningful have half the burnout risk of physicians who spend less.The study puts the cause in the system, which limits what any one physician can fix alone. Physicians can still protect the most meaningful parts of their work, which the research links to lower burnout risk.Comments or questions? Text us.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X  @BlairBigham and @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

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 @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @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/lifeplanComments or questions? Text us.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X  @BlairBigham and @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

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.comComments or questions? Text us.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X  @BlairBigham and @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions