by Dr Adrian Cois MD
An emergency physician steps out of the resuscitation bay to talk about what really keeps you out of it. Each episode breaks down food, movement, sleep, stress, and the systems around us into clear, practical steps for living a longer and better life. No shame, no biohacking gimmicks - just evidence, stories from the ER, and habits you can actually stick with.
Language
🇺🇲
Publishing Since
1/1/2026
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June 19, 2026
<p>Quick Hits Episode 6. A listener wrote in asking for a framework to read a medical paper — and it could not be timelier. Misinformation has now been ranked the most severe short-term risk facing the world by the World Economic Forum, ahead of armed conflict and cyber attacks. One in four Gen Z respondents turns to TikTok for medical advice, and viral medical content is consistently more likely to be wrong than non-viral content.</p><p>In this episode, Dr Cois walks through the three-question framework that every medical student is taught — and that he still uses today on every paper he reads. Then he pressure-tests it by walking you through three different studies that have tried to answer the same question: does saturated fat raise your cardiovascular risk? A human-and-overfeeding mechanism study, an umbrella review of cohort data, and a Cochrane meta-analysis of randomised controlled trials — same question, three different weights of evidence, one converging answer.</p><p>If you have ever wanted to push back on the loudest voice in the room without needing a medical degree, this is your playbook.</p><p><strong>Key Takeaways</strong></p><p>• Misinformation is the #1 short-term global risk; thefirehose is not slowing down</p><p>• Three-question framework: study type and journal,funding and authors, PICO</p><p>• PICO unpacks to Population, Intervention, Comparator,and Outcome</p><p>• The body of evidence is what matters — convergenceacross study designs is the signal</p><p>• Five red flags: single studies, surrogate outcomes, relative risk without absolute risk, cherry-picking, and conclusions that don’t match the data</p><p>• Your homework: track one social-media health claim back to the paper and run the PICO</p><p><strong>Disclaimer</strong></p><p>This podcast is for educational purposes only and does not provide medical advice or establish a physician patient relationship. Always consult a qualified clinician for personal health questions.</p>
June 12, 2026
<p>My pharmacy tried to charge me $90 for a generic nausea medication. Five minutes later, with a coupon I signed up for in the aisle, I paid $9. Same drug. Same store. Same five minutes.</p><p>If that sounds impossible — or like a trick — this episode is for you.</p><p>In Quick Hits Episode 5, I walk you through exactly how prescription drug pricing works in America, who is actually setting the price you pay (hint: not your insurance company, not the pharmacy), and the three-step habit you can use every single time you fill a script.</p><p>This is one of those moments where a small amount of knowledge gives you real power.</p><p>• There is no single “real” price for your medication. Multiple negotiated prices exist, and which one you pay depends entirely on which contract you invoke at the counter.</p><p>• Pharmacy Benefit Managers (PBMs) — not your insurance company — do most of the actual price-setting. Three companies control 79% of all U.S. prescription drug claims.</p><p>• The “cash price” is almost never the real price. It’s a sticker price designed for patients who don’t know to ask for anything else </p><p>• GoodRx isn’t cash. It’s a different PBM’s contract you can piggyback on.</p><p>• Three habits, every prescription: Ask the cash price. Compare on GoodRx and Cost Plus Drugs. Choose the lowest legitimate option.</p><p>• The February 2026 PBM reforms are a real step forward — but none of it changes what you pay today.</p><p><br></p><p>Disclaimer</p><p>This podcast is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Always consult your physician or pharmacist regarding your specific situation.</p>
June 5, 2026
<p><strong>Welcome to Overheard Journal Club. </strong></p><p>In this new short-form series, ED physician Dr Adrian Cois takes a single paper that's changed how he practises and breaks it down conversationally — PICO, results, critical appraisal, and the practical "so what do I do with this on my next shift" synthesis.</p><p>First up: SALT-ED. Self and colleagues, NEJM 2018. A pragmatic crossover trial in 13,347 noncritically ill adults asking whether balanced crystalloids beat normal saline as the default IV fluid in the emergency department. The answer reshaped Adrian's reflex — and gave him his favourite pharmacology joke.</p><p>In this episode: why "normal" saline carries a supraphysiologic chloride load, how the pragmatic crossover design hit 88% adherence without blinding, what the MAKE30 composite outcome actually means, and the short list of hard indications for which saline still earns its place on the IV pole.</p><p><strong>Key takeaways</strong></p><p>• In noncritically ill adults receiving IV fluids in theED, balanced crystalloids reduce major adverse kidney events at 30 dayscompared with saline (NNT 111).</p><p>• The mechanism is the supraphysiologic chloride load insaline, which causes hyperchloremic metabolic acidosis.</p><p>• Default to lactated Ringer's. Reserve saline for hyperkalemia, traumatic brain injury, hyponatremia, and drug compatibility issues — and even then, keep volumes modest.</p><p><strong>Disclaimer</strong></p><p>Educational content only. Not medical advice. Does not establish a physician-patient relationship. Always discuss management decisions with a qualified clinician.</p>
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An emergency physician steps out of the resuscitation bay to talk about what really keeps you out of it.
Each episode breaks down food, movement, sleep, stress, and the systems around us into clear, practical steps for living a longer and better life.
No shame, no biohacking gimmicks - just evidence, stories from the ER, and habits you can actually stick with.
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