What's it Worth? A Journal Club Podcast

S3E14 | Defending Evidence in a Broken Trust Environment

Welcome back What's it Worth? listeners. This episode steps away from traditional trial critique. It's a year-end reflection on what it means to practice evidence-based healthcare at a moment when trust in science, institutions, and clinicians is eroding—and when evidence itself is increasingly being misused to create fear rather than understanding. This episode is for frontline healthcare professionals and future providers who feel the weight of that shift and are asking how to respond without becoming part of a polarized conversation. The answer, I believe, is not louder certainty—but better questions. As we move into the next year, evidence-based practice will require more than knowing the literature. It will require clinicians who are willing to defend evidence with transparent communication, clarity, humility, and compassion—and who can help patients ask not just "Is there a study?" but "What's it worth?" Learn more and continue the conversation: Substack: https://whatsitworthpodcast.substack.com/ Email: whatsitworthpodcast@gmail.com

S3E13 | Secondary SBP Prophylaxis — Asking Better Questions of Retrospective Data

Episode Summary Secondary prophylaxis after spontaneous bacterial peritonitis (SBP) has long been considered standard of care—but how strong is the evidence behind it? In this episode, host Dr. Diana Langworthy is joined by Dr. Ben Webber (hospital medicine physician) and Danielle Luettel (PharmD Candidate 2026) to unpack a contemporary observational study examining outcomes associated with SBP prophylaxis. Together, they explore how historical trials, modern resistance patterns, and guideline recommendations intersect—and where uncertainty still remains. As care evolves over time, it is important to revisit standard practices to ensure they still make sense. How we revisit them is important and strong internal validity is still what we need to make practice changing claims. Key Takeaways * Secondary SBP prophylaxis is rooted in strong historical evidence but largely based on older trials. * Contemporary observational data raise important questions about mortality benefit and patient selection. * Guideline recommendations still support prophylaxis, but resistance patterns and evolving microbiology matter. * Association does not equal causation—especially in retrospective database studies. * Does this retrospective cohort study rise above the rest? ---> Tune in to find out! Featured Study Silvey S, Patel NR, Tsai, SY, et al. Higher Rate of Spontaneous Bacterial Peritonitis Recurrence With Secondary Spontaneous Bacterial Peritonitis Prophylaxis Compared With No Prophylaxis in 2 National Cirrhosis Cohorts. The American Journal of Gastroenterology 120(5):p 1066-1075, May 2025. | DOI: 10.14309/ajg.0000000000003075 Host Diana Langworthy, PharmD, BCPS Associate Professor, University of Minnesota College of Pharmacy Clinical Pharmacist, Inpatient Internal Medicine, M Health Fairview East Bank Hospital Guests Ben Webber, MD Associate Professor, Division of Hospital Medicine Senior Medical Director, Adult Med/Surg University of Minnesota Medical Center – East Bank Danielle Luetell PharmD Candidate, Class of 2026 Join the Conversation Subscribe [https://whatsitworthpodcast.substack.com/] to the What's it Worth? Podcast on Substack If you want to get new episode alerts, bonus content, and continue reflecting on what studies like this mean for real clinicians and real patients—head over to the What's it Worth? substack. Have a study you'd like us to decode on a future episode? Email whatsitworthpodcast@gmail.com or share how you're navigating evidence in practice—I love hearing how clinicians and learners think through uncertainty. Additional References & Guidelines * American Association for the Study of Liver Diseases (AASLD) * Biggins, Scott W.*,1; Angeli, Paulo2; Garcia‐Tsao, Guadalupe3,4; et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 74(2):p 1014-1048, August 2021. | DOI: 10.1002/hep.31884 * European Associate for the Study of the Liver * EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis Journal of Hepatology, Volume 53, Issue 3, 397 - 417 * Foundational Trial for Secondary Prophylaxis * Ginés P, Rimola A, Planas R, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology. 1990 Oct;12(4 Pt 1):716–724. doi:10.1002/hep.1840120416. PMID:2210673.

S3E12 | Tirzepatide vs Semaglutide for Obesity — What Did SURMOUNT-5 Teach Us?

Episode Summary SURMOUNT-5 delivers the first head-to-head comparison of tirzepatide vs semaglutide in adults with obesity but without diabetes. In this episode, host Dr. Diana Langworthy and expert guest Dr. Kylee Funk (clinical pharmacist in primary care at Mill City Clinic specializing in weight management and diabetes) unpack the trial's design, results, interpretation, safety considerations, and what these findings mean for real-world clinical practice. Key Takeaways * Tirzepatide achieved greater weight loss than semaglutide over 72 weeks. * Both drugs improved cardiometabolic markers with similar safety profiles. * Open-label design and exclusion criteria affect how broadly results apply. * Clinical decisions still hinge on access, coverage, tolerability, and goals. Want the full trial breakdown? I created a deeper analysis, including statistics, estimands, subgroup data, and my extended critique on my What's it Worth? Substack [https://whatsitworthpodcast.substack.com/?utm_campaign=profile_chips]. Subscribe there for extra trial notes, bonus insights, and updates between episodes. Featured Study Aronne LJ, Bade Horn D, le Roux CW, et al. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity. N Engl J Med. 2025;393(1):26-36. doi:10.1056/NEJMoa2416394. Host Diana Langworthy, PharmD, BCPS – Associate Professor, University of Minnesota College of Pharmacy Guest Kylee Funk, PharmD, BCPS – Clinical Pharmacist in Primary Care, Mill City Clinic (focus: weight management & diabetes) Join the Conversation Have a study you'd like us to decode on a future episode? Email whatsitworthpodcast@gmail.com. Share comments or takeaways — I love hearing how you're using evidence in practice. And for full-length study breakdowns and bonus content, subscribe at whatsitworthpodcast.substack.com.

S3E10 | GLP-1 Medications and Migraine - Exploring the Pressure Hypothesis

🧠 Episode Summary Could a medication designed for weight loss change how we think about migraine prevention? In this episode, host Diana Langworthy sits down with returning guest Dr. Natalie Heinrich, PharmD and student contributor Nena Abosi, PharmD Candidate 2026 to unpack a 2025 Headache pilot study evaluating liraglutide as an add-on therapy for adults with obesity and high-frequency or chronic migraine. The team breaks down study design, results, and limitations while questioning whether the observed benefit stems from weight loss, intracranial-pressure changes, or something else entirely. 💬 Key Takeaways * Study Design: Prospective open-label pilot (n = 31) using liraglutide 1.2 mg daily × 12 weeks in adults with BMI > 30 kg/m² and ≥ 8 headache days/month unresponsive to ≥ preventives. * Results: Headache days decreased by ~9 per month (≈ 50 % reduction); disability scores improved significantly, but BMI change was minimal. * Mechanism: Benefit appeared independent of weight loss—raising curiosity about GLP-1 effects on intracranial pressure and CGRP release. * Tolerability: Mild GI symptoms (~40 %), no discontinuations. * Caveats: Small sample, no control group, single center — results are hypothesis-generating, not practice-changing. * Clinical Pearl: Pilot studies like this spark conversation and awareness for emerging mechanisms while reminding clinicians to stay evidence-curious. 🧩 Featured Study * Braca S, Russo CV, Stornaiuolo A, et al. Effectiveness and tolerability of liraglutide as add-on treatment in patients with obesity and high-frequency or chronic migraine: A prospective pilot study. Headache. 2025; 00: 1–8. doi:10.1111/head.14991 [https://doi.org/10.1111/head.14991] 🎙️ Guests * Natalie Heinrich, PharmD, BCPS – Clinical Pharmacist in Neurology, M Health Fairview * Nena Abosi, PharmD Candidate (2026) – University of Minnesota College of Pharmacy 🎙️ Host * Diana Langworthy, PharmD, BCPS – Associate Professor, University of Minnesota College of Pharmacy 💬 Join the Conversation Have a study you'd like us to decode on a future episode? Send it our way at whatsitworthpodcast@gmail.com. We'd also love to hear your thoughts—drop a comment, share your takeaways, or let us know how you're using this evidence in practice.

S3E9 | Glucose-Lowering Drugs and COPD Exacerbations — Dual Benefits of SGLT2 and GLP-1 Therapy?

New population-based study suggests SGLT2 inhibitors and GLP-1 receptor agonists may reduce COPD exacerbations in patients with type 2 diabetes. In this episode of What's It Worth?, we examine a large real-world study assessing whether glucose-lowering medications influence the risk of COPD exacerbations in patients with type 2 diabetes and chronic obstructive pulmonary disease. We focus on SGLT2 inhibitors and GLP-1 receptor agonists and discuss whether potential pulmonary benefits should influence drug selection in patients with both conditions. Guest: Ashley Wilke, PharmD — PGY2 Critical Care Pharmacy Resident at M Health Fairview East Bank Hospital. Study at a Glance * Design: Retrospective cohort study using nationwide claims and registry data * Population: Adults with type 2 diabetes and COPD initiating glucose-lowering therapy * Exposures: SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors * Primary outcome: COPD exacerbations requiring hospitalization or systemic steroids * Key Finding: SGLT2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of COPD exacerbations compared with DPP-4's * KEY Caveats: Results are observational and this study cannot prove causality - only association. * Tune in for our conclusions when we ask, "What's it Worth?"! Key teaching points 1. SGLT2 inhibitors and GLP-1 RAs may reduce pulmonary inflammation and fluid overload, potentially contributing to fewer exacerbations. 2. In a patient with both COPD and type 2 diabetes, these agents may offer meaningful extra-glycemic benefits. 3. This evidence supports shared decision-making, not mandatory therapy selection 4. Pharmacists can identify dual-benefit opportunities and tailor therapy based on comorbidities, cardiovascular risk, and exacerbation history. Citation: Patorno E, Feldman HA, Bykov K, et al. Glucose-lowering medications and risk of chronic obstructive pulmonary disease exacerbations in type 2 diabetes. JAMA Intern Med. 2025;185(4):405-414. doi:10.1001/jamainternmed.2024.7811 🎧 If you find this episode helpful, follow and leave a quick rating—it helps other clinicians and learners find high-quality, evidence-based content. 🎧 Email me at whatsitworthpodcast@gmail.com [whatsitworthpodcast@gmail.com] if you have an article suggestion for me to decode!