Pomegranate Health

This popular episode was first published in 2019. Australia and NZ are made up of sprawling cities and far-flung towns and driving is often viewed as a fundamental freedom. It can be hard for clinicians to challenge that freedom with patients who they consider unfit to drive safely. And harder still to deal with the consequences if a patient does have a crash.
 
There are diagnoses that should raise red flags for driving fitness in various specialty areas, and a clinician can be drawn into the issue by two main pathways. The more straightforward is when a patient presents with a medical assessment form. It's the Driver Licencing Authority in each state which ultimately issues the driving permits and may require the recommendation of a medical professional. The other way is when the clinician detects a new or worsening condition in a patient who is already licenced. They are expected to warn their patients off driving and in some jurisdictions to report them to the DLA if this advice isn't being heeded.
Chapters
7:48     Legal expectations on a practitioner
17:20   Medical conditions affecting to fitness to drive
24:48   Considering age in driving performance
35:28   Approaching driving ‘retirement’
45:28   Updates to national standards
Guests
Dr Genevieve Yates FRACGP (Principal Medical Educator RACGP, MDA National's Education Services Advisory Group, Black Dog Institute)
Prof Roy Beran FRCP FAFPHM FRACP FRACGP FACLM (University of UNSW)
Marilyn Di Stefano PhD (Victorian Department of Transport and Planning)
Serge Zandegu (Victorian Department of Transport and Planning)
Production
Written and produced by Mic Cavazzini DPhil. Recording assistance in Melbourne from Sam Loy of Human/Ordinary. Music courtesy of Free Music Archive; 'John Stockton Slow Drag' and 'What True Self? Feels Bogus, Let's Watch Jason X' by Chris Zabriskie, 'Noir' by Daniel James Dolby, 'Hélice' by Monplaisir. Music licenced from Epidemic Sound includes ‘Knowledge is Power’ by Matt Large. 
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This is the second episode of in the series, [Contagious Conversations] from the Australasian Society for Infectious Diseases. Expert guests in this series will come from right across the interface of research, clinical care and public health.

In today’s episode we look at the immense progress that has been made over three decades in the management of HIV. Once a fatal diagnosis, the disease can now be completely controlled by anti-retroviral therapy. Access to prophylactic treatment has also made a huge impact on rates of transmission in the community although barriers still remain to equitable access.

Guests
Professor Sharon Lewin OA FRACP PhD (Peter Doherty Institute for Infection and Immunity, Director; University of Melbourne; Cumming Global Centre for Pandemic Therapeutics, Director)
Professor Dato’ Dr Adeeba Kamarulzaman FRACP FASc (Monash University Malaysia, President & Pro Vice-Chancellor; Centre of Excellence for Research in AIDS).
Richard Keane (Living Positive Victoria, CEO)

Host
Associate Professor Sanjaya Senanayake FRACP (Canberra Hospital; Australian National University)

Production
Production supported by Mic Cavazzini DPhil, and the Viral Hepatitis and HIV Special Interest Group particularly Dr Emma Paige and Dr Sushena Krishnaswamy. Thanks also to Inge Meggitt, events coordinator at ASID. Music licenced from Epidemic Sound includes ‘Exploring the Lake’ by View Points and ‘Emerlyn’ by Valante. Image copyright ASID (2026).
Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list.

This episode is a teaser for RACP LIFT 2026, a series of in-person events to promote Learning, Innovation and Forward Thinking. Coming up on the 1st of August in Melbourne there will be a Rapid Fire Clinical Update on Respiratory medicine, infectious diseases and critical illness. And on the 20th In Brisbane another one themed around Palliative medicine and also population health. In March, the Sydney RACP offices hosed a meeting on cardiometabolic and vascular health, and the talk shared here covers everything a generalist needs to know about metabolic dysfunction-associated fatty liver disease. 
The seminar was presented by Professor Jacob George, Director of the Storr Liver Centre at the Westmead Institute for Medical Research, and author of over 1300 peer-reviewed papers. He explains why fatty liver disease is a "canary in the coal mine" for metabolic health more generally, how to diagnose using scans and bloods, and the use of the FIB-4 index. Professor George also describes how patients can be stratified and managed for risk of more complex liver disease and reviews outcomes from the latest pharmacological interventions. 
 
Guests
Professor Jacob George FRACP PhD FAASLD (The Westmead Institute for Medical Research, Centre Director; University of Sydney)

Chapters
3:09     MAFLD is a positive definition
4:29     How common are MAFLD and MASH?
5:58     How do you define metabolic health?
9:02     Mortality and cardiovascular outcomes in patients with T2D
10:07   MAFLD in primary care guideline
12:40   Current and future therapies for MAFLD / MASH
15:24   Management algorithm for MAFLD
16:50   Test your knowledge

Production
Rapid Fire Clinical Update developed by LIFT advisory group and hosted/recorded by RACP Events team and. Podcast production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel and ‘Simmering Anxiety’ by Christian Andersen and ‘Little Liberty’ by Paisely Pink. 
Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list.

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

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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 promoted with financial assistance from ASHM and the Australian CDC.
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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