Pomegranate Health

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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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 <<REWIND>> 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.