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Iron deficiency affects as many as 40% of women of reproductive age, yet the problem often goes undetected—even when patients have symptoms and complications. On this episode, Dr. Blair Bigham and Dr. Mojola Omole speak with hematologists Dr. Michelle Scholzberg and Dr. Rita Selby about their structural solution to this pervasive problem: a province-wide change to how laboratories flag ferritin results. Their article, “Diagnosis and management of iron deficiency in females”, is published in CMAJ.

Dr. Michelle Scholzberg, a hematologist and clinician scientist at St. Michael’s Hospital and division director of Hematology at the University of Toronto, explains why iron deficiency without anemia is clinically important, how flawed reference standards and stigma around menstruation have contributed to underdiagnosis, why screening based on hemoglobin alone misses many patients and how structural barriers within medicine have long impeded timely detection and treatment. She outlines the evidence that drove a change to the clinical decision threshold for ferritin in Ontario laboratories and describes the movement that led to the change

Dr. Rita Selby, an academic hematologist and medical director of the Ontario Laboratory Medicine Program at Ontario Health, describes how change was implemented across Ontario’s major private labs. She clarifies the distinction between reference ranges and clinical decision limits, and how the shift helps clinicians identify subclinical iron deficiency earlier. She also discusses anticipated challenges, such as increased demand for treatment and the need for accessible knowledge translation tools.

This episode exemplifies how making structural change in Canadian medicine can be difficult, but is possible with grassroots advocacy and inter-institutional collaboration.

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Measles is resurging in Canada, with particularly serious implications for pregnant patients and newborns. A recent CMAJ article, Five things to know about measles in pregnancy, outlines the risks and clinical considerations. On this episode of the CMAJ Podcast, we speak with one of the article’s co-authors, Dr. Michelle Barton-Forbes, about what physicians need to know when caring for pregnant patients during a measles outbreak. We also get an update on the current state of the outbreak in Canada from Dr. Marina Salvadori.

Dr. Michelle Barton-Forbes, division chief of infectious disease at the Children’s Hospital at London Health Sciences Centre, highlights the risks of measles in pregnancy, including atypical presentations, preterm labour, and rare but severe complications like subacute sclerosing panencephalitis. She discusses the limitations of existing research, current guidance on immunoglobulin use in newborns, and the use of vaccines during pregnancy.

Dr. Marina Salvadori, senior medical advisor at the Public Health Agency of Canada, describes the scope of the ongoing measles outbreaks and their concentration in undervaccinated communities. She explains the public health challenges of engaging with vaccine-hesitant populations and outlines practical steps physicians can take to support informed vaccination decisions and to prevent further spread of the virus.

This episode offers physicians clinical guidance on recognizing measles in pregnancy, managing exposures and complications, and navigating conversations about vaccination during an ongoing outbreak.

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 @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

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On this episode of the CMAJ Podcast, hosts Dr. Mojola Omole and Dr. Blair Bigham speak with two authors of the latest “Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care”

The discussion reflects a shared urgency: despite past successes, Canada’s hypertension control rates are declining. The new guidelines aim to reverse this trend by simplifying diagnosis and treatment for frontline clinicians.

Dr. Rémi Goupil, a nephrologist and clinician researcher at Sacré-Cœur Hospital in Montreal, and Dr. Greg Hundemer, a nephrologist and clinician scientist at The Ottawa Hospital, explain that the updated guideline is deliberately designed for primary care providers. They highlight key shifts: lowering the diagnostic threshold for hypertension to ≥ 130/80 mm Hg, simplifying blood pressure targets, and emphasizing accurate, standardized measurement techniques both in clinic and at home. The guidelines were created with input from a majority-primary care committee—including family physicians, nurses, pharmacists, and patient partners—to ensure clinical applicability.

Together, the panel outlines a streamlined nine-step treatment algorithm, emphasizing combination therapy as first-line pharmacologic management. They explain the evidence supporting ARB–thiazide combinations, discuss cost considerations for drug selection, and address adherence challenges. They also explore red flags for secondary hypertension and how the algorithm supports—but does not replace—clinical judgment.

For physicians, this guideline offers a clear and practical roadmap: measure blood pressure correctly, aim for systolic pressure below 130 mm Hg, and use the simplified treatment sequence to improve adherence and outcomes. Designed to be easy to implement, the new approach aims to empower primary care providers to act with confidence.

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 @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions