Happy Wednesday & last day of Autumn!

We associate Dec. 21 with the start of Winter, based on Earth’s proximity to the sun. 🌎☀️

But —❓Trivia Question❗️— What’s the first day of winter in terms of the meteorological season? (Answer at the bottom)

Now on to this week’s stories!

• ChatGPT’s healthcare roulette 🎯

• 💉 Moderna’s mRNA-1345 vaccine

• “Adding metformin to insulin in pregnancy treating diabetes?” 🩸

• 😷 The prevalence of TB among foreign-born Canadians

• A knife skimmed the pericardial sac without damaging the myocardium

• 🎫 Trump gets kicked off the ballot in Colorado (for now)

• IMGs are about to get fast-tracked ⏩️ 

• 🫀 Taking the Pulse: “Should naturopaths be able to prescribe?”

Driving these numbers: The S&P/TSX composite index rose nearly 200 points on Tuesday, with gains in base metal stock and energy leading the rally. In a recent interview, BoC Governor Tiff Macklem said rate cuts are ahead in 2024 but that the first part of the year is “not going to feel good.”

And just a quick reminder 💡:

• The Canada Revenue Agency (CRA) has confirmed that the annual contribution limit for a TFSA will be $7,000 for 2024.

• The annual contribution period for the FHSA is January 1st to December 31st. (You must contribute before December 31st to have your contribution amount deducted from your taxable income for 2023).

ChatGPT: The Good, the Bad, and the Botched 🎯

Hi, I’m ChatGPT. You might remember me from scandals such as spreading racially biased and inaccurate medical info.

What happened: In a 16-month study, Long Island University researchers tested the free version of ChatGPT, firing 39 medication questions at it and comparing responses to trained pharmacists. The results? ChatGPT solved only 10, about a quarter of the test 😬. The other 29? Incomplete, inaccurate, or just ignoring the questions. Take the interaction between Paxlovid and verapamil, for instance. ChatGPT claimed zero issues, but reality check: it could dramatically drop a patient’s blood pressure. Real doctors customize patient-specific plans for this duo, unlike ChatGPT's one-size-fits-none approach. When researchers asked the bot for citations, ChatGPT made them up. Who knew AI could be so shady 🕶️?

Why it’s interesting: In November 2022, after ChatGPT became an AI celeb (with almost 100 million fans registering within two months), researchers worried students, pharmacists, and regular folks might rely on ChatGPT for health advice. Dr. Sara Grossman was astounded by ChatGPT’s swift information synthesis, a feat that takes professionals hours. While she understands the appeal of instant medical advice, she believes online answers can't replace healthcare professionals' guidance. This aligns with an OpenAI spokesperson's caution against relying on ChatGPT as a substitute for professional medical advice or treatment🙅‍♀️.

But that doesn’t mean there aren’t things doctors can learn from AI: In a 2023 study, researchers from multiple American universities pitted ChatGPT's responses against verified physicians' on Reddit's r/AskDocs subreddit. Clinicians preferred the chatbot's responses in 78.6% of the 585 scenarios. They rated them 3.6x higher in quality and 9.8x higher in empathy — due to its longer, more personable answers compared to physicians' brief, time-saving responses. One physician tweeted, “It should be self-evident that one secret of good care for the patient is caring for the patient. In reflection, I could be doing a better job at this.”

Bottom line: While medical chatbots have a ways to go, they have the potential to free up time for doctors, fostering increased presence with patients. But for now, when patients have medical questions, going with a doctor is still the safest bet ✅.

Things your attending might pimp you on 🙋🏽‍♀️👨‍⚕️ 

1. “What’s the efficacy of the mRNA vaccine for RSV in adults?”

A new, phase 3 study has shown that Moderna’s mRNA-1345 vaccine for RSV is safe and effective. One dose resulted in lower incidences of RSV-associated lower respiratory tract disease (83% efficacy) and acute respiratory disease (68 % efficacy) compared to placebo in adults > 60. Protection was observed against both RSV subtypes (A and B). 

2. “Should you add metformin to insulin in pregnancy for the treatment of diabetes?”

The MOMPOD trial investigated addition of metformin to insulin in pregnant individuals with either pre-existing T2DM or diabetes diagnosed at <23 weeks GA. The study did not detect a significant difference in the primary outcome of composite adverse neonatal outcome. However, the metformin-exposed neonates had lower odds to be large for gestational age (0.63). 

3. “What’s the prevalence of TB among foreign-born Canadians?”

A CMAJ study set out to estimate the prevalence of tuberculosis (TB) among Canadians born abroad. The estimated overall TB prevalence was found to be 1 in 4. Importantly, very few individuals were infected within 2 preceding years i.e. to detect 1 person infected within the last 2 years among all foreign-born residents, 2410 people would need to be tested.

🍔 Quick Bites

1: 🚗 On Dec. 13, Tesla issued a recall for approximately 2 million of cars (basically all of them) for lack of safety on self-driving features. This doesn’t mean they’ll be brought in for service — there’ll be a software update to add Autopilot alerts. Critics, including the US National Highway Traffic and Safety Administration, say the recall doesn’t go far enough. Others point out that Tesla’s compliance has led to fewer hardware-based recalls than other car makers.

2: 💉 In a public advisory, Health Canada has warned consumers not to buy unauthorized injectable drug products from Canlab Research — like oxytocin and triptorelin, promoted as peptides. Canlab has been ordered to stop advertising and selling these products that typically require a prescription. As you can see, they haven’t yet complied (as of Dec 19) 😟.

3: 🩺 In the newest response to Canada’s health care shortage (which we covered last month), the fed. gov. is planning to accelerate the process for international med grads to find work in Canada. Some applaud the plan, saying it’ll serve shortages in remote communities. Naysayers point out many Canadian grads already can’t secure residencies. (By 2028, Canada will be short approximately 44,000 doctors.)

4: 🏠 Canadian housing prices are lower than they’ve been in the last 14 months. Borrowing rates are still high — at their highest in more than 2 decades(!) — so potential buyers are holding off. So are potential sellers. Looks like current prices aren’t moving enough 🤷‍♀️.

5: 🦾 The future is now! A 10-year-old boy received an Iron Man-themed bionic arm — one of the first people in the UK to be fitted with Open Bionics’ “Hero Arm.” Manufacturer of 3D printed bionic arms Open Bionics has partnered with companies like Disney, 20th Century Fox, and Konami to create themed prosthetics inspired from universes like Star Wars, Marvel, and Frozen.

6: 👩‍⚖️ Well, it finally happened - Colorado supreme court disqualified Trump yesterday from its 2024 ballot. “A majority of the court holds that Trump is disqualified from holding the office of president under Section 3 of the 14th Amendment” (a rarely used provision that bars insurrectionists from holding office) wrote the court, whose justices were all appointed by Democratic governors. Trump has vowed to appeal to the US Supreme Court.

Taking the Pulse 🫀

Last week, we asked Postcallers: “Should naturopaths be able to prescribe opioid-use-disorder medications?”

Just about all of you said, “Heck no.” So here some of our favourite comments:

Regardless of what’s up with other fields of healthcare - it’s been a big year for Canadian medicine.

Have a positive, uplifting healthcare story to share? Or maybe a controversial view on the field of medicine? We want to hear it.

Let us know, and we’ll share the best stories in the final issue of the year next week.

Postcall Picks ✅ 

📖 Read: about more futurism and the human body in space — in this New York Times article The Bodily Indignities of the Space Life.

💳 Buy: a rare first-edition copy of Harry Potter and the Philosopher’s Stone - for only £55,000. In an ironic twist, the original owner (who purchased the book in 1997) stored her copy in a cupboard under the stairs for years.

👀 Watch: this clip of an OR thoracotomy where the surgeon removes a knife that just barely skimmed the pericardial sac with no damage to the myocardium.

🕹️ Game ⛳️

Time for your cerebral checkup! 🧠 

First question: What do you call a tumour of the adrenal gland, causing excess release of adrenaline?

Last week’s fastest times: 1:26 & 1:45!

Our puzzles are like Christmas cookies 🍪 — sweet, hand-baked, and meant to be shared! (Enjoyed the puzzle? Forward it!)

❓Trivia Answer❓

December 1.

The meteorological calendar follows “the changing of the calendar, month to month, and are based on the annual temperature cycle.” According to this calendar, spring starts Mar. 1, summer on June 1, and fall on Sept. 1.

Share Postcall, Get Exclusive Merch! 🐕

Share Postcall, rack up referrals, get merch. It’s that easy. Plus, you’ll get our eternal gratitude. Maybe we’ll name our next pet Shiba in your honour! 😜

Click here or share by copying and pasting this link: https://postcall.ca/subscribe?ref=PLACEHOLDER

🤘 If you’re reading this, you know that our readers are Canada's best and brightest physicians, medical learners, and other smart, ambitious people. Learn about partnering with Postcall if you’d like to reach them.