Staying #Up2Date 🚨

1. Semaglutide vs. Tirzepatide for weight loss  🏋️

This cohort study is the first to perform a head-to-head comparison of tirzepatide vs. semaglutide for weight-loss in individuals with increased BMI or obesity. In a 40K propensity score-matched population, patients receiving tirzepatide were significantly more likely to achieve weight loss. For achieving ≥5% weight loss, the hazard ratio (HR) was 1.76, with a 95% confidence interval (CI), 1.68, 1.84. For ≥10% weight loss: HR, 2.54; 95% CI, 2.37, 2.73; and ≥15% weight loss: HR, 3.24; 95% CI, 2.91, 3.61. The GI adverse events were similar between groups.

2. Anticoagulation in cirrhosis and afib 🩸

There’s not much guidance on anticoagulation in patients with cirrhosis and afib. In this retrospective cohort study ,1:1 propensity score-matched patients with cirrhosis and nonvalvular atrial fibrillation received apixaban vs. rivaroxaban vs. warfarin. Patients on apixaban were less likely to have major bleeding than patients who received rivaroxaban (5.1% vs. 8.7% annually) or warfarin (5.1% vs. 7.9% annually). There were no differences between groups in ischemic embolic events such as stroke or all-cause mortality. 

3. M & M (multivitamins and mortality) 💊

In this study, researchers pulled data from observational cohort studies comprising almost 400, 000 patients who were taking multivitamins. Taking multivitamins was not associated with lower all-cause mortality risk in the first (multivariable-adjusted HR, 1.04; 95% CI, 1.02-1.07) or second (multivariable-adjusted HR, 1.04; 95% CI, 0.99-1.08) halves of follow-up.

Around the Clock Care

Is subscription-based care the future of medicine?

What happened: Some doctors are turning to concierge medicine to help treat patients.

What is concierge medicine? Patients have the opportunity to pay a membership fee to gain access to a doctor’s practice. The average price for concierge services ranges anywhere from $2-20K a year. Some of the perks include: 

• Running multiple tests (labs, EKG, imaging)

• Extended visits with primary care physicians

• No wait times with appointments 

• Quick refills on prescriptions

• Unlimited text/telemedicine follow ups

One Calgary woman said after she struggled to find a family doctor she decided to check out Calgary clinic Provital Health Wellness, where she was able to pick from three different doctors. She said concierge medicine has made her feel empowered and engaged in her own health as the clinic gives her access to nutritionists, massage therapists, and counselors (for the low price of $3,000 a year). Vancouver based company, Concierge Medical is another clinic that offers services like IV vitamin therapy, personal home care, on-call urgent care, and even COVID-19 testing. Prices for the care depend on which type of resources patients need.

But: People have criticized concierge medicine for not being accessible to everyone due to the cost. Others say it’s immoral to charge patients money for primary care, as they believe it's a basic right. And south of the border, patients might still need to visit and pay for the hospital or emergency room.

Although doctors are allowed to charge patients for concierge clinics, one Whitby physician found themselves in trouble after they required patients to pay an annual fee for services not covered under medicare like dieticians and breast-feeding consultants. The fee was mandatory if patients wanted access to the doctor's care which is a violation of the ethical standards made by the Ontario College of Physicians. The doctor agreed to stop charging the fee but said they weren’t the only ones asking patients to give more money to receive services.

Curious about it? Here’s how you could get involved:

1. Join an existing concierge medical practice. Having a support staff to help make the transition is important, as they can give advice on how to retain as many patients as possible from your previous practice. 

2. Convert your current practice. Although this might seem straightforward, there are a few steps you must take, including recruiting and training a team of staff, determining your ideal panel size, and communicating with your existing patients about the switch.

3. Merge your practice with an existing concierge practice. While this might be the most complicated option as the process is much longer, it can be beneficial for doctors who don’t want to run a business anymore but instead focus on their patients. 

Hot Off The Press

1: 🇺🇸 Donald Trump — now the official Republican nominee for president — is “fine” but injured after an apparent assassination attempt at a rally last Saturday. Republicans are looking to capitalize on the attack (“We will not tolerate this attack from the left,” said Rep. Mike Kelly), though there is still little evidence about the shooter’s motivations. Oh, and Trump announced Senator JD Vance as his VP running mate.

2: 💜 Researchers may have found a root cause behind lupus, a disease that affects over 1 in 1,000 Canadians. A new study in Nature discovered an imbalance of types of T cells — that lupus hinders the production of T cells that heal wounds on the barrier of the skin, lungs, and gut, but stimulates the production of T cells that create autoantibodies.

3: 🪲Tick-spread illnesses are rising in Canada, according to the CBC. New data in the US has shown a 4x spike in American cases — a spike that could easily happen up here because of climate change. Many healthcare workers know little about these diseases, which is problematic because tick-borne illnesses are generally time-sensitive.

4: 🧑🏻‍🏫A new medical school is opening at SFU in September 2026. The school aims to gain preliminary accreditation by fall 2025. It’ll be the first new medical school in Western Canada in 55 years.

5: ⛈️ More than a month’s worth of rain fell in three hours in Toronto yesterday afternoon, and not even Drake was spared from the effects of flooding (who posted this crazy video from his house). Guess Toronto weather is a Kendrick Lamar fan.

💬 Notable Numbers

2.5 million: the number of Ontarians who lack a family doctor, according to the Ontario College of Family Physicians. Someone put that on the CMA website ASAP.

2-1: the final score when Spain defeated England and won their 4th European Championship last Sunday in Berlin. It was a great day for Spain, since on Sunday, Carlos Alcaraz won his second Wimbledon title.

56 per 100,000: the death rate in Vancouver, which is nearly 3x the national average. Last year, BC recorded 2,511 drug-related overdoses, 87% of which were reportedly because of fentanyl.

💬 In Our Community

When our colleagues tell us about sketchy financial practices, we face a variety of thoughts (and that’s totally normal). A recent thread on Facebook where a doc mentioned their colleagues don’t declare income from private insurances had some interesting comments. Our takeaways:

• For better or for worse, our tax system operates on an honour system.

• Most people felt that doing this yourself is too high risk/low reward (and we agree). Private insurance income is a small % of income, but if caught by the CRA there are significant consequences.

• Is it worth reporting them? This is a highly individual choice, with significant consequences like relationships in your professional group. It’s also not clear if this would even fix anything.

How much can I pay my spouse for their help with bookkeeping and other financial tasks?

This is asked often by docs who have a lower-income spouse, who would benefit from a lower tax bracket. On a Facebook thread last week, we heard that between $24K and $50K is reasonable and should pass the “market rate” requirement.

Postcall Picks

😂Laugh: This should replace the century-old Hospital emergency codes modules they force us everyone to do yearly. 

🧠Learn: Tune in to Sawbones episode on the medicinal history of chocolate and learn whether it should be added to your go-to-prescription list. 

🪞Reflect: An important story that reminds us to always imagine the person behind the disease and all of the reasons that got them to where they are – it's rarely as simple as it may appear. 

🤑Save: Upgrade your activewear game with a fantastic 15% cashback deal on Lululemon from Rakuten!

In fact, there’s great deals everywhere this week since there’s Prime Days on Amazon, and the Aeroplan eStore has 10x points on a variety of retailers. Sorry not sorry, wallet.

Relax

First Question: What is the life threatening hypersensitivity reaction that prompts you to use Clue #7 Across?

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