Happy New Year! Postcall here, hoping you rang in the New Year like it was Sydney 2023!

2023 was a year of medical advancements: the approval of world’s first CRISPR-based gene therapy, AI helping to detect breast cancer, a new prostate cancer treatment for men, & many, many more.

❓Trivia question❓: The 1923 Nobel Prize recognized what 1921 medical breakthrough at UofT? (Answer at the bottom of today’s issue!)

Time for some stories!

• 😈 666 IMGs are unleashed

• Should DAPT be extended in TIA or stroke?

• Can primidone be repurposed for ALS?

• How quickly should we be uptitrating GDMT in HF?

• AutoScribe by Mutuo Health

• Are you middle class?

• You may have to file a T3

• "Dog bed for humans" - Yes, it's a thing

• ⛳️ Crossword

• ❓ Trivia Answer

Driving these numbers:

Like many of us, the stock market had a bit of hangover the first day back after NYE celebration (slightly down). But don’t fret - 2023 was the best year for markets since 2019 despite multiple major wars and looming US elections. The biggest winner? NVIDIA, which has rode the AI wave all the way to $1.2T.

666 IMGs Unleashed 👿 

Warning: do not read this article if you have hexakosioihexekontahexaphobia (a fear of the number 666).

What happened: BC Health Minister Adrian Dix announced that 666 international medical graduates (IMGs) registered in 2023 are now practicing as doctors in the province, with over half in family medicine. BC's even sending some IMGs to rural areas via return of service programs. As BC grapples with hospital overcrowding and a family doctor shortage, Dix says that this additional help, well… helps. 

The secret sauce? BC's shiny new payment model, recognizing time spent with patients and their needs complexity (covered by Postcall last month). 

Why it's interesting: Historically, foreign-trained physicians account for about 25% of all doctors — but that’s been on a decline. Reports surfaced early last year that some foreign-trained doctors are leaving Canada because of the current challenging process. Thousands of Canadian-born doctors are also working abroad while Canada faces a severe physician shortage, as medical schools prioritizing Canadian-educated students for the limited residency spots each year

Getting the green light to practice in Canada right now isn’t easy. For example, one Canadian doctor has been battling bureaucracy for nearly 16 months to obtain work documents.

B.C. Premier David Eby announced measures to bring more doctors to B.C., letting internationally trained family physicians get licensed quickly via legislation like Bill 38 (which lets newcomers swiftly use their skills by removing barriers like redundant language testing and Canadian work experience requirements for 29 professions). Ottawa is also in on the action, unveiling a new "express entry" stream for health professionals in the economic immigration program, and sending invites to foreign healthcare professionals to apply for permanent residency. 

Wait, not so fast: There’s still several outstanding questions before we’re full steam ahead.

• Some of the LMCC requirements help maintain public trust in the healthcare system. Knowing that all doctors, whether trained domestically or internationally, have met the same stringent criteria, helps in reassuring the public about the quality of medical care they receive.

• Canada's health care system and patient demographics may differ significantly from those in other countries. IMGs still need to understand the Canadian healthcare system, cultural competencies, and ethical practices.

• Hiring IMGs into areas where there aren’t shortages might hurt job prospects for home-grown doctors seeking full time roles. Supply and demand for needs to be managed well, as the investment in our medical schools is significant.

Bottom line: In less than a decade, we’ll likely be facing a shortage of about 43,900 physicians, including 30,000 family doctors and general practitioners. IMGs may be a solution along with others to keep our system afloat.

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

1. "Should DAPT be extended in TIA or stroke?"

The newly published INSPIRES trial explored initiating clopidogrel-aspirin within 72h after acute cerebral ischemia from atherosclerosis, rather than within a 24h window. Over 6000 patients with mild ischemic stroke or high-risk TIA who had not undergone thrombolysis were included in the randomized, double-blind trial conducted in China. Clopidogrel–aspirin therapy initiated within 72 hours after stroke onset led to a lower risk of new stroke at 90 days than aspirin therapy alone but was associated with a low but higher risk of moderate-to-severe bleeding.

2.  “Can primidone be repurposed for ALS?”

Receptor-interacting protein kinase 1 (RIPK1) has been proposed to mediate pathogenesis of ALS. In a new study, mice treated with primidone, which inhibits RIPK1, showed significant delay of symptomatic ALS onset and improved motor performance. In the same study, 162 people with ALS treated with primeidone showed significant reduction in serum RIPK1 and IL-8 levels, which may represent new clinical biomarkers for RIPK1 activation. 

3. “How quickly should we be uptitrating GDMT in HF?”

The STRONG-HF trial compared the safety and efficacy of a high-intensity care (HIC) strategy comprising early uptitration of oral HF medications (BBs, RASi, MRAs). Now, a post hoc secondary analysis of this trial has shown that among patients randomly assigned to high-intensity care, achieving higher doses of HF GDMT 2 weeks after discharge was feasible and safe in most patients. Patients prescribed more GDMT had lower rates of readmission for HF or death at 6 months and improved quality of life.

🍔 Quick Bites

1: 🏡 According to a poll, the vast majority Canadians consider themselves middle class. Only 8% of respondents called themselves lower class and 0.5% upper class. When this skewed ideological alignment was pointed out to them, 100% said, “Sorry, eh?” 😏

2: 🧫 According to new research, there could be a new cancer-killing machine on the block. In Nature, researchers describe a way to destroy cancer cells via vibration using near-infrared light. These molecular jackhammers sound like they might make a big impact!

3: 🚬 A new study has smoked out a potential alternative to nicotine replacement therapy: cytisine, an inexpensive stop-smoking aid that’s been used in eastern Europe since the 1960s. Cytisine showed no safety concerns and “increases the chances of successful smoking cessation by more than two-fold compared with placebo.”

4: 🏦 New tax-reporting obligations require individuals who are part of trusts — even those who don’t know they’re part of a trust — to file T3 Trust Income Tax and Information Return. It’s common to not know you have trust issues. 😬

5: Microsoft’s is bringing Copilot to phones - it’s very similar to ChatGPT, with access to chatbot capabilities, image generation through DALL-E 3, and the ability to draft text for emails and documents. It also includes free access to OpenAI’s latest GPT-4 model, something you have to pay for if you’re using ChatGPT (Apple | Google Play)

6: A Japan Airlines (JAL) plane collided with a Coast Guard aircraft at Tokyo's Haneda Airport, leading to a fire. The Coast Guard plane was enroute to deliver aid after series of powerful earthquakes that hit near the Ishikawa prefecture. All 379 people on the JAL plane escaped, but five of the six crew members on the smaller plane were killed.

Postcall Picks ✅ 

🛫 Travel: Get flights to Japan from the west coast for $700 with new discount airline ZIPAIR.

👀 Say no: Burnt out from all the socializing over the holidays? NPR’s put together 3 ways to decline invites, politely.

💳️ Buy: One of the top trending gifts by Google searches this holiday season was a $429 “dog bed for humans” made by crowdfunded startup Plufl.

👂️ Listen: Dr. Blair Bigham wrote a book (based on his experiences in the ICU) about how sometimes keeping people (and their hopes) alive only prolongs the suffering. In this podcast (apple | spotify), he talks about how he had to rethink this view when his own father was diagnosed with pancreatic cancer.

🕹️ Crossword ⛳️

Time to see how many brain cells were lost to egg nog! Every word in this week’s crossword is related to NEWness.

First question: Neovascularization of the eye that results in vision loss is called Proliferative Diabetic ____?

Did you beat last week’s average of 4:13? If you enjoyed the crossword, send it to a friend!

❓Trivia Answer ❓

The breakthrough was insulin. 1923 Nobel Prize in Physiology or Medicine was controversially awarded to Dr. Frederick Banting and J.J.R. Macleod. Some believed it should have gone to Banting and Charles Best. Others celebrated the contributions of J.B. Collip. Today, the discovery is recognized as a team effort.

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