Happy Wednesday, and happy start to certification exam season for residents!

It’s certainly a happy day for the woman who, last month, beat melanoma. The first patient ever to test a new treatment, TIL — tumour-infiltrating lymphocyte therapy — is now cancer-free. TIL therapy is FDA-approved and works by replacing ineffective TIL cells with the patient’s own lab-grown cells.

Now on to this week’s stories!

The Money Monster 👺 

The markets are in greed mode:

• Both US and Canadian equity markets soared to new record highs (although dipped a bit early this week).

• Big tech is growing even larger — boosted by AI (read: Nvidia’s massive earnings report last week).

• Bitcoin surged past its previous high, hitting $68K USD earlier this week.

This growth trend persists despite the delay in the much-anticipated rate decreases. So, does this mean a market downturn is on the horizon and you should move to bonds or cash? Maybe, maybe not: cycles of exuberance can extend over months, even years, especially when company earnings are as robust as they currently are.

*we’re not financial advisors, this newsletter is intended for entertainment only.

Staying #Up2Date 🚨

1. A breakthrough in cervical cancer

A new RCT published in NEJM compared radical hysterectomy vs. simple hysterectomy with lymph-node assessment in patients with low-risk cervical cancer. The simple approach was non-inferior based on the 3-year incidence of pelvic recurrence: 2.17% for radical and 2.52% for simple hysterectomy, which represents an absolute difference of 0.35 percentage points (90% confidence interval, −1.62 to 2.32). Simple hysterectomy was also associated with a lower risk of urinary incontinence or retention at 4 weeks after surgery (2.4% vs. 5.5%; P=0.048) and beyond 4 weeks (4.7% vs. 11.0%; P=0.003).

2. Bronchodilator response: yay or nay?

How many of you remember learning that bronchodilator responsiveness (BDR) differentiates between asthma and COPD in med school? A prospective cohort study with 3,500+ patients looked into the utility of a positive BDR in obstructive airway diseases. The BDR was 19% for asthma, 18-25% for COPD, and 23-30% for asthma plus COPD. So, should a positive BDR test be a diagnostic requirement for asthma? Since a positive BDR does not differentiate asthma from COPD, some suggest it should be repurposed for predicting asthma severity and treatment response.

3. Achy breaky heart (from NAFLD)

Non-alcoholic fatty liver disease (NAFLD) is an underrated risk factor for atherosclerotic cardiovascular disease (CVD). A study from South Korea using an 8 million-person database found that, regardless of diabetes status, 5-year risks for CVD and all-cause death were higher for patients with grade 2 NAFLD than for those with grade 1 NAFLD, and were higher for those with grade 1 NAFLD than for those without NAFLD. Risks within each NAFLD group were substantially higher in patients with diabetes than in those without diabetes. 

🧑‍💻 Tech Bites

1: AI’s making progress in reducing paperwork already across clinics — but the next big hurdle will be implementation in complex environments like the ED. Fortunately, Unity Health Toronto has been partnering with Signal 1 to develop the ability to predict and automatically update staff as new information becomes available, like lab results from bloodwork (accelerating discharge and reducing overcrowding).

2: Another way AI could help in the ED: wrist fractures are often missed as they’re hard to see on a X-ray, but a new meta-analysis in EJR found that convolutional neural networks (CNNs, a type of AI) accurately detect wrist fractures from plain X-rays. However, heterogeneity was observed among the studies, raising concerns of bias and quality.

3: With online gambling and live betting on the rise, it was only a matter of time before AI went all-in ♠️ . Companies using AI (like EquinEdge) are personalizing betting experiences and improving user engagement, while critics raise concerns about exploitation and addiction.

The Race Towards Driverless Cars 🚗

Patients won’t need someone to drive them home from their appointments… if manufacturers can get self-driving cars to work.

What happened: Major car companies are putting pedal to the metal as they begin creating prototypes for self-driving cars.

Why it’s interesting: Volvo, Cadillac, and Audi have developed electric cars with features like a panoramic screen on the roof to create a party atmosphere. They’ve also created office and living room spaces with swiveling front seats to allow for conferences. 

Not having a “gas-guzzling motor” means more room for innovation. Ideas for the next gen of vehicles include: holographic tech so people can take meetings on the go, AI voice assistants, and VR metaverses allowing users to see their offices inside their cars.

These advancements could help get patients to and from appointments without calling a car service, or could help physicians provide care to patients who are unable to leave their houses by sending their medication. 

BUT: Don’t kick it into high gear yet because Cruise, a driverless car company under GM, has recently lost a big chunk of their funding due to excessive accidents like blocking ambulances from entering hospitals. The vehicles are no longer allowed to operate on roads. 

Driverless cars understand the rules of the road, but they have trouble reacting to subtle cues shared among human drivers, causing unnecessary traffic. The software code for self-driving cars is incredibly error-prone, and the problem only grows as the systems become more complex.

Bottom line: The future may be now, but until engineers can get over the software speed bumps, you might want to hold onto your keys.

Notable Numbers 🔢 

🔻 32%: That’s the proposed decrease in the fee schedule from the BC’s Society of Eye Physicians and Surgeons for retinal procedures. Retinal specialists (some of whom bill over $2M per year) are ready for a fight - they’re saying they’ll leave the retinal diseases treatment program (which provides funding for about 20K patients), as the decrease is “simply not sustainable.“ Will they though? Participating specialists receive an extra $250K/year each from the program (that’s not reflected in the Blue Book)…

$1B: How much a longtime professor is donating to the Albert Einstein College of Medicine in the Bronx. 96-year-old Ruth Gottesman inherited $1 billion in stock from her husband, which is set to cover tuition in perpetuity.

4: Four is the maximum number of patients one nurse will cover in general medical wards in BC, as it becomes the first province to set nurse-to-patient ratios. Five other areas also receive ratios to improve the quality of care and reduce the risk of burnout.

Postcall Picks ✅ 

🛫 Travel: to the Galapagos and the Amazon — DoT has a tour on Apr 2-16, 2024, where you can visit Quito, the Amazon, and penguins while also earning 15+ CME hours. $11,995 CAD (double occupancy) — Learn more here.

💳️ Buy: with care. Basically all reviews online are now basically bullsh*t — as shown by this air purifier review company.

🧠 Learn: about Achieving Financial Independence for Women in Medicine through this talk from Dr. Steph Zhou and the OMA Women Committee.

🤣 Laugh: “Surgeons only use a few dozen neurons to operate… a therapist can help unlock the rest of it.”

🕹️ Game ⛳️

Wait… where did it go?

We’ve moved it to our Saturday edition, when we all have a bit more time to decompress after the busy week.

Check your inbox this weekend for more Postcall goodies!

Share Postcall, Get 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

🤘 PS. 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.