Staying #Up2Date 🚨

1. Ozempic & osteoarthritis

This RCT with 407 people with obesity and moderate knee OA, weekly semaglutide (2.4 mg) led to a significantly greater reduction in body weight (−13.7% vs. −3.2%) and WOMAC pain scores (−41.7 vs. −27.5 points) compared to placebo. Semaglutide also improved SF-36 physical-function scores more than placebo (12.0 vs. 6.5 points). The rate of serious adverse events were similar between groups. This suggests that semaglutide may benefit weight and pain management in patients with knee osteoarthritis.

2. Central lines & complications

This multivariable analysis of 1,900 central venous access devices in hospitalized adults revealed an overall failure rate of 10%, primarily due to central line–associated bloodstream infections (over half of failures), catheter occlusions (17% of failures), and dislodgements (17% of failures). Antimicrobial nontunneled CVADs significantly reduced the incidence of bloodstream infections but were used in only half of the cases. 

3. Cancer diagnosis & Canadian EDs

This Ontario retrospective study found that 35.3% of ~600K patients visited the ED within 90 days prior to their cancer diagnosis, with over half  of patients being admitted. Rural residence, living in marginalized areas, and specific cancer types (intracranial, pancreatic, and thoracic cancers) were linked with increased ED use. These findings highlight the ED's significant role in cancer diagnosis, especially in those without primary care access.

Not MAiD For Everyone

Why some doctors believe MAiD is not a viable solution for patients with chronic illnesses

What happened? Quebec will begin accepting advanced requests for those interested in Medical Assistance in Dying (MAiD).

Why it’s interesting: Quebec has become the first province to allow individuals with incurable diseases to request a medically assisted death before their conditions leave them unable to give consent.

Rather than Quebec waiting for Ottawa to update the Criminal Code, the province asked the Crown prosecutor’s office not to charge doctors who participate in the MAiD program, provided they follow the rules. Some include health-care workers who must ensure the patient gives “express consent” right before they receive the procedure, and allow patients to withdraw consent. Patients must also meet certain criteria, including a detailed assessment of their symptoms, which healthcare workers must witness before the procedure can be performed.

According to provincial data, requests for MAiD have increased every year since the law went into effect in 2015. Between April 1st, 2023 and March 31st of this year, 5,717 people received MAiD. The number of doctors who administered MAiD rose 10 percent in the same time period.

But: Many of us object to MAiD, believing there are “ethical and practical problems” surrounding the advance requests for the procedure. A doctor from McGill University stated that patients’ wishes often evolve throughout their chronic illnesses, which can make proper consent difficult to obtain. 

As well, some doctors argue that patients cannot give informed consent to MAiD, as patients can’t predict their future experiences and may not want the service when the time comes.

Bottom line: Even though Quebec has the green light to advance its MAiD program, it might take longer for the rest of the country to catch up — if at all. Understanding ethical concerns around the procedure should be top priority. 

Hot Off The Press

1: 🩺 An Ontarian doctor who was celebrated during the pandemic for leading mass vaccination clinics now faces a $600,000 repayment demand from OHIP, allegedly due to administering shots outside her office. Dr. Elaine Ma has called for government intervention, but the Ford administration has been silent. MPP Ted Hsu raised the issue in parliament, questioning whether Ontario's healthcare system will stand by doctors who take bold actions to protect public health.

2: 🏥 According to critics, Ontario’s medical oversight system needs an overhaul — CBC News revealed a 4th alleged victim of Dr. Eleazar Noriega, a pediatrician with a decades-long history of abuse claims. Noriega continued to practice despite multiple suspensions and tribunal hearings. Critics argue that the system's self-regulation and the powerful legal protections for doctors make it harder for abuse survivors to get justice and compensation.

3: ⚧️ Alberta’s government has introduced 3 controversial bills impacting transgender youth, from restricting hormone treatments for minors to requiring parental consent for name or pronoun changes in schools. Premier Danielle Smith argues these moves “protect” youth, but many doctors and LGBTQ+ advocates warn the policies disregard medical expertise and could seriously harm vulnerable young people.

4: 🐀 For the 3rd year in a row, Toronto has been named Canada’s most rat-infested city by Orkin (pest control company). Vancouver rates are working on their comeback strategy.

5: 🇺🇸 Yesterday was election day down south... And that's all we'll say about that, since you'll probably hear about the results non-stop elsewhere. Also, at print time:

(Okay, if there isn’t a definitive outcome by Wednesday morning and you’re looking for a dashboard to check every 2 minutes: this one by New York Times is our favourite).

Notable Numbers 🔢

129,000: the number of malaria cases reported in Brazil in 2022. According to a new Harvard study, deforestation in the Amazon escalates malaria transmission risk. Researchers say that seasonal data could guide better malaria policies, but it’s been a struggle to get policymakers on board.

35%: the percentage decrease in diabetes risk for adults conceived during UK sugar rationing in the early 1950s, compared to those born after. A new study links early-life sugar exposure to lifelong health impacts, calling attention to the long-term risks of high sugar intake during pregnancy and early childhood.

38,000: the number of lives that could have been saved in Europe during the 2022 heatwave if it weren’t for greenhouse pollution, according to a new study. The research reveals that over half of the 68,000 heat-related deaths that summer were driven by climate change.

Postcall Picks

😭 Laugh: at the never-ending cycle of dodging colonoscopy prep.  

🎧 Listen: to John Green discuss how the power of coffee and tea are being harnessed to eradicate TB.  

🎫 Learn: why plague doctors wore beaked masks and the real reason behind their increased protection from Yersinia pestis.

🤑 Save: $320 off a Breville Espresso Machine to keep you cozy and energized for the coming winter months.

🆓 Get: a free iPhone 16 or Macbook Air? We sure did - you can too if you transfer a bunch of your cash into Wealthsimple (and we’re pretty sure corporate $$$ can count too).

Relax

First Question: Suspect this with high lipase, abdominal pain, and positive ultrasound.

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