Good morning. Have you noticed that your parents or grandparents seem to be getting sharper with age? Well, it's not just a fluke. Recent studies reveal a fascinating trend: while younger adults’ cognitive abilities are staying relatively steady, the minds of older adults are actually improving. This shift, historically driven by advancements in education, healthcare, and nutrition, suggests that what we once considered inevitable cognitive decline might be becoming less common. Way to go, gramps!

☕️Postcall’s one-sip markets update:

It’s been down and up — specifically, down on inflation news and prolonged interest rates, but up on strong tech earnings. The S&P 500 finished up 2.3%, while the TSX gained about 1%.

Here’s what we got for you today:

1. RCTs on calorie restrictions

2. Pharma reps - should we meet with them?

3. Norovirus is ramping up

4. So are campus protests

5. Learning opportunities (both about your taxes, and CME)

6. Discounts on stethoscopes

Staying #Up2Date 🚨

1. Guideline watch 👀 

The U.S. Preventive Services Task Force now recommends q2y screening with mammography for women ages 40 - 74. This represents an update from 2016 in which women ages 40 - 49 were advised to make individual decisions. Canada guidelines still recommend screenings for 50+, but there’s discussion at the Canadian task force on changing that to 40+ as well.

2. Clocking calories

This RCT looked at whether time-restricted eating leads to greater weight loss. Among 41 adults with obesity and prediabetes or diet-controlled diabetes, there was no significant difference in weight loss between those instructed to eat between 8AM - 6PM vs. those allowed to eat until midnight. Weight loss in both groups over the 12-week period was modest and primarily linked to controlled calorie intake based on individual metabolic needs.

3. Should we be screening kids for high cholesterol? 

This observational study investigated whether lowering high non-HDL cholesterol from childhood to adulthood resulted in cardiovascular risk (CV) factor modification. After pooling data from six prospective cohort studies, resolution of non–HDL cholesterol dyslipidemia from childhood to adulthood was associated with the same risk for adverse CV events as when lipids were at recommended levels through both childhood and adulthood. Although this study cannot prove causality, it makes an argument for lipid screening in childhood to reduce CV outcomes into adulthood. 

4. Plain films a little too plain in early rheumatoid arthritis (RA)

A retrospective cohort study looked at the utility of routine hand and feet XRs in patients with suspected RA. Only 4% of these XRs showed erosions with overall impact on patient management and outcomes being minimal. These findings challenge the utility of performing plain films of the hands and feet in early RA diagnosis (currently UptoDate does say that obtaining this imaging can help track disease progress)

Should we meet with pharma reps?

As part of our day-to-day work, we may come across invites to lunches, sponsored talks, and other interactions with representatives from pharmaceutical companies. Like all drugs… just say no, right?

Before we condemn the industry that gave us vaccines and PReP, here’s some considerations.

Why might we say yes?

1. Meeting with reps can provide lunches for the staff, which saves the practice money and offers a perk to the staff, compensating them indirectly.

2. Reps provide samples, which can be beneficial for patients, especially when trying new medications.

   • Pro tip: You can ask reps to just drop off samples, without meeting with them.

3. CME: Interactions with reps can introduce physicians to new treatments and medications, potentially benefiting patients with more options.

4. The educational pamphlets from reps on drugs or general drugs classes are very well made, which can prove useful during discussions with patients.

5. Some argue that it's part of the industry and treating them fairly could contribute positively to patient care (since their revenues do fund scientific innovation).

Why we may say no:

1. There's a strong ethical stance against accepting anything that could be perceived as a bribe or affecting the impartiality of prescribing practices (basically, we may be influenced to act against the best interest of patients, even subconsciously).

2. Meeting with reps can be seen as a poor use of the our limited time, which could be better spent on patient care or other (less-biased) educational activities.

3. Some physicians prefer to maintain professional integrity by not relying on perks or benefits offered by pharma companies.

4. We’re sometimes skeptical of the real educational value of interactions with reps compared to unbiased, peer-reviewed sources of medical education.

At the end of the day, we’re advocates of you making the choices that allow you to deliver the best care to your patients and yourself.

Speed Reads 🚤 

1: 🪧 The heated protests you’ve heard about on university campuses in the US? They’re spreading to Canada: hundreds of protesters have set up tents on McGill University’s campus, demanding the university divest from companies that do business in Israel. The University of Toronto is warning students against setting up similar encampments ahead of convocation season.

2: 🌌 A blind astronomer created an astronomy project in England for visually impaired children. In the Tactile Universe project, Dr. Nicolas Bonne uses 3D printers to make models of galaxies, allowing students to feel how galaxies develop. This work is up for a Royal National Institute of Blind People (RNIB) See Differently Award.

3: 💻 Google stock surged after buying back stock from investors, increasing as much as 13% in after-hours trading. They also announced their first quarterly cash dividend of $0.20 / share.

4: 🖱️ Did someone order MouseGPT? Delivering the feature no one asked for, Logitech’s newest wireless mouse includes a dedicated button to launch its AI prompt builder. This follows on the heels of manufacturers adding dedicated AI buttons to their devices, including Microsoft’s Copilot button (the first new key to since 1994).

5: 🦠 In Alberta or Ontario? “The number of norovirus cases reported has been higher than expected in 2024 compared to the previous five-year historical average,” across the country and especially in those provinces.

Notable Numbers 🔢

$19.4B: the amount of revenue the federal government expects to generate with their proposed changes to capital gains tax. The CMA has opposed the increase, saying it’ll negatively impact doctors’ retirement savings.

3,000: the estimated amount of IVF cycles in BC last year. The BC government is planning to launch a $68M IVF program in spring 2025, which will fund one round of treatment and medication.

$1M: the amount of an anonymous donation this week to the Saint John Regional Hospital Foundation, which will go toward reducing MRI wait times.

Postcall Picks ✅ 

🚢 Travel: Embark on a 2-week journey to Sri Lanka from October 24 to November 10 offering 15+ CME hours focusing on health and healing, including visits to wellness sanctuaries, botanical gardens, holistic wellness centers, and local hospitals to explore Ayurveda medicine, and indigenous health practices. (Doctors on Tour).

💰️ Taxes: Dr. Yatin Chadha from beyond MD chatted with Ali Spinner on the implications of the proposed hike in the capital gains inclusion rate. Highlight for us was his answer to the question: is it still worthwhile incorporating, and what’s the departure tax for those considering leaving Canada? Listen here.

🧠 Learn: Dr. Anish Mody will share strategies to maximize team efficiency and promote autonomy in a complimentary virtual seminar for OMA members on May 29th. Register here.

💳️ Buy: a new stethoscope or clinic equipment at 20% off from Surgco, if you’re an OMA member.

🚰 Drink: clean water by washing your reusable water bottle at least once a week (and ideally every day). A microbiologist and professor of virology at the University of Arizona says that’s the minimum to avoid things like staph infection and mold poisoning.

🏡 Mortgage: Refinancing or buying this summer? Get up to $4,000 cashback with BMO’s 130-day rate guarantee before June 30th, 2024! Just email Helen Sy at [email protected]. **

** this is sponsored content

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