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- The Fall of Phenyl 😵👑
The Fall of Phenyl 😵👑
PLUS: Medicine in Nepal, Arc'teryx sale for all, and "Girl math" is a LOL
Nicka Kalaydina, Ihomehe Agbebaku & Melody Tang
September 20, 2023
Good morning! It’s Wednesday – which means Postcall is coming at you like a flash mob of wolverines!
Speaking of wolverines — did you know Marvel specifically created Wolverine as a way to break into the Canadian market? Writer Len Wein proposed two names for the new superhero: Badger and Wolverine. Given the character’s memorable traits of ferocity and reclusiveness — and not digging and burrowing — we think they made the right call.
Done with wolverines and badgers? Let's dig into the headlines.
The Fall of Phenyl 😵👑
Betrayal! Secrets revealed! Phenylephrine… doesn’t work?
What patients might say this week 🙊
Is testosterone-replacement therapy safe?
The Fed-Up and The Furious 🚗🏁
The Big Three auto workers are mad as hell, and they’re not going to take it anymore!
Quick bites 🍉
Did you know that you’re literally making money when you skip your daily Starbucks run?
🏀 Baller of the Month 🏀
A doctor trades comfort for svayansēvaka (the Nepali word for volunteer).
🐶 Postcall Picks
Tips on travelling better, eating at the new Enroute top 30 restaurants, and saving on new jackets.
💼 Job opportunities
Tips on new opportunities if you’re looking for a change (or your first gig)
Driving these numbers 🧧 : Canada's annual inflation rate increased to 4% in August (up from 3.3% in July), mostly due to rising oil and gasoline prices. But it wasn’t enough to lift the TSX index.
Table of Contents
The Fall of Phenyl 😵👑
An FDA panel has voted against phenylephrine pills for decongestion in the US following years of uncertainty surrounding its efficacy. Its future in Canada, however, remains uncertain.
What happened: Phenylephrine is found in many over-the-counter cold and flu meds such as: Sudafed PE, Benadryl Allergy Plus Congestion, Mucinex Sinus-Max, and Nyquil Severe Cold & Flu. This week, it was determined that phenylephrine pills are ineffective at treating a stuffy nose. The final verdict is years in the making, with doubts about its efficacy dating back to 2007. I guess the FDA got sudaFED UP.
Why it’s important: Phenylephrine got the FDA’s green light in the 1970s based on small-scale studies. But the evidence has always been mid tbh. For starters, it’s extensively metabolized with a cited bioavailability of 38% in the literature, that appears to be closer to 1% in practice. When taken as a pill, only trace levels of the drug reach nasal passages to relieve congestion, rendering it essentially ineffective.
This brings us to our problematic fave, pseudoephedrine, which is considered by many to be a superior decongestant. Unfortunately, the evidence behind it is similarly mixed. Oh, and it’s also used to cook meth. As a result, there are much tighter regulations surrounding its sale.
What’s next: Phenylephrine pills might eventually be removed from store shelves in the US, but not for a while. North of the border, Health Canada has not provided a comment yet. However, the Canadian Paediatric Society called phenylephrine's use into question back in 2011.
Postcall’s Take:
Consider using Flonase or antihistamines instead.
In children, try using Children’s Tylenol and Children’s Advil instead
When in doubt, ask your Pharmacist.
Bottom line: Beware of cold & flu meds and educate your patients about their efficacy ahead of the upcoming cold & flu szn.
Read more at A Popular Decongestant
What patients might say this week 🙊
“When can I get my booster?”
Starting this fall and only if it’s been 6 months since your last dose. Note that only Moderna has been approved for those > 6 months old, while Pfizer and Novavax are pending approval. Oh, and ensure to use the term “updated vaccines” over “booster.”
“I have low T: is testosterone replacement safe for my heart?”
An RCT published in the NEJM has shown that in men with hypogonadism and preexisting or a high risk of cardiovascular disease, testosterone-replacement therapy was noninferior to placebo with respect to the incidence of major adverse cardiac events.
“I want a female surgeon!”
A retrospective cohort study published in JAMA found that patients treated by female surgeons in Ontario had a lower risk-adjusted likelihood of adverse outcomes (at 90 days and 1 year after surgery).
The Fed-Up and the Furious 🚗🏁
Hot Girl Summer is over, but Hot Strike Summer☀️ (which we dove into a few weeks back) continues.
Nothing unites workers more than job dissatisfaction, especially when their employers are the Big Three: Ford, Stellantis, and General Motors (GM).
What happened: On the heels of 13,000 United Auto Workers (UAW) striking in the US on Friday, workers at Ford in Canada narrowly managed to avoid their own strike last night. Unifor, the Canadian union representing 5,680 workers, chose Ford because it’s the closest of the Big Three to making the switch to electric.
Meanwhile, auto strikes in the US may grow: there’ll be more strikes on Friday if no progress is made. According to UAW president, Shawn Fain, the objective is to keep companies guessing what’ll happen next.
UAW might sound like a toxic ex playing mind games, but their game is bargaining for a fair contract. Terms include: a 32-hour workweek, company-financed healthcare in retirement, and a wage increase of 36% over four years.
Why it’s interesting: This is the first time UAW has gone on strike against The Big Three simultaneously. Each company has been individually negotiating with workers, offering wage increases ranging from 17.5% to 21%. The Big Three must’ve had Mr. President on speed-dial because top aides were dispatched to Detroit.
Despite layoffs and pay-cut threats, when it comes to sticking with their original terms, many workers — especially third generation ones — have the conviction of a dystopian YA protagonist leading a revolution. 🏹 They hope to win not just for themselves, but “future generations of automakers.”They even have ex-presidential approval on their side.
Bottom line: If negotiations drag, expect to see new car prices increase, and the economy worsen — which might affect Biden’s 2024 presidential campaign. But don’t panic! Consumers have a habit of panic-buying if they see supplies dwindling. It all depends on how long the strikes last.
Learn the future by keeping up with live updates. 🔮
🍔 Quick Bites
1: India expelled a Canadian diplomat in response to PM Justin Trudeau alleging the Indian government was involved in the killing of a Sikh leader in Canada. Indo-Canadian relations are on 🧊.
2: The Commandments of “Girl Math”: If you buy a $50 shirt with cash, it’s free 💰️. If you wear it 50 times, it’ll cost $1/wear. If you return that shirt, anything you buy with that $50 is also free! Don’t worry, this TikTok trend justifying fun spending isn’t meant to be taken seriously.
3: Everything’s bigger in Texas… including book banning. In 2022, they made more attempts to censor access to books than any other state. The American Library Association reports there were more censorship attempts last year than in recorded history, particularly in Republican-led states.
4: 🤑 Were you a resident in Ontario in any year 2020 or later? If so, you’re owed some backpay due to a recent arbitration (use the PARO calculator to determine how much). Your payroll centres should be processing it automatically, but confirm with PARO/PGME.
5: Best of luck 🍀 to everyone going through the internal subspecialty interviews! When in doubt, just answer “high sensitivity troponin“. If you’re stressed, just think about all the med students going through the CaRMS R1 match, which just opened today and is due Dec 1.
🏀 Baller of the Month 🏀
Ever wondered how you'd fare in a foreign healthcare system? Meet Dr. Corinne Hohl, a seasoned EM physician with a decade of experience, who traded her Canadian comfort zone for volunteering at Patan Hospital in Nepal.
It wasn’t just about adventure – it was about making a real difference where it counted.
Why travel so far? "I wanted to take the silver spoons out of my kids' mouths," she says. "Stepping out of my comfort zone to make a difference was priceless."
Nepal’s rich culture and fair share of challenges called to her. She wanted to share her much-needed expertise by offering full 9-month mentorships for EM fellows.
How did she make it work?
Corinne managed to afford a year off through three key steps:
She saved money with the intention of taking a year off.
By renting out her house, she was able to cover her mortgage.
Her academic appointment at UBC, while not as lucrative as her regular clinical work, helped fill in the financial gaps.
Corinne’s journey was no stroll through the Himalayas. She arrived with a tourist visa – a common practice among volunteers – only to find out the rules had changed. She faced a tough choice: break federal laws that prevented doctors from working on a tourist visa, or walk away from her commitment.
What did she do next?
Determined to help, Corinne found an in-between solution by working with local authorities and carefully navigating the balance of legal requirements in Nepal (which were never fully resolved).
This journey exposed her family to global disparities and emphasized the importance of respecting local cultures. As Corinne puts it, "Many Westerners visit underdeveloped countries with a philanthropic mindset without understanding the culture and needs," which is why volunteering is often discouraged in Nepal.
Corinne returned home feeling refreshed, with a greater understanding of her diverse patient population and motivation to offer compassionate, culturally sensitive care. She felt thankful to work within a system that, despite its imperfections, provides a comparatively higher level of care and support.
In a world where many play it safe, Corinne's daring journey led to eye-opening discoveries, making her a true Baller.
Read the personal account of Dr. Corinne’s journey (and the medical stories), or watch the YouTube talk to go in depth into her journey.
Source: Dr. Corinne Hohl’s blog
Doing cleft palate surgeries abroad? Baller. Know somebody who started a sick side hustle? Baller. If you know of any ballers in your life you want to nominate, let us know at [email protected].
Postcall Picks ✅
🦐 Eat: Enroute Magazine came out with their list of top 30 new restaurants across the country, and we’re drooling.
💳️ Buy: Arc’teryx hit us with a surprise sale: 30% off many of their popular lines, including Atom and Cerium. Check out their sale, but don’t sleep on it — the sale ends today (Sep 20) at 11:59PM PST!
👀 Watch: Remember the Gamestop saga (when folks on the social media site Reddit tried to mess with professional investors/short sellers)? They made a move about it that premiered last week at TIFF.
🛫 Travel tip: Lounge access is starting to get tighter. American Airlines and Delta just overhauled their reward programs and we’re nervously awaiting Canadian programs to follow suit.
Job Opportunities 💼
Role: Cardiothoracic Imaging Radiologist
Location: Manitoba X-ray Clinic Medical Corporation (Winnipeg, MB)
Compensation: $550,000
Role: Pediatrician
Location: Yarmouth Regional Hospital (Yarmouth, NS)
Compensation: $300,000 - 350,000
Role: Clinical Associate Locum (Oncology)
Location: Saskatchewan Cancer Agency (Regina, Saskatchewan)
Compensation: $263,455 - $352,030
Role: GP Oncology Support Physician
Location: Horizon Health Network (St. John, NB)
Compensation: $179,000 - $209,000
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Take your horse to the old town road 🐽
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