Congratulations to UBC’s Li Lab, which has developed oral insulin drops that could change how diabetes patients receive insulin. A project that took 3 years to develop, the drops contain a mixture of insulin and a unique cell-penetrating peptide that helps the insulin reach the bloodstream quickly.

☕️Postcall’s one-sip money update:

It’s finally here — interest rates have started coming down. The BoC took its benchmark interest rate from 5% to 4.75% late last week. And experts are guessing it’ll happen again in July.

Stock to watch this week: Dollarama (they’re reporting results today). They’re a great hedge against inflation (up 50% over the past year) as shoppers hunt for bargains.

Oh, and that proposed capital gains tax we’ve all heard about? Yup - it became law yesterday in the House. From Finance Minister Freeland: "Provinces and territories should be using some of that revenue to increase the actual salaries, the rate of compensation of doctors”, but it’s only words (for now).

Ready for this week’s stories? (7 min read)

Staying #Up2Date 🚨

1. Returning to play 🏀 

Earlier this month, Bronny James was officially cleared for the NBA draft following his cardiac arrest last year, just as new, international recommendations on arrhythmias in athletes of all ages have surfaced. The recommendations emphasize:

• Appropriate treatment and proof of suppression of arrhythmias with sports-specific stress testing prior to return to play for athletes with arrhythmic risk.

• Endurance activities may increase the risk for afib and development of arrhythmogenic right ventricular dysplasia.

• Sport and athlete considerations should guide pacemaker or implantable cardioverter-defibrillator choice.

2. The “legacy effect” 🏆 

A UK prospective study from 1977-1991 enrolled 5,000 patients with newly diagnosed type II diabetes (t2dm) who were randomized to early intensive glycemic control with sulfonylurea or insulin (or metformin) vs. diet alone. At 10-year follow-up, those who received early medication had significantly lower risk for all-cause mortality and myocardial infarction (MI). Now, after a median 18 years of follow-up, patients who initially received sulfonylureas or insulin were found to have significantly lower risk for all-cause mortality (hazard ratio, 0.90), MI (HR, 0.83) and microvascular disease (HR, 0.74). The mechanism of this “legacy effect” is unclear, although the lifelong value for t2dm diagnosis and early intervention is clear. 

3. Guideline Watch 👀 

The American Colleges of Cardiology and Heart Associations have updated their 2016 peripheral artery disease (PAD) guidelines. Low-dose rivaroxaban and aspirin is now recommended to decrease the risk for major adverse cardiovascular events (MACEs) and major adverse limb events in patients with symptomatic PAD who are not at increased bleeding risk. In patients with PAD and type 2 diabetes, the use of glucagon-like peptide-1 (GLP-1) agonists and sodium–glucose cotransporter-2 (SGLT-2) inhibitors are effective to reduce MACE. This update mirrors in the 2022 Canadian guidelines for PAD.

4. What did Postcallers say about the new breast cancer guidelines? Last week, we asked you whether you believe, based on your clinical experience, the guidelines should be lowered to 40. And you told us how you felt:

    

   🟩🟩🟩🟩🟩🟩 Yes, lowered to 40 (62%)

   🟨⬜️⬜️⬜️⬜️⬜️ No, keep them at 50 (18%)

   ⬜️⬜️⬜️⬜️⬜️⬜️ Neither, another age should be considered (0%)

   🟨⬜️⬜️⬜️⬜️⬜️ I don't know enough to say (20%)

Speed Reads 🚤

1: 💜 According to the Canadian Paediatric Society, all adolescents should be screened for eating disorders, which have been on the rise since the pandemic. After obesity and asthma, eating disorders are the 3rd most common chronic illness in adolescence.

2: 🔍️ If you need another reminder to follow PHIPA rules: Privacy regulators in Canada and the U.K. are launching a joint investigation into a 2023 data breach that compromised the genetic and ancestry data of 6.9 million 23andMe users.

3: 🫀 The woman who received a pig kidney transplant — the 2nd person to receive a kidney from a gene-edited pig — is back on dialysis 47 days after the doctors removed the kidney. NYU will study the failed organ to learn what it can about how it reacted inside a person.

4: 🤑 A Hulk Hogan-themed memecoin — allegedly promoted by Hulk Hogan — lost $15M in its market cap within minutes after Hogan deleted all posts promoting the crytopcurrency. Hogan has since denied he wrote any of the promotional posts.

5: 💊 A pain management startup, Sword Health, has announced a new AI that patients can talk to, which will help patients manage pain from home. The AI will guide patients through virtual physical therapy sessions, and will help avoid other treatments like opioids and surgery. We’re not clear on how evidence-based the treatments are though.

6: 🌲 Don’t get greenwashed - a longitudinal study of 118K people in the UK published this week in the Lancet found that every 10 percentage points increase in plant-sourced non-ultra-processed food consumption was associated with a 13% lower risk of CVD mortality. Conversely, plant-sourced UPF consumption was associated with a 12% higher mortality. Unfortunately, Canadians get nearly 50% of their daily calories from ultra-processed foods, according to the Heart and Stroke Foundation.

A Brew-tiful Summer? 🍻

Ontario wants to start your happy hour earlier.

What happened: Premiere Doug Ford announced that customers could see beer and hard ice teas in grocery stores as early as Aug. 1, while other alcoholic beverages could hit convenience stores by Sept. 5. Wine, ciders, and cocktails will be available in grocery stores by 2026.

Why it’s interesting: The government is creating a new legal framework, which includes allowing licensed grocery stores to offer curbside pickup of alcohol and streamlining licensing and renewals for businesses through a single primary licence. Stores must follow mandatory rules like not selling to anyone underage or intoxicated. Alcohol must only be available in a designated section of each store. 

The province said it will spend $10 million to support social responsibility and public health efforts related to the consumption of alcohol as part of its 10-year, $3.8-billion mental health plan. 

Yes, but: The Centre for Addiction and Mental Health (CAMH) has accused the Ford government of choosing convenience over the health and wellbeing of Ontarians. Alcohol kills over 17,000 Canadians annually and costs the government more than tobacco and opioids combined. It was reported that the federal government hasn’t implemented many evidence-informed alcohol policies, and scored a 37% across 10 policy domains related to public practices regarding the substance. The country received low scores in pricing, marketing and advertising controls, and impaired driving countermeasures. 

80% of patients 15 years and older consume alcohol. 40% drink at levels associated with risk — possibly because many Canadians aren’t aware of the harms linked to alcohol. Some believe Canada should adopt an alcohol act similar to tobacco and cannabis. It would include raising taxes, implementing marketing controls, and requiring health risk information on bottle labels. 

Bottom line: It might be a little while before Ontarians can run down to a 7/11 to buy a case of beer. In the meantime, keep those IDs handy and drink responsibly.

Notable Numbers 🔢

$163 US: how much providing a basic income could boost GDP, “while acting to curb environmental degradation,” according to new UBC research. (For more on how socio-economic factors affect patient care, check out our interview with Dr. Gary Bloch.)

20: the number of people in the English-speaking medical world who have been diagnosed with “auto-brewery syndrome” — also known as “gut fermentation syndrome.” The rare condition means fungi in a person’s gut ferments alcohol from carbohydrates and can cause a person to feel alcohol intoxication without drinking.

(more than) 100,000: the number of personal support workers (PSWs) in Ontario, who, as of Dec. 1, will be able to register with the Health and Supportive Care Providers Oversight Authority (HSCPOA). The Ontario government will also start to regulate PAs through the College of Physicians and Surgeons of Ontario (CPSO) as of Apr. 1, 2025.

14%: That’s the % of how much of the total market trading volume is penny stocks (up from just 5% just a few years ago). Which is wild. From crypto to sports betting to penny stocks to GameStop, everyone wants the magic lottery ticket. We don’t think trading penny stocks is the way to get it.

Postcall Picks ✅ 

🤣Laugh: You’ve writing off office supples, but have you been writing off your meals? Now you can. Go ahead and order a “basic steel stapler” with a side of “braided HDMI cord”… we won’t tell anyone 😉!

🤑Save: In charge of hosting the next team lunch? Doordash and Instacart $100 vouchers for $79.99 at Costco online

🎧Listen: to Dr. Chadha and international best selling author Andrew Hallam’s intimate conversation about the foundational pillars for a successful and happy life. 

🧠Learn: Are you passionate about artificial intelligence (or just now catching up with the times) and want to learn more? Join HEAL on June 19th for a day about all things AI in medicine!

📱 Feel superior: to your Android-using friends. Apple announced on Monday that new AI features are coming to iPhone 15, M1 Macbooks, and newer. Our 3 favourite features:

1. ChatGPT inside of Siri (but don’t worry, it’ll ask you for permission before sending anything off-device)

2. Generate custom images and emojis for your emails and texts

3. The calculator on iPad can now do this:

Game ⛳️

First question: What is a condition characterized by light scratches becoming raised and inflamed?

If you enjoyed our puzzle, please share!

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