Staying #Up2Date 🚨

1: Smoky szn 🔥

As we head into summer, here are some things the CMAJ wants you to remember and educate your patients about on wildfire smoke: 

• When the AQHI is > 7, at-risk people (pregnant, elderly, children, or those with resp or chronic diseases) should reduce time spent doing outdoor, strenuous activity. 

• Staying indoors with closed windows and using air purifiers can reduce the concentration of fine particulates by 32%–88%. Patients can even claim these prescribed devices as medical expenses on their tax returns!

• ​​Wearing N95 or KN95 can minimize fine particulate exposure by > 90%. 

2: Early tx of asthma & COPD 🫁

A Canadian RCT using case-finding methodology studied participants who were found to have undiagnosed COPD or asthma on spirometry. Participants received care from a respirologist or asthma-COPD educator vs. their primary care physicians. During the 12-month study, respiratory-related urgent care visits were 50% lower in the pulmonologist-directed treatment group (1.1 vs. 0.5 events/person-year).

3. E-cig vs. varenicline ⭐

An RCT from Finland recruited patients 25-75 y.o. who smoked daily and had volunteered to quit. Participants received one of three options: 1) 18 mg/mL of nicotine-containing electronic cigarettes (ECs) with placebo tablets 2) varenicline with nicotine-free ECs 3) placebo tablets with nicotine-free ECs. The primary outcome (7-day cigarette abstinence confirmed by exhaled carbon monoxide level on week 26) occurred in 40.4% in the EC w/ nicotine group, 43.8% in the varenicline group, and 19.7% in the placebo group (P < .001). Varenicline and nicotine-containing ECs were both effective in helping individuals in quitting smoking conventional cigarettes for up to 6 months.

One Big Thing: Hands Off Mifepristone 🤏🏽

Why the FDA is in charge of approving medications… and anti-abortion activists aren’t.

What happened: The US Supreme Court made the rare unanimous decision that the abortion drug mifepristone will stay on shelves in the US.

Why it’s interesting: 9 justices ruled that opponents to abortion don’t have a legal right to sue over the FDA’s approval. The case threatened access to mifepristone — even in states where abortion is legal.

• Justice Brett Kavanaugh noted that the anti-abortion activists chose the wrong forum. Instead, he said they should’ve tried to persuade lawmakers and regulators to make changes. 

• President Joe Biden praised the decision, saying the Democrats will continue to campaign on abortions ahead of the November election. The procedure is currently banned in 14 states. 

• Mifepristone was first approved by the FDA in 2000. Since then, over 6 million people have used it. The drug works by blocking the hormone progesterone and primes the uterus to respond to the contraction-causing effect of a second drug, misoprostol. 

• Drug manufacturers warned anti-abortion campaigners that suing the FDA could undermine the drug approval process, in that it would allow judges to second-guess the agency’s professional judgement. The plaintiffs argued that the FDA’s decisions in 2016 and 2021 to relax restrictions on mifepristone could “jeopardize women’s health across the nation.” 

• According to the lab that makes mifepristone, it’s one of the safest drugs the FDA has ever approved. The plaintiffs couldn’t identify any instances where a doctor was required to perform an abortion (or abortion-related treatment) that violated the doctor’s conscience since the approval of mifepristone.

How does this affect our day to day? Some doctors say the constant back and forth over abortion leaves them confused and exhausted. Some physicians in Texas and Idaho have opted for early retirement. One doctor from Chicago said they feel helpless when they can’t provide patients with timely and urgent care. 

What about those of us who are pro-life? The doctors who were plaintiffs in the case say that allowing women to use mifepristone harms them as it “forces them to perform post-medication procedures that violate their beliefs.” One doctor from Indiana said she has to treat women who show up to the ER with complications from the drug such as heavy bleeding, causing her and other pro-life doctors to complete a process they have a moral opposition to.

Bottom line: Abortion rights advocates can breathe a sigh of relief… for now. Things could change if Trump wins the White House this fall. If elected, they could repeal Biden’s regulations on abortion and revert to in-person medical consultations before allowing access to mifepristone.

Hot off the Press

1: 🏥 Outsourcing hospital services could compromise infection controls in hospitals, according to CBC. It’s difficult to prove a causal link between cleaning staff cutbacks and the rise in superbug rates in Canadian hospitals. Still, many experts believe that in-house cleaning operated by hospitals is more effective. We say, cutting corners when it comes to cleanliness is not the way to go.

2: 🩸Insulin icodec, or Awiqli — the world’s first once-a-week basal insulin injection — will be available in Canada starting June 30. Canada will be the first country to get the product. It’s been approved for both Type 1 and Type 2 diabetes, but will mostly be useful for Type 2 patients.

3: 🥛According to the New England Journal of Medicine, a small but detectable amount of H5N1 survived pasteurization on milk infected with the virus. This means that, technically, small amounts of the bird flu could remain in flash-pasteurized milk. The next step is for researchers to replicate real-word conditions.

4: 🚬 Canada’s government has recalled Zyn Nicotine Pouches because they’re technically not authorized for sale here. (Back in November, we covered the controversy of Zonnic, the first nicotine pouch to actually be green-lit in Canada.) Meanwhile, Zyn is flourishing in the States, with a 62% increase in sales from 2022 to 2023.

5: 🚫 Speaking of warnings from the government, top health officials in the US are saying that social media should have warning labels like those on cigarettes.

6: ⛪️ The latest person to speak out against AI? The Pope. At the G7 summit last week, Pope Francis said that AI must remain “human-centred.” He called for an international treaty to ensure the ethics of AI are agreed upon.

Notable Numbers 🔢

$220 billion: the approximate amount of medical debt held by Americans. The US’s Consumer Financial Protection Bureau (CFPB) recently proposed a regulation that could help the 15 million people who have a combined $49 billion affecting their credit scores. (Though, in total, there are actually about 100 million people with medical debt in the US.) Suddenly feeling a little more patriotic? 🇨🇦

2 hours: the amount of light physical activity at work that will add a 6% increase to your odds of healthy aging (i.e. no major chronic disease and no impairment in subjective memory, physical health, and mental health.) Conversely, 2 extra hours of sitting to watch TV decreases your chances of healthy aging by 12%. Researchers looked at 20 years of information and determined that more activity and less sitting while watching TV helps to significantly contribute to healthy aging.

100,640: the number of people in the US who are projected to be diagnosed with melanoma this year, according to the American Cancer Society (ACS). There has been a rise in the number of people diagnosed with skin care over 50. Cases of melanoma have risen from 2% to 3% between 2015 and 2019.

$100M: That’s how much money the fraudulent pill mill Done Global Inc. founder Ruthia He made in the US by distributing Adderall through telehealth platforms, while submitting false claims for reimbursement. Fortunately, the DOJ is coming down on them hard.

💬 In Our Community

The award for “weirdest thing found in a body” this week from medicine reddit? Goes to a full-term sized calcified fetus. No sepsis in the parent too.

Other professions: Worried about scope creep and an erosion in the definition of “physician?” So are folks in the UK, where the NHS recently started promoting this:

Mortgages: Folks have been getting some great mortgage rates these days since the rate drop last week. The lowest we’ve seen on this* FB thread is 4.67% for 3-year fixed.

Capital Gains: Dr. Mark Soth has summarized his latest views on the capital gains tax changes in a blog post titled “Capital Gains Tax Increase: Actions, Discussions & Deliberate Inactions”. Our biggest takeaway is that those of us with who were already looking to rebalance their portfolios, or planning a sale of a secondary property should consider taking action before the tax increase.

* Link may not work if you’re not already part of the private Facebook group.

Postcall Picks

💳️ Buy: Looking for a new Macbook or iPad? Wait just a couple more days: we’re hearing that Apple’s Back to School promotion should be starting this week. Last year’s promotion was a free $200 gift card, and this year the offer should be similar.

📺 Watch: Discover what's in store with iOS 18 this fall. (Android users: we know you’ve had these features for years now.)

🧠 Learn about Insurance: You won't want to miss Vijay Wealth's guide on preventing your insurance broker from selling you everything. We give you the honest answers on the coverage you'll need as a physician.*

🤑 Save: Elevate your look and step into clinic with style. Burberry’s 60% private sale is happening now!

🎊 Celebrate: The OMA is joining the Toronto Pride parade for the first time ever! Register and join fellow physicians and medical learners to support and celebrate 2SLGBTQI+ communities. 

🧠 Learn: from Ben Felix and Dr. Soth’s podcast how your time and money choices define your life's path, and gain valuable insight on how to best optimize them.

* sponsored content

Relax

First Question: What is a tightening of the skin over the fingers, associated with systemic sclerosis?

If you enjoyed our puzzle, please share!

Share Postcall, Get Rewards

Help Us Get Better