Staying #Up2Date 🚨

1. Cardiovascular disease (CVD) risk stratification

This study from CMAJ incorporated anxiety and depression into the PREVENT score and found that depressive sx score was associated with CVD after adjusting for the PREVENT predictors and anxiety/depression hx. Though depressive sx scores showed slight increases in C-index (0.005) and specificity (0.89%), sensitivity remained unchanged, suggesting that the mental health modifications had little incremental benefit for CVD risk stratification at a population level. 

2. Nicotine replacement therapy (NRT) approaches

This RCT compared 3 quitting strategies in 630 lung cancer screening-eligible current smokers: quitline referral with NRT (QL), quitline referral with NRT or prescribed medications (QL+), and integrated care with more counselling and tailored tx (IC). The IC model had the highest abstinence rates: (32.4%), followed by QL+ at 58 (27.6%) and QL at 43 (20.5%) at 6 mo. The QL+ approach may be a viable option in low-resource settings.

3.  Aspirin (ASA) in left ventricular assist device (LVAD)

In a prespecified analysis of the ARIES-HM3 trial, LVAD recipients with a history of conditions that typically require ASA (prior PCI, CABG, stroke, or PVD) were randomized 1:1 to receive ASA vs. placebo. Thrombotic events were rare with no differences between groups (P for interaction = .77). Avoiding ASA was associated with fewer nonsurgical bleeding events compared to those who continued on ASA (RR placebo vs ASA, 0.52; 95% CI, 0.35-0.79). 

Alcohol’s Cancer Connection 🍸

Should “Dry January” become “Dry Forever”?

What happened: Canadian health experts are pushing for updated alcohol warning labels after a US study finds links to cancer. 

Why it’s interesting: The US Surgeon General released a report highlighting that drinking alcohol can lead to 7 different types of cancer, including mouth, throat, larynx, and breast. In Canada, about 7,000 people lose their lives to alcohol-related cancer each year. A Public Health Ontario scientist said Canadians have a right to clearer information about these risks, arguing that updated labels could empower people to make more informed choices in the checkout lane. 

The need for updating warning labels is overdue as the World Health Organization on Cancer categorized alcohol as a group 1 carcinogen. Ethanol, found in all beverages – including wine, spirits, and cider – is the common factor increasing cancer risk.  Of course, biological, economic, and environmental factors also play a role in an individual’s likelihood of developing cancer. 

But: Cutting out alcohol isn’t always an easy feat. One doctor noted that  cracking a cold one remains a social norm for many. Friends, environments, and the pleasure of a drink all play into why people drink alcohol. Health experts hope updated warning labels might encourage  folks to have a new perspective on their choices. 

Like most things in life (especially those that cause enjoyment), moderation could be the key in risk reduction. Mocktails and non-alcoholic beer offer alternatives for those looking to drink less while still maintaining an active social life, and are gaining in popularity. 

Bottom line: While it’s scary to think that a delicious, pool-side margarita could increase cancer risk, knowledge is power. Understanding the risks could give Canadians the opportunity to make informed choices that balance enjoyment with their long-term health.

Hot Off The Press

1: Here’s why we shouldn’t rely solely on AI for diagnostic outcomes: A recent study by NYU reveals that introducing just 0.001% medical misinformation into an AI’s training data can significantly degrade its accuracy, producing harmful or unreliable medical advice. Since large language models are often trained on internet-sourced data rife with misinformation, even vetted medical databases aren’t immune to errors — a challenge when creating reliable AI tools for healthcare.

2: Starting next year, provincial and territorial health plans will cover primary care services provided by nurse practitioners, pharmacists, and midwives, according to Health Minister Mark Holland. The new policy, effective April 2026, ensures these professionals can bill for medically necessary services, which addresses gaps where patients were previously paying out of pocket.

3: Beijing is experiencing a sharp rise in human metapneumovirus (HMPV) cases, particularly among young children, during low winter temperatures and seasonal patterns. The virus, first identified in 2001, causes flu-like symptoms and poses greater risks to immunocompromised individuals and children under 2. Images of crowded hospitals have sparked concerns, but experts stress that HMPV isn’t a new — and similar seasonal increases happen across the Northern Hemisphere.

4: A recent study looked at doxycycline postexposure prophylaxis (doxyPEP) use among people on HIV PrEP in California, and showed impressive results. In this cohort of over 11,500 individuals, doxyPEP was linked to big drops in chlamydia (79%), syphilis (80%), and a modest decline (12%) in gonorrhea rates. DoxyPEP could make a real difference in reducing STI transmission on a larger scale, especially for people on PrEP, making it worth considering as part of the strategy for STI prevention in this group.

Notable Numbers 🔢

5,000: how many hours of ER closures have been prevented by programs like BC’s Virtual Emergency Room Rural Assistance (VERRa) since 2021. Provinces like BC and Nova Scotia are relying on these programs, which use virtual doctors alongside local nurses to support rural hospitals. Virtual care is supposed to be a temporary fix, but concerns remain about quality of care and the need for long-term solutions (like hiring more staff.

12: how many hours norovirus can survive on surfaces, contributing to a spike in cases across Canada, the US, and the UK, with Canadian counts exceeding the 5-year average (the University of Guelph recently reported 190 cases in an outbreak linked to the virus). Experts warn that alcohol-based hand sanitizers are ineffective against this "winter vomiting bug," which spreads rapidly through contaminated surfaces and food. Vaccines are in development — including a Moderna mRNA candidate currently in phase 3 trials.

50%: how much US iodine levels dropped from the 1970s to the 1990s. Once nearly eradicated, iodine deficiency is reemerging due to changing diets and the rise of noniodized salts. While most Americans still get enough, doctors are increasingly seeing mild deficiencies in pregnant women and children, raising concerns about developmental impacts like lower IQ and language delays.

Postcall Picks

🤣 Laugh: at “If Medicine Was Multiple Choice.”

🧠 Learn: about balancing personal risk vs. reward in both money and in life — from the latest White Coat Investor podcast episode.

🏦 RRSP: Banks are competing for our business, and it’s worth it to hold onto your contribution for another few weeks in return for free money. Wealthsimple may be able to release a 2% match on all incoming RRSP transfers (screenshot here), while TD is offering 1% match on all transfers.

💵 Taxes: Is there a way to pay fewer taxes in a personal investment account? There may be, according the Loonie Doc’s latest analysis of Global X corporate class ETFs (by swapping dividends for capital gains).

❌ Eliminate*: redundant paperwork and reclaim your time using PocketMD (Patent Pending). Dr. Badawi saved 3 hours daily already, and Postcall readers can get 25% off here (code: POSTCALL25)

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