mnHappy Wednesday, and happy start to certification exam season for residents!

It’s certainly a happy day for the woman who, last month, beat melanoma. The first patient ever to test a new treatment, TIL — tumour-infiltrating lymphocyte therapy — is now cancer-free. TIL therapy is FDA-approved and works by replacing ineffective TIL cells with the patient’s own lab-grown cells.

What happened in the markets this week?

Things your patients might ask:

1. Do oral antidiabetic agents slow non-alcoholic fatty liver disease (NAFLD)?

In a retrospective study of 80K people with diabetes and presumed NAFLD, SGLT-2 inhibitors, thiazolidinediones, and DPP-4 inhibitors were associated with 99%, 70%, and 45% higher probabilities of NAFLD regression compared to sulfonylureas. The NAFLD regression was significantly more likely with SGLT-2 inhibitors, and this was the only medication associated with lower risk of adverse liver outcomes.

2. Transcatheter vs. surgical aortic valve replacement (TAVR vs. SAVR)?

The NOTION trial has dropped its 10-year outcomes. Why is it significant? It provides the longest available follow-up data involving 280 patients aged >70 who were randomized to SAVR vs. TAVR. At a 10-year follow-up, there was no significant between-group difference in the composite of death, stroke, or myocardial infarction (66% for both groups) or any of the individual components. 

3. What are the risks of cardiovascular (CV) events from ADHD meds?

In a Swedish case-control study, stimulant use for ADHD was associated with hypertension (but not arrhythmia or ischemic heart disease). In a nutshell: the longer you take stimulants for ADHD and/or the higher your dose, the higher the risk for “any CV disease” (adjusted odds ratio, 1.23 for >5 years exposure). Specifically, hypertension accounted for nearly all the excess CV risk and no significant association was noted between ADHD drug exposure and arrhythmia, ischemic heart disease, cerebrovascular disease, or heart failure. Of note, these results do not apply to non-stimulants used in ADHD.

DTx: 2024’s New Cash Cow?🐄

The next medication you prescribe may already be in your pocket. 

What’s trending: Digital therapeutics (DTx) are evidence-based software products for treating health conditions through web and mobile apps, VR, and video games. Investors seem DTF with DTx, as its market is set to explode with a 25.2% CAGR from 2022-2030. 

Why it’s interesting: What sets DTx apart is its clinical validation and specificity, tackling addiction, depression, chronic illnesses, and more with cognitive behavioral therapy, coaching, and remote monitoring. These scalable, cost-effective solutions could empower individuals and provide valuable insights to healthcare providers. 

DTx’s Green Flags:

• Prescription-required and a Health Canada initiative. 

• Software-based, avoiding medication-related issues.

• Accessible anywhere via smartphones or tablets.

• Studies say Better Therapeutics and Fitterfly’s DTx significantly slashed blood sugar in Type 2 diabetes.

• Akili's game tech improved ADHD, lupus, and depression symptoms.

• Luminopia’s VR helped treat lazy eye in kids.

• Adding to the momentum, last week, Better Therapeutics secured FDA Breakthrough Device Designation for their CBT platform.

But:

• DTx presents challenges for tech-challenged patients or those without electronics/home internet.

• DTx's goldmine of patient data raises concerns about security and misuse (recall our 23andOops coverage).

• DTx’s rules and regulation are still changing, lacking clear guidelines for ensuring safety, effectiveness, and quality.

• Smoothly fitting DTx into regular healthcare systems is crucial for patient care.

Bottom line: If virtual care is already your thing (check out our tea on it), ongoing studies suggest delivering treatment virtually might be the next big move. Maybe, by 2030, our phones will be more than just a meme-scrolling gadget. 

🍔 Quick Bites

1: 💊 The NDP and Liberal government have reached an agreement over pharmacare. The first piece of the national program will be introduced Mar. 1. The deal includes full coverage for contraceptives, insulin, and other diabetes drugs — though the full details won’t be known until after the weekend (such as if Alberta can successfully opt out).

2: 🏥 Prince Edward Island’s first-ever mental health and addictions ED is opening next week. The first of its kind in Atlantic Canada, the department will support patients with urgent needs and create treatment plans to connect them to other programs and services.

3: 🪧 Almost 9,000 South Korean medical residents have walked out of hospitals in response to the government’s push to increase medical school seats by 65% annually to solve a doctor shortage. South Korea has 2.1 physicians per 1,000 people (3.7 is the average among developed countries), as well as an aging population.

4: 🌚 For the first time since 1972, a US spacecraft has landed on the surface of the moon. Odysseus, a lander from a Houston-based private company, landed last week… and promptly tipped over on the uneven moon surface. “Chill, we’re all a bit rusty” was the response when we asked what happened.

Postcall Picks ✅ 

👂Listen: to this episode of Planet Money: Why do doctors still use pagers? It’s crazy, but kinda not.

🛫 Travel: to the “Land of Fire and Ice” – Iceland! DoT has a tour from May-June where you can visit the Blue Lagoon clinic (specializes in psoriasis and eczema treatment), and learn more about the human genome at deCODE Genetics (and earn 15 CME hours). Learn more here.

💳️ Buy: You’re currently seeing how little snow we’re getting on the mountains. In a few months, experts are saying that will translate to a 🔥 wildfire season. So grab an air filter (like this Dyson that’s $200 off) while there’s still stock.

🤣 Learn: whether Stygimoloch is a muscle or a dino:

alimentaryschool

View more on Instagram

🕹️ Game ⛳️

Last week’s average time: 9:39. Either the puzzles are getting harder, or more people have been taking bathroom breaks while playing 🙃

First question: A baby might have this head deformity if they don't get enough tummy time!

❓Trivia Answer❓

Rosalind Franklin was a X-ray photographer expert whose photographs gave Watson & Crick fundamental ideas about the structure of DNA. According to Today in Conservation, “had she not died from ovarian cancer in her late thirties, today we might be talking about Watson, Crick and Franklin as three, not two, scientists credited with the discovery.”

Job Opportunities 💼

Role: Family Physician

• Location: 2520 23 Street NE (Calgary, AB)

• Compensation: $500,000-$600,000

• Learn more 

Role: Medical/Surgial Doctors

• Location: Fraser Valley Cataract and Laser (Abbotsford, BC)

• Compensation: $500,000

• Learn more 

Role: Assistant/Associate/Full Professor – Minimally Invasive Surgery 

• Location: Department of Obstetrics and Gynaecology at the Temerty Faculty of Medicine, University of Toronto (Toronto, ON)

• Compensation: $250,000

• Learn more

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