Now on to our headlines!

• 👶 Canada ranks highest in injury during childbirth from forceps- and vacuum-assisted deliveries

• Are OACs for Afib contraindicated in brain bleeds? 🧠 

• 🍷 Naltrexone or acamprosate is recommended for moderate to severe alcohol use disorder

• Pikachu and Taylor Swift are both things we can’t get enough of 🎙️ 

• AI medical chatbots flunk the test 🤦🏽‍♀️

• Play: this week’s Postcall med-themed crossword puzzle ! ⛳️

Driving these numbers: Bitcoin jumped on expectations of a Bitcoin ETF approval, but markets are in waiting mode. There are two events happening this week:

1. The beginning of tech earnings season (Microsoft crushed their Q3 projections on strong revenue from cloud yesterday).

2. The Bank of Canada’s rate decision this morning (expected to stay flat because of slowing inflation).

What patients might say this week 🙊 

1. “Is this gonna hurt?”

A new study published in the British Medical Journal found that out of 24 high-income countries, Canada ranks highest in injury during childbirth from forceps- and vacuum-assisted deliveries. The rate of maternal trauma is 16% in Canadian mothers, compared to 5% for other countries.

2. “One tequila, two tequila, three tequila, floor!”

Canada has new guidelines on recognizing and treating moderate to high-risk drinking. Among the 15 new recommendations, use of naltrexone or acamprosate is recommended as first-line for supporting abstinence or reduction in moderate to severe alcohol use disorder. Of note, naltrexone is contraindicated with concomitant treatment for chronic opioid therapy and in acute hepatitis.

3. “Why does long Covid cause brain fog?”

A study published in Cell last week has shown that molecules called viral RNA-induced type 1 interferons, released by the Covid virus, deplete the body of serotonin. This serotonin slump can impair cognition, resulting in the brain fog and memory problems often cited as sequelae of long Covid.

4. “Are OACs for Afib contraindicated in brain bleeds?”

It’s a tricky one, but according to a letter published in the Lancet, authors from the (still ongoing) ENRICH-AF trial recommend that patients with two particular types of intracranial hemorrhage (lobar intracranial and convexity subarachnoid) stop receiving edoxaban due to an unacceptably high risk of recurrent hemorrhagic stroke. But don’t worry, there’s at least five ongoing trials still studying this very topic, so don’t change your practice just yet!

🍔 Quick Bites

1: 📣 There's growing opposition to making family doctor training longer (which the CFPC is moving towards ahead of its AGM in November). The College says, “Two years is not enough time to learn the core skills,” while med students say, "If this third year were to happen, they would not become family doctors." Meanwhile, provincial health ministers are firmly opposed to the extension due to the shortage of FM docs. 👇 What do you think? 👇

2: 💰️ Wondering why big business keeps raising prices? The Competition Bureau of Canada may have found the cause: our economy’s competitive intensity has fallen over the last 20 years. In response, the federal government is pushing to change legislation so regulators can have an easier time preventing consolidation and introducing more entrants in key industries, like groceries, telecoms, and air travel.

3: 🐕 Bobi, the world’s oldest dog and certified Good Boi, passed away last Saturday at the age of 31 (nearly 31 ½). A purebred Rafeiro do Alentejo living in Portugal, he beat a nearly century-old record as the oldest dog ever. The secret to his longevity? 1: Genetics (his mother lived to age 18). 2: Living in a "calm, peaceful environment.” 🥹

AI medical chatbots flunk the test 🤦🏽‍♀️

Flunking a test isn’t the end of the world… Unless you’re a Resident Evil scientist battling zombies 🤔. But in the real world, flunking medical chatbots have — in the words of Dr. Roxana Daneshjou — “real world consequences.”

What happened: A recent study from Stanford School of Medicine delivered a reality-check on AI medical chatbots. ChatGPT, the newer GPT-4 (a.k.a. the annoying, know-it-all sibling), Google’s Bard, and Anthropic’s Claude have been caught spreading racially-biased and inaccurate medical information, potentially worsening health disparities for Black patients. When researchers quizzed chatbots about kidney function, lung capacity, and skin thickness, bots responded with racial misbeliefs 😬. No excuses here — postdoc researcher and study co-leader Tofuni Omiye grilled these chatbots on an encrypted laptop, resetting after each question to prevent bias.

Why it’s interesting: Medical experts have spent years combatting misconceptions about biological differences between Black and white individuals. Daneshjou finds it deeply concerning to see them regurgitated, as more physicians use chatbots for daily tasks. These misconceptions have led to misdiagnoses, the undervaluing of pain, and less effective treatments for Black patients. In Canada and the US, Black people face higher rates of chronic ailments, and COVID-19 due to race-related stress and medical bias.

Dr. Adam Rodman believes “no one in their right mind” would rely on a chatbot to calculate kidney function. But algorithms — which, like chatbots, draw on AI models for prediction — have been deployed in hospital settings for years, and many fail people of colour. In 2019, academic researchers uncovered hospitals using an algorithm that systematically favoured white patients, while Black patients had to be deemed much sicker to receive equal treatment.

Bottom line: Omiye is grateful his team discovered these racial biases early. He believes technology can provide shared prosperity and close gaps in healthcare delivery. Doctors are noticing more patients self-diagnosing with chatbots before appointments, and the medical chatbot market is predicted to hit $1.2 billion by 2032 (from $296 million in 2022). With Canada and the US facing a critical shortage of healthcare workers, these chatbots could become the first contact point for primary care — provided they stop ditching class and ace those tests on racial bias 📚.

Postcall Picks ✅ 

💳️ Buy: Pikachu with Grey Felt Hat promo card. Oh wait, because of the "unsafe swarming" by collectors and fans, the Van Gogh museum has removed it from the shelves. But some cards have been spotted on ecommerce websites for as much as €8,060. Ϟ(๑⚈ ․̫ ⚈๑)⋆

🎃 Eat: Only 6 more days in Oct, but the pumpkin fun doesn't need to stop there. Here is the ever delicious Pumpkin Pie Coffee Cake recipe.

👀 Watch: Taylor Swift Eras Tour concert movie, which held its top position against Scorcese this weekend by bringing in a whopping $31M.

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