👋 Happy Friday. I knew you’d be back. You just love medical news. You always have. You’ll probably never beaten the nerd allegations. That’s okay, this is a safe space. Anyway…

Here’s what we got:

• ⚔️ The Biggest Loser: Pharma Special. Ozempic vs Mounjaro

• 😴 NHS England Abolished!…So What Now?

• 🕺“Correct” Calcium: A 70’s Relic We Should’ve Left With Disco

•  🦾 Missed The Vein Again? There’s A Robot For That!

• #TheMoreYouKnow: Other Top Stories of The Week

RESEARCH NEWS

⚔️ The Biggest Loser: Pharma Special. Ozempic vs Mounjaro

The cat’s out the bag. Weight loss drugs are incredibly effective. Losing weight has never been easier. 

A balanced diet and structured exercise regime? Far too stressful.
Bariatric Surgery? I like my stomach intact, thank you very much.

With a quick telephone appointment, and a couple fibs to the telehealth doc, you too can have access to the famous weightloss drugs. But you have some options. Semaglutide? Liraglutide? Tirzeptide?

Semaglutide is the poster child. The Ozempic, The Wegovy. The one that has Katy Perry looking suspiciously hollow around the bucals 🤔
The dark horse Tirzeptide aka Zepbound or Mourjaro has a dualistic action. It’s both a GLP1 + GIP agonist.

So…which is more effective? A phase 3 multicentre RCT conducted across the States and Puerto Rico, published in NEJM, set out for the answer. 

The aim was to compare the efficacy and safety of Tirzepatide vs Semagluide in obese adults(BMI >=30) without T2DM. More specifically, they wanted to investigate if Tirzepatide was actually superior to Semaglutide in reducing weight and waist circumference over 72 weeks. 

750 Participants were randomised 1:1 to take one of the two drugs. Both groups were administered the maximum tolerated dose(Tirzepatide 10/15mg or Semaglutide 1.7/2.4mg) and were given it subcutaneously for the 18 month period. 80% of participants completed the trial.

Who was the biggest loser?

1. Weight loss: Tirzepatide came out on top with a mean weight change of -20.2%. Semaglutide was -13.75%.

2. Waist Circumference: Again Tirzepatide won with a mean reduction of -18.4cm to Semaglutide -13.0cm

The adverse effects, nausea, vomiting and diarrhoea were mild in both groups. But even then, Zepbound has Ozempic beat. The discontinuation due to side effects was 6.1% to 8.0% respectively.

So it seems like Tirzepatide is the weight loss drug to rule the land of Big Pharma. Glad we cleared that up. But…hold on.
Wait a damn minute.

Funded by Eli Lilly?!? The owners of Tirzepatide?!? Sworn enemy of Novo Nordisk– Ozempics daddy? I feel like I’ve been swindled. 

Whilst the study is academically sound, peer reviewed, high quality. I'm sure by next week we’ll have sweeping evidence Ozempic is in fact superior from Novo Nordisk’s camp. 

Well, I guess all’s fair in love, war and Big Pharma.

RESEARCH UPDATE

🕺 “Corrected” Calcium: A 70’s Relic We Should’ve Left With Disco

If there is one thing technology has made better, it’s scrutinizing blood results. Seeing that bright red abnormal marker pop in a sea of grey normality. It’s like a medical game of Where’s Wally?... except Wally may be dying. But just because it’s red… does that actually mean you need to care?

Some clinical habits are like those weird old-school childhood traditions we never shook off. I don’t know why I instinctually shout “SHOTGUN!” when I want the front seat. Desgagés et al. don’t know why we still cling onto albumin-adjusted/“corrected” calcium levels when looking at U&Es.

Why do we adjust calcium levels, anyway ?

About 50% of the calcium in the blood is bound to albumin. So only the ionised(free) half does anything useful (muscle contraction, neurons firing etc). So in 1973 a guy named Payne created a formula to try to “correct" for this discrepancy and thus “corrected” calcium was born.

Problem is, the Payne formula was based on 200 patients, a lab method that doesn’t exist anymore and never validated against ionised calcium. Not the exactly scientific rigour we’ve grown up on. 

So this JAMA published study put unadjusted total calcium head-to-head with “corrected” calcium at scale. Let's see who has a better measure of ionised calcium. Also, they evaluated the impact of these measurements on diagnosing calcium disorders (hypo-, hyper- and norm- calcaemia) in practice.

This cross-sectional study, looked at 22,658 adults in Canada between 2013 to 2019. 

They took the total calcium results.
They took the corrected calcium results.
And then they compared both to the gold standard, ionised calcium.
The goal was to see which one matched it more closely, using R² values as the measure of accuracy.

The results?

• Correlation: Total calcium (R² = 71.7%) correlated better with ionised calcium than commonly used simplified Payne formula (R² = 68.9%)

• Classification Accuracy: Unadjusted total calcium had the highest agreement (74.5%) with ionised calcium for categorising calcium status, outperforming both the original Payne (63.0%) and simplified Payne (58.7%) formulas.

• Misclassification: All adjustment formulas tended to underestimate hypocalcemia and overestimate hypercalcemia, with misclassification worsening in patients with hypoalbuminemia (albumin <30 g/L)

Bottom line: Sometimes simpler really is better. It’s time to break up with "corrected” calcium. Payne formula can be forgiven, it was the 70’s after all. 
People were making a lot of questionable choices.

NHS NEWS

 😴 NHS England Abolished!…So What Now?

In a move reminiscent of Avengers Infinity War, Keir Starmer abolished NHS England with a snap in March 2025.

Like Thanos, he announced a massive headcount wipeout—50% of local health board staff to be axed. But not much has happened since… so what now?

Quick Recap: 
2 months ago, the PM scrapped NHS England. The plan is to merge it with the Department of Health and Social Care(DHSC). He wanted to cut out the middlemen to enable the healthcare boat to float. Read more here

The problem is now, um…they haven’t really explained what happens next or taken any further actions. Which is fine I guess. Everyone loves a good mystery– especially the 1.5 million staff members and the 1.7 million patients the system sees every day. 

The Public Accounts Committee(PAC), the government's personal pocket watchers, just dropped the DHSC Annual Report. This report scrutinises how the government manages public funds to make sure they aren’t using it for…creative purposes. Whilst the funds were used to fund secret lockdown parties(this time), the PAC still weren’t impressed. 

They say the whole move has created what they call a “hazy” future for the NHS. The report lists some major concerns:

1. Unclear Transition Plans: They haven't got into the nitty gritty of its impact on funds and its alignment with the NHS 10-Year Health Plan. Just a sweeping headline and vibes 😎

2. Healthservice Morale: As if spending 12-hour shifts under flickering LED lights wasn’t bleak enough. PAC says the 50% job cull for NHSE and DHSC + a 50% funding cut for ICB’s will be sure to undermine morale during times of “huge pressure”.

3. Clinical Negligence Cost Burden: £58.2 billion. Yes, £58.2 billion has been set aside to cover hospital related mishaps. PAC suggests the government is focusing on problems. They suggest either taking action to reduce patient harm or… hire cheaper lawyers (magic circle firms are overrated anyway).

Also… this isn’t their first rodeo. The NHSE was a Tory-led restructuring in of itself. 
Now sceptical of political party fueled overhauls, PAC gave the government some homework. 

• Within 3 months come up with a clear plan of action for the NHS-DHSC merger.

• Within 6 months they should deal with haemorrhage that is the Negligence Bill.

Well. Good luck Mr Streeting. We all believe in you. You can do this!

MEDTECH NEWS

Missed the Vein Again? There’s a Robot For That 🦾

Just admit it. It’s okay. We all hate taking bloods. There is no worse feeling than missing the vein. Looking up at the patient with that sheepish look of incompetence and the patient staring back at you like this

If robots and AI are coming for our jobs, they should come for this part first 🙏.

And healthtech firm BH Healthcare is taking steps to do so. They have created this autonomous blood drawing device called HEIVA (Health Equipment for Innovative Venous Access).

HEIVA is a device that uses advanced robotic and high-end imaging technology to locate veins and perform blood draws more precisely than the ward phlebotomist. Hopefully improving efficiency, patient safety and risk of needle stick injury.

BH Healthcare has been in the headlines as they have secured three European medical labs for 30+ orders of HEIVA, promising to serve over 100,000 patients per day. 

They haven’t named the labs or disclosed how much cash changed hands(classic). But the interest speaks volumes. After nearly a decade of development, BHealthCare seems confident HEIVA is ready to roll into clinics, find veins on the first go, and maybe never miss again.

It’s not on the market just yet. Still waiting for CE and GCC approval, with rollout across European hospitals for scheduled for 2028. So for us in the NHS… give it another decade. The class of ‘38 will be so lucky.

OTHER NEWS YOU SHOULD KNOW

• Assisting Dying Bill Is Back In Parliment

• A New Medication For Narcolepsy

• New Treatment For Hep C. Cheaper and Shorter Treatment

• Asthma Attacks and The Propgesterone-only Pill

• 16,600 Deaths associated with long A&E wait times(RCEM Reports)

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