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It’s not Christmas, Diwali or even Hanukkah.
But it is a very special day for us within the medical community.
As on this day 7 months ago, the Treaty of Handovia was signed.
Decreeing that the latest in medicine must be delivered to the inboxes of loyal citizens every Friday.
Just one missed Friday could result in global catastrophe and universal bleep failure.
So yeah, we take our job very seriously.
Here’s what we got:
🏆 The Award Goes Too… Ozempic vs Bariatric Surgery
🍿 A Tale of Woe: The Multiparametric Tell All
🧠 QuickBits: Other Top Stories of The Week
If you want to read any previous editions of The Handover, you can on our website.
RESEARCH UPDATE
🏆 And The Award Goes To... Ozempic vs Bariatric Surgery
Semaglutide is a global superstar.
From humble beginnings as a fourth-line diabetes medication, the GLP-1 agonist felt her talents going to waste.
So she packed her bags and left her small hometown of Diabetesville to chase her big break in Obese-City.
It didn’t take long to attract interest from major agencies like Eli Lilly and Pfizer, but she eventually signed with Novo Nordisk.
Deeming her name too ethnic, they gave her a new stage name: Ozempic.
From there, her career took off.
She became the darling of Obese-City.
A generational talent in the world of weight loss.
And like all breakout stars, she started landing roles in conditions she had no business in.
Alzheimer’s, addiction, cancer.
She was like Brad Pitt playing Black Panther.
Now she’s up for the big one:
Academy Award for Weight Loss Management of the Year.
But standing in her way is an industry veteran.
Winner of the award every year since its birth in 1953…Bariatric Surgery.
Does the rookie have what it takes to dethrone the champ?
This study, published in JAMA Surgery, set out to compare weight loss and long-term cost of metabolic bariatric surgery (MBS) vs GLP-1 receptor agonists (GLP-1 RAs)
This retrospective cohort study was conducted across the USA and recruited over 30,000 US adults with class II and III obesity. Drawing on electronic health records and insurance claims, they took 14,101 MBS patients and 16,357 GLP-1 RA patients. Bariatric methods were gastric sleeve and bypass surgery. GLP-1 RAs included were semaglutide, tirazepatide or liraglutide.
The main outcome measures were: Total weight loss, Treatment costs, and Obesity-related comorbidities.
So what did they find?
Weight Loss: Surgery wins here. BMS led to a greater mean weight loss of 28.3% over 2 years vs GLP-1 RAs 10.3%. And in 96% of MBS patients, a >10% weight loss was sustained vs 45.9% in the GLP-1 RA group.
Costs: Bariatric surgery has a mean cost of $51,794 across two years. In that same time period, GLP-1 maintenance came up $63,483. The study found it took just 15 months for GLP-1s to catch up in cost to the surgery.
Health Outcomes: MBS has fewer inpatient stays, outpatient visits and A&E visits + lower rates of comorbidities at follow-up.
So, for another year running, the award goes to bariatric surgery as the most clinically effective and cost-effective weight loss strategy.
Presently, surgery is the last resort therapy for weight loss management. There’s no shock regarding its effectiveness, but its price comparison does come as a surprise 👀
Ozempic has been snubbed. Surgery is still on top. But with stronger versions coming out every week, who knows what the future holds for GLP-1 RAs.
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That’s why she sent you a WhatsApp video on treating hypertension with desmopressin. Not even medicine is safe. But who can blame them? ChatGPT is trained on Reddit and Quora after all.
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RESEARCH UPDATE
🍿 A Tale of Woe: The Multiparametric Tell All
It started out like any other Tuesday.
I was humming away, churning out lovely, detailed multiparametric reports, when I heard the words no imaging modality ever wants to hear: “We might not even need contrast anymore!”
How DARE they?
They called me the gold standard! I'd been shortlisted in the Top 10 Passmed Concepts of the decade!
Patients travelled miles to lie immobilised in my magnetic embrace, whilst I cooked up batches of different sequences; T1, T2, DWI - I could do it all.
Not to mention contrast!
Me and Gadolinium. Together, we were unstoppable.
We had gravitas. We had class. We looked so damn good on the referral form.
But then came the PRIME trial. Threatening to separate me from contrast and demote me to a lowly biparametric MRI.
Published in JAMA, it asked a devastatingly practical question:
If you strip away the contrast, are the rest of my images alone enough to catch prostate cancer?
PRIME was a prospective, multicentre trial with 490 male participants presenting with clinical suspicion of prostate cancer (raised PSA and/or abnormal DRE).
Every participant underwent a full, multiparametric MRI(mpMRI) – featuring contrast imaging, of course.
Radiologists first read the scan as a biparametric MRI (T2 + DWI only), then re-read it after adding contrast to complete the full mpMRI.
(If either flagged suspicion, the patient went to targeted biopsy, and the primary outcome was detection of clinically significant prostate cancer (Gleason Grade Group ≥2); GG1 detection was a secondary outcome.)
The trial had a non-inferiority margin of -5 percentage points: essentially, bpMRI would be deemed acceptable if it wasn’t more than 5 points worse than mpMRI at finding the important cancers.
What did they find?
bpMRI found clinically significant disease in 143/490 (29.2%) men versus 145/490 (29.6%) for mpMRI
That’s an absolute difference of -0.4 percentage points (95% CI -1.2 to 0.4), well inside the 5% safety fence
TLDR; A slimmed-down, contrast-free biparametric MRI picks up the same important cancers as the multiparametric MRI. That means shorter waiting times, fewer contrast doses and a smoother experience for patients.
Caveats? Of course. This all hinges on decent image quality and a sufficiently high-level wizard(radiologist) to interpret my images. Plus, biopsies remain the invasive gold standard confirmation test.
And although I’m being downsized for most cases, contrast will still come out for those stubborn cases.
My glorious, multiparametric days are not entirely over yet.
But with waiting lists soaring and prostate cancer rates on the rise, when it comes to diagnostics, sometimes less really is more.
QUICKBITS: OTHER NEWS YOU SHOULD KNOW
Type 5 Diabetes is Born - Did you know this? Type 5 diabetes is a newly recognised form of diabetes subtype recognised by the International Diabetes Federation. It’s characterised by insufficient insulin production in those who are undernourished. Without insulin production, glucose control goes haywire. Crazy that it’s only been recognised this year, as some 25 million people globally are affected.
Enough is Enough: FY1’s Strike Back - FY1s have officially backed strike action over a brutal lack of training jobs. There were only 10,000 places for 30,000 applicants this year. Even GP posts are oversubscribed, despite patients waiting weeks for appointments. 97% of doctors voted to strike. Meanwhile, the government's big move? 1,000 extra training spots. 💩
Are We Overdoing PSA? - Maybe. Under current UK guidelines, PSA testing can be requested by patients. But for a variety of reasons(celebrity influence), it’s being checked when it’s not needed. A study looking at 1.5 million patients found 72.8% never have a value that would normally warrant a need for the test. Combine that with PSA’s lack of specificity, and we’re basically overdiagnosing for shits and giggles. Cheers.
Bone Glue For Fracture Repair - A team in China have created a glue, named Bone-02, that can heal fractures in a matter of minutes. Sounds too good to be glue, right? It’s even naturally absorbed by the body, meaning no follow-up surgery is required. Ortho surgery is sounding less like DIY and more like Art’s ‘n’ Craft by the day.
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Fun Fact: CRISPR comes from yoghurt bacteria. GLP-1s come from Gila monster venom. Taq polymerase comes from hot spring bacteria. Shoutout Mother Nature
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