🩸Smear Tests, 💊 Statins and 🤖 AI Surgeons?

Hectic week of celebrations coming up, so…

Happy-Chinese-Valentine’s-New-Year-Black-History-Month-Freddy-Krueger-Friday 13th-Ramadan-Mubarak week to all those celebrating 🥳

And most importantly…

👋 Happy Friday. Here’s what we got:

If you want to read any previous editions of The Handover, you can on our website.

For the last 10 months, The Handover has existed exclusively in your inbox. Giving you all the latest in Medicine in written form. As we approach one year of The Handover, it’s time to finally emerge from our cocoon.

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Production will be to the same quality as these newsletters. Just give us the direction, and we’ll shoot.

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Dearest Gentle Reader,

As you young ladies of the ton approach that most momentous milestone of five and twenty, so too does the looming spectre of the smear grow ever nearer.

Fresh from your quarter-life crisis, you ascend the examination couch, assume the lithotomy position and steel yourself for what can only be described as the least festive of birthday offerings.

Alas, it must be done.

Or… must it?

For this author bears a most titillating Public Cervix Announcement.

Hot off the BMJ press comes a rather thrilling dispatch from China, wherein researchers dared to challenge the supremacy of the speculum.

Instead of continuing to subject women to an invasive and uncomfortable procedure, these intrepid investigators posed the question: 

What if we could simply test menstrual blood instead?

A most promising idea! But how did they put it to the test?

Over 3000 women across China participated, providing three specimens each:

(*Women with positive findings on any test received subsequent colposcopy and biopsy)

The hope was that these ‘minipads’ might prove as capable at detecting CIN (cervical intraepithelial neoplasia - ie, precancerous changes) just as well as a smear.

And what a CIN-derella story it proved to be.💎

In essence, a negative menstrual blood HPV test was just as effective at ruling out high-grade neoplasia as the traditional cervical sample.

But before you cast aside your speculum, a caution:

Nevertheless, the implications could be considerable.

Too often are women dissuaded from the smear, be it the discomfort, the stigma around women’s health or cultural reasons. 

A future in which unnecessary pain, embarrassment and discomfort is avoided for women is one this author embraces most fervently. 

So take heart, dear reader.

The season of the speculum may soon be coming to a close.

Yours in both scandal and science,
Lady Whistledover🪶

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In some ways, the point of statins are obvious.

They lower cholesterol.
They reduce the risk of heart attacks and strokes.
They are one of the most widely prescribed drugs in modern medicine.

And, depending on who you ask, they are also:

An instrument of silent mass genocide.
Deployed government plot to shave twenty years off your lifespan.
A chemical lobotomy designed to shrink your brain “to the size of a marble.”

Worryingly, it isn’t just Big Pharma conspiracists and the Manosphere who are Statinophobic.

Even outside the fever swamps of social media, statins have a genuine reputation problem.

You see, regulation works like this:
Product labels are not a list of proven harms. They are a catalogue of reported or suspected associations, some well established, others far more uncertain.

And as a result of being such a mainstream drug, statins have been investigated to death.
Resulting in a large list of “potential” side effects of taking the medication.

Product labels side effects include: memory loss, depression, sleep disturbance, neuropathy, liver dysfunction… in fact, there is a listed 66 “undesirable effects” that statins have warnings against. 

And for many patients, that list alone is enough to decline a prescription that might otherwise reduce their risk of a life-threatening cardiovascular event.

So instead of arguing on X, a group of researchers did the unsexy thing and went back to the research:

Published in The Lancet, this meta-analysis asked this:

According only to high-quality evidence, are the side effects listed on statin drug labels actually caused by statins?

To be included in this study, strict inclusion criteria had to be met:

And after whittling down all the evidence, they landed on 19 statin vs placebo trials and 4 more‑intensive vs less‑intensive statin regimen, totalling 154,664 participants in this meta-analysis.

After doing their statistical magic, the headline finding was this:

Out of the 66 “undesirable effects” investigated, there was no evidence of causality found in 62 of them. 

Those categories include:

In other words, in all these categories and more, according to the highest quality evidence, participants taking statins were no more likely to experience these conditions than those taking a placebo.

The four categories where statins did have a significant effect were:

So even in those where effects were found, they seem to be very marginal.

So yes, statins appear to slightly nudge up certain liver enzyme levels and retain more fluids than you normally would.

But they don’t quite cause widespread cognitive collapse, emotional ruin, kidney failure, lung disease, or sexual dysfunction - at least according to 150,000 patients. 

Which means that if statins are part of a grand government plot to chemically lobotomise the population…
…it is statistically one of the least effective conspiracies ever attempted.

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🤖Elon Musk Robots >>> Every Surgeon Ever

Well, it’s been a good run, lads and lasses. Tech Tycoon and Almost-a-trillionaire Elon Musk has made his judgment on healthcare, stating in a recent interview, “Don’t go to medical school, it’s pointless now”. 

What’s 5 years of medical school and 100k in student debt anyway? Best quit before the clankers take over and find a job in a field that AI robots totally won't decimate - Like fortune-telling or perhaps a career as a court jester. 

The prophetic claim comes from an interview speaking about his AI robot Optimus, also claiming that in three years, there will be more great Optimus surgeons than human surgeons on Earth altogether.

The good news is that there is a whole wiki page on Elon’s prediction accuracy. With his hit rate, you’ll have a good 25 years before needing to enrol in Jester School. 

⚠️ Be Warned: Renewed Warnings For Ozempic et al. 

The Medicines and Healthcare products Regulatory Agency (MHRA) has updated its warnings for GLP-1 receptor agonists (semaglutide) and its GLP-1/GIP brother (tirzepatide).

The two main label changes include updated warnings to reflect a teeny-weeny risk of severe acute pancreatitis and a rare risk of non-arteritic anterior ischaemic optic neuropathy (NAION).

Naturally, patients on these medications should be counselled appropriately and advised to attend A&E if they experience vision loss or acute abdominal pain.

Good bit of safety-netting, that.

💸 A “Pay Rise” Across The Board 

All rejoice, A pay rise for all NHS workers is coming this April🥳. A sweet, sweet 3.3% pay rise for all 1.4 million healthcare workers… minus doctors, dentists and top directors. 

And also (totally unrelated), the annual rate of inflation is estimated to be 4.18%(RPI).
Which means the real terms pay rise is something like -0.8%. But a win is a win, right… right? 

Up in the North, the Scots seem to be thriving. A 10% pay rise this year and at 9.4% rise in 26/27 have been confirmed and accepted by BMA Scotland. I’m so very jealous. 

🍼Baby Formula Poisonings: Beware

I hope everyone here is old enough to recall the “mmm, Danone” TV jingle. 

Unfortunately, “mmm” and “Danone” are having a rough time co-existing right now :(

UK officials have reported 36 cases (and counting) of babies becoming unwell after consuming recalled batches of Aptamil and Cow & Gate formula, due to possible contamination with a toxin associated with Bacillus cereus.

The Food Standards Agency has issued alerts, and clinicians are being advised to stay vigilant, check batch numbers, and switch formula if affected. So… stay vigilant.

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