🎙️The Late Show With The Handover

Yes…I’m sorry. I know what you’re thinking.
"Ominious faceless voice of The Handover…What time do you call this?” 🤨

But here’s the truth: I did send The Handover at 9 am this morning…
on NHS public WiFi.

So really, if anything, it arriving 12 hours later is less of a delay and more of a minor miracle.

So as you settle in for bed, here’s a short medicine-themed lullaby.

👋 Happy Friday. Here’s what we got:

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

Weed. Ganja. The Devil’s Lettuce. 

Loved by many. Adored by that guy who insists it “fixes everything, bro” and really “mellows him out.”

Upset? Hash it out.
Wanna chill? Take a quick trip to Cali.
Can’t sleep? Be soothed by the sweet voice of Mary Jane. 

At some point, the wacky baccy went from fringe friend to best bud.
And for some… It’s a therapist, psychiatrists & life coaches… ground into one.

But just because something feels like it’s helping… doesn’t mean it actually is. 

So naturally, researchers asked the obvious question:
If we strip away the anecdotes, the TikToks, and your pothead mate’s life advice…

Do cannabinoids actually work for mental health?

This study, published in The Lancet Psychiatry, set out to assess the efficacy and safety of cannabinoids as primary treatments for mental and substance use disorders.

And what better way to search than to conduct the mother of all research? A meta-analysis.

They looked at 14 different conditions and dependencies ranging from anxiety to autism, Tourette's to tobacco abuse. 

Their search for relevant RCTs started in the 80’s. After searching far and wide, over a 45-year horizon, they settled on 54 trials, involving 2477 participants. The intervention arm of each study was treatment with CBD, THC or mixed THC/CBD given orally over 5 weeks(tablets, not brownies 😑)

The primary outcome for every study was the reduction of disorder symptoms or remission of the disorder. Additionally, the safety of the intervention was measured too. 

And what did they find? Largely… that Cannabinoids? A bit overrated

And interestingly, munchies doesn’t just apply to food; in cocaine use disorder, cannabinoids were associated with increased cocaine craving 

Whilst it is a meta-analysis, it’s not without its blemishes. Limitations:

So what does this mean?

Well, to put it blunt-ly, weed isn’t quite the cure it’s rolled up to be…

Yes, there are some benefits in specific cases. But for most mental health conditions, the evidence is either weak, inconsistent or just not there.

That transition from CBT to CBD shouldn't be made just quite yet.

My goodness.
You’ve only gone and done it!

You’ve made it through the world of medicine.

Cue the prestige.
The respect.
The glitz and the glamour.

Scrubs dramatically billow in slow motion as you stride down the ward corridor.
It’s everything Grey’s Anatomy or The Pitt promised it would be. 

…is it?

Reality feels more like.

Admin.
Death via mandatory e-learning modules.
And a discharge summary that somehow requires four separate logins and your childhood pet’s name.

And just to top it all off…
The constant fear that running on four hours of sleep might finally catch up to you.

Perhaps a complaint. Maybe an investigation.
A meeting with someone whose job title includes the word “disciplinary.”

Suddenly, the thing you spent a decade training for feels… slightly fragile.

Relax.
Calm your cortisol. 

This is exactly why Medical Protection exists!

Medical Protection supports clinicians when medicine gets a bit complicated:

And unlike many providers, there are no financial caps on the legal fees they’ll take on for you, and no limit on compensation payouts.

Allowing you to focus on what you do best.
Maintaining your professional swagger on ward rounds 😎 ...oh, and saving lives too. 

So join over 350,000 clinicians and medical students protected by Medical Protection today, using the link below 👇

*Membership is based on an application process. All the benefits of membership are discretionary, as set out in our Memorandum and Articles of Association. Among these benefits is the right to ask for assistance with a range of medicolegal issues, including indemnity for clinical negligence claims.

Another week filled with controversy

Oscar favourite Timothee Chalamet loses Best Actor. 
UKFPO Hunger Games returns, shipping new doctors 50 bigillion miles from home. 

As the world argues and crumbles around them, cardiologists have had a reckoning of their own. Stemming from the most controversial heart study to emerge since Love is Blind Season 1… 

Before we get there, here’s a quick prologue.

DOACs are great for atrial fibrillation.
No INR checks. No dietary paranoia. No woeful warfarin.  

Unfortunately, some patients with higher bleeding risk simply can't take blood thinners.
It’s a no-go zone. 

For these guys and gals, what do we do?

One option is something called left atrial appendage closure(LAAC) 

In the left atrium, there is a pocket where blood can stagnate. An anatomical afterthought, much like the appendix. 
Stagnation leads to clots.
And clots lead to strokes.

So the treatment is simple. If most clots form there… just seal it off 🤝

The assumption was that closing the appendage is no worse than medical management.

Yeah… that assumption didn’t age too well. 

Enter the CLOSURE-AF trial: The first paper to legit check left atrial appendage closure. 

Published in NEJM, the primary aim was to test whether LAAC is noninferior to physician-directed best medical care(primarily DOACs). 

This multicenter, open-label RCT recruited 912 patients across 42 sites in Germany with clinically significant AF + high-risk for bleeding & stroke(CHADsVASc… HAS-BLED, you know the vibe)

They then sorted them 1:1 to receive either:

Patients were followed for a median of 3 years, tracking a composite endpoint of:

Then compared to see if there was actually a difference between the groups.

What did they find? 

In this patient population, left atrial appendage closure was not noninferior to medical therapy in reducing the risk of stroke, embolism, major bleeding, or death at 3 years. Not noninferior…? 🤔

In layman's terms, they couldn’t prove it was as good 🤷. Looking at the endpoint data broken down

I have never seen medical Twitter more heated up for a study ever in my life. Check out the discourse here

Public Health Announcement: Meningitis Outbreak

In case you missed it, there is a meningitis outbreak in the UK. The UK Health Security Agency have declared an urgent public health alert. 

Seemingly spreading around a nightclub in Kent, the total number of cases has risen to 29. 10,000 doses of antibiotics have been given out around Kent, and two people have sadly passed away. 

If the symptoms of meningitis have escaped you, watch out for a high fever, neck stiffness, severe headache, nausea and vomiting and light sensitivity. Stay safe. Stay vigilant. 

NICE Approves New AI Colonoscopy Tools

They just can’t stop these clankers, can they?

NICE has just approved six new AI systems to help detect colorectal polyps during colonoscopy.

When the naked eye, decades of experience, and the MDT aren’t quite enough, tools like CAD EYE, ENDO-AID, and GI Genius (still the best name) step in to flag what might’ve been missed.

And like most new tech in healthcare, they’re on a short leash—four years to prove they’re worth it, or they’re out.

Sent to the chopping block… or maybe a compactor. Not entirely sure how you “kill” an AI, but I assume it’s less dramatic.

Yet Another Ozempic Study

Ozempic’s really been doing a world tour lately…weight loss, diabetes, kidney disease… probably fixing your Wi-Fi next. So naturally, researchers thought, “Alzheimer’s? Sure, why not?… let's see if it can slow cognitive decline.”

Two massive phase 3 trials, including 3,808 patients, 40 countries, and the full Avengers lineup of clinical research, put oral semaglutide to the test in early Alzheimer’s.

And guess what? It didn’t beat placebo. At all. On the main cognitive scale (CDR-SB), patients on semaglutide worsened by 2.3 points, compared to 2.3 and 2.1 in the placebo groups. So patients on semaglutide declined at basically the same rate as those on placebo over two years

Maybe we can't throw Ozempic at everything and expect it to stick. Huh, who woulda thought…

I am fresh out of deep dive ideas. Whilst ruminating, deliberating and ponderating what to cook up this weekend, I had this genius idea.

Let you guys do the hard work!

What do you want a deep dive on?

Ruminate, deliberate and ponderate, then click the button above for a topic you’d fancy being written, Handover style.

Handover Over 🫡

If you liked it, tell your mates
(forward along, please. It only takes 12 seconds, making this took 12 hours.)
If you hated it, tell your enemies.

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