🇺🇸 Trump vs 💊 Tylenol: Casually Explained

No small talk today.
Just business.
This week Trump did alot… too much.
Put you’re game face on. We’re in for a ride.

👋 Happy Friday. Here’s what we got:

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

On Monday, Donald Trump stood at a podium (presumably the same one where he once said to drink bleach for cure COVID-19 ) and gave the American public some urgent and unsolicited medical advice:

Not exactly a message grounded in peer-reviewed nuance. But hey, nuance has never been his strong suit.

Now before you riot against the WHO pain ladder or blame Paracetamol for your cousin’s train obsession, let’s talk about what the science actually says. Unlike campaign speeches, this isn’t something you can just say and then go golfing. 

Especially when half the women in the world currently use it during pregnancy.  

Before looking at the papers lets make sense of the rising incidence of autism, independent of paracetamol:

In short: we’re diagnosing more autism, not necessarily seeing more autism.

But let’s look at the evidence, starting with the big one.

A Swedish study published in JAMA earlier this year looked at nearly 2.5 million children and found… brace yourself… a whopping 0.09% increase(p ≈ 0.003) in autism risk in kids whose mothers took paracetamol during pregnancy. 

Not quite the smoking gun the Administration is making it out to be. 

Moreover, researchers compared siblings. One was exposed to paracetamol in the womb and the other was not. What they found was… no difference(HR = 0.98, 95% CI 0.93–1.04, p = 0.55) And mentally bookmark the sibling point, because it rules out many confounding variables. 

Controversially and conversly, a review published in the Environmental Health earlier this year used the “Navigation Guide” methodology (that’s science talk for “we tried to be thorough”) and concluded there’s evidence consistent with an association between prenatal acetaminophen use and neurodevelopmental disorders like autism and ADHD.

Sounds scary…until you dig a bit.

Out of 46 studies they reviewed, the majority did show some kind of link… but they also admit the evidence is wildly inconsistent. Some studies even showed protective effects. Others were based on maternal recall, which is about as reliable as hospital Wi-Fi.

In order to suddenly claim Tylenol leads to autism, we would need better data, which we do not currently have. Declaring that tylenol use in pregnant people can lead to autism, with the available evidence we have now, is scientifically irresponsible.

But… Why? What’s the incentive?
Right or wrong, it’s obvious why the Administration might have strong opinions on immigration or vacinnes when it appeals to a specific demographic…
But there is no clear motive in this situation. 

Idk, honestly, it’s giving me a headache just thinking about it. 
But I guess I’ll ride it out… wouldn’t want risk my future kids becoming math prodigies.

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You’ve just walked out of the hospital. You’re wrecked.
The ED registrar did the worst possible thing.

They… taught you something.

Not in a “here’s a fun mnemonic” way. No.
You got ambushed with actual, clinically relevant questions.

“What are the borders of the triangle of safety?”
“Where does the phrenic nerve originate?”
“How many ribs do you have?”

Umm. Urrgh. Arghh. 😵‍💫
The med school fog rolls in. 

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You actually did know it all once upon a time. 

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Remember that cosy pre-med dream? 

Finish F2, waltz straight into training, secure a cushy consultant job and let the just stacks roll on in … 

Consider that bubble officially burst - the 2025 reality is roughly 7 applicants per specialty training post, up a whopping from 4.7 last year. Which is fine. This is fine. 

You’re a Hopeful Psychiatrist? Aspiring GP? 

Not in 2025 you’re not; forget “communication skills” or “empathy” (famously irrelevant in these specialties). If you can’t tell your Sporothrix schenckii from your Capnocytophaga canimorsus in the MSRA, you’re cooked.

How did we get here?

In short: a ton more medical graduates, only a smattering more posts (gee thanks Streeting) and a woefully inadequate training pathway. 

With trusts being stingier than ever, AND no increase in alternative jobs like JCFs AND growing concerns about super-qualified IMGs claiming training spots, the problems just keep piling up.

This leads to ballooning pool of qualified, career-ready doctors stuck in prolonged professional purgatory. 

So what are my options?

Here’s the current lineup:

Jokes aside, we have a very real crisis here: an NHS with more junior doctors than ever, but fewer pathways to turn them into the consultants we’ll desperately need ten years down the line.

There’s nothing scarier than thinking about your future, but have you given it much thought? Have you considered alternative careers? Going abroad?
Let us know in the pole below 👇

You’ve always wanted this. 
We need our first publication. Stay back behind lectures.
Ask questions you already know the answer to. No time for house parties.
You’re a machine. 5 publications, 3 poster presentations, 2 QiP’s. All by 3rd year.

You’ve always wanted this. 

USMLE Step 1.
Test booked. $1000 gone.
You’ve never worked this hard before.
Placement. Research. UWorld. Sleep. You deserve this. 
Step 1 Passed. Elective in Mayo Clinic. 3 international presentations.
Graduate top decile. 

You’re going to get this. 

Foundation Begins.
Step 2 & 3 booked. $2000 gone.
Surgery. UWorld. Sleep. Nothing more. Nothing less.
It’s Match day. You open it with your family. Lucky you. You’ve matched.

You did it.

It was worth it. The worst behind.
You leave the foundation programme early
Who needs a GMC number, when you’ve got the USA?
All that’s left is the visa. How hard can that be? `
Check your phone. What’s that on the news?

It’s Trump: “H1-B Visa fee will go from $2500 to $100,000. Effective immediately.” 

Okay, quick breakdown: 
To practice in the USA, you need a couple things. USMLE completion, matching to US hospital and, of course, a valid visa.

There are two main visas needed to practice in the States: J-1 and H1-B Visa. 

J-1 visa is more common for IMG’s wanting American residency. But this requires a two-year home-country residency after finishing the course. AKA back to stinky Britain before you return to the land of the free. 

The more attractive visa is the H-1B visa. This is because there is no return requirement. As will all attractive things, it’s a bit rarer too. Fewer programmes sponsor it, but if you do get it, happy days. 

On the 19th September, the Trump Administration announced plans to raise the price of this coveted visa from a maximum of $4500 to $100,000. That’s a six-figure bet your residency programme now has to place on you.

This was done to deter tech companies from hiring IMG’s, but as with a lot of this new administration's decisions, it clearly hasn’t been fully thought through… especially considering the States already has doctor shortage(86,000 by 2036) and they made plans to make it easier for Brits to emigrate a couple months ago.  

Some preliminary reports suggest healthcare professionals will be exempt, but with a POTUS as unpredictable as the end of Shutter Island, do not bet on it. 

Handover Over 🫡

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Runners up won’t be left out…

Get a free pair of Crocs Surgical Clogs if you get top 3.

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