⚕️Your PRN Medical News

It’s Friday, Friday, gotta gotta get down on Friday. If that reference means didly squat to you. You’re either:

It’s okay, we’re all united here for our collective love of medical news.
So, 👋 Happy Friday

Here’s what we got:

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

What’s the peak performance supplement stack? Glad you asked.

We got Huel to replace mealtime.  
Multivitamins because they’re yummy.
Ashwaganda to keep the bloodline alive. 
Iron to make my poo black. 
Creatine because Steven Bartlet said so. 
And Vitamin D plus Calcium - keep my bones nice and strong. 

Now, I can’t personally vouch for the effectiveness of every substance currently being peddled to men by podcasters with Turkish veneers. But vitamin D and calcium?

Between osteoporosis advice, Petits Filous ads, and every GP over the age of 45, I thought it was basically settled?  Calcium and vitamin D help prevent fractures.

We’re bullish on vitamin D and calcium because of their critical role in bone homeostasis. I won’t bore you with a repeat of pre-clinical medicine, but in short, low levels of calcium and vitamin D have been associated with:

So, logically, keeping them high should reduce all these terrible outcomes, right? …right? 

This meta-analysis and systematic review, published in The BMJ, put this thinking to the test. 

If we gave patients calcium, vitamin D, or both, would it reduce their risk of fracture and falls? Let’s find out

They looked out at 69 randomised controlled trials, including 153,902 participants. Sizable indeed…

They excluded patients already on bone protection medication and those who were already very frail. Leaving only regular community-dwelling elderly(average age 71).

After crunching data from 69 randomised controlled trials using random-effects meta-analysis, they came to a fairly awkward conclusion:

For reducing fractures and falls, Vitamin D and Calcium are overrated. 

However, when you put the two together(Calcium + Vit D), there is a glimmer of hope. 

Combined supplementation showed a statistically significant relative reduction in the risk of any fracture (15 trials, 51,126 participants; RR 0.91, 95% CI 0.84 to 0.99).

But that glimmer was quickly extinguished.

This is pretty fascinating because as of 2021, the NHS pay £111 million per year on Vitamin D prescriptions. £111 million! I wonder what else that money could be put towards 🤔…

To be fair, the paper doesn’t say vitamin D is useless in every situation. Evidence was limited for people with severe deficiencies, people living in residential care, and patients already at very high fracture risk.  

But for regular people in the community?
The evidence for routine supplementation suddenly looks a lot shakier than the wellness industry would probably prefer.

Anyway, I’m still taking Huel, nothing tastier than liquid food slop 😋

Everyone always asks us.

“Handover Team, where on earth do you acquire such quality medical research?” 

It’s a secret we’ve gatekept.
Kept sealed away.
Hidden as tightly as the Krabby Patty Secret Formula.

We’ve debated revealing this… but I think it’s time to come clean 😔
The truth is:

We use NEJM Clinician from the publishers of the New England Journal of Medicine. 

Every week, their team scours thousands of peer-reviewed papers published in over 150 top-ranked journals. Then:

Their summaries are short, sweet and straight to the point. 

Essentially, they do what we do… just 10x better and with a MUCH bigger budget. 

We kinda just copy their homework. 

So if you…

…you’ll probably love NEJM Clinician as much as we do.

Join those of us in the know and start using NEJM Clinician today. Click the link below for 30% off your subscription.

There’s a cowboy medic inside ya, isn’t there?

I bet you’re just itching to do the risky surgery, or fancy manoeuvre, or whack a disease with all the brand new biologics science has on offer. (I, too, secretly long for my own Grey’s Anatomy moment of glory🪚)

Sadly, in case you hadn’t clocked, there’s a whole load of caution in real-life medicine. 

But when it’s your GMC number on the line, suddenly “watch and wait” seems like a sweet idea.

And when it comes to ischaemic stroke, you just don’t wanna get it wrong. That’s why we’ve historically been pretty cautious about early antiplatelet therapy. Sure, they stop clots. Unfortunately, they also have an awkward tendency to make people bleed into their brains 😬

But here’s where the TAPIS trial comes in.

Published this week in The Lancet, they questioned whether we were actually right to delay dual antiplatelet therapy (DAPT) in the first place. What if we just … gave it at the start instead?🤷

And these mad lads conducted a trial to test exactly that: 

1382 patients across 60 hospitals in China with moderate stroke severity (NIHSS 4–10) were randomised to receive either ticagrelor plus aspirin (DAPT) or placebo within 6 hours of stroke onset

And the results were pretty wild: 

In a nutshell, patients receiving early ticagrelor + aspirin were significantly more likely to have minimal or no disability after stroke. 

Better yet. Symptomatic intracranial haemorrhage actually remained low:

So statistically, there was no significant difference between the groups (RR 1.20, 95% CI 0.37–3.93; p=0.76). 

Put simply, despite throwing extra antiplatelets at freshly thrombolysed stroke patients, they didn’t obviously start catastrophically bleeding into their brains. Nice! 

This was a clinically sound double blind RCT with a pretty big sample size. But even then, it was limited to China and only considered moderate strokes. Plus, with a risk like intracranial haemorrhage on the line, we really need a lot more research to make sure it’s as safe as TAPIS suggests. 

Still … for all you crazy yeehaw medicine enthusiasts, TAPIS hints at a future where stroke treatment might involve a little less ‘watch and wait’ … and a little more ‘lock and load’ 🤠

☣️ The New Contestant for Miss Pandemic 2026

Hantavirus may have won the swimsuit round, but it’s Ebola making headlines this week. 

The outbreak, which began in eastern Democratic Republic of Congo and Uganda, has now been labelled a public health emergency of “international concern” by the WHO.

This particular flavour is caused by the Bundibugyo virus, as opposed to the more famous Zaire Ebola strain that caused outbreaks previously. 

The best part? There’s currently no approved treatment. Or vaccine.

Oh, and the mortality rate is a staggering 30-50%.

But transmission is trickier than your average flu or COVID. Only through direct contact with blood, vomit and other bodily fluids can it be spread. 

Poor hygienic practices and cultural practices such as burial rituals facilitate rapid transmission, hence healthcare settings and funerals are high-risk areas of concern. 

As of Tuesday, 514 cases are suspected, with 136 resultant deaths. The priority is to emphasise public health measures ie PPE and handwashing, in an attempt to curb the spread to more densely populated urban areas. 

At this rate, the Hantaebola virus is just around the horizon. Or before GTA 6 at the very least. Just redownload Plague inc instead.

☀️ Sun’s Out, But so is Skin Cancer

Turns out, the beloved British tradition of scorching red in the backyard at the first hint of sunny weather isn’t without risk. 

Sorry to burst your heatwave weekend plans of sun and spritzes at the park, but the incidence of melanoma in the UK has risen above 20,000 for the first time.

Thanks to our national love of sun beds, tanning and lax use of sun protection, our rates of skin cancer are creeping up. This is despite a ban on under-18s using sun beds, but stricter mandatory ID checks are being considered to enforce this.

Consider this your reminder to slap on the SPF on the daily, and be vigilant with your mole patrol🕵️

No shade to the tanners amongst you … but actually yes please stay in the shade ⛱

💉BREAKING: GLP-1 News at 7

Would it really be a Friday Handover without a cheeky GLP-1 RA update? 

We got two for you, one serious and one less serious.

Serious: Retatrutide – the new triple-agonist obesity drug from Eli Lilly and Company currently being sourced by gym bros on the grey market more easily than a dodgy Fire TV Stick for the football – might actually be heading mainstream.

Phase 3 TRIUMPH-1 data released yesterday confirms that retatrutide is the first obesity drug to consistently approach bariatric-surgery-level weight loss in a broad non-diabetic obesity population. 

45.3% of participants lost ≥30% of body weight. Making it more effective than semaglutide (15%) and Tirrezepide (22%).

Less Serious: Ozempic Daddy, Novo Nordisk forgot to pay $250 for the rights so Semagluide in Canada, now allowing for generic semaglutide to be sold to the public, potentially costing the pharma titan billions. Oh dear…

Read about it here

🗞 Handovers Article of The Week

Title: AI is making clinical reasoning optional – and that should worry us.

Now this is my type of article. Published in The BMJ by Nguyen Nghia. An interesting opinion piece on how AI is affecting the future of healthcare delivery. 

It’s topical. It’s punchy. It’s provocative, it’s what gets the clinicians going. Great read!

Check it out  👉here

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