Latest / Morning Medical with Dr. Chow / Cannabis Effects, Acetaminophen Safety, and Saskatchewan's Healthcare Initiative

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Cannabis Effects, Acetaminophen Safety, and Saskatchewan's Healthcare Initiative · Morning Medical with Dr. Chow

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Welcome to Morning Medical with Dr.
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Chow, your daily dose of the latest health and medical news from around the globe.
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I'm your host, Dr.
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Chi-Ming Chow, and today we've got some intriguing topics to explore.
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Let's dive right in!
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Our first story of the day takes us to the Hebrew University of Jerusalem, where
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researchers have been investigating the potential of cannabis compounds to treat one of
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the world's most common chronic liver disorders.
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This condition, known as metabolic dysfunction-associated steatotic liver disease,
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affects about one-third of the global adult population.
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It's closely linked to obesity and insulin resistance, and currently, there are limited
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pharmaceutical treatments available, leaving many to rely on lifestyle changes, which can be
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challenging to maintain.
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The study, published in the British Journal of Pharmacology, highlights two non-psychoactive
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compounds found in cannabis: cannabidiol, commonly known as CBD, and cannabigerol, or
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CBG.
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These compounds were shown to significantly reduce liver fat and improve metabolic health
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in experimental models.
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Unlike tetrahydrocannabinol, the primary psychoactive component in cannabis, CBD and CBG
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don't produce a 'high,' making them promising candidates for long-term medical treatment.
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Lead study author Joseph Tam, who is also the director of the Multidisciplinary Center for
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Cannabinoid Research at Hebrew University, noted that these compounds enhance hepatic
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energy and lysosomal function through a process called 'metabolic remodeling.' Essentially,
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they create a backup energy source for the liver by increasing levels of phosphocreatine,
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a high-energy molecule typically stored in muscle cells.
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This discovery suggests a novel way the liver can function under the stress of a high-fat
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diet.
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Moreover, the study found that CBD and CBG restored the activity of enzymes known as
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cathepsins, which are crucial for breaking down harmful fats and waste within cells.
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This process aids the liver in clearing out dangerous lipids like triglycerides and
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ceramides, known for triggering inflammation.
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While the results are promising, the researchers caution that these findings are
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based on controlled experimental environments.
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Further clinical trials are essential to determine how these compounds can be applied
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effectively in human patients.
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Recent reviews have also highlighted the gap between public perception and scientific
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evidence regarding the effectiveness of cannabis for most medical conditions.
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Let's explore the fascinating intersection of routine mammography and cardiovascular health.
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In a recent study, researchers have discovered that routine screening mammograms, which are
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typically used to detect breast cancer, could also be utilized to identify women at higher
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risk for cardiovascular disease.
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This is achieved through the use of artificial intelligence to measure breast arterial
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calcification, or BAC.
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Breast arterial calcification is a condition where calcium deposits build up in the arteries
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of the breast.
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This study, published in the European Heart Journal, suggests that a greater amount of
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AI-calculated BAC is associated with an increased risk of major adverse cardiovascular
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events, such as heart attacks and strokes.
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These findings present a unique opportunity to use routine mammograms for early cardiovascular
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risk assessment without exposing patients to additional radiation.
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The study was conducted by Hari Trivedi and colleagues at Emory University in Atlanta, and
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it involved a large, multiracial population.
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They found that each additional square millimeter of BAC was linked to a two to three
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percent increase in the risk of major adverse cardiovascular events.
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This was consistent across various age groups, including women under the age of fifty, and was
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independent of traditional risk factors and the PREVENT risk score, a tool designed for
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cardiovascular risk stratification.
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Dr.
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Trivedi highlighted that BAC quantification is not meant to replace comprehensive risk models
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like PREVENT.
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Instead, it serves as a powerful tool to identify at-risk patients who might otherwise
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be overlooked.
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This could lead to earlier conversations between patients and their doctors about
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preventive measures, such as cholesterol testing or medication.
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The appeal of this approach is significant, especially considering that cardiovascular
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disease is the leading cause of death in the United States and is often underdiagnosed in
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women.
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Currently, about seventy percent of women over the age of forty undergo mammography for breast
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cancer detection.
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Incorporating cardiovascular risk assessment into these routine screenings could be a
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game-changer for preventive care.
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An accompanying editorial by Lori Daniels from the University of California San Diego
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emphasized the clinical importance of distinguishing BAC from coronary artery
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calcification.
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Although related, BAC reflects vascular aging and arterial stiffness, which are linked to
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heart failure, particularly heart failure with preserved ejection fraction.
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This distinction could have significant implications for treatment and prevention
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strategies.
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The retrospective study included women from two healthcare systems: Emory Healthcare and the
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Mayo Clinic.
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It demonstrated the prognostic value of BAC quantification across different populations,
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rather than creating a single risk model.
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The researchers noted that this approach adds value as an independent predictor of
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cardiovascular risk, even among populations with varying baseline risks.
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Despite its promising findings, the study did face limitations, such as underrepresentation
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of certain racial groups and missing data on some risk factors.
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Nevertheless, the growing body of literature linking BAC to cardiovascular disease is
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compelling.
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Lori Daniels concluded that it's time to move BAC from mere observation to implementation,
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leveraging a trusted touchpoint like mammography to advance preventive care for
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women.
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Let's turn our attention now to a study that delves into the ongoing conversation about the
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safety of acetaminophen, commonly known as Tylenol, during pregnancy.
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A nationwide cohort study in Taiwan has provided some interesting insights into this
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issue, particularly concerning its links to neurodevelopmental disorders such as
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attention-deficit/hyperactivity disorder and autism spectrum disorder in children.
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The study analyzed data from over two million births and initially found positive
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associations between maternal acetaminophen prescriptions during pregnancy and both
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attention-deficit/hyperactivity disorder and autism spectrum disorder in offspring.
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However, these associations became null when using a sibling-matched analysis.
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This type of analysis helps control for genetic and familial factors, which can often confound
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such studies.
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Interestingly, when further analysis was conducted on sibling data, the results were
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somewhat mixed.
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A positive association between prenatal acetaminophen exposure and adverse
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neurodevelopmental outcomes was observed when the older sibling was exposed, but a negative
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association was found when only the younger sibling was exposed.
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This reversal of findings suggests that there might be unaddressed sources of bias in the
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study, which prevents firm conclusions from being drawn.
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Despite these mixed results, the American College of Obstetricians and Gynecologists and
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the Society for Maternal-Fetal Medicine continue to affirm the safety and benefits of
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acetaminophen use during pregnancy for pain and fever.
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This aligns with other national studies from countries such as Sweden and Japan, which have
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also found that the positive associations between acetaminophen exposure and
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neurodevelopmental outcomes did not persist when sibling comparisons were accounted for.
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Dr.
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Cynthia Gyamfi-Bannerman from the University of California San Diego Health, a past president
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of the Society for Maternal-Fetal Medicine, noted that while there might still be some
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unmeasured biases in these studies, the sibling analysis brought the findings to the null.
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This indicates that the well-designed cohort studies have not yet proven a causal
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relationship between acetaminophen use during pregnancy and neurodevelopmental disorders.
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The research team, led by Pei-Chen Lee at National Cheng Kung University in Taiwan,
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suggests that further studies are necessary.
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They propose that a sibling design using investigator-led and age-standardized outcome
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assessments could help address potential biases arising from changes in medical diagnostic
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patterns.
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It's worth noting that the study did have some limitations, such as relying on maternal
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acetaminophen prescription records, which do not capture over-the-counter use of the
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medication.
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In Taiwan, acetaminophen is available both by prescription and over-the-counter at
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pharmacies, but not at convenience or grocery stores.
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This detail could be significant, as over-the-counter use is common and might not be
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accurately reflected in the study's data.
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Hiring more primary care doctors is a topic that often sparks debate, especially when
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considering the costs involved.
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Yet, the benefits of expanding our primary care workforce are profound and far-reaching.
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As the academic year winds down, many senior residents are on the hunt for jobs, and
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healthcare institutions face the complex task of determining how many new doctors to bring on
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board.
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It's a challenging process involving numerous considerations, such as retirements, reductions
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in clinical sessions, and shifts in practice locations.
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In recent months, there's been a flood of resumes from residents and fellows eager to
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begin their medical careers.
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However, a notable trend is emerging: fewer young physicians are opting for roles in
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academic medical centers.
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Instead, many are drawn to private practices, concierge medicine, and telehealth
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opportunities.
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This shift highlights the growing shortage of primary care doctors, a critical concern given
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the increasing demand for healthcare services as our population ages.
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The shortage of primary care physicians is not just a matter of inconvenience; it has
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significant implications for patient care.
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Every day, healthcare practices turn away patients, sometimes hundreds a week, due to a
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lack of available doctors.
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This shortage is felt acutely by those who have lost their primary care provider due to
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insurance changes or relocations.
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Often, patients hear the all-too-common refrain, "Your doctor no longer takes Medicare;
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you're the only one in my network who has availability."
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So, why is hiring more primary care doctors so crucial?
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While the initial costs of hiring a new doctor—such as salaries, benefits, and
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administrative support—are significant, the long-term returns far exceed these expenses.
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New doctors enhance the healthcare system's capacity, allowing more patients to receive
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timely care.
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This can prevent the need for more costly interventions down the line, such as emergency
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room visits or hospitalizations.
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Primary care doctors play a vital role in forming long-term relationships with patients,
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fostering trust in the healthcare system, and advocating for patient health.
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They are on the front lines of preventive care, vaccinating patients, screening for diseases,
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and managing chronic conditions.
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These efforts are invaluable in preventing severe health complications and improving
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overall health outcomes.
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Moreover, primary care doctors are instrumental in educating the next generation of healthcare
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professionals.
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They serve as mentors and teachers, ensuring that future doctors are equipped to provide
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high-quality care.
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This educational role is critical, as it helps sustain the healthcare workforce and prepares
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it to meet the evolving needs of our society.
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The downstream benefits of hiring more primary care doctors are substantial.
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They facilitate referrals to specialists, order necessary diagnostic tests, and coordinate
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comprehensive care plans.
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These actions contribute to the overall efficiency and effectiveness of the healthcare
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system.
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In light of these benefits, it's essential for healthcare decision-makers to recognize the
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value of investing in primary care.
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By doing the math, they can see that the costs associated with hiring more doctors are
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outweighed by the improvements in patient care and system efficiency.
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Expanding the primary care workforce is not just a financial decision; it's a commitment to
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better health outcomes for our communities.
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Premier Scott Moe has unveiled Saskatchewan's new blueprint for health care, aiming to
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enhance access across the province.
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The Patients First Health Care Plan outlines over fifty actions designed to ensure residents
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receive the right care at the right time and place.
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At a news conference held at the under-construction Urgent Care Centre in
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Saskatoon, Premier Moe reiterated his government's commitment to connect every
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resident with a primary health-care provider, as first mentioned in the 2025 Throne Speech.
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This promise was echoed by Health Minister Jeremy Cockrill, who emphasized the role of
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nurse practitioners in improving access to primary care.
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Minister Cockrill has committed to removing any limits on expanding nurse practitioner
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contracts throughout the province.
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Additionally, the government plans to test team-based models led by nurse practitioners.
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Cockrill highlighted that even the Premier's primary-care provider is a nurse practitioner,
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underscoring the importance of these professionals in the healthcare system.
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The expansion of virtual care is another key component of the plan, with the aim of making
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virtual health services accessible to all residents.
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The Whitecap Dakota First Nation's virtual health hub serves as a model for this
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initiative, with certain communities prioritized for initial access to virtual care.
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However, the plan has faced criticism from the Opposition New Democratic Party.
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Leader Carla Beck accused the government of recycling old commitments, pointing to a
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similar announcement from 2012 under Premier Brad Wall.
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Beck criticized the government's decision to retract plans for 24-hour staffing at the
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Regina Urgent Care Centre, arguing that the province needs "big, bold change" in health
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care.
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She expressed skepticism about the government's ability to repair the health-care system,
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asserting that the current administration broke it.
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An interesting aspect of the government's plan is the proposed expansion of the scope of
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practice for various health-care professionals, including dietitians, optometrists, nurses, and
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potentially chiropractors.
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Discussions with regulatory bodies are ongoing, and the government plans to introduce ambitious
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legislation in the fall session.
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The plan also includes recruiting and training more doctors, nurses, and nurse practitioners,
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with an increase in training capacity by adding twenty-six new nurse practitioner seats across
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the province.
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This expansion will involve thirteen new seats each at the University of Saskatchewan and the
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University of Regina, increasing the province's training capacity by forty-five percent.
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To attract more registered nurses to become nurse practitioners, the government is offering
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a seventy-eight thousand dollar financial incentive over two years, tied to a return of
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service contract.
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Premier Moe outlined several goals for 2028, including ensuring every person in Saskatchewan
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has access to a primary care provider, ninety percent of patients receive diagnostic scans
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within sixty days, ninety percent have a three-month wait time for surgeries, and
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completing four hundred fifty thousand surgeries over four years.
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To achieve these surgical targets, the province will utilize more private surgery clinics for
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publicly funded procedures.
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The plan also aims to modernize laboratories and expand scanner capacity to reduce
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diagnostic turnaround times, including adding a magnetic resonance imaging machine in Estevan.
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More urgent care centers are planned for cities like Saskatoon, Regina, Prince Albert, Moose
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Jaw, and North Battleford to alleviate pressure on hospitals.
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Additionally, thirty-six new acute care beds will open at Royal University Hospital in
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Saskatoon, and the neo-natal intensive care unit at the Regina General Hospital will expand
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by three beds.
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These efforts are part of a comprehensive strategy to improve health care delivery across
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Saskatchewan.
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Our final story today brings us to the intriguing realm of vitamins and their
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potential role in slowing down the biological aging process.
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This comes from the COSMOS trial, which recently published findings suggesting that a
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daily multivitamin-multimineral supplement may actually slow markers of biological aging in
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older adults.
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This is a fascinating development, as the quest to extend healthy lifespans has long been a
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topic of interest in the medical community.
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According to the study, older adults who took a daily vitamin and mineral supplement
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experienced a significant reduction in the yearly rate of increase in two specific
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epigenetic clocks, PCPhenoAge and PCGrimAge.
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These clocks are developed to estimate the risk of mortality.
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The reduction was about 2.6 months and 1.4 months, respectively, which might not seem like
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much at first glance, but in the context of biological aging, it's quite significant.
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The research, led by Howard Sesso and colleagues at Mass General Brigham in Boston,
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highlighted that the supplement had a more pronounced effect in individuals who were
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experiencing accelerated biological aging at baseline.
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This suggests that those who are aging faster might benefit more from daily supplementation.
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While the results are promising, the study's authors, as well as an accompanying editorial
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by Daniel Belsky and Calen Ryan from Columbia University, caution that whether a daily
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vitamin can indeed increase a healthy lifespan remains an open question.
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They noted that epigenetic clocks, which are biomarkers used to measure the pace of
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biological aging, have shown potential in predicting both healthspan and lifespan.
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The COSMOS trial, which included over twenty-one thousand older adults, tested the
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effects of a vitamin and mineral supplement against a placebo.
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It also explored the effects of cocoa extract, which, interestingly, did not show any impact
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on the epigenetic clocks tested.
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This suggests the unique potential of multivitamins in this regard.
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The trial's findings are particularly compelling when considered alongside other
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studies, such as the DO-HEALTH study, which found that omega-3 supplementation might also
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slow epigenetic clocks in healthy older adults.
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Moreover, the COSMOS-Mind trial, an ancillary study, showed that daily vitamin and mineral
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supplementation improved cognitive function in older adults, especially those with
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cardiovascular issues.
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The researchers evaluated the effects of the supplements on five different DNA methylation
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clocks, noting that while the directions of effect were consistent, the magnitude varied.
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This variability underscores the complexity of the aging process and the need for further
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research to understand how these biological changes translate to clinical outcomes.
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As we continue to uncover the potential of daily multivitamins in slowing biological
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aging, future research will be crucial.
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The COSMOS team plans to investigate how these supplements might affect other health outcomes,
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including cognition.
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This could have significant implications for public health guidelines if further evidence
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supports these findings.
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And that wraps up today's episode of Morning Medical with Dr.
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Chow.
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We've covered some fascinating topics, from the potential of cannabis compounds in treating
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liver disease to the implications of routine mammograms in cardiovascular health, and the
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role of multivitamins in slowing biological aging.
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Thank you for joining me, Dr.
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Chi-Ming Chow, as we explore the latest in health and medical news.
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Stay healthy, and I'll see you next time!