Latest / Morning Medical with Dr. Chow / Primary Care in BC, Marijuana & Mental Health, and GLP-1 for Atrial Fibrillation

Transcript

Primary Care in BC, Marijuana & Mental Health, and GLP-1 for Atrial Fibrillation · Morning Medical with Dr. Chow

• 0:00
  Good morning and welcome to Morning Medical with Dr.
• 0:02
  Chow.
• 0:03
  I'm your host, Dr.
• 0:04
  Chi-Ming Chow, bringing you the latest updates in medical and health news from around the
• 0:09
  world.
• 0:10
  Today, we'll begin by discussing a major recruitment effort in British Columbia, Canada,
• 0:15
  which has successfully brought in hundreds of health-care workers from the United States.
• 0:23
  In a strategic move to address the shortage of health-care professionals in British Columbia,
• 0:27
  the province has managed to recruit more than 400 health-care workers from the United States
• 0:33
  over the past year.
• 0:36
  This recruitment blitz, launched by British Columbia's Ministry of Health, saw 414 American
• 0:43
  health-care workers accepting positions throughout the province between March 2025 and
• 0:49
  January 2026.
• 0:52
  The initiative targeted a range of professionals, including 89 doctors, 42 nurse
• 0:58
  practitioners, 260 nurses, and 23 allied health professionals.
• 1:05
  One of these recent recruits is Dr.
• 1:07
  Anne Herdman Royal, a pathologist who relocated from Tulsa, Oklahoma to Nanaimo, British
• 1:13
  Columbia.
• 1:14
  Dr.
• 1:15
  Herdman Royal was driven to leave the United States due to a combination of political unrest
• 1:20
  and a traumatic mass shooting at the hospital where she previously worked.
• 1:25
  Her decision to move north reflects a larger trend among American health-care workers
• 1:30
  seeking stability and a better work-life balance in Canada.
• 1:35
  Health Minister Josie Osborne highlighted the significant impact of this recruitment effort,
• 1:40
  noting that even if only half of the 89 recruited physicians are family doctors, it
• 1:45
  could mean more than 50,000 British Columbians gaining access to primary care.
• 1:50
  This influx of health-care professionals is spread across the province, with job placements
• 1:55
  in both urban centers and rural communities.
• 1:59
  The campaign initially focused on attracting health-care workers from nearby U.S.
• 2:03
  states such as Washington, Oregon, and California.
• 2:07
  Creative strategies like setting up a truck outside Seattle hospitals to offer free coffee
• 2:11
  and tea, along with grassroots social media campaigns, helped to spread the word.
• 2:16
  Encouraged by the success, British Columbia is now considering expanding its recruitment
• 2:21
  efforts to other parts of the United States.
• 2:25
  The trend of American health-care workers moving to Canada isn't confined to British
• 2:29
  Columbia alone.
• 2:31
  Other provinces, like Manitoba and Nova Scotia, are also actively recruiting U.S.
• 2:37
  health-care professionals.
• 2:39
  However, experts like Dr.
• 2:41
  Rita McCracken from Simon Fraser University caution that while these recruitment campaigns
• 2:45
  are beneficial, the overall health-care infrastructure must also be strengthened to
• 2:49
  support the influx of new professionals.
• 2:53
  For Dr.
• 2:54
  Anne Herdman Royal, the move to Vancouver Island has been life-changing.
• 2:59
  She is in the process of applying for permanent residency and has rediscovered her passion for
• 3:04
  her work.
• 3:06
  She also enjoys the elusive work-life balance that she found on Vancouver Island, a sentiment
• 3:12
  echoed by many of her peers who have made similar moves.
• 3:16
  Today, we're diving into the complex topic of using marijuana as a treatment for mental
• 3:21
  health conditions.
• 3:22
  Despite its growing popularity for this purpose, recent scientific analyses have found
• 3:27
  little evidence to support its efficacy.
• 3:30
  Two new analyses, which reviewed existing gold-standard research, suggest that
• 3:34
  marijuana—both medical and recreational—does not effectively ease symptoms of anxiety,
• 3:41
  depression, or post-traumatic stress disorder.
• 3:44
  These are some of the leading reasons people turn to cannabis for relief.
• 3:49
  Jack Wilson, a postdoctoral research fellow at the University of Sydney’s Matilda Centre for
• 3:54
  Research in Mental Health and Substance Use, led one of these studies.
• 3:58
  Published in the journal Lancet Psychiatry, the study analyzed results from 54 randomized
• 4:05
  controlled trials conducted between 1980 and 2025.
• 4:10
  Wilson notes that the cannabis medications tested were largely oral formulations, such as
• 4:17
  capsules, sprays, or oils.
• 4:21
  However, in real life, many users prefer smoked cannabis, for which there's even less evidence
• 4:26
  of effectiveness for mental health conditions.
• 4:30
  The study also found that marijuana did not improve other mental health conditions like
• 4:34
  anorexia nervosa, bipolar disorder, obsessive-compulsive disorder, or psychotic
• 4:39
  disorders such as schizophrenia.
• 4:42
  Conducting studies on marijuana can be challenging, but the randomized controlled
• 4:46
  trials reviewed are considered the gold standard in research.
• 4:51
  Dr.
• 4:52
  Deepak Cyril D’Souza, a professor of psychiatry at Yale University, emphasized that these
• 4:57
  findings clearly demonstrate the lack of evidence to recommend cannabis for mental
• 5:02
  health treatment, despite its widespread approval for these conditions across the United
• 5:07
  States.
• 5:08
  Interestingly, about 27 percent of individuals aged 16 to 65 in the United States and Canada
• 5:15
  have used marijuana for medical purposes, with around half of them using it to manage mental
• 5:21
  health.
• 5:22
  Yet, despite the lack of proof of its efficacy, some doctors continue to prescribe medical
• 5:27
  marijuana for mental health conditions.
• 5:31
  It's worth noting that the cannabis industry has connections to some of these studies, which
• 5:36
  could present conflicts of interest affecting the findings.
• 5:41
  Regular use of high-potency marijuana can pose significant risks, especially for vulnerable
• 5:47
  populations such as pregnant women, adolescents, and young adults.
• 5:52
  For instance, heavy use of marijuana by teens and young adults with mood disorders has been
• 5:58
  linked to an increased risk of self-harm, suicide attempts, and even death.
• 6:05
  In those at high risk of bipolar or psychotic disorders, marijuana use can increase the
• 6:11
  likelihood of developing a mental health disorder.
• 6:15
  Using marijuana after the onset of a mental condition can also worsen cognition and
• 6:20
  increase the chance of relapse.
• 6:23
  The potency of modern marijuana is much higher than it was in the past.
• 6:28
  The average THC content has risen from about 4 percent in the 1970s to 18-20 percent today,
• 6:35
  with some available strains reaching up to 35 percent.
• 6:40
  Marijuana concentrates can have a THC content as high as 80 percent, significantly
• 6:47
  contributing to addiction rates.
• 6:49
  About 30 percent of marijuana users in the United States have cannabis use disorder, which
• 6:56
  is characterized by dependence and withdrawal symptoms such as cravings, irritability, and
• 7:01
  sleep difficulties.
• 7:03
  For those seeking treatment for mental health conditions, there are proven alternatives to
• 7:08
  marijuana.
• 7:09
  Selective serotonin reuptake inhibitors, or SSRIs, are commonly used for treating
• 7:14
  depression and anxiety.
• 7:16
  Another effective treatment is cognitive behavioral therapy, which focuses on changing
• 7:22
  negative thoughts and behaviors.
• 7:24
  This therapy is often used in combination with SSRIs to improve emotional regulation and mood.
• 7:33
  Today, I want to discuss a fascinating development in the treatment of atrial
• 7:37
  fibrillation, particularly among patients who are obese.
• 7:42
  A recent study has shown that GLP-1 receptor agonist drugs may offer significant benefits
• 7:49
  for controlling atrial fibrillation, especially when compared to bariatric surgery in patients
• 7:55
  who have undergone catheter ablation.
• 7:58
  This retrospective cohort study, conducted by Dr.
• 8:01
  Rutvij Patel and colleagues from Creighton University, analyzed electronic medical records
• 8:07
  of over 250 million patients from 142 health care facilities in the United States.
• 8:15
  The study focused on adults with a body mass index of 30 or higher who had undergone atrial
• 8:21
  fibrillation ablation between 2016 and 2025.
• 8:26
  These patients were divided into two groups: those who started GLP-1 receptor agonist
• 8:32
  therapy after ablation and those who opted for bariatric surgery.
• 8:37
  The findings revealed that patients who received GLP-1 drugs had a lower rate of atrial
• 8:43
  fibrillation readmissions two years post-ablation compared to those who underwent
• 8:48
  bariatric surgery.
• 8:49
  Specifically, the readmission rate was 36.4 percent for the GLP-1 group versus 45.3 percent
• 8:57
  for the bariatric surgery group.
• 9:00
  This suggests that GLP-1 drugs may be more effective in reducing the chances of atrial
• 9:06
  fibrillation returning after ablation.
• 9:09
  In addition to atrial fibrillation readmissions, the study found that GLP-1
• 9:15
  receptor agonists were associated with better outcomes in terms of heart failure
• 9:20
  readmissions, all-cause readmissions, and even all-cause mortality.
• 9:25
  These benefits were observed even though the GLP-1 group had a higher baseline prevalence of
• 9:30
  conditions like diabetes, hypertension, heart failure, and chronic kidney disease.
• 9:37
  The authors of the study, which was published in the Journal of the American College of
• 9:41
  Cardiology: Clinical Electrophysiology, highlighted the potential role of GLP-1
• 9:48
  receptor agonists in rhythm management strategies.
• 9:52
  They emphasized the need for prospective randomized trials to further explore these
• 9:57
  promising results.
• 9:59
  Atrial fibrillation is a common and sustained arrhythmia closely linked with obesity.
• 10:07
  While bariatric surgery has been effective for weight loss, it hasn't consistently helped with
• 10:13
  atrial fibrillation recurrence in past studies.
• 10:18
  However, GLP-1 receptor agonists, which are increasingly used by electrophysiologists for
• 10:24
  weight management, have shown potential in reducing arrhythmia recurrence.
• 10:29
  It's theorized that these drugs may reduce fat deposits around the heart or aid in reversing
• 10:34
  atrial remodeling, which could contribute to their effectiveness.
• 10:39
  Several trials are currently underway to further investigate the impact of GLP-1 drugs
• 10:44
  on atrial fibrillation outcomes.
• 10:46
  These include the TIRO-AF trial of tirzepatide, the METSAFE trial comparing metabolic surgery
• 10:53
  to GLP-1 drugs, and the WAIT trial in Sweden testing semaglutide before catheter ablation.
• 11:01
  These studies aim to provide more robust data on how these medications can be integrated into
• 11:06
  treatment regimens for atrial fibrillation.
• 11:10
  The retrospective cohort study by Dr.
• 11:13
  Patel and his team is the first to directly compare GLP-1 receptor agonists to bariatric
• 11:18
  surgery in this context, showing superior outcomes for the drug therapy.
• 11:23
  Despite some limitations, such as reliance on potentially miscoded data and lack of
• 11:28
  procedural details, the study provides compelling evidence that GLP-1 receptor
• 11:33
  agonists may offer benefits beyond weight reduction, including improving atrial
• 11:38
  remodeling and reducing arrhythmogenic triggers.
• 11:43
  Today, let's delve into an intriguing topic regarding the use of GLP-1 receptor agonists
• 11:50
  and their impact on endoscopic procedures.
• 11:54
  A recent clinical trial, known as the OCULUS trial, has shed light on the issue of retained
• 12:00
  gastric contents during endoscopy, particularly among patients who continue their GLP-1
• 12:05
  medication up until the time of the procedure.
• 12:08
  The study, conducted by Dr.
• 12:10
  Tilak Shah and colleagues at Cleveland Clinic Florida, found that patients taking GLP-1 or
• 12:15
  GLP-1/GIP agonists experienced higher rates of residual gastric volume if they did not hold
• 12:23
  their medication prior to an upper endoscopy.
• 12:25
  This residual volume was significant enough to preclude endoscopic examination in some cases.
• 12:32
  Interestingly, following a clear liquid diet the day before the procedure seemed to
• 12:37
  eliminate the risk of significant residual gastric volume, regardless of whether the GLP-1
• 12:43
  medication was paused.
• 12:45
  The trial involved 68 patients scheduled for various endoscopic procedures and compared
• 12:51
  those who continued their GLP-1 medication with those who did not.
• 12:56
  The findings highlighted that 25 percent of patients who continued their medication as
• 13:01
  usual had clinically significant residual gastric volume, compared to just 3.1 percent of
• 13:07
  those who skipped their last dose.
• 13:10
  This significant difference underscores the potential need to reschedule procedures for
• 13:15
  patients who have not paused their GLP-1 medication.
• 13:20
  The implications of these findings are quite important.
• 13:24
  The presence of retained gastric contents can increase the risk of regurgitation and
• 13:29
  pulmonary aspiration during procedures that require sedation or anesthesia.
• 13:34
  As such, the study suggests reevaluating current fasting recommendations and possibly
• 13:41
  incorporating point-of-care ultrasound as a tool to assess gastric contents before
• 13:48
  proceeding with an endoscopy.
• 13:51
  Interestingly, the study also found that gastrointestinal symptoms, such as nausea and
• 13:56
  constipation, were not reliable indicators of retained gastric content.
• 14:01
  Many patients with significant residual gastric volume did not exhibit any upper
• 14:06
  gastrointestinal symptoms, challenging the traditional reliance on symptoms to guide
• 14:10
  clinical decisions.
• 14:12
  The American Society of Anesthesiologists had previously revised their guidelines, allowing
• 14:17
  most patients to continue GLP-1 drugs up until the day of elective surgery, provided they
• 14:23
  adhered to a liquid diet 24 hours prior.
• 14:26
  However, the results of the OCULUS trial suggest that a more cautious approach might be
• 14:31
  warranted, especially for endoscopic procedures.
• 14:35
  This trial is a significant step forward in understanding how GLP-1 receptor agonists
• 14:41
  affect pre-procedural preparation.
• 14:44
  Further research, such as the ongoing OCULUS-2 trial, will continue to explore these questions
• 14:50
  and may lead to refined guidelines that optimize patient safety and procedure efficacy.
• 14:56
  As always, these findings highlight the importance of personalized medical care, where
• 15:01
  treatment plans are tailored to the specific needs and circumstances of each patient.
• 15:07
  Let's turn our attention to an important topic concerning the treatment of high cholesterol in
• 15:12
  younger individuals.
• 15:14
  Recent guidelines from the American College of Cardiology, the American Heart Association, and
• 15:20
  other medical organizations are suggesting that treatment for high cholesterol may need to
• 15:25
  begin earlier than previously thought, even for those in their 30s.
• 15:30
  Statins, which are medications that help lower low-density lipoprotein or LDL cholesterol, can
• 15:37
  be an effective treatment option.
• 15:40
  LDL cholesterol, often referred to as the "bad" cholesterol, can accumulate in the arteries
• 15:46
  over time, leading to blockages that increase the risk of heart disease and stroke.
• 15:52
  The updated guidelines recommend statin therapy in addition to lifestyle modifications for
• 15:57
  adults as young as 30 years old who have an LDL cholesterol level of 160 milligrams per
• 16:04
  deciliter or higher, a strong family history of premature heart disease, or a high 30-year risk
• 16:11
  of developing cardiovascular disease.
• 16:15
  The rationale for starting treatment earlier is to prevent the long-term consequences of high
• 16:21
  cholesterol and cardiovascular disease.
• 16:24
  By addressing these issues sooner, individuals can reduce their risk of developing serious
• 16:29
  health conditions later in life.
• 16:31
  This proactive approach involves not only medication but also significant lifestyle
• 16:36
  changes, such as adopting a heart-healthy diet and engaging in regular physical activity.
• 16:42
  A heart-healthy diet typically includes plenty of fruits, vegetables, whole grains, and lean
• 16:49
  proteins while minimizing saturated fats, trans fats, and cholesterol.
• 16:55
  Regular exercise, such as brisk walking, jogging, or cycling, is also crucial in
• 17:00
  maintaining healthy cholesterol levels and promoting overall cardiovascular health.
• 17:06
  The goal of treatment is not just to lower LDL cholesterol levels but to achieve and maintain
• 17:12
  optimal cardiovascular health.
• 17:15
  Doctors are urging people to start earlier with these interventions to ensure that cholesterol
• 17:19
  levels are managed effectively, reducing the risk of heart attacks and strokes.
• 17:25
  As we conclude today's episode, it's important to remember that managing cholesterol is a
• 17:30
  lifelong commitment and requires a combination of medical treatment and lifestyle changes.
• 17:36
  If you have concerns about your cholesterol levels or risk factors, I encourage you to
• 17:41
  speak with your healthcare provider to develop a personalized plan that's right for you.
• 17:46
  Thank you for tuning in to Morning Medical with Dr.
• 17:49
  Chow.
• 17:50
  Join me again tomorrow for more insights into the latest medical and health news.
• 17:55
  Until then, stay informed and take care of your health.