Morning Report — Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Twice a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

We’re coming in hot with a controversial subject: vitamin D. Not since “Was the dress blue/black or white/gold?” has a topic sparked such debate. This time, the vitamin D dispute is on whether to screen for deficiency.

The USPSTF examined the evidence on screening for vitamin D deficiency, and they concluded that—DRUMROLL—not enough evidence exists to weigh the benefits and harms of screening for vitamin D deficiency among asymptomatic adults. See their analysis.

We’re guessing many clinicians will disagree. Data have suggested an upswing in primary care clinicians screening for vitamin D over the past few decades, with one study showing an 80-fold increase in Medicare reimbursement for screening between 2000 and 2010. Where do you fall on this debate?

Phew, that topic is now behind us. Let’s move on to discussing the “tuck rule.”

And the Best SUPPORTING Medicine Award Goes to…

Another drumroll, please—ASPIRIN!

In a multicenter trial, 5,713 adults without cardiovascular disease were randomly assigned to receive a daily polypill of simvastatin, atenolol, hydrochlorothiazide, and ramipril—with or without aspirin—or aspirin alone vs. placebo. After a mean follow-up of 4.6 years, researchers found a 31% relative risk reduction in cardiovascular events with the polypill PLUS aspirin regimen vs. placebo. This regimen proved more effective than polypill alone or aspirin alone.

Aspirin would like to start by thanking the Academy.

Healthcare Trivia

Playing what musical instrument has been shown to reduce
the risk of obstructive sleep apnea?

Answer at the bottom of newsletter.

mRNA Vaccines Save Face in New Study

We have good news about the COVID-19 vaccines this week! At least for the mRNA vaccines. A new study showed they do NOT confer a greater rate of facial paralysis than other viral vaccines.

During Moderna’s and Pfizer-BioNTech’s phase 3 trials, 7 cases of facial paralysis or Bell’s palsy (out of 35,654) were reported. While the percentage was incredibly small (like 0.01%, give or take a few zeroes) and causation could not be proven, the FDA advised monitoring vaccine recipients for this side effect.

Now that 320 million or so people have been vaccinated worldwide, researchers have a sizable sandbox of data to play with. They already know that facial paralysis can occur with viral infections, traumas, cancers, and pregnancy, and cases have been reported with viral vaccines for decades, so the real question is whether the new mRNA COVID-19 vaccines confer a higher rate of facial paralysis than typically expected. The analysis of the pharmacovigilance data suggested they do NOT. So, keep calm and vaccinate on!

Additional good news for one mRNA vaccine

The FDA plans to authorize use of the Pfizer-BioNTech vaccine in adolescents 12 to 15 years of age by early this coming week. This is fantastic news for millions more Americans!

Healthcare Humor

Physician: Nurse, how is that little girl who swallowed ten quarters last night doing?
Nurse: No change yet.

Which Patients May Want to Pass on the J&J Vaccine

It’s been about 2 weeks since the CDC un-paused the use of the Johnson & Johnson vaccine after cases of rare blood clots were reported, but a dark cloud remains over this vaccine.

Each of us has a greater chance of playing in the NBA than developing a blood clot from the J&J vaccine, but nonetheless, many patients view it as the redheaded stepchild of the vaccine options. And some have valid reasons. Even though the data show that the J&J vaccine is largely safe and effective, the CDC offers guidance to help clinicians and patients make informed decisions about which vaccine is right for them. See what the CDC has to say about people with a previous episode of thrombocytopenia and thrombosis, women under 50, pregnant women, and those with risk factors for venous thromboembolism.

We know we’re preaching to the choir, but the J&J vaccine and the others are safe, and patients should be encouraged to get in line as quickly as possible.

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Slowly Learning the Long-Term Effects of GAHT

Given the increasing number of people identifying as transgender in the United States, it’s important to understand how gender-affirming hormone therapy (GAHT) affects long-term health, and in particular, cardiovascular health. Recently, researchers examined the effects of GAHT on blood pressure (BP) in the largest and longest observational study of its kind to date. The study, which included 247 trans feminine and 223 trans masculine patients, revealed some key findings:

In the trans feminine group:

  • Mean systolic BP decreased after starting GAHT; no change in diastolic BP
  • Cases of stage 2 hypertension dropped from 19% at baseline to 8% at 11 to 21 months

In the trans masculine group:

  • Mean systolic BP increased after starting GAHT; no change in diastolic BP
  • No change in cases of stage 2 hypertension, but cases of stage 1 increased

Interestingly, one-quarter of trans feminine and trans masculine patients experienced systolic BP changes that were the reverse of the rest of their cohort. Why can’t data be neat and simple? Clearly, the takeaway is to be aware that GAHT may affect BP and to evaluate each patient individually for BP changes and risk of hypertension.

Long-Awaited Management Guidelines for Stage 1 Hypertension

Speaking of blood pressure, your patient has untreated stage 1 hypertension (130-139/80-89 mm Hg) and a 10-year risk of atherosclerotic cardiovascular disease <10%. After 6 months of lifestyle interventions, they still haven’t lowered their BP to <130/80 mm Hg. What should you do?

According to a new scientific statement from the American Heart Association (AHA), you should consider antihypertensive treatment for this patient.

This guidance fills a gap left by the 2017 AHA and American College of Cardiology (ACC) guideline, which lowered the classification of stage 1 hypertension from 140/90 mm Hg to 130/80 mm Hg but did not offer specific treatment recommendations for this new, vast patient population.

Food Allergies—A Tough Nut to Crack

Scientists have not been able to pinpoint what causes peanut allergies in children, but they are getting closer. A new study showed a causal link between peanut allergies and cesarean section deliveries. A team of Canadian researchers found that babies born via C-section have in their bodies a reduced amount of “Bacteroides,” a species of bacteria linked to developing a strong immune system and ultimately food tolerance.

We know that in an ideal world, C-sections should be avoided, but that’s not always possible. So how can we expose infants to diverse microbial environments that include these important Bacteroides? Some experts suggest introducing a furry pet into the home to expose infants to greater amounts of Bacteroides. Yikes, just what all new parents need when bringing home their new baby—a new pet!

Healthcare Trivia Answer

The didgeridoo.

This long, cylindrical instrument popularized by Aboriginal Australians requires a breathing technique called circular breathing—inhale via the nose and exhale via the mouth, engaging the tongue and cheeks. As a by-product, the tissues along the airway are strengthened, which may help reduce obstructive sleep apnea. Beautiful music AND safe sleeping! Win-win!

Singing and double-reed instruments may also help, but the didgeridoo seems to be making the most noise in the research community.

The last time we checked, there weren’t a whole lot of songs that featured the didgeridoo. Or the cowbell, for that matter. Let’s work to change that!

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

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Not your typical medical newsletter… We get it, you see a lot of medical newsletters, so hear us out. This newsletter is intended to be fun, refreshing, and informative!

Every other week, we’ll highlight important medical news, sprinkled with some witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.