Congratulations to the researchers who’ve developed oral insulin drops that could change how diabetes patients receive insulin. A project that took 3 years to develop, the drops contain a mixture of insulin and a unique cell-penetrating peptide that helps the insulin reach the bloodstream quickly.

☕️Postcall’s one-sip markets update:

The markets have reached new heights this week. We see some good news: inflation didn’t rise in May (yay!) and and therefore the Fed’s holding onto its interest rates. And they’re recognizing that there has been "modest further progress" toward their 2% inflation target.

Stock to watch: 🍎 Apple investors really liked their AI announcements at WWDC, pushing the stock to a record high in a vote of confidence.

Here’s what we got for you today:

1. Bronny James is back

2. The legacy effect of metformin

3. Novo Nordisk in the hot seat

4. The pig kidney transplant didn’t work 😥 

5. Don’t believe the “plant-based” hype

6. Postcall Crossword and Image Challenge

Staying #Up2Date 🚨

1. Returning to play 🏀 

Earlier this month, Bronny James was officially cleared for the NBA draft following his cardiac arrest last year, just as new, international recommendations on arrhythmias in athletes of all ages have surfaced. The recommendations emphasize:

• Appropriate treatment and proof of suppression of arrhythmias with sports-specific stress testing prior to return to play for athletes with arrhythmic risk.

• Endurance activities may increase the risk for afib and development of arrhythmogenic right ventricular dysplasia.

• Sport and athlete considerations should guide pacemaker or implantable cardioverter-defibrillator choice.

2. The “legacy effect” 🏆 

A UK prospective study from 1977-1991 enrolled 5,000 patients with newly diagnosed type II diabetes (t2dm) who were randomized to early intensive glycemic control with sulfonylurea or insulin (or metformin) vs. diet alone. At 10-year follow-up, those who received early medication had significantly lower risk for all-cause mortality and myocardial infarction (MI). Now, after a median 18 years of follow-up, patients who initially received sulfonylureas or insulin were found to have significantly lower risk for all-cause mortality (hazard ratio, 0.90), MI (HR, 0.83) and microvascular disease (HR, 0.74). The mechanism of this “legacy effect” is unclear, although the lifelong value for t2dm diagnosis and early intervention is clear. 

3. Guideline Watch 👀 

The American Colleges of Cardiology and Heart Associations have updated their 2016 peripheral artery disease (PAD) guidelines. Low-dose rivaroxaban and aspirin is now recommended to decrease the risk for major adverse cardiovascular events (MACEs) and major adverse limb events in patients with symptomatic PAD who are not at increased bleeding risk. In patients with PAD and type 2 diabetes, the use of glucagon-like peptide-1 (GLP-1) agonists and sodium–glucose cotransporter-2 (SGLT-2) inhibitors are effective to reduce MACE. This update mirrors in the 2022 Canadian guidelines for PAD.

Novo Nordisk feels the Bern 🥵 

What happened: Sen. Bernie Sanders (I-Vt.) is going after Danish drugmaker Novo Nordisk over its sky-high prices for the weight loss and diabetes drugs Wegovy and Ozempic. Sanders wants to subpoena Doug Langa, Novo’s North American head, to explain why Americans are paying up to 15x more for these meds compared to other countries. Novo’s American depositary receipts took a brief hit but quickly bounced back, continuing their upward trend this year.

Why it’s interesting:

• Novo’s stock is already up 37.1% this year, but dipped 1.3% on Tuesday.

• Wegovy’s monthly list price is $1,350 in the US, while Ozempic goes for $935, compared to just $328 and $103 in Germany.

• There’s a potential $2.8 billion annual cost to Medicare if just 10% of eligible beneficiaries use Wegovy. 📈 

• There are compounded alternatives: Hims & Hers Health is offering a compounded version of semaglutide or $199 a month — though it doesn’t accept insurance.

• A vote on whether to subpoena executives is set for June 18.

Yes, but: Novo argues a subpoena is unnecessary, claiming CEO Lars Fruergaard Jørgensen is ready to testify and has proposed dates for a hearing. The company insists it’s cooperating, saying the price reflects innovation and investment costs. Meanwhile, compounded alternatives raise safety concerns among branded drugmakers.

Postcall’s Take: We’re expecting this political drama to keep simmering. Sanders’s push highlights the ongoing tension over drug pricing in the US. With an election on the horizon, this issue isn’t cooling down anytime soon. For Novo, the demand for Wegovy remains sky high — so we also wouldn’t sell the stock.

Speed Reads 🚤

1: 🫀 The woman who received a pig kidney transplant — the 2nd person to receive a kidney from a gene-edited pig — is back on dialysis 47 days after the doctors removed the kidney. NYU will study the failed organ to learn what it can about how it reacted inside a person.

2: 🔍️ Privacy regulators in Canada and the UK are launching a joint investigation into a 2023 data breach that compromised the genetic and ancestry data of 6.9 million 23andMe users. Luckily, the data stolen did not include DNA records.

3: 🤑 A Hulk Hogan-themed memecoin — allegedly promoted by Hulk Hogan — lost $15M in its market cap within minutes after Hogan deleted all posts promoting the crytopcurrency. Hogan has since denied he wrote any of the promotional posts.

4: 💊 A pain management startup, Sword Health, has announced a new AI that patients can talk to, which will help patients manage pain from home. The AI will guide patients through virtual physical therapy sessions, and will help avoid other treatments like opioids and surgery. We’re not clear on how evidence-based the treatments are though.

5: 🌲 Don’t get greenwashed - a longitudinal study of 118K people in the UK published this week in the Lancet found that every 10 percentage points increase in plant-sourced non-ultra-processed food consumption was associated with a 13% lower risk of CVD mortality. Conversely, plant-sourced UPF consumption was associated with a 12% higher mortality.

Notable Numbers 🔢

20: the number of people in the English-speaking medical world who have been diagnosed with “auto-brewery syndrome” — also known as “gut fermentation syndrome.” The rare condition means fungi in a person’s gut ferments alcohol from carbohydrates and can cause a person to feel alcohol intoxication without drinking.

$217,875: the average annual compensation of paediatric endocrinologists, the lowest-earning specialty, according to the 2024 Doximity Physician Compensation Report. Check out more stats, like compensation growth by metro area and specialities with the highest average annual compensation, here.

14%: That’s the % of how much of the total market trading volume is penny stocks (up from just 5% just a few years ago). Which is wild. From crypto to sports betting to penny stocks to GameStop, everyone wants the magic lottery ticket. We don’t think trading penny stocks is the way to get it.

Postcall Picks ✅ 

💳️ Plan finances properly: with your spouse or partner in this week’s podcast from the White Coat Investor. They also answer another handful of questions about Roth IRAs, Roth conversions and rollovers, the mega backdoor Roth and more.

🤣 Laugh: at this one weird trick…

🦪 Eat: carefully (and tell your patients) if you live in Washington or Oregon or get shellfish from those states, due to an advisory from the FDA about paralytic shellfish poisoning (PSP). Watch out for patients with numbness of the mouth and lips, vomiting, diarrhea, shortness of breath and irregular heartbeat in severe cases.

📱 Feel superior: to your Android-using friends. Apple announced on Monday that new AI features are coming to iPhone 15, M1 Macbooks, and newer. Our 3 favourite features:

1. ChatGPT inside of Siri (but don’t worry, it’ll ask you for permission before sending anything off-device)

2. Generate custom images and emojis for your emails and texts

3. The calculator on iPad can now do this:

Game ⛳️

First question: What is a condition characterized by light scratches becoming raised and inflamed?

If you enjoyed our puzzle, please share!

Image Challenge 🖼️ 

lSource: Originally published on NEJM

🤘 PS. If you’re reading this, you know that our readers are America’s best and brightest physicians. Learn about partnering with Postcall if you’d like to reach them.