Congratulations to the world-famous pathologist who, one year after an experimental cancer treatment based on his own research with melanoma, is still cancer free. Diagnosed with glioblastoma, Dr. Richard Scolyer received a combination of immunotherapy, surgery, radiotherapy, and personalized vaccine. He says he “couldn’t be happier.”

☕️Postcall’s one-sip markets update:

Nvidia’s earning call isn’t happening until this afternoon, but that hasn’t stopped it from rallying over the last couple of days. That, and the strong earnings reports coming from companies across various industries (like Sony and Merck) are contributing to the S&P hitting its all-time high (again).

Here’s what we got for you today:

1. Hold that Ozempic

2. The game of pharma-opoloy

3. Scarlett Johansson wants her voice back

4. How to earn $1.26M a year

5. Image challenge and Crossword

Staying #Up2Date 🚨

1. Hold that Ozempic

The American Gastroenterological Association (AGA) has published a clinical practice update on withholding GLP-1 receptor agonists for upper endoscopy (increased risk of aspiration). An individualized approach is recommended: while GLP-1 agonists could be withheld in patients who take the drugs solely for obesity, in a patient with diabetes the risks may outweigh the benefits. For those on GLP-1s, proceed with the scope if an 8-hour solid-food fast and a 2-hour liquid fast has been observed (and no nausea/vomiting/abdominal distension).

2. Statins & ‘betes

A meta-analysis suggests that patients who take high-dose statins have about 1% higher risk annually for newly diagnosed type II diabetes. After crunching the numbers, new-onset diabetes was slightly but significantly higher with initiation of low-to-moderate–intensity statin (1.3% vs. 1.2% for placebo, annually) and higher still with high-intensity statins (4.8% vs. 3.5% for placebo, annually). Should we rethink primary prevention in patients with borderline indications for statin therapy?

3. Prostate cancer screening in Black individuals

A US panel conducted a systematic review of prostate cancer screening in Black individuals with the following recommendations: 

• Discussions about screening should begin as early as age 40, and if choosing to undergo screening, a baseline PSA should be obtained at age 40-45 (repeated q1y depending on health status). Although those with family history or high-risk genetic variants may require earlier screening (age 40). 

• Lowering the age for baseline PSA from 50 to 55 years of age and regular screening until 70 could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis.

👾 Patent Wars

Congress is shifting its attention from Medicare drug price brawls to the strategic overhaul of the patent system (that pharma giants use to delay competition).

What happened: The new bipartisan focus is on ending tactics like "product hopping," where minor changes to a drug extend a brand name's monopoly, which then keeps generics out (and preserves profits). Though multiple bills aiming to increase competition and lower prices have been proposed, a comprehensive reform package has been stuck in the Senate for 15 months.

Why it's interesting:

• AbbVie's Humira, which held a 20-year $200 billion monopoly, spurred calls for change.

• Sens. John Cornyn (R-Texas) and Richard Blumenthal (D-Conn.) proposed a bipartisan plan that works to limit patents a company can contest and address product hopping.

• But this bill has been awaiting floor action since the Senate Judiciary Committee advanced it in Feb. 2023.

Yes, but… Some senators, backed by big pharma, are pushing bills like the PREVAIL Act, which would restrict who can challenge patents, potentially making it harder to invalidate dubious patents. And drugmakers argue that generics already dominate 90% of prescriptions and blame pharmacy benefit managers for price hikes.

Speed Reads 🚤 

1: 👁️ The FDA has approved 2 drugs similar to Regeneron Pharmaceuticals' Eylea: Biocon Biologics' Yesafili and Samsung Bioepis and Biogen's Opuviz. Regeneron saw it coming, and have been focusing their marketing on the 8-mg higher dose of Eylea. (In the first quarter, they made $200 million.)

2: 🎧 Lawyers of Scarlett Johansson have sent OpenAI 2 letters asking how they developed the voice “Sky,” a voice that sounds suspiciously like her. Even more suspicious: OpenAI CEO Sam Altman approached Johansson to be the voice of ChatGPT 4.0 back in Sept. Think he’s just a big fan of that movie Her (in which Johansson plays an AI virtual assistant)?

3: 🤖 The world’s first AI law has been passed in the EU, prohibiting practices of “unacceptable risk.” The AI Act includes restrictions on biometric data, scraping facial data to expand facial recognition databases, and AI that manipulates or deceives people. First Apple, then AI… what will Europe save next?

4: 🩺 About time… our neighbours to the north (Canada) has green-lit a lawsuit against RateMDs. The civil suit was brought by a BC-based physician, Dr. Ramona Bleuler, who said that the site violates privacy laws. RateMD responded by saying that Bleuler doesn’t have a “reasonable expectation of privacy” and wants to “stifle warranted criticism with respect to how she practices medicine.”

Notable Numbers 🔢

94: the average number of hours that anesthesiologist Dr. Sebo Amirkhanian Namagerdy, LA County’s highest-paid employee, works every week at Rancho Los Amigos National Rehabilitation Center. Was it worth it? He did earn $1.26M USD in 2023.

2: the number of human cases of H5N1 now identified in the US. This new patient is based in Michigan and showed eye symptoms.

340B: A DC Circuit panel ruled Tuesday that drug manufacturers can limit the sales of drugs in the federal discount program for low-income patients.

Postcall Picks ✅ 

🌼 Plant: With April showers behind us, it's prime time to plant seeds (only $2 per pack)! Get outdoors, soak up some vitamin D, and prepare for the blooming beauty of May flowers.

✈️ Travel: Embark on a 1-week retreat to the Grand Hyatt Kauai Resort (Oct. 6 - 10) to learn about addictions, gastro, ortho, and sleep medicine. 20 CME credit hours. Register here.

📖 Read: "When Breath Becomes Air," a memoir by Dr. Paul Kalanithi who was diagnosed with terminal cancer at the age of 36. Through poignant reflections, Dr. Kalanithi invites us to contemplate the nature of existence and the significance of living a meaningful life.

🤣 Laugh: at the words that no doctor wants to hear…

Game ⛳️

First question: What is the recent holiday that commemorates the "Mother of Confederation," a.k.a. May Two-Four?

If you enjoyed our puzzle, please share! ☺️

Image Challenge 🖼️ 

Source: 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.