Don’t Miss 2024’s Top 5 Stories From Canada

Medscape Medical News tallied the most-read Canadian stories of 2024 to draft a list of the five that garnered the greatest interest and, in some instances, an outpouring of advice.

Here’s the countdown.

5: ED Visits for Cannabis Use a Harbinger of Anxiety Disorder

Many readers appreciated this story, which points to the risk that cannabis use may increase anxiety rather than alleviate it. This observation is particularly true for the Baby Boomer generation, who might be accustomed to a much weaker concentration of tetrahydrocannabinol (THC), the psychoactive ingredient in dried cannabis flowers. The concentration was 2% in the 1960s and 1970s and is between 20% and 30% now.

The researchers analyzed health administrative data for more than 12 million patients in Ontario aged 10-105 years with no previous visits for anxiety disorders. About 24% of those with an emergency department (ED) visit due to cannabis had an incident outpatient visit, ED visit, or hospitalization for an anxiety disorder within 3 years. These patients were almost four times more likely than the general population to be diagnosed with an anxiety disorder.

The increased risk for an anxiety order was seen across all age and sex strata. However, younger men with ED visits for cannabis use had a greater risk than younger women.

Not everyone agreed with the interpretation of the findings, however. Donald Condliffe commented, “The causal direction is missing in this type of study. It is as probable that predisposition to anxiety disorder causes more marijuana use to self-medicate as it is that marijuana use causes anxiety.” 

Dr Keith Raymond agreed, noting, “We need to address the behavioral causes of the anxiety, not the drugs used to alleviate it. That’s a bit like blaming fentanyl for overdoses.”

4: Plant-Based Meat Alternatives May Be Better for the Heart

This story covers a review of randomized controlled trials of plant-based meat alternatives (PBMAs), which found that these meats are a healthy alternative to animal meat.

The researchers analyzed the literature from 1970 to 2023 on PBMAs and their impact on cardiovascular risk factors. They found that compared with animal meat, PBMAs had less saturated fat, less cholesterol, more fiber, more carbohydrates, fewer calories, less monounsaturated fat, more polyunsaturated fat, and more sodium.

They also acknowledged, however, that no long-term research has evaluated how PBMAs may affect the risk for myocardial infarction or stroke. Similarly, there is little research on the healthfulness of some common components of PBMAs, such as vital wheat gluten.

Although many readers responded favorably to the story, several commentators did not. Some agreed that animal meat may entail risks for inflammation, cancer, and other ills, and that meat production is environmentally unfriendly, whereas others pointed to the downsides of processed meat substitutes, including a high amount of saturated fats, sodium, and carbohydrates. 

One commentator, Philip Caskanette, concluded, “I’ll stick with my protein sources: meat and fish with no or minimal additives, cheese in various forms in moderation, and eggs for breakfast on alternate days (oatmeal or homemade granola with fruit and nuts on other days).”

3: What Is the Clinical Course of Low Back Pain? 

This story reports on a study that updated an earlier systematic review and meta-analysis on acute, subacute, and chronic low back pain. The story was popular with readers, though several commentators pointed to the need for additional information.

The researchers analyzed 95 studies to understand the clinical course of acute, subacute (lasting for 6 to less than 12 weeks), and persistent (lasting for more than 12 weeks but less than 52 weeks) low back pain. They excluded retrospective cohorts and interventional studies, as well as studies of patients with low back pain for more than 12 months.

Overall, patients with back pain lasting less than 12 weeks had a high probability of substantial pain reduction over time, but patients with back pain that persisted for 12 or more weeks had a lower chance of improvement.

The study’s principal author acknowledged that the research team did not have individual patient data, which was a big limitation.

The story’s independent commentator stated that the study authors did not mention specific approaches that could decrease progression from subacute to persistent low back pain, noting, “It would have really improved the impact of the paper if they had seen anything along the way in their review of these articles that might have suggested how someone or a group might have been able to impact this progression.” 

Several commentators tried to fill the gap with their own treatment suggestions, and some noted that it was difficult to talk about solutions without having information on the type of pain and possible causes.

2: Prevalence of Dementia in Homeless Twice That in Housed

This story describes a study that pinpoints a higher prevalence of dementia among homeless people in Ontario and suggests that the disorder occurs at a younger age (45-55 years) in this population than doctors currently screen for it. 

The cross-sectional analysis compared dementia prevalence among individuals aged 45 years or older in 2019, including those who were homeless (12,863 people), low-income but not homeless (475,544), or in the general population (more than 2 million).

The researchers found that after adjustments for age, sex, geographic location (urban vs rural), and health conditions associated with dementia, the prevalence ratio of dementia among homeless people was 1.71 compared with the low-income group and 1.90 compared with the general population group. 

The authors of an accompanying editorial cited modifiable risk factors for dementia, such as lower education, traumatic brain injury, smoking, substance use, mood disorders, and social isolation, all of which may be disproportionately prevalent among homeless. individuals. 

“Ultimately, dementia could contribute to the cycle of homelessness, whereby housing instability increases the risk for brain impairment, and brain impairment makes breaking the cycle of homelessness progressively more challenging,” they wrote.

This story was popular with readers and drew few comments.

1: Postinfectious Cough: Are Treatments Ever Warranted?

This story covered an overview of postinfectious cough in adults that cites various studies on the condition’s prevalence, diagnosis, and management.

The authors concluded that in the absence of red flags such as hemoptysis, systemic symptoms or dysphagia, there is no evidence supporting pharmacologic treatment for this disorder. They also noted a lack of guidelines on the topic. 

The lead author stated, “A lot of patients come in looking for solutions, but really, all the evidence says the over-the-counter cough syrup just doesn’t work. Or I see clinicians prescribing inhalers or different medication that can cost hundreds of dollars, and their efficacy, at least from the literature, shows that there’s really no improvement. Time and patience are the two keys to solving this.”

Commentators cited in the story provided more nuanced advice, particularly for patients with underlying lung disease, and even for those who might have “cough hypersensitivity syndrome,” which could be helped with “therapies targeting the neuronal pathways.” One suggested that the authors “overplay[ed]” environmental concerns about metered-dose inhalers, which might be helpful in some cases.

This story was popular with readers, but commentators expressed dismay at the conclusions. Many talked about their personal experiences with postinfectious cough and how they treated patients. Several felt that the overview downplayed patient concerns. 

For example, Dr Pierre Filardi commented, “ Patients deserve treatment to mitigate their misery and suffering if the cough itself has become a problem. Pick your drug, but don’t deny them something just because in medical school you learned not to suppress a cough pharmacologically!” 

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.