What to Know

Not serious enough

Drug ads list so many potential side effects — the mild (“nausea”) and the serious (“children born with the head of a golden retriever*”), that consumers just tune them out — the “argument dilution effect.”

So finds a study published in Nature Human Behaviour.

* https://youtu.be/4MtmIaNc2FI

And Leon’s getting laaaaaaaaarger

More than 10 times as many kids are obese today as in 1975.

In unrelated news, which smartphone is better for your middle schooler? Time compares them.

Congress’s pharmacist clarifies remarks

I am not aware of any member that actually has Alzheimer’s and would certainly not disclose any such information if I did know,” said Mike Kim, owner of Grubb’s Pharmacy, which serves the U.S. Congress.

“I was speaking very broadly about disease states that the general American population have and that it also applies to everyone including members of the US House and Senate since they are also people just like you and I.”

E99. Z22.

Bingo!

Anthem planning Atlanta IT hub

352,000 square feet of health technology goodness, opening in 2020.

“I’m not dead yet”

If, like most people, you live in fear of being prematurely buried, don’t worry. You have options.

Trump signs order to halt insurance subsidies

President Trump issued another executive order to undermine the Affordable Care Act, this one saying that he won’t allow the government to pay cost-sharing subsides to health insurers. (The subsidies were promised in the ACA, but not officially authorized by Congress, leaving them in a sort of legal limbo.)

Expect court challenges and Congressional action, but until then, what does it mean if insurers aren’t getting the funding they were promised?

You can click here to read the 14-page summary from the Congressional Budget Office (enjoy!), or just check out our brief summary:

Obviously, without subsidies, insurers will raise premiums for silver plans. (The CBO estimates a 20 to 25 percent rise.) And some will pull out of marketplaces, at least at first, meaning some people won’t be able to buy health coverage, although the CBO figures the number of uninsured won’t change dramatically.

Then there are the tax implications. The move is likely to increase the federal deficit. Huh? you say. That’s because, as insurers exit the marketplace and raise premiums, the government will pay more tax credits to individuals — and those credits are linked to premiums. Higher premiums, bigger tax credits.

(One exception: Single adults making more than about $48,240 or families of four earning more than $98,400 — 400 percent of the Federal Poverty Level. They don’t qualify for subsidies, so they’ll pay the higher premiums if they don’t get employer coverage.)

The end result will be that the deficit will increase by $194 billion from 2017 through 2026, according to figures from the CBO and the government’s Joint Committee on Taxation.

Hence, likely Congressional action: The Left wants to be sure people can afford healthcare, and the Right wants to keep the deficit under control without raising taxes … and doesn’t want to be blamed when people can’t afford medical treatment.

But what if nothing happens? The good news is that the bottom-line cost for many people who purchase individual policies is likely to be about the same … or even lower. Sure, initial premiums will be higher, but the tax credits they get from the government will offset them.

But this is all speculation at this point. Congress can act and authorize the subsidies, and lawsuits are already in process from insurers. Once again, the mantra: Wait and see.

—Andrew Kantor • Oct. 13, 2017

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How do members of Congress get their meds?

From Mike Kim at Grubb’s Pharmacy, the official pharmacy of Congress’s Office of the Attending Physician. Read all about it.

“At first it’s cool, and then you realize, I’m filling some drugs that are for some pretty serious health problems as well. And these are the people that are running the country,” Kim said, listing treatments for conditions like diabetes and Alzheimer’s. “It makes you kind of sit back and say, ‘Wow, they’re making the highest laws of the land and they might not even remember what happened yesterday.’”

And don’t miss this:

In a STAT survey of some two dozen House and Senate members from both parties, only one knew about the single pharmacy that delivers all their drugs: Congress’s only pharmacist, Rep. Buddy Carter (R-Ga.).

So far, so good

An experimental Ebola vaccine works for at least a year.

Association health plans: Good and bad

Donald Trump is expected to sign an executive order that would loosen rules on association health plans.

An AHP means that associations could offer health insurance plans for members that did not meet the requirements of the Affordable Care Act, i.e., they could offer fewer benefits and charge sicker people more.

Good: Healthy people could buy bare-bones plans with significantly lower premiums, e.g., ones that don’t offer prescription coverage or maternity care, if they don’t need those services.

Bad: People who buy that limited coverage might not realize the limits, and would be hit by huge bills if they need extra services — for example, if they’re diagnosed with an serious illness or get pregnant.

Also bad: If healthy people leave employer plans and the individual marketplace, premiums for those plans will go up. That could be bad for … well, everyone else. As the American Academy of Actuaries put it, “Such adverse selection would result in higher premiums in the non-AHP [association health plan] plans. Ultimately, higher-cost individuals and small groups would find it more difficult to obtain coverage.”

Gottlieb wants to stay at FDA

He had been rumored to be on the short list to replace Tom Price as HHS secretary. But he thinks he can be most effective where he is.

Why Adam Fein is wrong

Adam Fein of Drug Channels argues that California’s new pharma law — which requires drug makers to notify the state 60 days before a price hike of more than 16 percent over three years — will cause pharmacies to stock up at the lower price and will result in “windfall profits” for those pharmacies. (Oh no!)

But these notifications are only required for major price increases over three years. Fein’s argument assumes a single big increase (e.g., 16.5% all at once) that pharmacies will rush to take advantage of. In reality, we’re more likely to see a series of smaller increases (5%, 8%, 7%) that eventually add up to 16 percent — at which time the company will notify the state.

It also assumes that pharmacies will be able to buy at the lower price and then (somehow) be reimbursed for the higher price by insurers.

So … yeah.

Bury that deal at Wounded Knee

The entire world wants Congress to put a stop to Allergan’s deal to sell its Restasis patents to the Mohawk Tribe. And by “entire world” we mean PBMs, insurance companies, the generic drug industry, and others.

Jury misconduct in talcum powder trial?

So a jury handed a $417 million verdict to a woman who claimed that the Johnson & Johnson’s talcum powder gave her ovarian cancer.

But it turns out that, when the jury deliberated on the amount of the verdict, it wouldn’t let three members participate in that discussion because they didn’t think J&J* was liable in the first place.

So the company wants that judgement reviewed, if not thrown out entirely.

It’s worth noting that, as J&J pointed out, “no peer-reviewed study, regulatory body or public health organization has found that talc use causes ovarian cancer.”

* Yes, our subject yesterday said “K&K.” Sorry about the typo.

—Andrew Kantor • Oct. 12, 2017

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Think of them as ‘better customers’

Today’s middle-aged Americans are in worse health than previous generations.

Today’s “Universal flu vaccine coming any day now” story

Rather than targeting the proteins that change from year to year, a new type of flu vaccine will target the ones that remain the same. The result could be a more-universal vaccine.

She’s on the roof….

If you’re giving bad news, don’t embellish — cut to the chase. “Explanatory information prior to bad news was never preferred over bad-news-first.” Besides, crying is good for them.

Oops!

The bad news: More than one in five people report being on the wrong end of a medical error.

The good news: More than half the time, someone takes responsibility for it.

Food labels delayed

The FDA will be delaying new food-labeling requirements for 18 months; they would require more and better nutritional information, but manufacturers argued that they needed more time to relabel their products and the administration agreed that two years wasn’t enough.

In unrelated news, Campbell’s Soup is introducing a new series of Star Wars themed soup labels, just in time for the release of “Star Wars: The Last Jedi. ”

The big O

And you thought they just wanted cuddles.

—Andrew Kantor • Oct. 09, 2017

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Cue the lawsuits

The Las Vegas gunman was taking diazepam (10 mg). Make of that what you will — others will certainly have something to say.

The word of the day is phylloquinone

It’s vitamin K-1, it’s found in leafy vegetables (kale, cabbage, broccoli, and even (shudder!) Brussels sprouts), and it may promote healthy hearts in kids.

Xarelto trial halted

Bayer: Meh, aspirin’s as good as Xarelto for preventing clots.

Stopping the revolving door

What if — now hang on, hear this out — what if instead of simply punishing opioid addicts for drug possession, we actually tried to help them? Crazy, right? But maybe crazy enough to make a difference.

The public defender’s office here is an enthusiastic backer of the opioid court. Flynn, the Erie County DA, says local law enforcement are supportive as well. It’s dumb, Flynn says, to keep arresting, jailing and prosecuting repeat offenders who are, first and foremost, opioid addicts in need of help.

No rest for the wicked

Insys has settled with Massachusetts for illegally marketing Subsys [fentanyl] and for paying kickbacks to physicians for prescribing it. The cost: $500,000.

But before the company could celebrate, guess what? New Jersey filed suit for just about the same reasons. Bonus: The state AG used the word “evil” to describe the company.

The lawsuit, filed in Middlesex County Superior Court, alleged Insys also paid kickbacks, including sham speaker fees to medical practitioners to prescribe Subsys and defrauded insurers into paying for it.

Have you detoxed your armpits lately?

What are you waiting for?

Vitamins during pregnancy may prevent autism

At least that’s the result of one study. It concluded: “Maternal multivitamin supplementation during pregnancy may be inversely associated with [autism spectrum disorder] with intellectual disability in offspring.”

Now simple remove the word “may” and ignore the authors’ comment that “These results on their own should not change current practice” and — presto! — you have a nightly news headline.

—Andrew Kantor • Oct. 06, 2017

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Atlanta votes to decriminalize marijuana

No, that doesn’t mean it’s legal. It means the cost for possession of less than an ounce will be $75 and no jail time. (The penalty had been up to six months in jail and a fine of up to $1,000.)

Come for the windmills, stay for the tulips

The EU’s version of the FDA, the EMA, has to move from Britain — you know, Brexit and all. The staff voted on where to move. The winner: Amsterdam.

Who’s gonna buy your next drink?

Let us recommend any of these folks:

  • Shilpa Durbal (Lawrenceville)
  • Brianna Aycock (Baxley)
  • Kayla Shuman (Claxton)
  • James Farr (Woodstock)
  • Janet Foley (Powder Springs)

They’re the five lucky winners of $100 Visa* gift cards just for answering our 2017 Member Satisfaction Survey. W000000t!

*Maybe American Express. It depends what Mary picked up.

These people need a better headline writer

Their hed: “Utilization, Cost, and Outcome of Branded vs Compounded 17-Alpha Hydroxyprogesterone Caproate in Prevention of Preterm Birth.”

The real story: The branded drug Makena costs 100 times more than the compounded version. Ingredients: same. Results: same.

The $10.7 billion we’ll all pay Allergan

So you know that deal Allergan has with the Mohawk tribe? The one that protects its Restasis patent? Some folks crunched the numbers: Without a generic, Americans will spend at least $10.7 billion-with-a-B more because of it. That’s the price difference over five years, coming out of taxes (Medicare, Medicaid) and insurance premiums and going into Allergan’s pockets.

UGA Pharmacy gets a cool $1 million

The UGA College of Pharmacy will receive $1 million from the Arthur M. Blank Family Foundation “to support pharmacy students facing financial hardships.”

The foundation is also giving UGA another $500K (matched by the Georgia Commitment Scholarship Program) for “need-based scholarships benefiting UGA students from Atlanta’s historic Westside neighborhoods.”

The mamas and the papas

The teen motherhood rate in the U.S. is about the same. But the teen fatherhood rate? Up, up, up.

Why? There are only hypotheses right now: Better paternity testing, the “cougar effect,” the changing tastes of teenage girls. Good news: Teen parents are staying in school longer.

You know what you need to do

Regular sauna bathing is associated with reduced risk of hypertension

SCOTUS rules against GSK

Six women sued GlaxoSmithKline in Illinois over birth defects they claim were caused by Paxil.

GSK said that Illinois doesn’t have jurisdiction because the women didn’t live there.

An Illinois court ruled that yes, yes it does.

GSK appealed to the Supreme Court, but yesterday SCOTUS declined to review that ruling. Illinois it is.

US stockpiles a million doses of Ebola vaccine

Nothing to see here, citizen.

—Andrew Kantor • Oct. 03, 2017

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It’s American Pharmacists Month

You got that right. The APhA even has a planning guide to help you celebrate it: events, tours, counseling, you name it. So spread the word, join the party, get schwifty … and celebrate being a pharmacist! (Technicians can celebrate October 17 — that’s Pharmacy Technician Day.)

Share the love: Show off your pics, stories, and whatever else you got with aphm@aphanet.org or hashtag it #APhM2017 on Twitter or Facebook. Or Instagram. Or Snapchat. Or whatever the kids are using these days.

Join GPhA in Cherokee County

If you’re near Woodstock (the one in Georgia) tonight, stop by the Cherokee County Opioid & Heroin Community Awareness Forum. GPhA’s gonna be there with a table, helping to spread the word that pharmacists are fighting the epidemic, too. The more white coats, the better!

STD rates are going up

According to the CDC, there are about 110 million cases of chlamydia, gonorrhea and syphilis in the U.S. right now, walking among us. (Note: That doesn’t (yet) mean that almost one in three Americans has an STD. Some people have more than one.)

Have some fun facts:

  • Chlamydia is the most common STD, and it’s up 4.7 percent just from 2015 to 2016.
  • Almost one in 10 girls aged 15 to 19 have it, and 8.0 percent of women aged 20 to 24. Rates are highest in the South.
  • Rates of chlamydia are down among African-Americans and American Indians.
  • Gonorrhea infections went up more than 22 percent among men and almost 14 percent among women — again, just from 2015 to 2016. “Almost 92 percent of cases are in people 15 to 44 years old.”

9 million kids about to lose health insurance

Congress has allowed the Children’s Health Insurance Program to expire. Without funding, about nine million will lose access to medical care ranging from routine checkups and immunizations to dental care and hospitalization.

Researchers uncover the source of diabetic nerve pain

Painful diabetic neuropathy appears to be caused by a single molecule: HCN2. The investigation is ongoing; police say HCN2 has been cooperating with their inquiries.

Compounders take note

USP intends to postpone the official date of General Chapter <800> Hazardous Drugs – Handling in Healthcare Settings.  You know what this means.

Tick tock, Clarice

The Nobel Prize in Physiology or Medicine 2017 was awarded to three Americans “for their discoveries of molecular mechanisms controlling the circadian rhythm.”

Bonus: Unlike the prizes for physics or chemistry, this one is actually understandable by lay people.

The buyer bites back

A judge has ruled that yes, a new Maryland law that lets the state say ‘No’ to price gouging on drugs can go into effect.

The state’s Medicaid program pays for a lot of drugs, obviously, and the new law allows it to flex some of that buyer’s muscle. If an “essential” generic drug’s price rises 50 percent or more over a two-year period, the state’s attorney general can take the drug maker to court.

Pharmaceutical companies had argued that the state should have to pay whatever they wanted to charge for medications. Seriously.

Bandwagon Watch

Washington state joined the growing list of states, cities, and towns suing opioid manufacturers for their role in the opioid epidemic.

Separately, the city of Seattle joined the growing list of states, cities, and towns suing opioid manufacturers for their role in the opioid epidemic.

Tom Price is out

The Health and Human Services secretary was asked to resign after investigations into his use of taxpayer money for private flights embarrassed the administration. (Yes, you know this already; we just couldn’t ignore it.)

—Andrew Kantor • Oct. 02, 2017

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We can forget it for you wholesale

Researchers have discovered the molecule that stores our long-term memories. (It’s called CaMKII, if you feel like Googling it.)

Understatement of the month: “Though it would raise serious ethical issues, it might also allow us to change our pasts by wiping out recollections of unhappy experiences.”

Playmobil: They don’t make it like they used to

Good news! That cancerous lump might only be a traffic cone.

GPhA out and about

In this week’s episode of “The Adventures of Bob and Greg,” our heroes visited with student pharmacist leaders at Mercer.

(L-R William Webb, Andrew Blake, Ellen Weng, Lillian Portillo, Mary L. Nguyen, Mary Kelly Hedgpeth, Vanessa Cano-Estrada, Dawn Lieber Sasine, Greg Reybold, Bob Coleman)

Feds balk, patients pay

So you know the whole issue of the federal government not paying insurance companies the subsidies they were promised under Obamacare? Result: Georgia is looking at rate hikes of more than 50 percent in 2017 because insurers aren’t getting those payments.

While the Trump administration has repeatedly threatened to withhold the money (hence the rate hikes), the collapse(s) of the ACA repeal effort(s) mean Congress may find a bipartisan solution that includes reinstating those ACA subsidies. Stay tuned.

Admit it, this is really cool

One-size-fits-all is so 2017. Imagine when custom drugs are printed on the spot for individual patients — then put in pills, on patches, in clothing … who knows?

Researchers at the University of Michigan have invented a technique that they say can print precise doses of multiple drugs onto a variety of surfaces. One day […] the technique could lead to on-the-fly printing of custom medications at pharmacies, hospitals and other locations.

It’s flu season

You know what to do: Spread the word, offer it to patients, yada yada yada.

Remember: 1) The FluMist nasal spray still doesn’t work (sorry, kids), and 2) adults with chronic conditions might benefit from the higher dose version given to seniors.

—Andrew Kantor • Sep. 28, 2017

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Why the chicken crossed the road

If you’re giving a flu shot to a senior, tell a joke. The shot will be more effective.

Shrinkage pays off

Losing weight — even if you just go from “obese” to “really fat” — can save you a lot of money in the long run. (And not just by cutting the Oreo budget.)

What is the world coming to?

For some reason, the FDA wants “Flawless Beauty” to stop selling unapproved, mislabeled, injectable skin whiteners to consumers.

A new take on BOGO*

Donate a kidney, get a voucher so a loved one can get an organ later.

*Buy one, get one. Do you people not shop?

Don’t look so surprised

If you’re a drug wholesaler shipping massive amounts of opioids to a handful of pharmacies in southern West Virginia, the U.S. Congress might want to have a word with you.

Is this really something you need pointed out?

Pro tip: When a drug can cause severe birth defects, you don’t want to wait 40 years to start spreading the word.

—Andrew Kantor • Sep. 28, 2017

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Gainsville Drug Summit tonight

If you’re in the Gainesville area, join GPhA at the Hall County Drug Summit tonight from 6:30 – 8:00 p.m. at the Brenau Downtown Center, 301 Main St. in Gainesville. The more pharmacists who show up, the better!

On second thought, we’d rather have the cash

Remember when drug makers promised to keep their annual price hikes to less than 10 percent? (That’s only about five times the U.S. inflation rate.) Now AbbVie is saying, “Maybe not.”

Why not? One reason, according to analysts on the call: The company makes more money if it raises the prices, and the hubbub about pricing is dying down. As one of those analysts put it, “[P]rice hikes have been an important growth driver at AbbVie.”

Meanwhile, distributors are suffering

Drug distributors profits have been increasing year over year, but the latest estimates show that those increases are slowing.

The Big Three distributors are only expected to see revenues of $424.9 billion in 2017. That’s 4.5 percent above 2016, which may sound good, but while revenue is increasing, revenue growth is slowing — as this Drug Channels chart shows:

Psst, you. Yeah, you

If you use Facebook without an ad blocker (you fool!), get ready for some targeted drug ads.

Facebook and the music streaming service Pandora are aggressively vying for pharma dollars by promising to help drug makers identify and reach the users most likely to have certain diseases or conditions.

I can’t see clearly now

Cutting through the jargon (see below if you like jargon), we learn that kids who play outside are less likely to become nearsighted than kids who don’t, although genetics still plays the biggest role.

Jargon:

Lower amounts of sports and outdoor activity increased the odds of becoming myopic in those children with two myopic parents more than in those children with either zero or one myopic parent. The chance of becoming myopic for children with no myopic parents appears lowest in the children with the highest amount of sports and outdoor activity, compared with those with two myopic parents.

Don’t quit

Do you take a low-dose aspirin to help protect against heart attack or stroke? In the name of all that’s holy, don’t stop.

—Andrew Kantor • Sep. 26, 2017

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Candler. Cook. Wheeler.

Georgia — and those three counties — are ground zero for the rural hospital crisis: Here’s a great report from Georgia Health News.

Spoiler: People can’t afford healthcare. Rural hospitals lose money treating them. Hospitals (which are major employers) close. Communities collapse with them.

ManganeseWatch™

Manganese: It’s not just an obscure Asian language group* — it’s an essential mineral, too much of which could lead to a Golden Horde “golden staph” infection of the heart.

*Kidding! Kidding!

Medicare changes on the horizon?

Tom Price and the Trump administration are floating ideas for Medicare changes (don’t call them cuts!) that would allow physicians to charge patients more and would encourage ‘premium’ Medicare options for those who could afford them.

Librarian of the Year

A high-five to narwhal-friendly PCOM librarian — and School of Pharmacy liaison — Skye Bickett, who was named Academic Librarian of the Year by the southern chapter of the Medical Library Association.

Nobody likes the latest GOP healthcare bill

Let’s see … who’s come out against it?

The American Medical Association, the AARP, governors from both parties, the American College of Physicians, the American Academy of Pediatrics, the American Cancer Society, the American Diabetes Association, the American Heart Association, the American Lung Association, the Arthritis Foundation, the Cystic Fibrosis Foundation, the March of Dimes … and about a dozen more.

From the right: “Doctor, hospital, and insurance groups are blasting the Republican healthcare bill

From the left: “Physicians rarely agree on anything as strongly as they do that the Graham-Cassidy health-care bill is harmful.”

Also from the right: “…a bill that is based on dishonest claims, avoids the usual professional analysis, and makes a mockery of serious legislative process.”

From the center: “Doctors, insurance companies and patient groups slam Graham-Cassidy“:

Insurance companies, doctors, patients, hospitals and other patient-provider groups are rallying together against the Graham-Cassidy plan, saying it could result in millions losing access to affordable health care and coverage.

Here’s a small way to fight opioid diversion

Timer caps for pill bottles, so legit users can see if anyone else has taken anything from the bottle. Downside: $10 a bottle.

Post-approval, schmost-approval

Did you know that, after a drug is approved, the manufacturer is supposed to conduct studies to determine dosing and side effects? Did you know that in many cases these aren’t done? Now you do.

Georgian on the move

A shout-out to a native son who’s done good: Congrats to James “Randy” Evans, who was named Ambassador Extraordinary and Plenipotentiary of the United States of America to the Grand Duchy of Luxembourg.

—Andrew Kantor • Sep. 22, 2017

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