We were wrong about how Alzheimer’s spreads

Alzheimer’s doesn’t spread the way we thought it did. That’s the big takeaway from an international study out of Cambridge University.

Old thinking: Alzheimer’s starts in one part of the brain, then spreads like a cancer.

New revelation: The disease’s tau proteins are already clumping throughout the brain when the disease starts.

[T]he mechanism controlling the rate of progression in Alzheimer’s disease is the replication of aggregates in individual regions of the brain, and not the spread of aggregates from one region to another.

Or, oversimplified, the disease spreads slowly from a lot of points, rather that quickly from a single location, “and so trying to stop the spread between regions will do little to slow the disease.”

The key, they say, will be to stop those many regions from expanding.

Best immunization weekend ever

Pharmacists! Pharmacy techs! With booster shots coming, you need to be the best immunizer ever — just like you swore to be when you were a little kid.

Good news: GPhA is offering the hot courses you need in early December, giving you plenty of time to plan.

For technicians there’s GPhA’s Immunization Delivery Training for Pharmacy Technicians — a 6.0 hour CE program consisting of both home-study and live training. It’s on Saturday, December 4, from 9:00 am to noon at the GPhA World Headquarters classroom in Sandy Springs. (Of course it’s PTCB-recognized!) Click here for the details and to register now.

For pharmacists, we’ve got APhA’s Pharmacy-Based Immunization Delivery: A Certificate Program for Pharmacists on Sunday December 5, 8:00am to 5:00pm. It’s part of the 20-hour certificate program (including self-study). That’s also in the GPhA classroom. Get the details and register today.

Remember: Because these are in-person programs, space is limited!

Remission potential

How many people achieve type 2 diabetes remission? About 5 percent, according to Scottish researchers, after studying the medical records of 162,316 people.

Notably, the people in remission usually didn’t take any glucose-lowering meds, but they did lose weight, including via bariatric surgery. (They also tended to be older and have a lower HbA1c.)

What does this mean? It means remission is possible, and when it comes to type 2 diabetes, weight management might be just as important than drugs.

Wariness about molnupiravir

With Merck/Ridgeback’s molnupiravir looking like it’ll be the first Covid-19 treatment in pill form, there is a little bit of worry out there — as there always is. In this case, it’s because of how the pill works. Molnupiravir, a mutagen, increases the virus’s mutation rate until it turns into … well, let’s say not one of the X-Men.

It’s only supposed to affect viral RNA, but “One study has suggested that the drug, though intended to disrupt only viral RNA, could also incorporate into and cause mutations in human DNA.”

UNC biochem/biophysics professor Ron Swanstrom cut to the chase:

“The question that I don’t have an answer for, and it’s unknown, as far as I’m concerned: is it a totally acceptable risk that means nothing? Or is it a more significant risk, but we won’t know the outcome for 10 years?”

A quick pic from the Hill

Georgia compounding pharmacists Austin Hull and Shawn Hodges prepared to meet with Senator Jon Ossoff — they’re in D.C. as part of the Alliance for Pharmacy Compounding’s “Compounders on Capitol Hill” advocacy event.

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“You’re so bad at math, I bet yo mama took SSRIs”

Here’s an odd correlation: Kids whose mothers took antidepressants during pregnancy scored lower on standardized math tests (but not on language tests). That’s what those shifty Danes found when they looked at the records of 575,369 school kids and their moms.

To be clear, the effect was real, but …

The magnitude of the difference in the mathematics test score was small and of uncertain clinical importance, and the findings must be weighed against the benefits of treating maternal depression during pregnancy.

D: Enough is enough, but not enough is not enough

And here’s a not-so-surprising correlation: A British study found that, while having enough vitamin D won’t make a difference in your life, having low levels increases your risk of “all-cause mortality outcomes.” It can also increase your chance of heart attack or stroke specifically, but that risk was “generally non-significant*.”

How much do you need in your blood? At least 40 nmol/L, or, for we normal people, 11.5 ng/mL.

* Because they used stratified Mendelian randomization analyses, it must be true.

Trigger warning: ivermectin update

Some interesting updates to the ‘ivermectin for Covid’ story. Try to keep calm and just say, “Hm. That’s interesting.” (Why this particular drug is somehow political, I have no idea. Why not molnupiravir?)

Background: The idea of using ivermectin for Covid-19 started with an Egyptian study that found ivermectin was a powerful potential treatment for asymptomatic people.

Unfortunately, that study turned out to have some serious issues, “including dozens of patient records that seemed to be duplicates, inconsistencies between the raw data and the information in the paper, patients whose records indicate they died before the study’s start date.”

It was withdrawn by the publisher, but not before it was being used in meta-analyses. (Hold that thought.)

The same thing then happened with a different study — this one out of Lebanon and published in May. It was just retracted after similar issues of questionable patient data came to light.

The latest: So now the authors of one of those aforementioned meta-analyses have re-done their work and published a preprint correction. Their conclusion:

The results suggest that the significant effect of ivermectin on survival was dependent on largely poor quality and potentially fraudulent studies.

That doesn’t mean ivermectin doesn’t work — just that the existing studies aren’t good enough to give an answer. We need better studies to know what’s what.

But wait: The authors of that Lebanese paper say they submitted the wrong file.

After revising the raw data we realised that a file that was used to train a research assistant was sent by mistake for analysis. Re-analysing the original data , the conclusions of the paper remained valid.

Now they’re considering re-submitting the paper. If it’s valid, of course, its results could swing the pendulum the other way as meta-analyses take it into account. Science, baby!

Good Covid news

It doesn’t seem to infect brain cells after all.

German and Belgian neurogenetics researchers found that conditions like loss of smell were from the virus attacking structural cells in the nose, not the sensory neurons. “Olfactory sensory neurons,” they wrote, “would become affected without getting infected.”

Mayo Clinic’s cancer test

The Mayo Clinic is rolling out Galleri, a new test it says can detect more than 50 cancers; it’s expected to be widely available in time for the holidays*.

And yes, that phrase comes up:

“In the year 2021 this is so far beyond anything else we’ve been able to do. This is a game-changer,” said Dr. Greg Plotnikoff.

Galleri was actually announced in June, but now a national rollout is imminent. It won’t be available in a blister pack by the register, though. For one, it’s intended for people at an elevated risk for cancer. For another, it’s $949 in the U.S., prescription only, and not covered by insurance.

Despite that, Galleri already has its own spiffy, patient-focused website. And Plotnikoff is all in — he’s “prescribed the test for patients and family members with risk factors, saying cancers caught early are in more treatable stages.”

* And way less risky than giving someone a 23-and-Me kit.