Pain, schmain, let me sleep

If you’re in pain, wait till morning if you need the ER. Physicians working late into their shifts — i.e., who are sleep-deprived — have less empathy for patient pain and thus prescribe fewer painkillers. So found a joint U.S.-Israeli study of prescribing habits.

Looking at more than 13,000 medical records…

The study found the physicians’ propensity to prescribe analgesics to patients presenting with severe pain during the night shift was 11% lower in Israel and 9% lower in the U.S.

Who’s the best pharmacist you ever saw?

Do you know an amazing independent pharmacist? Of course you do — but do you know one who should be the independent pharmacist of the year?

Don’t tell us — tell NCPA. It’s looking for nominations for the Willard B. Simmons Independent Pharmacist of the Year, and you have until July 13 to submit your nomination.

Laird Miller received the award in 2018, and Ira Katz snagged it last year. Let’s go for the trifecta!

Click here to download the PDF nomination form. Then fill it out, gather any supporting documentation you can (news clippings? photos? letters?) and either email it to donna.johnson@ncpa.org or fax it to (571) 549-4013.

Questions? Email Donna Johnson at that address, or call her at (703) 683-8200.

D is for diabetic bone density

Vitamin D, the gift that keeps on giving. The latest: Diabetics taking canagliflozin (or another SGLT2 inhibitor) can suffer from bone loss as a side effect, and vitamin D supplements can help.

University of Maryland researchers found that people with low vitamin D levels “have an even higher risk of bone loss and possible fracture when taking SGLT2 inhibitors.” But given supplements helped reduce that risk by boosting levels of a hormone that regulates calcium levels in the blood.”

More research is needed, as always, but for now:

“[W]e recommend that patients and physicians consider the possibility of taking vitamin D supplements to restore normal vitamin D status in vitamin D-deficient patients receiving (or who will receive) SGLT2 inhibitors.”

Supreme Court ruling* — what you should know

This isn’t directly about pharmacists, but it’ll affect you: The capital-C Court has ruled that prescribers can only be held liable for illegal prescriptions if they knew it was not lawful … and the government can prove that.

In other words, per SCOTUS, the government can’t say “they should have known” — it has to be “they did know.” As for you, dear pharmacists:

This consolidated case has implications not only for prescribers of controlled substances but also for pharmacists and pharmacies who are subject to a “corresponding responsibility” to only fill prescriptions issued for a legitimate medical purpose.

Disclaimer: This is an occasionally snarky pharmacy newsletter, not a legal opinion. Seriously, talk to your attorney if you have questions.

* What, you thought we were gonna talk about a different ruling?

Money money money

Premiums set to jump (how high?)

The income cap for Obamacare subsidies was removed because of the pandemic, but it’s set to come back after this year. In short, that means about 13 million Americans could be looking at a huge jump (we’re talking 50%) in their health insurance premiums unless Congress renews the tax credit that was part of the two-year American Rescue Plan. As usual, yeas and nays fall along partisan lines.

Diabetics: borrowing to live

A new survey finds that almost 4 out of 5 diabetics in the U.S. have borrowed money, usually from credit card companies, to pay for their insulin, “with the average credit card debt reaching $9,000.”

According to CharityRx, the average American diabetic currently spends about $400 per month on insulin. A bill that passed the House in March would cap consumer out-of-pocket costs for insulin at $35 a month, but it wouldn’t affect people without insurance.

An HIV med could help with … Down syndrome?

Mice with Down syndrome that were given lamivudine — a common HIV antiretroviral drug — showed improved cognition.

Biomedical researchers in Spain believe that both HIV and retrotransposons (which cause some of the effects of Down syndrome) require the same enzyme to function — an enzyme that lamivudine blocks. “Therefore, we thought that it could be useful to counteract the cognitive impairment associated with Down syndrome.”

And — at least in a preliminary experiment, it worked: “They found that mice receiving lamivudine showed improved cognition.”

Next up are clinical trials for people with Down syndrome and Alzheimer’s.

MRSA news

The bad news

A highly antibiotic-resistant strain of MRSA — called CC398 — is dominant in European livestock, has persisted for decades … and can jump to humans.

The good news

After a successful phase-3 trial, Switzerland’s Basilea Pharmaceutica has filed for FDA approval for its antibiotic ceftobiprole.

If it gets a green light, it will be the first antibiotic in the beta-lactam class to [be approved for] the treatment of SAB S. aureus, including hard-to-treat infections caused by methicillin-resistant strains (MRSA).

Weird science: Intermittent fasting repairs nerves

Nerve damage is often permanent — they don’t regenerate, and surgery is rarely effective. But here’s an odd twist: Mice with damage to their sciatic nerve were put on an intermittent-fasting diet (alternating eating as much as they like one day, fasting the next).

The result: The mice’s gut bacteria began producing more of a metabolite called 3-indolepropionic acid, or IPA. And IPA is used by the body to regenerate the axons in nerve fibers.

In fact when British researchers examined the mice, “The length of the regrown axons was measured and was about 50% greater in mice that had been fasting. […] This suggests that the IPA generated by these bacteria has an ability to heal and regenerate damaged nerves.”

If you said, “Wait, what?” you’re not alone.

“I think the power of this is that opens up a whole new field where we have to wonder: is this the tip of an iceberg? Are there going to be other bacteria or bacteria metabolites that can promote repair?”