Opioids: Big three agree to pay big

Really, the headline says it all: “CVS, Walmart, Walgreens agree to pay $13.8 billion to settle U.S. opioid claims.”

The chains are opening their wallets to settle the Giant Opioid Lawsuit (the one that involves thousands of governments across the country — states, tribes, cities, towns, villages, hamlets, etc.), although none of them would admit to actually mishandling opioids and contributing to the epidemic.

Fun fact: That same money could pay for nine F-35A fighter jets — three per company — thus helping them “defend [themselves] vigorously against any future lawsuits not covered by the settlement.”

Also: CVS reported an almost $4 billion loss for the quarter because of the settlement. Ouch.

What you need to know about hearing aids

With hearing aids now sellable over the counter, you might be wondering “What do I need to know?” Our friends at NCPA are just itching to tell you.

They’ve got a free (non-CE) webinar: “Hearing Aids — What’s the Opportunity?” at 8:00 pm on Monday, November 14 to tell you all about “this emerging market and business opportunity.” Registration is required, of course.

After 17 years, FDA to consider pulse oximeters and dark skin

Way back in 2005 (two years before the first iPhone), it was discovered that pulse oximeters don’t work well with darker skin. This week, an FDA panel finally decided to examine the issue.

It’s simple physics: More melanin in the skin means less light passes through to the meter — it’s enough of a difference that devices can be as much as eight percent off; someone with a blood ox of 90 might get a reading of 95. Not good.

(A study published in JAMA Internal Medicine this summer found that “Asian, Black, and Hispanic patients got less supplemental oxygen than White patients, and that was associated with differences in their pulse oximeter readings.”)

The question is, should today’s cheap devices come with a warning? Should the agency mandate the better kind, which use 8 wavelengths of light rather than just 2? Could manufacturers add a adjustment for skin color? And what about forehead thermometers that use the same technology?

The panel of the committee of the FDA is on the case!

Are ya yellow? (aka, turmeric and jaundice)

Tell your patients who use turmeric supplements to go easy. Health officials are reporting cases of people turning yellow — thanks to liver injury — from taking a bit too much of the stuff. Although everyone eventually recovered, some became seriously ill, requiring steroids and N-acetylcysteine treatment. One woman even spent three weeks in hospital:

Her symptoms resolved when she temporarily stopped taking the supplement but returned when she resumed the regimen. She also developed yellowing to her skin and the whites of her eyes. Blood tests and a liver biopsy later revealed she had a severe liver injury.

Latest drinking study: stroke risk

It’s time to shake the Magic 8-Ball of alcohol consumption again!

The latest study says … moderate to heavy beer drinking can increase the risk of stroke. Light drinking is okay, stroke-wise, and the risk goes down once you stop — that’s according to research out of Ireland’s University of Galway examining data for 26,000 people across 27 countries.

• Current drinkers overall: 14% increase in the odds of any stroke and a 50% increase in odds of intra-cerebral hemorrhage
• Regular high alcohol intake: 57% greater risk of any kind of stroke
• Binge drinking: 39% increase in odds of any kind of stroke — but up to 76% increase in intracerebral hemorrhage

Big caveat: Wine is fine — “predominant wine consumption” didn’t cause a problem, but they think that might be due to the social circumstances; outside of bachelorette parties, there isn’t a lot of binge drinking of Chardonnay.

FDA scolds Amazon again

FDA to Amazon: Stop selling^* dietary supplements that contain undeclared drugs. In this case, the agency found some arthritis treatments that also contained diclofenac, and in some cases dexamethasone, and methocarbamol, too.

Saying they can treat arthritis and gout, stop joint deterioration, and improve mobility — well, that makes them new drugs under the the FD&C Act, and they ain’t approved. Fix the problem or there will be … trouble.

* “introducing, delivering, or causing the introduction or delivery into interstate commerce”

Cocaine feedback loop

What do you get when you mix cocaine with gut bacteria? A cocaine craving.

Like the headline says, it’s essentially an addiction feedback loop. The short version: Cocaine increases epinephrine in the gut. Certain gut bacteria love this, so they proliferate. Those same microbes also happen to eat the the amino acid glycine, and lower glycine levels make cocaine stronger and addiction easier.

A bonus in the international team of researchers’ graphical abstract — an image of a mouse snorting lines:

Air pollution news

It raises dementia risk

Looking at data from 17 previous studies, Canadian researchers found that exposure to “fine particulate matter” increases the risk of dementia.

Specifically, they found that the risk of dementia increased by 3% for every 1µg/m3 increase of fine particulate matter exposure. (In Georgia, particulate levels average about 6–12 µg/m3, but can get as high as 50 or more.)

It can make women obese

A study out of the University of Michigan found that…

Women in their late 40s and early 50s exposed long-term to air pollution — specifically, higher levels of fine particles, nitrogen dioxide, and ozone — saw increases in their body size and composition measures.

That’s based on data from more than 1,600 women from 2000 to 2008.

Who’s gonna pay for all this?

Healthcare costs are going up, up, up, and next year is gonna be a doozy. So who’s gonna pay for it? Eventually, all of us, but who’s first on the list? Insurance companies … that pass costs down to employers and individuals? The government … that will pass costs down to taxpayers? Pharma and healthcare companies … that will have to cut shareholder dividends and executive pay?

Americans are unique in the developed world in having trouble paying for healthcare, and eventually it’s going to come to a head. “The question isn’t whether, but when.”

In unrelated news

Health insurer Humana reported $1.2 billion in third quarter profits; its revenue was up 10 percent compared to the third quarter last year, to $22.8 billion, thanks in large part to its Medicare Advantage health plans.