Kids are OD’ing on melatonin

Melatonin overdoses are becoming a problem with kids, especially the youngest ones. It’s a multipronged issue: The popularity of sleep aids (could anxiety be a factor?), the perceived safety of natural products (arsenic is natural), the fact that melatonin gummies look like candy, and that because they’re unregulated, melatonin supplements may have more or less of the hormone than what’s on the package — and don’t need to be childproof.

Perhaps a verbal comment to parents buying them is in order: “Just be sure to keep these away from your kids.”

K is for diabetes

Vitamin K (the real stuff, not ketamine^*) might have an unexpected upside. It might protect against diabetes.

No one ever thinks of poor vitamin K, stuck there after all the early letters (heck, how many ‘B’ vitamins are there?). But Canadian scientists found — after 15 years of research — that the mechanism vitamin K uses to affect blood clotting also affects the production of insulin.

Here comes the science: Vitamin K helps kick off a process called gamma-carboxylation. Gamma-carboxylation helps create a protein called ERGP. ERGP is important “in maintaining physiological levels of calcium in beta cells.” And those calcium levels are needed to keep insulin secretion humming along.

Knowing about ERGP, they say, means “opening a new field of research in this area.”

^* (shakes fist) Darn you kids and your confusing slang!

E-6 for Narcan

How do you make naloxone and other lifesaving or “harm reduction” drugs easier to get? You put them in vending machines.

It’s a new idea and uptake is limited so far; the FDA only just approved OTC Narcan. But for local governments looking to provide lifesaving tools without spending a lot on infrastructure and personnel, they’re gaining plenty of interest.

Said one vending machine manufacturer:

“We’ve worked on machines that dispense Narcan nasal spray, fentanyl testing strips, HIV testing kits, prescription disposal bags and then even some first aid kits and safe sex kits. Really anything that they’re looking to get into the hands of the public.”

Leqembi: the price we’d pay

So what happens if the FDA approves lecanemab for Alzheimer’s and CMS agrees to pay for it for eligible patients? Ka-ching.

Medicare would spend an extra $2.0 to $5.1 billion annually, according to a research letter published online May 11 in JAMA Internal Medicine.

Essentially there would be 44 million Medicare beneficiaries eligible for lecanemab, which would cost taxpayers about $33,000 per patient per year. (Remember, it has to pay whatever Eisai and Biogen feel like charging.) Those patients would each need to shell out $6,600 a year for co-payments. And this for a drug that hasn’t proven to make a significant impact in quality of life.

The Long Read: I Can Hear You Now edition

The approval of over-the-counter hearing aids has led not only to the proliferation of the devices, but to turning them into “lifestyle” products as big names like Bose get into the business. (Fun fact: A recent poll found that half of Americans turn on subtitles to watch movies at home. It’s sometimes impossible to keep the loud noises reasonable while still being able to hear the dialog.)

The non-prescription products were found to increase uptake and were cost-effective as long as they’re at least roughly half as beneficial to patient quality of life as traditional hearing aids […] Another study last month in the American Journal of Audiology found individuals with mild to moderate hearing loss were able to use self-fitted hearing aids effectively.

Short Takes

PBMs’ second front in the war

While Congress works on measures to limit PBMs’ cash grabs, the FTC is also expanding its probe into their practices.

The FTC said Wednesday that its fact-finding inquiry aims to shed light on questionable PBM practices that include directing patients towards PBM-owned pharmacies, unfair auditing of unaffiliated pharmacies, and the use of undisclosed pharmacy reimbursement methods, among other tactics.

ICYMI: RSV vax gets panel approval

An FDA advisory panel has recommended the agency approve giving the RSV vaccine to pregnant women to protect infants. Of note, while the committee agreed unanimously that it was effective, four members were concerned about its safety — specifically that in rare cases it can cause premature birth or possibly make some childhood vaccinations less effective.