The Long Read: The secret payments that made sure opioids kept flowing

Why didn’t PBMs do more to stop the flow of opioids? Because, it turns out, they were paid by drug makers to make sure patients got as many painkillers as possible.

For years, the benefit managers, or P.B.M.s, took payments from opioid manufacturers, including Purdue Pharma, in return for not restricting the flow of pills. As tens of thousands of Americans overdosed and died from prescription painkillers, the middlemen collected billions of dollars in payments.

I could paste quote after quote, but it’s worth reading the whole story — the New York Times investigation that uncovered how PBMs conspired with drug companies to remove roadblocks to opioid prescriptions. The two groups raced to the ethical bottom of the barrel: Pharma companies threatened to reduce rebates to PBMs, and PBMs threatened to restrict prescriptions.

Because the P.B.M.s often shared a portion of the rebates with the insurers and employers that hired them, these clients had a financial incentive not to impose restrictions. Purdue and the P.B.M.s sometimes reminded clients of this when they considered limiting access.

Now do we worry?

The CDC has reported the first severe case of H5N1 bird flu in a human — a hospitalized Louisiana patient who had contact with backyard, not commercial, poultry.

This is the 61st human case reported in the US, although there are probably a lot more going unreported. Our friends up north have already seen at least one severe case — a teenager who was hospitalized* in critical condition in British Columbia last month. (The Canadian government refuses to comment on his or her condition.)

Feline danger: A new study says “that domestic cats could potentially prompt a public health crisis” because they can interact with both livestock and humans, and act as a “bridge” for the virus to become more transmissible to us.

* Technically hospitalised

New Veosah warning

The FDA has given Veozah (fezolinetant) — the drug used to treat hot flashes from menopause — a new boxed warning because of the risk of serious liver injury.

We made this update after reviewing a postmarketing report of a patient with elevated liver blood test values and signs and symptoms of liver injury after taking the medicine for about 40 days.

The agency also recommends increasing the frequency of liver blood testing, especially for the two months after a patient starts using it.

Driving away Alzheimer’s?

Taxi and ambulance drivers seem to have lower rates of Alzheimer’s, although it’s unclear why this might be the case. Researchers from Mass General Brigham looked at the death certificates of about 9 million people whose occupation was listed, and they found that while overall Alzheimer’s was the cause of death for about 3.9% of people, only 1.03% of taxi drivers and 0.74% of ambulance drivers died from it — the lowest rates among any profession.

If you saw that two types of high-stress drivers had lower rates of Alzheimer’s death, you would raise an eyebrow, too. But why is this the case? The thought is that it has to do with the use of the hippocampus for spatial reasoning, but the authors are clear, “We view these findings not as conclusive, but as hypothesis-generating.”

Draw your own conclusions.

A little late….

The discredited study that claimed hydroxychloroquine could help treat Covid-19 has (finally) been withdrawn by the author and retracted by the journal that published it … but not before a lot of damage was done.

The French Society of Pharmacology and Therapeutics said the paper constituted a clear example of scientific misconduct, which was marked by manipulation and bias to “falsely present” the drug as effective against COVID-19. […]

“The promotion of the results led to the abusive prescription of hydroxychloroquine to millions of patients, leading to unwarranted risks to millions of people and potentially thousands of avoidable deaths.”

What’s with all the food recalls?

You might have noticed that there seem to have been a lot of food-borne disease outbreaks and recalls. In fact, “Food and cosmetic recalls […] nearly doubled from 2012 to 2024.”

What’s going on? It’s most likely a combination of factors, including people eating more processed foods, “increased globalization of food production,” and even some missed inspections.

Within US states, there are about 3,000 different jurisdictions for food safety […] “And not everyone’s on the same page.”

Perhaps taking science too far

Experts publishing in the British Medical Journal warn that princesses depicted in Disney movies (and remakes and remakes and remakes) are facing a slew of health risks.

As a scullery maid, Snow White, for example, finds “opportunities for social interaction are extremely limited,” increasing her risk of “cardiovascular disease, depression, anxiety, and all cause mortality.” Ditto for Jasmine: “[W]hile the Genie might sing ‘you ain’t never had a friend like me,’ the truth is that Jasmine has no friends at all.”

Rapunzel’s uncut hair probably means permanent damage to her follicles, while Belle — well, “Close contact with the Beast exposes Belle to many potentially life threatening infectious diseases, such as brucellosis or rabies.”

And Pocahontas? Ouch:

Her cliff dive has an impressive falling time of nine seconds. Based on the falling time, we estimated the height of the cliff through simulations using coupled differential equations for height and velocity with quadratic drag. Assuming average female anthropomorphic measurements […] and standard environmental constants (drag coefficient of 1.0, gravitational acceleration of 9.81 m/s2, and air density of 1.2 kg/m3), the cliff height was estimated at 252 m. Studies on slamming dynamics of diving suggest that hand first dives from heights above merely 12 m could already be critical for clavicular compressions.

Don’t forget Kringle

He isn’t owned by Disney (yet), but Santa is facing his own health issues, as the director of Lancaster University’s Clinical Anatomy Learning Centre points out. Sure, all that body fat is good insulation, but a diet high in milk and cookies “increases the risk of developing obesity and chronic conditions such as heart disease, stroke, type 2 diabetes, osteoarthritis, and colorectal cancer.”

And, he point out, “Santa’s flushed complexion is often viewed as an indication of his cheery nature — but red cheeks can also be a symptom of rosacea, a chronic skin condition.”