New knee, fewer opioids

After an orthopedist cuts open your knee, removes parts, replaces them, and sews you back up, you might think you the only solution is heavy-duty painkillers (of the opioid variety). Not so fast, say ’Enry Ford Health researchers.

Patients might be able to cut down on the opioids by taking oral dexamethasone after surgery. (They already knew that IV dexamethasone worked.) And they reported “ no increase in reported difficulty sleeping, surgical healing, or infection,” either.

Vitamin D vs Covid

Old news: People with a vitamin D deficiency are at higher risk of contracting Covid-19.

New news: Even with sufficient vitamin D, taking a supplement (from 20 IU to 50,000 IU) appears to protect against Covid. That’s based on a study of more than 650,000 patients in the VA system.

Slight twist: Vitamin D2 supplementation reduced the risk of Covid infection by 28 percent, compared to only a 20 percent reduction from vitamin D3. (And the effect was even greater for Black patients.

Depressing guts

At some point we’ll have to accept that our gut bacteria is in control. The latest finding: People with depression are likely to have different gut bacteria than those without. Different = They have more of some bacteria and less of others.

The Dutch study does not mean that these microbial changes cause depression — the cause/effect direction isn’t clear (“Depression can, for instance, cause people to eat poorly”), but the fact that the finding carries across racial and ethnic lines is extra important.

Caveat: The results involve groups of bacteria, so it’s not clear (yet) which specific strains are involved.

Prepare for the Paxlovid price hike

Pro tip: If you’re gonna catch Covid-19, do it soon. Sometime next year, the federal government will stop paying for it, meaning the best treatment — Pfizer’s Paxlovid — won’t be free anymore. How much it’ll cost will, of course, depend on a patient’s insurance.

How much more? Pfizer hasn’t set its price yet, but you can bet it won’t be cheap.

[Pfizer CEO Albert] Bourla told investors in November that he expects the move will make Paxlovid and its Covid vaccine “a multibillion-dollars franchise.”

Fast facts

Lilly limits diabetes drug

Ah, GLP-1 receptor agonists. Good for diabetics and good for losing weight, especially for TikTok users. But three of the four — Ozempic, Trulicity, and Wegovy — are in shortage, leaving one: Lilly’s tirzepatide, aka Mounjaro.

Problem: It’s only approved to treat type-2 diabetes. Physicians, of course, are prescribing it off-label, but now Lilly is cracking down to avoid a tirzepatide shortage by limiting co-pay coupons for the $1,000/month drug to diabetics, and “Some pharmacies are also now checking if people have a diabetes diagnosis before filling prescriptions.”

Whether tirzepatide can officially be used to treat obesity won’t be decided until late next year.

Speaking of shortages…

The Adderall shortage is expected to last into 2023. That is all. (Well, almost all. Did you know demand for Adderall increased by 20% from 2020 to 2021?)

Colds and the cold

Grandma was right, and not just about the scratching noises in the attic. Cold weather really does increase your chances of getting sick. And it’s not just because we stay inside (and around disease-ridden other people).

Harvard and Northwestern researchers found that “a previously unidentified immune response” inside the nose helps fight off viruses, and “this protective response becomes inhibited in colder temperatures, making an infection more likely to occur.”