Acetaminophen danger

We all know that too much acetaminophen can lead to liver issues, but at lower, less-frequent doses it’s great stuff. Well, that might not be true for people over 65.

A new British study found that “repeated doses of paracetamol in people aged 65 and over can lead to an increased risk of peptic ulcers, heart failure, hypertension, and chronic kidney disease.”

Caveat: Although it compared 180,000 acetaminophen ‘users’ with 400,000 ‘non-users,’ it was only based on prescription information — it didn’t take into account over-the-counter tylen— er, paracetamol use. So while there appears to be a connection, you know the drill: More research is needed.

A better SSRI target?

Instead of systemic SSRIs like we’re using today, what if the drugs were targeted at the gut? After all, “90% of our bodies’ serotonin is in the gut,” according to a cell biologist at NYU Grossman School of Medicine, and the vagus nerve connects it to the brain.

That’s why she co-led a study to see what would happen if they increased the serotonin in mice’s guts, rather than their brains. They genetically engineered some mice to have more serotonin signaling there (“which mimicked an SSRI delivered selectively to the gut”), and, lo and behold, those mice were less anxious and depressed than their littermates.

“[T]o see enhanced serotonin signaling in the gut epithelium produce such robust antidepressant and anxiety-relieving effects without noticeable side effects was surprising even to us.”

Even better: A guts-only delivery system would be good for pregnant women. Some studies have shown that taking ‘systemic’ SSRIs during pregnancy can affect the child in ways you don’t want to. So next up: Finding a way to target SSRI delivery.

Drug politics

CVS anti-trust questions

Republicans in the US House of Representatives are looking into whether CVS Caremark threatened independent pharmacies if those pharmacies participated in pharmacy hubs not controlled by CVS. That would be violating anti-trust law, and laws are occasionally enforced against pharma companies.

Georgia considers requiring coverage of alternative pain meds

A bipartisan group of Georgia state house members — a committee looking at ways to deal with the opioid crisis — “is considering introducing legislation next year forcing insurance companies to cover the cost of alternatives to opioid pain medications.” I.e., they would have to “cover nonopioid pain management options the same way they do for opioids.”

Unjustified price hikes (now there’s a shock)

I guess it’s Econ 101: When drugs show more benefits, pharma companies raise the price because more people will be taking them.

But sometimes, just sometimes, it seems pharma raises the price of drugs even when there’s no evidence of additional benefits. That’s according to the Institute for Clinical and Economic Review.

When it comes to the 10 drugs whose price increases contributed most to a rise in U.S. medical spending in 2023 — half of those price hikes “were not supported by clinical evidence and drove costs higher by $815 million.” (And yes, those price hikes were way above the rate of inflation.)

Johnson & Johnson’s cancer drug Darzalex was on the list of price increases not backed by clinical evidence for the second time this year. A 7.6% rise in the treatment’s list price added about $190 million to U.S. spending, according to the report.

Perspective: If Ford raised the price of its F-150 truck — the most popular vehicle in the world — by 7.6% a year from its introduction in 1975, it would cost more than $145,000 today.

^* The base model sold for $4,002, or $23,233 in 2024 dollars

A different kind of antiviral

Today’s antivirals are great, for sure, but like antibiotics they’re likely to become less effective over time. A way to prevent that (or at least delay it) is by creating an entirely new class of antivirals. That’s what researchers at Rockefeller University say they’ve done.

They’ve developed an antiviral — well, a proof-of concept of one — that they say represents “a wholly new way to treat SARS-CoV-2 infections.” It might also tackle other viruses including Ebola, dengue, and poxes.

In short, rather than disrupting a virus’s proteases as antivirals like Paxlovid do, this new type of drug targets methyltransferase.

“Even in isolation, a virus would have trouble escaping this compound. But as a combined therapy along with a protease inhibitor — escape would be almost impossible.”

It has the added benefit of only affecting the virus particles, not human methyltransferases, meaning side effects should be minimal. Next up: Testing it on other viruses and even some fungal infections. And they’re looking for a drug-industry partner to turn it into a human therapy.

Another drug microbot

The latest folks to develop a microscopic drug-delivery robot are at Caltech. Medical engineers there created the usual: microrobots that can withstand the brutal inside of the body long enough to deliver their drug cargo to the target. In this case, they used a “printable” hardening hydrogel that includes magnetic nanoparticles allowing the microbot spheres to be steered to wherever in the body they’re needed^*.

They’ve tested their bots on mice (successfully), but it’ll be a while before they can do a human study.

^* That could be Star Trek technobabble. All they need to do is invert the tachyon field and reroute the beam through the main deflector.