Fun with math

Purdue Pharma is trying to claim that it’s only responsible for 3.3 percent of the opioid market from 2006 to 2012. What’s wrong with that? That figure only represents the number of pills, and not the dosages (so a 5 milligram Percocet = an 80 milligram OxyContin).

When you take into account the dosages, Purdue is actually responsible for about 16 percent of the market.

Vaping-related illness — the latest

At least five people have died from something in their e-cigarettes, but health investigators still aren’t sure exactly what’s causing it. The New York Times has a good write-up with what you need to know.

Meanwhile, the FDA is continuing its crackdown on Juul.

Two insulin discounts from Nordisk

Novo Nordisk says that, starting next year, it will offer discounts on its Levemir, NovoLog, and Tresiba insulin products. This follows similar discounts from Lilly and Sanofi.

The company will offer a cash discount program for those products, allowing non-Medicaid/Medicare patients to pay only $99 for a month’s supply starting January 2, 2020.

For its Novolog products, those shifty Danes will remove the brand name from the boxes and sell them for half price (e.g., $279.41 for five “generic” NovoLog FlexPens, instead of $558.83 for the box with the brand name).

“We want to do something that lowers drug prices for Americans —

Antibiotics might weaken flu vaccine

By interfering (i.e., killing) chunks of the gut microbiome, antibiotics might be reducing the effectiveness of the flu vaccine.

Why don’t you just stay home with us, dear?

A study out of UGA finds that teens who don’t date “are less depressed and have better social skills.”

Non-dating students had similar or better interpersonal skills than their more frequently dating peers. While the scores of self-reported positive relationships with friends, at home, and at school did not differ between dating and non-dating peers, teachers rated the non-dating students significantly higher for social skills and leadership skills than their dating peers.

Elsewhere: British Chemists edition

Britain’s National Health Service is considering making high-dose statins available over the counter to any survivors of Brexit. We’re not talking on the shelves; the NHS would allow pharmacists — who recently got the OK to give “heart checks” — to dispense them without a prescription.

“Pharmacists are highly trained health professionals who are greatly valued by patients. Since the NHS will be funding local chemists [American: “pharmacists”] to undertake health checks, it makes sense to consider whether there are a broader range of medicines that patients could access conveniently and locally on the high street [American: “on Main Street”] .

The long read: 50 ways to cut your drug costs

“States Pass Record Number Of Laws To Reel In Drug Prices” from transparency rules to laws banning gag clauses to Medicaid “drug affordability boards” and more.

It’s come to this

Patients are resorting to using Groupon (!) for buying medical procedures. “Welcome To Today’s U.S. Health Care.”

Brittany Swanson, who works in the front office at OutPatient Imaging in the Buckhead neighborhood of Atlanta, said she has seen hundreds of customers come through after the center posted Groupons for mammograms, body scans and other screenings around six months ago.

Vaping sickness: Could vitamin E be the culprit?

The spate of vaping illnesses, which has caused at least two deaths, might be the result of contamination by a derivative of vitamin E (vitamin E acetate, if you’re interested).

“Might” is the word: At this point, this particular oil is the only common factor among the dozens of cases nationwide.

Hospitals join in on opioid suits

A group of 23 Kentucky hospitals — and, separately, a group of 29 Texas hospitals — are suing opioid manufacturers and distributors over the opioid crisis. That’s everyone from Purdue and Teva Pharmaceutical to McKesson, AmerisourceBergen, and Cardinal Health. And more.

Texas hospitals charge that surgical procedures on opioid addicts have been complicated and costly, as has treatment of opioid-related conditions such as infections and HIV.

These costs are a “direct and proximate result of the false narrative campaign” conducted by the companies, the lawsuit charges.

Blood (pressure) and guts

People with high blood pressure and depression have a different set of gut bacteria than people with high blood pressure and no depression.

The gut microbiome is getting a lot of attention lately, although we’re not quite at the point of knowing which bacteria are the best ones to have (or if there even is a “best”).

What does this latest news mean? It means “there’s potential for this research to uncover treatment approaches that could improve outcomes in people with treatment-resistant hypertension.”

Anti-vax crackdown continues

Facebook (and by extension Instagram) will activate pop-up windows when people search for vaccine-related information, directing them to legitimate resources for information.

This follows moves by Pinterest (only content from public-health organizations will appear in searches for vaccine info), Amazon (anti-vax videos were removed from Amazon Prime Video), and YouTube (no ads allowed on anti-vax content).

Meanwhile, California just passed a bill cracking down on physicians who offer fake vaccine exemption letters. It “would allow state public health officials to investigate doctors who grant more than five medical exemptions in a year and schools with vaccination rates of less than 95%.”

Keep ’em concealed

CVS and Walgreens have joined Kroger and Walmart in asking customers and patients to not openly carry guns in their stores. (Target made that request back in 2014.) At this point, they say, it’s only a request — not yet an outright ban.

Joe vs. the gallstones

Want to avoid symptomatic gallstone disease? (And really, who wouldn’t?) There’s a simple solution: Drink more coffee!

Path of lesser resistance

As America cracks down on opioid abuse, drug makers are turning abroad. Last week we told you about India; today’s story is about how they’re moving into Australia.

Australia has failed to heed the lessons of the United States and is now facing skyrocketing rates of opioid prescriptions and related deaths. Drug companies facing scrutiny for their aggressive marketing of opioids in America have turned their focus abroad, working around marketing regulations to push the painkillers in other countries.

Elsewhere: Never Too Late edition

A 73-year-old woman* in Andhra Pradesh has given birth to twins. (Her husband is 82.)

* or 74-, depending on which site you visit

Judge approves CVS/Aetna merger

He had some reservations, and didn’t like being treated as a “rubber stamp,” but in the end judge Richard Leon signed off on the $69+ billion deal.

But let’s not forget that GPhA, with help from other Georgia associations, won major concessions from the companies before the state insurance commissioner would sign off on the deal — check them out at GPhA.org/cvs-aetna.

Mushrooming research

Johns Hopkins is launching the world’s largest center for researching psychedelics “to study the mind and identify therapies for diseases such as addiction, PTSD, and Alzheimer’s.” A $17 million grant from private donors will kickstart the research.

Much of the early work with psychedelics has focused on psilocybin, the chemical found in so-called magic mushrooms. Further studies will determine the chemical’s effectiveness as a new therapy for opioid addiction, Alzheimer’s disease, post-traumatic stress disorder, post-treatment Lyme disease syndrome (formerly known as chronic Lyme disease), anorexia nervosa, and alcohol use in people with major depression.

Tramadol and hypoglycemia

It seems users of the popular opioid might see their blood sugar drop significantly. So finds pharmacy researchers from UC San Diego (and published in Nature’s Scientific Reports).

The researchers also looked at other widely prescribed opioids and similar acting, non-opioid medications, such serotonin and norepinephrine reuptake inhibitors (Cymbalta, Effexor XR) and NMDA receptors (ketamine and memantine). Only tramadol produced a significant risk of developing hypoglycemia in patients.

Birth control and UTIs — there’s an app for that

Planned Parenthood is expanding its Planned Parenthood Direct app to all 50 states by next year. (It currently operates in only 27.) The app allows women to get birth control and treatment for UTIs by mail without having to physically come to a clinic or doctor’s office.

Mail order birth control has soared in popularity as reproductive health advocates try to find solutions to so-called “contraception deserts” in rural areas. About 19.5 million people live in these deserts.

Under your tongue

The War on Peanut Allergies continues, with a new potential weapon: sublingual immunotherapy — aka SLIT, aka “putting a miniscule amount of liquefied peanut protein under the tongue, where it is absorbed immediately into the blood stream to desensitize the immune system to larger amounts of peanut protein.”

The technique has passed its phase 2 trial. It’s not expected to allow kids with allergies to eat a handful of peanuts, but it is hoped to protect them from tiny, accidental exposures.

The long read: Medical care in lockup

“Death and politics roil a Georgia jail” from Reuters

[The report] described staff shortages, unclear health guidelines and failures to give inmates prescribed medications. Such failings, they warned, could trigger “potential loss of life.” Indeed, that September, six weeks before the second report was issued, an inmate strangled himself with a telephone cord.

Flu vaccine recommendations for kids

The American Academy of Pediatrics has released its “Recommendations for Prevention and Control of Influenza in Children, 2019–2020.” If you give out the flu shot to kids, you’ll want to check out the list.

Purdue threatens bankruptcy to avoid opioid payments

Purdue Pharma is looking at declaring bankruptcy so it doesn’t have to pay billions for its role in the opioid crisis. Purdue hopes making the threat will scare plaintiffs into accepting the company’s $12 billion offer.

PDMPs doing their job

Prescription drug monitoring programs do work — that’s the result of a study from Weill Cornell Medicine that found…

States that require prescribers and dispensers to register with and use prescription drug monitoring programs saw notably fewer opioid prescriptions and reduced opioid-related hospital use compared to states with weak drug monitoring program mandates.

E-scripts doing their job

Surescripts finds that e-prescription accuracy has increased by 64 percent since 2016, even with 40 fields that need to be filled in.

Spend early, spend often

Pharmaceutical companies are spending a lot of money to support the senators they need to stop any kind of drug-pricing legislation.

[T]he executives are using their considerable personal wealth to fund GOP lawmakers playing key roles in the Senate’s ongoing consideration of a bill to lower drug costs, which is projected to cost drug companies $85 billion in revenue in the next decade.

Bad breath is your friend

Using mouthwash messes with your oral microbiome enough that it might even outweigh some of the benefits of exercise.

An international team of scientists has shown that the blood pressure-lowering effect of exercise is significantly reduced when people rinse their mouths with antibacterial mouthwash, rather than water – showing the importance of oral bacteria in cardiovascular health.

Elsewhere: Michigan edition

The state has banned sales of flavored e-cigarettes — “the latest crackdown by regulators amid an outbreak of vaping-related illnesses and a growing recognition of its threat to the country’s young people.”

PharmD on the faster track

PCOM Georgia and Valdosta State University have joined forces to allow aspiring pharmacists to shave a year off their doctoral programs.

[T]he agreement will allow eligible students at VSU to enter the school of pharmacy after completing their junior year of college. Students who meet the pharmacy school’s requirements may matriculate into professional school before graduating from VSU, he said, and will have the opportunity to earn a combined BS-PharmD while at PCOM Georgia.

Walmart opens Georgia medical clinic

The retail giant* is opening a first-of-its-kind Walmart Health clinic in Dallas, Georgia. The facility, which will be next to the actual store (“to give a sense of privacy for patients”) will offer primary care, dental, mental health, counseling, and other services.

* I think it’s a law that you always have to refer to Walmart as “the retail giant” … in case people forgot

Vaping “illness” spreads

The as-yet-unnamed “vaping-related illness” that’s hit 29 states is growing, with the number of cases doubling in a week. And health officials are still stumped — stumped, but “focusing on the role of contaminants or counterfeit substances.”

This oughta get your philosophical juices flowing

Scientists turned human skin cells into stem cells. Then they turned the stem cells into brain cells. Then they let those “brain organoids” grow in a nutrient broth.

And then the organoids started producing brain waves.

As the organoids mature, the researchers also found, the waves change in ways that resemble the changes in the developing brains of premature babies.

So the scientists stress that these are but “clusters of replicating brain cells, not actual brains.” But then they flip to:

“There are some of my colleagues who say, ‘No, these things will never be conscious,’” said Dr. Muotri. “Now I’m not so sure.”

I guess that’s worth a headline

The headline: “CVS offers affordable alternatives to high cost drugs“.

The deal: The PBM “removes drugs with especially big price tags with lower-priced, clinically equivalent alternatives.”

The savings: Removing five such drugs in April “are projected to save clients $0.38 per member per month or $4.60 per member per year.”

ICYMI: Werewolves of Madrid

At least 17 children in Spain were turned into werewolves because of a medication mix-up. Takeaway: Don’t mislabel minoxidil as omeprazole.

The laboratory [that mislabeled the meds] was eventually shut down and the medicine taken off the market. Officials have opened an investigation.

No long-term harm done: The kids’ excess hair is expected to fall out shortly.

Elsewhere: Mumps spreads in migrant camps

Having so many people concentrated in detention camps has lead to a danger of mumps spreading — at least 931 cases so far have been reported, per the CDC.

One bit of good news: Many of the countries the migrants are from have high vaccination rates of the MMR.

Vaccination coverage in El Salvador varies
from 90% to 93%, depending on the vaccine, while vaccination coverage
ranges from 93% to 98% and 88% to 93% in Guatemala and Honduras.

The long read: reviving the immune system

“Getting ‘exhausted’ T cells back into action against cancer“.

When a malignancy or chronic infection sets in, a kind of immune combat fatigue can follow. Finding ways to recharge immune cells can restore their ability to fight deadly diseases.

Boles named to healthcare task force

Georgia Lieutenant Governor Geoff Duncan named GPhA past president (and owner of Hartwell Drugs) Lance Boles to a new task force on healthcare access and cost.

Rather than focus on Medicaid expansion, the new task force “will focus on ‘price transparency and other free market solutions,’ technology and employer innovation,” according to the AJC.

Congratulations, Lance — we know you’ll serve Georgians well!

Shout-out to Ben Ross!

The owner of Forest Heights
Pharmacy in Statesboro donated 10 Narcan kits to the Georgia Police K9 Foundation. The cops will have it on hand not just for humans who overdose, but in case any of their dogs is exposed to opioids, especially fentanyl.

DCH changes to provider enrollments

The Department of Community Health is making changes to the way provider enrollments are submitted — so you might need to know this stuff!

Effective immediately, all provider enrollment updates (individual practitioners
and facilities) must be submitted through the Georgia Medicaid Management
Information System (GAMMIS). The Care Management Organizations
(Amerigroup, CareSource, Peach State Health Plan, and WellCare) will no longer
accept provider enrollment updates that are not processed through GAMMIS.

Click here for a PDF from the DCH that gives the details.

DEA continues dragging feet on marijuana research

For at least three years, the DEA has been refusing to grant any permits for suppliers of marijuana for scientific
research. The agency has said since 2016 that it will, but then … nothing. At least 33 applications are awaiting review.

Now, under pressure from Congress and scientists, the agency has said it will … work on new guidelines.

Despite marijuana being legalized or decriminalized in one form or another in more than half of U.S. states, the DEA still considers it a Schedule I substance, as dangerous as heroin.

What’s in a name?

Purdue University continues to shout from its rooftops, “We aren’t related to Purdue Pharma!”

[University spokesman Tim Doty] said Purdue University was monitoring social media, standing by with a statement that hasn’t changed since 2017.

Meanwhile, we presume, Perdue Farms (the chicken people) is patting itself on the back for that letter “e”.

Measles no longer eliminated

Albania, the Czech Republic, Greece, and the U.K. have lost their ‘measles eliminated’ status as the preventable disease makes a resurgence thanks to anti-vaxxer misinformation.

The United States is expected to lose its status later this year; we were officially declared measles-free in 2000, but that has since changed, and the current outbreak will probably break the one-year mark.

Gosh, I can’t imagine why

“Pharmacy closures may have negative effect on medication adherence”

Dried-toad secretions: Once is enough

A single inhalation of dried-toad secretions could give you “sustained enhancement of satisfaction with life, mindfulness-related capacities, and a decrement of psychopathological symptoms” — but only if it was the right kind of dried toad. Obviously.

The long read: Hacking for medical data

“China’s hackers are ransacking databases for your health data”

State-sponsored Chinese hackers are breaking into U.S. healthcare companies, looking for research data and intellectual property.

They’re called wild animals for a reason, you goobers

Don’t invite people to pet the cute baby raccoon at a public event. That’s advice too late for 33 people in Macon who “interacted” with one at an event called (we kid you not) “Raccoon or Kitten?” that allowed people to pet both animals.

The raccoon turned out to have rabies.

No one is believed to be infected, but A) 21 of them have opted for treatment just in case, and B) the article features a video with horrific pictures of people who did contract the disease, vicious dogs, and dead animals. And one cute raccoon.

The raccoon apparently showed no sign of the disease other than sudden premature death.

Drug misuse in Georgia: low

Good news for Georgia: The state has among the lowest rates of painkiller abuse in the country. (Hawai’i has the lowest rate, with 3.4% of people there misusing painkillers; Georgia is tied for second place with Illinois, Massachusetts and New Jersey.)

Now I really want to see what’s in those documents

August 26: “Court Lets Purdue Pharma Court Records Be Made Public”

August 27: A settlement proposal is leaked that would have the Sacklers giving up Purdue Pharma, paying $3 billion out of their own pockets, and transforming Purdue “from a private company into a ‘public beneficiary trust.'”

That would allow the profits from all drug sales, including the opioid painkiller OxyContin, to go to the plaintiffs — largely states, cities, towns and tribes.

Even more, the Sacklers would also give up their other drug company, Mundipharma — one of the companies we wrote about yesterday that’s making inroads into the ripe-for-the-picking Indian opioid market.

Want to live forever?

Eat more plants. At least if you’re a middle-aged Japanese person, which is who was studied. (Although it probably applies to everyone else, too.)

Compared to people who consumed the smallest amount of plant protein, participants who consumed the largest amount were 13% less likely to die during the study and 16% less likely to die of cardiovascular causes.

You gotta believe: It’s more than just eating plants. You have to believe it’ll work because, as researchers at Boston University School of Medicine found, optimists can achieve “‘exceptional longevity.”

Following the money

Are you worried that, with all the attacks on pharma companies lately, they might not get support in Washington? Fear not: They’re pouring in the lobbying cash.

“We support candidates from both political parties who support innovation and patient access to medicines,” said PhRMA spokeswoman Holly Campbell.

Suicide factor

It’s not clear about cause and effect, but here’s an interesting finding: People with Restless Leg Syndrome are more likely to harm themselves or commit suicide. Further, “[T]he increased risk is independent of depression, sleep disorders, chronic conditions, and other factors being examined.”

Not what you think

The headline was “Fat pumps generate electrical power.” Alas, the story — while interesting — was not nearly as interesting as I had hoped for.

A previously unknown electrical current develops in the body’s cells when the vital fat pump function of the flippases transfers (“flips”) lipids from the outer to the inner layer of the body’s cell membranes.

Admit it, you also thought it was a way to fight obesity while reducing our carbon footprint.

From uterus to cradle

If you know any pregnant mice, here’s some advice: When pregnant, they should eat a high-fat diet to protect children from Alzheimer’s later in life. But once those kids are born, they need to avoid “overnutrition” to protect the kids from diabetes and premature aging.

This might apply to humans as well.

As for humans: Keep away from pesticides when you’re pregnant.

Shout-out to Nikki

GPhA Region 3 President Nikki Bryant was featured in Mercer University’s “Mercer News” for her work in Webster County. Check out the video, “How one Mercer Pharmacist is improving health care in rural Georgia.” Way to go Nikki — we’re blessed and proud to have members like you!

Speaking of videos…

Jennifer Shannon of Lily’s Pharmacy in Johns Creek got a pat on the virtual back from NCPA, which featured her parody video showcasing the absurdity of DIR fees. (And our hats off to husband Mike, pictured below, who — rumor has it — is on the short list for an Oscar nod.)

ICYMI

Johnson and Johnson lost the opioid court case in Oklahoma* and was ordered to pay $572 million for its role in the crisis. “Lost” is a bit of a misnomer, as the state had asked for $17 billion (and, of course, the company will appeal).

“That’s interesting,” you say. “Where can I get more details about this potentially groundbreaking case?” Glad you asked; the Guardian has you covered.

* Where the wind comes sweepin’ down the plain

Speaking of opioids…

While the U.S. is slogging its way out of the epidemic and rethinking how (and how much) to use opioid painkillers, there’s a whole new market ripe for the picking: India.

Into the country flow fentanyl patches from Johnson & Johnson, buprenorphine from the Sackler family (owners of Purdue Pharma), tramadol shots from Abbott Laboratories, and more.

Speaking of Purdue Pharma…

The once-secret testimony of the company’s former president is about to be made public — part of 17 million pages of documents that a judge ordered released after ruling in favor of health news site STAT (owned by the Boston Globe), which sued to open those records.

Vaccination images updated

The American Academy of Pediatrics, working with Self magazine, has made available a host of new, updated stock photos to illustrate vaccinations.

What’s new? Well, the people are more diversified, for one. The syringes in the new pictures are the kind that are actually used. And this time the people getting shots aren’t looking scared.

The AAP is making the new images available free to anyone looking to illustrate a print, broadcast, or online publication.

Speaking of vaccinations…

Today’s long read: “The Message of Measles.”

As public-health officials confront the largest outbreak in the U.S. in decades, they’ve been fighting as much against dangerous ideas as they have against the disease.

Australian purple snail mucus*

Australian researchers have found that the white rock sea snail produces a purple compound to protect its eggs — a compound that appears to protect against bowel and colon cancers. They’re looking for pharma-company investment to follow up.

* A headline we guarantee you have never seen before, nor will again