Nope, no prices on drug ads

A court has blocked yet another Trump administration rule — this one that required drug companies to put their prices on ads. The federal judge ruled that being forced to disclose their prices exceeded the authority of the Department of Health and Human Services. (He did not say whether the rule also violated the companies’ First Amendment rights, another argument they had made.)

Teen gateway

Teens who use opioids for the high (as opposed to using them for pain management) are more likely to start using heroin by the time they graduate high school — so finds a new survey out of the University of Southern California.

Chew on these numbers:

• Teens who previously used opioids: 10.7% chance to use heroin before graduation.
• Teens who currently use opioids: 13.1% chance to use heroin before graduation.
• Teens who never used opioids: 1.7% chance to use heroin before graduation.

Hep A, take 2

A Georgia restaurant employee tested positive for hepatitis A after serving guests. No, this isn’t the story we wrote about on June 28 — this one was at a Wendy’s in Lawrenceville.

A year at a time

Giving women a full year’s supply of birth control pills would prevent more unintended pregnancies, according to a study out of the University of Pittsburgh School of Medicine.

“Our analysis shows that concerns about wastage of contraceptive pills are overshadowed by the potential consequences of missed refills, and especially of unintended pregnancies.”

Looking at the Veterans Administration, the researchers found it could also produce “substantial cost savings.”

Novartis enters the battle against the EpiPen shortage

The company will be making its pre-filled Symjepi shots, for children and adults, available to pharmacies. (Currently it’s in use in hospitals only.)

Wait, what?

“Legalizing pot tied to less teen marijuana use.”

But when you hear the possible reason, it makes more sense: “It may actually be more difficult for teens to obtain marijuana as drug dealers are replaced by licensed dispensaries that require proof of age.”

Elsewhere: France

The French healthcare ministry will stop reimbursing patients for homeopathic remedies, “citing what it said was the insufficient effectiveness of the drugs.”

Keeping terminology straight: These aren’t alternative medications, like St. John’s Wort. These are homeopathic “remedies” — highly diluted substances made under the theory that water ‘remembers’ the chemical that it once contained.

The long read: pacemaker edition

Today’s long read was going to be “What the Measles Epidemic Really Says About America*,” but that was depressing. So instead check out “What Good Does a Pacemaker Do in a Corpse?” — granted it’s medicine rather than pharmacy, but it’s a fascinating story nevertheless.

* Link here if you’re really interested

It’s not supposed to work that way

Ah, the funkiness of the U.S. healthcare system, where, it turns out, “Medicare Part D enrollees may pay more out of pocket for high-priced specialty generic drugs than their brand-name counterparts.”

Why? Rebates and the “doughnut hole” — the gap before catastrophic coverage kicks in. Patients in the doughnut hole get discounts on brand-name drugs, but those discounts are considered out-of-pocket spending. More OOP spending means being eligible for catastrophic coverage (and its lower co-pays) faster.

More naloxone should be coming soon

The FDA is planning to speed up approvals of generic version of naloxone. That is all.

Still more measles

The current measles outbreak is slowing, but people are still getting sick, with 14 new cases of the once-eradicated disease being reported, bringing to 1,109 people across 28 states.

For diabetes, the future is cloudy

Just because an older person has elevated blood sugar doesn’t mean he or she will develop diabetes — so say researchers from the Aging Research Center at the Karolinska Institute in Stockholm. Most of them actually won’t.

“In fact, the chance to stay prediabetic or even revert back to (normal blood sugar) is actually pretty high (64%), without taking medication. Lifestyle changes such as weight management or blood pressure control may help stop prediabetes from progressing.”

Goat’s milk and the microbiome

OK, file this tidbit for next time you’re at the watercooler: It seems that goat’s milk, unlike cow’s milk, has a host of oligosaccharides that are similar to what’s in human milk — and that can do more for the gut biome because of that. So while “breast is best,” it would seem that “milk from the goat can float the boat” or something like that.

Bro, do you even lift?

If so, good for you. It’s apparently better for overweight people’s hearts than aerobic exercise.

To drink or not to drink

The latest study on moderate drinking says (shakes Magic 8-Ball) that it’s best to quit.

The investigators observed that people who had never consumed alcohol had the greatest level of mental well-being at baseline. Then, they saw that people who had quit drinking — particularly women — experienced a significant improvement in mental health.

We’ll see you when the next study comes out!

High-five Ashish!

Shout-out to GPhA member Ashish Advani — he appeared on Fox5’s Good Day Atlanta to talk about supplements, and how pharmacists can help determine which ones are helping, which aren’t doing anything, and whether they’re OK to take together. Check it out!

Facebook crackdown

With so many of America’s best and brightest getting their news from random Facebook posts, the company has said that it’s going to try to reduce the number of bogus-health claims.

Facebook said it will take actions to reduce posts making assertions about a “miracle cure”, and against the ones aimed to promote products or services on health-related claims, such as a pill for weight loss.

Diabetes? Treat depression too

A study in the Journal of Clinical Endocrinology & Metabolism found that giving antidepressants (except MAO inhibitors) to patients with diabetes can reduce their risk of death — we’re talking by 35 percent.

Don’t feel like reading a paper? (And who can blame you?) Click here for the news article.

What happens when you get older?

You start adding “the” to the name of diseases (“the gout”). You remember when everything cost a nickel. You pine for your MySpace page. And you start making your meds easy for your grandkids to get ahold of.

Another reason to use a VPN*

Log into the Wi-Fi network in the waiting room? Get ready to see ads for medication as a new “service” tracks who’s waiting for the physician. (And yes, it will also track how many scripts that doc writes for those meds.)

* Virtual private network: software that essentially hides who and where you are

Cybersquatting drug names

Pound randomly on keyboard. Register domain names from the letters you see (wgehduqb.com?). Wait for the lawyers to call. “Adamis says rival Kaléo co-opted its Symjepi trademark.”

The long read: Climate Change edition

“Why pharma needs to care about global warming”

Pharma needs to start planning ahead. This includes reviewing the need to increase global supplies of drugs and vaccines against climate crisis-induced diseases, whether non-communicable or infectious in nature. It may also be necessary to enhance research efforts related to the treatment of infectious and tropical diseases.”

Shout-out to UGA’s Hawkins

Congrats to Anthony Hawkins, clinical assistant professor at UGA’s College of Pharmacy — he was named the college’s Teacher of the Year.

Who’s the best independent pharmacy owner you ever saw?

NCPA wants to know. It’s accepting nominations for the 2019 NCPA Willard B. Simmons Independent Pharmacist of the Year award — independent pharmacists who demonstrate “exceptional leadership and commitment to independent pharmacy.”

The winner will receive free travel to the NCPA convention in San Diego this October, $1,000 cash, and, most importantly, an engraved commemorative plaque.

Click here the the details — and yes, you can nominate yourself.

It’s still out there

Health officials would like you to know that the Zika virus is still a threat. Have a great weekend!

But the good news….

Researchers have found a neurotoxin that affects the malaria-carrying Anopheles mosquito — and only the mosquito. As in, they injected the stuff directly into mice and nothing happened. But for the skeeters… well, I don’t know what “It cleaves the mosquito syntaxin” means, but I hope the little buggers suffer.

This discovery could hopefully lead to an eco-friendly insecticide.

Allison still wants to know if you’re doing MTM

Allison Smith at the Georgia Department of Public Health still needs our help. She’s looking for pharmacists to complete a short survey on MTM services. DPH wants to see how many pharmacists are offering it, and what has helped or hindered your plans to provide it to patients

The better DPH knows what’s out there, the more it will be able to help, so please, click here to take the short survey by July 8. Thank you!

FDA taking it easier

The FDA has cut back considerably on enforcement actions since early 2017: “Official Action Indicated” forms reports are down 45% since Barack Obama was president, warning letters are down 33%, and injunctions are down 26%, according to an article from the American Association for the Advancement of Science.

“Sometimes the actions we take are visible, like warning letters (or) recalls. … At other times, our actions to protect consumers are less discernible, but equally vital.”

Welcome, John King

Doraville police chief John King was sworn in as acting insurance commissioner by Governor Kemp, either filling in or taking over for Jim Beck, who is currently suspended. Of note: Born in Mexico, King is Georgia’s first statewide Hispanic* official. A former member of the National Guard, he saw combat in Bosnia-Herzegovina, Iraq, and Afghanistan, and later put his life on the line as an Atlanta police officer.

* Hispanic statewide? Statewide Hispanic? You know what we mean, right?

Atlanta to ban more smoking

The Atlanta City Council has approved a ban on smoking (and vaping!) in restaurants and bars — as well as in Hartsfield-Jackson Atlanta International Airport; say good-bye to those smoking lounges.

Sparks, they be a-flyin’

So there are two big trials involving opioids: One in Oklahoma (originally involving several pharma companies, but now down to just Johnson & Johnson), and the big, multi-jurisdiction event in Ohio.

Those sparks were flying in OK, CNN reports, as the state’s attorney went at it with an expert witness for J&J.

The exchange grew so heated that [attorney Brad] Beckworth threw his hands in the air after constant objections by Johnson & Johnson lawyers. “At some point, I have to be able to cross examine this guy,” Beckworth snapped.

And look for even more fireworks in Ohio, where the guy leading the lawsuits against opioid makers says he expects to bankrupt those companies. No, we’re not exaggerating … and he’s the same guy who won the 1998 case against Big Tobacco, Mike Moore.

“Ohio is losing $4 billion or $5 billion a year from the opioid epidemic. And they’re losing 5,000 or 6,000 people a year from overdose deaths. So when a jury hears the evidence in this case, they’re not gonna award just a couple hundred million dollars. It may be $100 billion. And whoever amongst these companies thinks they can stand up to that? Good luck.”

Going up

Remember when we heard that drug makers were going to be lowering their prices? Ah, those halcyon days of innocence. Turns out that “More than 3,400 drugs have boosted their prices in the first six months of 2019, an increase of 17% in the number of drug hikes from a year earlier.”

Ignorance is bliss

Speaking of drug pricing, the pharmaceutical makers still really, really don’t want to include prices in their ads. One reason? They say it would confuse consumers. (Of course, those same consumers don’t seem to be terribly confused by car ads — MSRP, financing, leasing, “nicely equipped,” and so on.)

And we’d keep the headline simple, too

What do we do if there’s an interesting pharma story, but it’s also on a really sensitive topic? We just link to it without comment.

Sounds like fiction (but isn’t)

This story sounds like the plot of a mid-tier thriller: Boy has rare condition that will confine him to a wheelchair. Scientists replicate that condition in zebrafish, then try various treatments until they find one that works. They give it to the boy… and “he’s now playing basketball and helping coach soccer.”

And this sounds like it’s out of a Neal Stephenson* novel: The FDA is warning that a whole bunch of Medtronic’s MiniMed insulin pumps are vulnerable to hackers. The pumps (click the link to see the list) are being recalled, and the FDA says “Patients with diabetes using these models should switch their insulin pump to models that are better equipped to protect against these potential risks.”

* A little bit Snowcrash, a little bit The Diamond Age

Hep A in Cartersville

Have you eaten in Willy’s Mexicana Grill in Cartersville lately? You might want to get a hep A test… and maybe tell your patients as well.

Walmart makes staff cuts

Walmart is laying off up to 40 percent (!) of its senior pharmacists — what the company calls “aligning our staffing with the demands of the business.”

HPV vaccine through age 45

Although the human papillomavirus vaccine has been recommended for preteen girls and boys to protect against various cancers, a new recommendation out of the CDC says people up to age 45 could benefit from it.

And, like just about every other vaccine, the HPV vaccine turns out to work a treat in the real world, according to researchers who looked at records of 60 million people.

Get ’em if you smoke ’em

If you’re a pharma maker with some extra manufacturing space you’d like to unload, the medical-cannabis industry is interested in having a chat.

Overdose deaths look like they’ll be dropping

And it would be the first time since 1990.

[CDC] data predict there were nearly 69,100 drug deaths in the 12-month period ending last November, down from almost 72,300 predicted deaths for 12 months ending November 2017. If the trend holds through December, annual drug deaths will fall for the first time since 1990, when overdoses killed about 8,400 people.

Do you sell blood-glucose meters?

It seems that over the past 20 years, LifeScan meters had more problems that any other medical device on the market, period.

Common problems included displaying incorrect messages, losing power or being damaged before customers started using them, according to the database.

That’s one bit of info that came out of the FDA’s once-secret database of medical device malfunctions and injuries, which was recently released. (Other devices with lots of issues: dental implants, surgical staplers, and breast implants.)

Flu vaccine results

This past flu season’s vaccine was doing great … until a new strain of flu started making the rounds. At first, it was about 47% effective, but that plunged to only 9% (“virtually worthless”) against the newer strain, giving a final result of about 29% effective for the year.

This past season, 44 Georgians were killed by the flu, and 1,582 were hospitalized.

Looking ahead, the 2019-2020 flu season’s vaccines will protect against two ‘A’ strains — H1N1 (A/Brisbane/02/2018), H3N2 (A/Kansas/14/2017) — and one ‘B’ strain (B/Colorado/06/2017-like). The quadrivalent version will also protect against a second ‘B’ strain (B/Phuket/3073/2013-like).

Meanwhile, in the hospital

Hospital pharmacists: What’s the best way you can think to spend, say, $359 million? I bet “dealing with drug shortages” isn’t on your list. And yet….

Oh, and when older patients are discharged, they may not take their meds anyway because they can’t afford them. Even with health insurance of some kind, 14% of urban patients and 26% of rural patients said they didn’t always take their medication because of the cost.

You know what can help? Asking patients if they can afford their meds. The alternative ain’t great:

Methods commonly described to pay for medicines included: pharmacy
discount programs, spending less on basic needs like food and heat,
borrowing money, skipping doses of medicines to save money, increased credit card debt and asking a relative to buy medicines.

Up, up … and away?

The U.S. “suicide belt” contains a lot of higher-altitude cities and towns. Could the lower oxygen be a factor?

Viral for a reason

If you haven’t seen the video of the injured dog who went into a pharmacy for help (and got it, of course), you owe it to yourself to see it.

Your bones don’t want antibactierials

Women exposed to triclosan — an antibiotic found in some toothpastes and other personal care products (but not soap or hand sanitizer, ’cause the FDA banned it) — are more likely to develop osteoporosis, according to a new study.

Sticks and stones

Speaking of breaking bones, a different study found that infants who are given PPIs and other acid suppression therapy in their first year of life are more likely to do just that.

What you don’t know can hurt you

What if there was a law that could have helped save people from the opioid crisis, but there was no penalty for ignoring it? Is it still a law? It’s not a rhetorical question. Read the Reuters special report: “How judges added to the grim toll of opioids.”

The law is one that requires judges who seal evidence in cases to explain why they have made that choice. But when it came to opioids, those seals were commonplace — and when the evidence was finally leaked, “for untold numbers of opioid users who had overdosed, it was too late.”

Tune your rose quartz to 1.734 milliparsecs and face east

In what must surely be a shocking revelation, the Washington Post looks at how people who turn to social media for medical advice “get sucked into a world of bogus medicine.”

[One] video, with more than 1.4 million views, claimed that baking soda could cure cancer. [Another] was an interview with self-described cancer expert Leonard Coldwell, in which Coldwell explains that every cancer can be cured in weeks with a special diet that “alkalizes” the body.

The video has more than 7 million views.

Implanted drug delivery… with remote control

Forget daily shots or pills — the future could be a grape-sized device implanted in your body that delivers meds “without the use of pumps, valves, or a power supply for possibly up to year without a refill.”

The device would be controlled via Bluetooth, which oughta help generate a whole lot of plots for murder-mystery writers.

Smell the roses again

If you or someone you know is suffering from both nasal polyps and chronic rhinosinusitis, you’re in luck: The FDA has just approved the first treatment for both.

A “softer landing” after an OD

New Jersey has a new policy: Paramedics can not only administer naloxone to someone overdosing, they can follow it up with a hit of buprenorphine to counter withdrawal symptoms. “This comes out of left field, and it’s very interesting,” said one expert. “It’s a potentially brilliant idea.”

Elsewhere: We-all-see-where-this-is-headed edition

Illinois became the 11th state* to legalize recreational marijuana, and will also expunge the records of many people convicted of possession. (New York legislators also recently voted to expunge those records.)

The Illinois law, which legalizes adult usage and allows for marijuana sales from licensed dispensaries starting on Jan. 1, is projected to generate over $57 million in new tax and fee revenue in fiscal 2020.

* That includes D.C. and Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, and Washington state. It is decriminalized in 15 others — and six Georgia cities — meaning you get a ticket, not an arrest.

The long read: Black pharmacists and the cultural gap

“Independent black-owned pharmacies fill a void for African American patients looking for care that’s sensitive to their heritage, beliefs and values.”

A frightening link between dementia and some drugs

A new study out of the University of Nottingham found a link between some anticholinergic drugs and dementia — we’re talking about a 50 percent increase in the odds of developing dementia.

There were statistically significant associations of dementia risk with exposure to anticholinergic antidepressants, antiparkinson drugs, antipsychotic drugs, bladder antimuscarinics, and antiepileptic drugs

For a list of the drugs, click here (PDF).

Speaking of drugs causing problems….

A study from Ohio State University that looked at health records found that people who took statins had double the risk of developing type 2 diabetes.

On the other hand, caffeine remains a miracle drug

It seems that caffeine can stimulate brown adipose tissue — aka, BAT or ‘brown fat’ — increasing its rate of thermogenesis. In other words, the brown fat speeds up metabolizing the stuff you don’t want building up, notably “white fat” and other lipids.

“These results demonstrate that caffeine can promote BAT function … and may have the potential to be used therapeutically in adult humans.”

Are you doing MTM? Allison wants to know

Allison Smith at the Georgia Department of Public Health needs our help. She’s looking for pharmacists to complete a short survey on MTM services. DPH wants to see how many pharmacists are offering it, and what has helped or hindered your plans to provide it to patients

The better DPH knows what’s out there, the more it will be able to help, so please, click here to take the short survey by July 8. Thank you!

AbbVie buys Allergan

Humira can’t support the company forever, so it’s doing the next best thing to developing a new med: buying a company (in this case for $63 billion).

They just have better germs

Turns out that elite athletes have something surprising in common: gut bacteria from the genus Veillonella. How does that particular bacteria help?

Veillonella metabolizes lactic acid produced by exercise and converts it into propionate, a short chain fatty acid. The human body then utilizes that propionate to improve exercise capacity.

So all you need to do is convince your favorite athlete to donate some gut bacteria. We’ll leave that up to you.

The long read: Turnaround

“Drug Companies Are Focusing on the Poor After Decades of Ignoring Them”

Once demonized as immoral profiteers, many of the world’s biggest 20 pharmaceutical companies now boast about how they help poor countries and fight neglected diseases. They compete on the Access to Medicine Index, which scores their charitable efforts.

Rite Aid to focus on pharmacists

Rite Aid wants its pharmacists to “spend more time providing clinical services to patients” as it revamps its stores to, it hopes, take advantage of how much patients trust their pharmacists.

Gut bacteria linked to fibromyalgia

It may or may not be causal, but there appears to be a clear link between fibromyalgia and the species of bacteria in women’s guts.

A side-by-side comparison of women with and without fibromyalgia revealed over a dozen different species of gut bacteria in the gastrointestinal tract of study participants with fibromyalgia in comparison to a healthy control group without the disease.

Reminder for techs

Back in March we told you how PTCB was streamlining its certification process. Just a friendly reminder — if you haven’t already, you’ll need to create an NABP e-Profile before your next recertification deadline. Check out the details from PTCB.

Newest “female Viagra” gets FDA approval

The FDA has approved Vyleesi, a drug designed to increase sexual desire in premenopausal women. Obviously inviting comparisons to Viagra/Cialis/Levitra, Vyleesi isn’t a pill — it’s administered with a self-injector 45 minutes before anticipated sexual activity. And yes, that does raise the question of how someone can have no desire for sex, but anticipate it at the same time.

Unlike the previous “female Viagra” (Sprout Pharmaceuticals’ Addyi), Vyleesi has fewer side effects, doesn’t restrict alcohol use, and can be taken as needed rather than every day.

Easier hospital shopping?

The Trump administration says it’s going to require hospitals to provide prices for various procedures in an “easy-to-read, patient-friendly format” so patients can potentially shop around for the best price for non-urgent care.

The Affordable Care Act required hospitals to make their pricing available, but the results — cloaked in various non-standard codes and jargon — aren’t understandable by most people. If HHS does in fact create a new rule, the goal will be to make those prices clear.

Interesting aside: Economists aren’t sure if this will make prices go down (more consumer info), or up (easier coordination of price hikes). The latter, it seems, is what happened in Denmark with concrete….

Are pregnant women taking the supplements they need?

The answer: Many are not getting what they need, and many others are taking too much of what they don’t need, especially sodium.

A significant number of pregnant women are not meeting recommendations for vitamins D, C, A, B6, K, and E, as well as folate, choline, iron, calcium, potassium, magnesium, and zinc even with the use of dietary supplements.

Almost all pregnant women in this study were at risk of excessive consumption of sodium, and many were at risk of excessive consumption of folic acid and iron.

Splinter group

If a patient has a recurring headache, you could suggest it might be wood splinters in his brain.

A computerized tomography scan revealed that he had several pieces of wood with a combined length of 11 cm stuck in his brain. Asked how on Earth he had ended up with so much wood deep inside his skull, [the patient] recalled an accident that had occurred half a decade prior.

A massive, nationwide opioid settlement could be in the works

Small towns, big cities, and everything in between — they would all get a share of a settlement with opioid manufacturers if an “comprehensive national opioid settlement with the pharmaceutical industry” is approved. (Notably, this doesn’t affect various state cases against drug companies and “doesn’t invite potential plaintiffs from among other types already in the federal litigation, such as tribes, unions and hospitals.”)

Sorry, no dollar figure has been mentioned yet.

To determine what each municipality would receive, the lead plaintiffs’ lawyers have created an interactive map that will immediately show each participant their expected share of any proposed settlement. The lawyers created the map using federal data pinpointing distribution of prescriptions as well as opioid overdoses and deaths nationwide.

Infusion Options recalls, well, everything

The company issued a voluntary recall for “all lots of all sterile products within expiry to the hospital level” due to a lack of assurance of sterility.

You can’t make me talk

Amgen, Eli Lilly, and Merck are suing the Trump administration, saying that being required to put drug prices in ads violates their First Amendment rights. Their concern, the companies say, is for the patients who may not take their drugs because they think the price is too high.

The real threat from Amazon

Big pharmacy companies might say they aren’t worried about Amazon entering the market, but in reality they are. Not because of the prescription-filling angle — because Amazon is looking to bypass the PBMs. with its acquisition of PillPack.

“While investors have viewed PillPack as a risk factor for retail pharmacies…[the] lawsuit shows that PBMs are now also at risk of being disintermediated, especially if [Amazon’s] efforts to directly contract with large payers gains traction.”

Cold weather increases opioid overdoses

The headline says it all, really. “The new analysis uncovered a 25 percent increase in opioid overdose deaths within three to seven days of freezing temperatures, compared to stretches when the temperature averaged 52 degrees Fahrenheit.”

Horns and hard art

The headline: “Horns are growing on young people’s skulls. Phone use is to blame, research suggests.”

The reality: It’s true — people are developing actual bone spurs on the backs of their skulls, although phone use might not be the only culprit.

Here’s the art*:

* We needed to call it “art” to make the headline pun work

Elsewhere: Out West Edition

A new New Mexico law requires that any opioid script for more than five days includes a co-prescription for naloxone.

Insurers in California were discriminating against people who wanted to take the HIV-preventative medication Truvada, aka pre-exposure prophylaxis or PrEP. The state called them out, and now “many insurers have reported that they’ve already stopped discriminating against people who take PrEP.”