Pharmacies prepare for disaster

Foundations from the National Community Pharmacists Association and AmerisourceBergen are partnering to create the AmerisourceBergen Foundation–NCPA Foundation Disaster Relief Grant Fund*, which will “provide financial assistance to community pharmacy owners for the repair of pharmacies in the event of disaster, accidents, illness or other adverse circumstances.”

* We pity whoever has to have all that on a business card

Health-app ‘formulary’

Express Scripts is trying to launch what it calls a digital-health formulary — a list of technology and apps that have been vetted for safety and effectiveness “with the aim of helping payers and consumers navigate the growing number of digital health tools.”

Make them suffer

How to get anti-vaxxers to change their minds? Expose them to the “real-life pain of diseases.”

New research from Brigham Young University […] finds there is a better way to help increase support for vaccinations: Expose people to the pain and suffering caused by vaccine-preventable diseases instead of trying to combat people with vaccine facts.

A couple of bits of opioid news

More young people than ever are overdosing on drugs, and the main culprit is painkillers — either prescription or bought on the street.

Death rates from drug overdoses for people ages 15 to 24 rose by 19.75% from 2006 to 2015, according to a study published in the peer-reviewed Journal of Studies on Alcohol and Drugs.

The pendulum is swinging back, as this Wired article explains. Patients with chronic pain who need prescription painkillers to function are finding it harder to get their meds — and they are fighting back.

One in four cancer patients have had trouble getting their pain medication because a pharmacist refused to fill the prescription, even though the drug was in stock, according to a survey by the American Cancer Society Cancer Action Network. Thirty percent said they couldn’t get the pain meds their doctor prescribed because their insurance wouldn’t cover the costs.

Perhaps a hearty handshake* instead

“Kissing is a risk factor for throat gonorrhea”

* Followed by a round of Purell

Good luck with that

Back in April we told you how hacker diabetics are making their own artificially intelligent insulin pumps — DIY artificial pancreases, essentially, that work better than what patients can buy (or afford).

But now one such hacker (out of thousands) gave himself an accidental insulin overdose requiring “medical intervention,” so the FDA is warning people not to build their own devices.

The FDA warning is an example of the tension between patients who want to take more of their health care into their own hands and increasingly have the technological tools and know-how to do so, and regulators charged with safeguarding public health.

Deal with it

Health.com answers the important medical questions. (Bonus: It’s a slideshow!)

This doesn’t bode well

The current flu in Australia — which later this year will be our flu — is looking pretty awful, with three times as many cases today as the same time in 2019.

The trade war and generic meds

The trade war with China means we’re all paying more for a lot of Chinese goods (and those made with Chinese components), but not a lot has been written about how it might affect medication. Forbes weighs in with a piece on how the war might affect generics.

China produces 40% of the active components (APIs) of our medicines. These APIs then supply much of the Indian market, where final manufacturing of the drugs occurs. We import 80% of our medicines from India.

Downside: The piece seems to flip between issues: the risk to medication supply, and the differences between “identical” generic meds.

The guts to battle anxiety

Add anxiety to the list of conditions treatable by a change in gut bacteria.

research has indicated that gut microbiota — the trillions of microorganisms in the gut which perform important functions in the immune system and metabolism by providing essential inflammatory mediators, nutrients and vitamins — can help regulate brain function through something called the “gut-brain axis.”

Pot, pain, and the NFL

The NFL and it’s players’ union are together looking into the use of marijuana to treat pain. Currently a positive test for pot can lead to fines and suspension.

In recent years, some players have expressed frustration over the continued punishment of players who test positive for marijuana, even if it’s being used to help manage pain, at a time when more states are legalizing the drug.

Don’t mix meds and the other stuff

A watchdog group is suing Walmart for its homeopathic products — not for selling them, but for selling them mixed in with actual medicine.

“By displaying homeopathic products alongside science-based medicines, without any distinction between them, Walmart is failing to provide truthful information to its customer base, and deliberately creating the false idea in its customers that there is no difference between these two radically different sets of products.”

The suit is not asking Walmart to remove the products. “Instead, the organization seeks to ensure retailers properly label products and keep science-based medicine from being sold side-by-side with homeopathic products.”

Have a Coke and a rictus

If you drink sugary beverages, including fruit juices, you’re gonna die soon. That’s the conclusion of a six-year study of 13,440 black and white adults 45 years and older.

Specifically, “each additional 12-oz serving per day of sugary beverages was associated with an 11% higher all-cause mortality risk, and each additional 12-oz serving per day of fruit juice was associated with a 24% higher all-cause mortality risk.”

So if our math is right*, drinking just a little more than nine cans of Coke in one day (or a quart and a half of orange juice) will mean 100% mortality.

* It isn’t.

Shocking medical headlines

“Anxious people quicker to flee danger”

“Children who walk to school less likely to be overweight or obese“

CMS doesn’t include DIR reform

CMS issued its final Medicare Advantage and Medicare Part D Drug Pricing Rule, and to the surprise of many, didn’t include DIR-fee reform.

National pharmacy associations were quick to recover from their shock and register their displeasure.

Calling the decision “a significant blow to patients seeking relief from the high out-of-pocket costs they face on drugs,” Sheila Arquette, executive director of the National Specialty Pharmacy Association, said, “Allowing the continued collection of these fees threatens quality, affordable medication access for seniors while giving the largest PBMs leeway to continue anticompetitive market practices and keep more Medicare dollars for themselves.”

Meanwhile, the National Community Pharmacists Association and the National Association of Chain Drug Stores issued a joint statement saying they were “disappointed and frustrated” with the decision.

“Pharmacies are in a tenuous situation, and our organizations are exploring all options to accomplish desperately needed reforms to pharmacy DIR. It is necessary for community pharmacies and for the benefit of seniors that this reform take effect as soon as possible.”

Pharmacist Day at the Braves

Check out these pics of GPhA members having a blast at SunTrust park, watching the Braves play the Brewers:

And see some more at GPhA.org/braves!

Pharmacy techs: Free T-shirt

Pharmacy techs — Here’s a cool and comfy reason to register for the Georgia Pharmacy Convention: The first 20 techs to register will get a free convention T-shirt courtesy of Paradigm Education Solutions.

But don’t just come for the shirt. Come for the 20 CE courses accredited for pharmacy technicians. Come for the magical resort with fun for the entire family. Come for the first meeting of GPhA’s Academy of Pharmacy Technicians.

Registration is only $235 for the full convention, or just come Saturday, June 15 for $75 for the day.

The networking opportunity is the best you’ll have all year, and making the right connection is priceless!

Go to GPhAconvention.com for the details — then register and reserve your room!

Fred’s closing more stores

At least 104 more, to be specific.

The danger of charcoal toothpaste

Yet another health trend that really isn’t: charcoal toothpaste. Manufacturers claim it has antibiotic or antifungal properties, or can strengthen tooth structure. In fact, the opposite is more likely true.

“There is simply no scientific proof that these products are capable of detoxifying your mouth, offer any increased antimicrobial activities (antibacterial, antifungal, antiviral), or can fortify/remineralize/strengthen tooth structure,” said Dr. John Brooks, a researcher at the University of Maryland School of Dentistry in Baltimore.

Charcoal, say the writers of a paper in the British Dental Journal, is too abrasive, and can actually damage tooth enamel. And then there’s the issue of it being a carcinogen… so, yeah, stick with the fluoride toothpastes that actually work.

Self-medication before takeoff

What’s worse than being trapped in a sealed metal tube with a few hundred people with varying levels of personal hygiene?

Answer: Having way too many of them self-medicate and then get abusive. That’s what’s happening to flight attendants.

38% of respondents said they had been physically abused by a passenger who had taken medication, while 46% said they had received a verbal insult from a medicated passenger.

This is on par with what they get from drunk people, so it’s basically doubling the abuse.

(Hint: Do you want to be the other kind of passenger? Bring a box of chocolates for the flight crew on a long trip.)

Mom was right

Broccoli really is good for you. An ingredient in it (and its less-desirable cousins, Brussels sprouts, cauliflower, collard greens, kale, etc.) can deactivate a gene “known to play a role in a variety of common human cancers” and even suppress tumor growth.

The long read: CBD regulation can’t keep up

“Dude, where’s my regulatory framework?” from Stat News

Georgia hospitals getting safer

The latest Leapfrog report on hospital safety found that no Georgia hospitals received an ‘F’ this time, and more are getting higher ratings — including 27 out of 76 in the state that got an ‘A’. This moves the state up from 17th place to 15th among the 50 states and Washington, D.C.

Nature red in tooth and, um, gum?

Having a drug cross the blood-brain barrier is tough, because so many meds have molecules that are too large to make it. But some brain conditions put “holes” in that barrier … and now researchers from the University of Wisconsin-Madison have found a way to use molecules from the creepy, jawless* parasitic sea lamprey to take advantage of that and deliver anti-cancer drugs directly to brain tumors.

“Molecules like this normally couldn’t ferry cargo into the brain, but anywhere there’s a blood-brain barrier disruption, they can deliver drugs right to the site of pathology.”

* You don’t want to click here to see how.

Sunscreen questions continue

The other day we told you that the FDA was going to be looking at how safe sunscreens are, now that we know the ingredients actually enter the bloodstream.

The FDA proposed some new guidelines for the products, but now it seems that 60 percent of products on the market wouldn’t meet those new ‘safe and effective’ guidelines, according to a review by the Environmental Working Group.

As the group has reported in the past, over 60% of the products evaluated do not offer adequate sun protection or contain potentially harmful chemicals. What makes this year’s report different, said Director of Healthy Living Science Nneka Leiba, is that the 2019 products were judged using FDA safety guidelines proposed in February.

“The fact that 60% of the market seemingly wouldn’t be considered safe and effective by the FDA is a huge deal.”

Pick up the pace

You may not be able to cheat Death, but if you walk fast you might get yourself a few steps ahead of him. (That’s the headline, but what the study actually says is that ‘amount of exercise’ is a better indicator of mortality risk than body-mass index.)

Low salt, light head

People who reduce their sodium intake (e.g., to try to reduce hypertension) might tend to get lightheaded more often thanks to orthostatic hypotension, i.e., a drop of blood pressure when standing.

An app to diagnose ear infections

Nifty trick — researchers at the University of Washington, Seattle have created a smartphone app that can diagnose ear infections more accurately than a physician with an otoscope — 85 percent for the app vs. 51 percent for the otoscope

All the app needs is a small paper funnel, which can be fashioned at home from a piece of paper and with directions in the app. The funnel is placed on the outside of the ear, at which point the app sends a bird chirp-like sound into the ear. Depending on the sounds that the app picks up in return, a machine learning algorithm built into the app is able to tell whether or not there is liquid in the ear.

More kids, more diabetes

The more children a woman has, the greater the chance she will develop diabetes after menopause — at least according to a new study out of the Zhejiang University School of Medicine in Hangzhou, China.

The “hidden health crisis” we bet you didn’t know about

Snakebites. Really.

CVS to require supplement testing

The company’s “Tested to Be Trusted” program will require that all supplements sold in its stores be tested to ensure they contain what they say they do.

So far, 7% of the supplements failed testing requirements, meaning their labels were updated or the products were pulled from shelves.

Measles update

2019 already has double the cases of 2018.

CVS/Aetna update

What, you thought this was over? Silly you. Latest twist: The judge overseeing the case ruled against CVS and the Justice Department (and for the American Medical Association) and is allowing witness testimony about antitrust issues.

The ruling means there will be a full airing of the arguments for and against the DOJ’s merger settlement agreement, through three witnesses for each side.

It’s looking official: Low-dose aspirin might not be a good idea

More evidence that aspirin shouldn’t be used to prevent heart attacks or strokes: Unless someone is clearly at risk, the danger from brain hemorrhages is greater, although this doesn’t seem to apply to overweight people. (Bonus: Article includes a photo of a handful of ibuprofen. Really, doesn’t everyone know what aspirin looks like?)

Speaking of ibuprofen…

Got a patient in pain after a tonsillectomy? Hopefully you sell ice cream, but you might suggest skipping the ibuprofen in favor of another painkiller. A study in JAMA Otolaryngology Head and Neck Surgery found that ibuprofen may increase the risk for severe bleeding after a tonsillectomy.

Don’t you have something better to do?

The U.S. birth rate fell for the fourth year in a row, “leading to the fewest babies in 32 years.” Is this a big deal? No, probably not.

Vitamin A, bacteria, and acne

There’s a bacteria-killing protein on your skin that can prevent skin infections, and a new study finds that it requires vitamin A to work. (The research was looking at why people with vitamin A deficiency had more skin infections. Now it seems they know.)

That info leads to the next leap: Is this why retinoid can treat acne? It’s basically synthetic vitamin A after all, and, while it works for patients, it’s never been clear exactly why.

Too much vitamin B and hip fractures

Older women who take excessive vitamin B supplements (that’s B6 or B12) are at a greater risk of hip fracture. Note: We’re not talking a multivitamin here. “The intakes were far higher than the recommended dietary allowances,” wrote the researchers.

The long read: CBD

“Can CBD Really Do All That?” from the New York Times Magazine.

Insurance commissioner indicted

Georgia Insurance Commissioner Jim Beck was indicted on charges of fraud and money laundering. More on this story coming soon.

E. coli outbreak easing

The 10-state (including Georgia) outbreak of E. coli from tainted ground beef is finally easing, according to the CDC. Instead of 18 reports a day, the agency says it’s only received 19 in the last month. At least 49 Georgians have been sickened.

Get your parchment*

Certificates don’t just look great on the wall. They tell your patients (and your employer) that you’re at the top of your game.

What we’re saying is Check out the certificate courses GPhA has coming up: point-of care testing, immunization, diabetes, and medication therapy management. Find info and dates conveniently at GPhA.org/certificates!

* Certificates not actually parchment. It’s a metaphor.

The word of the day is “Blepharospasm”

The FDA has approved Merz’s incobotulinumtoxinA — known to its friends as Xeomin — for treatment of involuntary blinking. Which of course raises the question, “Isn’t most blinking involuntary?”

Promacta recall

Novartis is recalling three lots of the liquid version of its anemia drug Promacta because it may have been contaminated with peanut flour.

This is the Promacta 12.5 mg for Oral Suspension; click the link above for details and the NDCs of the recalled lots.

The operative word is “occasional”

Pigging out every now and then won’t cause irreversible damage: “The body adapts and quickly bounces back from an occasional day of gluttony.”

The long read: UVA and UVB

“Why Is Sunscreen ‘Better’ in Europe?”

Bonus: Consumer Reports just released it’s annual sunscreen review.

Generics lawsuit: 44 to 20

A whopping 44 states — but not Georgia — have filed a lawsuit against 20 generic-drug makers, alleging the companies engaged in illegal collusion and anti-trust activity — including raising the prices of drugs (by more than 1,000 percent in one case), and stifling competition. Defendants include Mylan, Novartis, Pfizer, and Teva.

A key element of the scheme, the complaint alleges, was an agreement among competitors to cooperate on pricing so each company could maintain a “fair share” of the generic drug markets. At the same time, the companies colluded to raise prices on as many drugs as possible, according to the complaint.

The call is coming from inside the house!

Most healthcare data breaches, it turns out, are inside jobs, according to a Verizon investigation.

It seems 59 percent of “threat actors” were internal, with the goal usually being some sort of financial gain. (Although 6 percent of breaches were apparently done for fun, and 3 percent were acting on a grudge.)

All in the family

Diabetic kids who argue with their family about the condition are more likely to have poor glycemic control than those who live on the same block as the Cleavers.

Even worse…

If any of those kids ends up with peripheral neuropathy, it’s going to impair their driving skills.

Motorists with diabetic peripheral neuropathy drive at slower speeds and are at increased risk for losing control of the vehicle compared with adults without peripheral nerve dysfunction.

Mirror, mirror

At a hearing of the House Energy and Commerce Committee’s Subcommittee on Health, PBMs and drug makers agreed on who was to blame for high medication prices: the other guy.

Medical shocker

The health claims on breakfast cereal boxes are apparently bogus.

There was also not much of a connection, they found, between the positive claims and the nutritional content of the breakfast cereals. In fact, [study co-author Pierre] Chandon notes that the actual correlation was almost zero.

Opioid use dropped last year

So says a report from the IQVIA Institute for Human Data Science — in fact, it fell at a record rate.

Prescription opioid use in the U.S. was down 17% in 2018, marking the largest annual decline ever recorded [….] In 1992, prescription opioid use was at roughly 22 pain pills per U.S. adult per year and rose to a peak level of 72 pills per U.S. adult in 2011, IQVIA said. Since 2011, use has declined by 43% to 34 pills per adult.

The needs of the many outweigh the nonsense you read on Facebook

“77% of Americans say kids should get measles shot even if parents object.”

Resistance is a little more futile

Colistin is a last-resort antibiotic, and yet there are some infections that resist it. Now scientists have identified the gene that makes resistance possible, called mcr-9. The bad news: It’s a “jumping” gene, meaning it can spread to other organisms.

Knowing what mcr-9 can do might not help with treatment (yet), but if it can be identified in food products or people that might help prevent a resistant infection. “This improves our ability to get an early warning,” said Cornell’s Martin Wiedmann, senior author on the study.

Say it again

If you want kids to eat healthier, repetition is the key.

Saying “Lentils will help you run faster,” for instance, encourages preschoolers to understand the benefits and pick the foods they want, the study authors write in the Journal of Nutrition Education and Behavior.

Say it again

If you want kids to eat healthier, repetition is the key.

Saying “Lentils will help you run faster,” for instance, encourages preschoolers to understand the benefits and pick the foods they want, the study authors write in the Journal of Nutrition Education and Behavior.

Because why not

Guys, have you been shaving with cold steel blades like… like some kind of animal?

Fear not, Gillette feels your pain. The company is introducing a five-bladed heated razor called, well, the Heated Razor. It will sell for a mere $200; additional blades are just $25 each. (The company felt the need to point out that the Heated Razor is also waterproof.)

Now you no longer need to walk around like a scruffy-looking nerf herder.

You using that pickle?

If so, it might be a smart move. Medical News Today explains “What are the benefits of pickles?“

Governor signs HB233, HB323

It’s the end of PBM steering in Georgia — and much more. We’ll give you all the details of what these two companion bills mean for you and your patients, but for the moment let’s just say that it’s a very very big deal.

A host of GPhA members and staff joined Governor Kemp as he signed our bills yesterday, notably Jennifer Shannon of Lily’s Pharmacy who put her time, effort, and heart into making this happen:

Border caravan on the move

Not, not that border caravan. The one going to Canada to buy insulin.

But they might become unnecessary: “Trump asks Health secretary in Oval Office to help Florida import Canadian drugs.”

So it shall be written; so it shall be done

HHS has made it official: Drugs that cost more than $35 a month must have list-pricing info included in any television ads. The rule takes effect July 8*.

* Maybe it’s the 7th. Or the 9th. It’s 60 days from yesterday.

Diabetes patch as good as a needle

If you’re helping patients manage their type 2 diabetes, this is good to know:

An insulin patch can safely provide similarly effective glycemic management in adults with type 2 diabetes compared with a standard insulin pen, according to findings published in Diabetes Technology & Therapeutics.

Injury to insult

Depressed mice — those that don’t produce enough serotonin — also seem to have stomach issues. Serotonin not only affects the brain, but also gut neurons, causing constipation and other issues.

“Ultimately, many patients with depression are faced with limited treatment options and have to suffer with prominent GI dysfunction.”

Phages come through again

We love us some bacteriophages, especially in this age of drug-resistant bacteria. That’s why this story is doubly interesting. Physicians not only successfully treated a teen’s antibiotic-resistant mycobacterial infection with phages (a first), but they had to first genetically engineer the phage to turn it into a bacteria killer.

“Drug-resistant mycobacterial infections are quite common, and there is a strong need for new approaches to treat them,” [phage expert Graham] Hatfull* said. “Bacteriophages are super interesting and harbor numerous unsolved mysteries. Studies such as this illustrate the potential for phages to control bacterial infections but also emphasize the need to make further research advances in order to determine if and how they can be broadly applied.”

Governor set to sign HB233 and HB323 today

Yesterday afternoon we were notified that Governor Kemp will sign both HB233 and HB323 this afternoon! (HB233 represents landmark legislation, prohibiting PBM steering; HB323 strengthens portions of the Patient Protection Act passed in 2017.)

Thank you to all GPhA members who took the time to write or call the governor’s office. The PBMs lobbied hard for a gubernatorial veto, but those messages from you made the difference.

We look forward to celebrating these hard fought victories with you in June during at the Georgia Pharmacy Convention!

New commissioner, new standing order

Remember, you can give naloxone without a prescription, but you need the DPH commissioner’s standing order on hand. With Kathleen Toomey taking over that position, the standing order has been updated.

You can grab the latest version at GPhA.org/naloxone.

Sunscreen in the blood

Sunscreen makers: Our products aren’t absorbed into the bloodstream, so we don’t need FDA oversight.

FDA: Really? Let’s test that.

The results, published in the journal JAMA, show that contrary to what sunscreen manufacturers have been saying, UV-blocking chemicals do seep into circulation.

“Everyone had always thought that because these are intended to work on the surface of the skin that they wouldn’t be absorbed, but they are,” said Theresa Michele, director of the FDA’s division of nonprescription drug products.

This doesn’t mean the chemicals are safe or unsafe — just that they get into the blood and thus testing needs to be done now. Don’t worry: The FDA has asked the sunscreen makers themselves to test how much of the ingredients (avobenzone, ecamsule, octocrylene, and oxybenzone) are absorbed into the bloodstream, and to prove they’re safe.

Unusual side effect

Teen girls who take oral contraceptives are less likely to suffer from … ACL tears? Apparently so, according to a study out of Brown University.

OCPs [oral contraceptive pills] have a protective effect on ACL tear, especially in the 15–19 age group, which exhibited a 63% reduction in the rate of tear. Consideration should be given to prescribing OCPs to younger athletes, after careful assessment of the risks of these commonly prescribed medications.

CVS adding dental care — sort of

The chain is putting the SmileDirectClub teeth-straightening service into hundreds of its stores.

Permanent resident

Probiotics can do a lot of good for gut bacteria, but one “bad” actor it can’t get rid of: Helicobacter pylori. Once it’s in … well, it’s staying in.

The stomach-dwelling bacteria Helicobacter pylori survives in the stomach—a hellish, churning vat of hydrochloric acid—by holing up inside that organ’s pitlike glands and establishing squatter’s rights. Once the germ has set up shop, the investigators learned, even competing strains of the same species can’t displace it, or even share its hideout.

* Not really bad, of course. It just does what it does.

Preventable

Ebola continues to spread in Congo, in large part due to fear and misinformation among the people there, causing many to shun modern medicine.

In a completely unrelated story, the U.S. measles outbreak added at least 60 more cases in the last few days; it’s already the largest outbreak in a quarter century. “Two overlapping groups have suffered the most this year: children under age 4 and people who were unvaccinated.”

In Europe, more than 34,000 people have contracted the preventable disease, prompting the WHO to issue a plea for vaccinations.

Headline shocker

“Diet blogs often fail to provide accurate information, references”

Elsewhere: I didn’t know they could do that

“Pharmacy student launches startup for medical marijuana patients“