CVS: Let me share with you my nefarious plan

In an analysis of the CVS/Walmart spat, one analyst (George Hill at RBC Capital Markets) said — according to Business Insider — that it’s “an early sign of how CVS will use its massive negotiating power to its own benefit.”

The goal is to direct more people who use CVS and Aetna insurance products into the company’s drugstores, Hill said.

CVS, surprisingly, didn’t disagree. In fact, it said, that’s exactly the plan.

CVS has said that directing Aetna customers into its stores to receive healthcare is a major element of the strategy for the combined company, because that can keep them healthier at a lower cost.

Here at GPhA — where we fought hard against the merger, knowing it would be bad for patient choice and thus for patient care (and received some major concessions through the good efforts of the insurance commissioners office) — we can only say, “Not a big surprise.”

Get yourself an MTM certificate

Quick and simple: We’re offering APhA’s MTM certificate program. Real soon.

• February 17, 8:00 am to 5:00 pm.
• In Sandy Springs, Ga. (just outside Atlanta).
• 21 total CPE hours.
• $349 for GPhA members, $499 for non-members, which includes a GPhA membership.
• Visit GPhA.org/mtm for details on the program, speakers, requirements.

A LOT of inappropriate antibiotics

A new study published in the British Medical Journal looked at more than 19 million outpatient antibiotic prescriptions. It found that almost a quarter of all those scripts were inappropriate, and a lot more may have been.

• 23.2% were inappropriate, period
• 28.5% “were not associated with a recent diagnosis code” (meaning there was no clear reason for the antibiotic to be given)
• 35.5% were potentially appropriate

Only the remaining 13.8% were absolutely recommended for the reported diagnosis.

And who is writing all these prescriptions? A different investigation found that it’s dermatologists who write the most (although they are writing fewer long-term scripts).

Don’t tell Humpty Dumpty*

Get out your favorite flipping coin — ours is a 1975 U.S. quarter. Today we learn that eggs are (flip that coin!) … good for you. That’s right, the Finns report that an egg a day can help stave off diabetes.

* Why does everyone assume he’s† an egg?
† And why do they assume it’s a he?

What’s in your dental floss?

Some brands that use Teflon fiber contain PFAS — which you may have heard of in relation to non-stick cookware. (Hint: It’s not good) So, assuming you sell floss, you might consider which types you carry. (And just between us, as we told you a couple of years ago, flossing really doesn’t have any proven benefit.)

Brunner to IACP

Former GPhA CEO Scott Brunner — currently a senior VP at NCPA — is moving to the International Academy of Compounding Pharmacists (IACP). He’ll take over as IACP’s new CEO effective March 4.

Note: An earlier version of this story reported that Brunner was going to the International Association of Culinary Professionals (IACP). We regret any confusion.

Note: An even earlier version of this story reported that Brunner was going to the International Association of Chiefs of Police (IACP). We regret any confusion.

Elsewhere: Emerald Isle edition

As reported in the Irish Medical Journal, a man there was hospitalized after he tried to play pharmacist and treat his own back pain. “He had devised this ‘cure’ independent of any medical advice.”

Who you gonna call?

800-662-HELP is the number, but you rarely hear it. It’s the number of the Substance Abuse and Mental Health Services Administration — the people to call for addiction help. But researchers found that the number is hardly ever publicized*, especially compared to the National Suicide Prevention Lifeline number.

(Georgia pharmacists and technicians who need help with addiction can call the PharmAssist Recovery Network at (404) 558-1983, any time day or night.)

* The exception? When a celebrity overdoses

Dogs can be trained to smell hypoglycemia

Yep, you read that right. Trained “glycaemia alert dogs” can tell their diabetic owners when the owner’s blood sugar goes out of range.

The dogs weren’t perfectly accurate, and the data are still preliminary, but…

When asked to recall the incidence of hypoglycaemia, currently and before having a trained dog, all clients reported a reduction in either frequency of low blood sugar, unconscious episodes or paramedic call outs and six clients believed all three had been reduced. Eight people reported that they had never been unconscious since having a trained dog (although they had previously), whilst three reported paramedic call outs pre- but not post-dog acquisition.

The price of independence

Adam Fein at Drug Channels looked at the info in the recent 2018 National Community Pharmacists Association Digest [link] as part of his annual review of pharmacy economics. He did not find good news for indy pharmacists.

[W]e estimate that in 2017, the average pharmacy owner’s salary fell to a level comparable to that of an employed pharmacist. Owning a pharmacy, with all of its hassles and additional obligations, now brings the same reward as being an employee.

That’s a big reason to work towards expanding your healthcare offerings: medication therapy management, diabetes monitoring and education, promoting immunization, joining community-pharmacy networks … you get the idea.

Georgia Tech creating long-term contraceptive patch

Georgia Tech researchers have developed a long-acting, self-administered contraceptive patch. What’s the big deal? The “self-administered” part. If it leaves the lab, the microneedle patch would give women the option of long-term birth control without having to visit a doctor for an injection or an implanted device.

Quick, find a cure!

In the movies, developing a cure for the Deadly Disease That Will Soon Wipeout Mankind can take only hours: “Now that we have a sample of the virus, we can create a vaccine!”

Reality? It doesn’t work that way. But the Coalition for Epidemic Preparedness Innovations — funded in part by the Bill and Melinda Gates Foundation — just gave $10.6 million to the University of Queensland “to develop a ‘molecular clamp’ vaccine platform.”

A what? It’s a technology that enables “targeted and rapid vaccine production against multiple viral pathogens.” In other words, a step towards creating vaccines quickly when a new pathogen is discovered … or starts to spread.

The polite term is “mislead”

Turns out that the Sackler family, owner of OxyContin-maker Purdue Pharmaceutical, may have been much more involved in the marketing of Oxycontin than it admitted. In fact, according to court filings…

…one of them, Richard Sackler, advised pushing blame onto people who had become addicted.

“We have to hammer on abusers in every way possible,” Mr. Sackler wrote in an email in 2001, when he was president of the company, Purdue Pharma. “They are the culprits and the problem. They are reckless criminals.”

ICYMI: Walmart won’t accept Caremark

Walmart pharmacies will no longer accept prescription drug coverage from CVS Caremark because the two companies can’t agree on pricing.

You know this is gonna confuse the heck out of a lot of patients. They’re about to learn A) what a PBM is, and B) that CVS pharmacies and CVS Health are two different things.

Caremark controls about 25 percent of the prescription-drug-coverage market, just behind Express Scripts.

Quick follow-up, South Carolina style

Yesterday we mentioned that the Georgia legislature may consider allowing farmers to grow hemp (not marijuana!). South Carolina Pharmacy Association CEO Craig Burridge wrote to point out a cool fact about the plant: “It’s a great rotational crop as well. It’s a plant that actually puts more nitrogen onto the soil than it takes out, and that’s good for other crops.”

To keep our lawyer from having a fit: GPhA has no official stance on the legalization of hemp growing. We just thought it was an interesting tidbit.

Elsewhere: Birth control in Arkansas

A bill introduced by a Republican representative in Arkansas would allow pharmacists there to dispense oral contraceptives without a prescription. Arkansas, you see, has the highest rate of teen pregnancy in the nation, although the bill would only allow OTC birth control for women 18 and older.

Leadership advice from a member

A big Buzz shout-out to GPhA member Snehal Doshi, PharmD, vice president of pharmacy services for Marietta-based WellStar Health System, who was interviewed by Becker’s Hospital Review about “what pharmacy leaders need to succeed.” (Bonus: Last year, Becker’s named him one of its “Rising Stars in Healthcare.”)

House begins investigating drug pricing

And so it begins: The House Committee on Oversight and Reform sent letters to 12 pharmaceutical companies asking some probing questions about how they price their drugs, when and why they raise prices, and how much of that money really does go to research.

The best-laid plans (for reducing drug costs)

Speaking of the House, what exactly are the ideas on the table for tackling drug prices? Dylan Scott at Vox has a breakdown of the seven major ideas and their pluses and minuses, from “speedier approval of generics” to “patent-system reform.”

Drug prices are a thorny problem. What we do know for sure is people want something done about drug costs. The current proposals on the table range from the realistic to the purely aspirational.

New legislature, new look at hemp

Georgia’s new and returning legislators are ready to consider changing the state’s hemp laws. One proposal: Now that hemp is legal to grow under federal law, allow it under Georgia law as well. (Georgia is one of only about 10 states that don’t allow hemp to be grown.)

Although it’s somewhat related to marijuana, hemp is an entirely different plant, and it contains little or no of the psychoactive THC. What it does contain is CBD, the PG-13 compound* that could also have medicinal benefits.

More importantly to legislators, though, is that legalized hemp-growing could be good for the state’s struggling farmers. (Hemp can be made into fabrics, paper, plastics, and dozens of other products.)

*Admit it — it’s a pretty good metaphor.

The emerging market for diabetes test strips

For diabetics who can’t afford the test strips they need to keep their blood sugar in line, a strange market has developed: reselling leftover, unused strips at deep discounts. Whether patients simply receive more strips than they use, or if they switch brands of strip-reader, the result is a glut of leftovers.

For a patient testing their blood many times a day, paying for strips out-of-pocket could add up to thousands of dollars a year. Small wonder, then, that a gray market thrives. The middlemen buy extras from people who obtained strips through insurance, at little cost to themselves, and then resell to the less fortunate.

FDA and the shutdown

The FDA will soon have to stop approving new drugs as it runs out of the money it’s received from user fees. Even though those fees come from industry rather than government, the agency isn’t able to accept the payments.

And, while the CDC says the national romaine lettuce crisis is officially over, now some chocolates might be contaminated with hepatitis A. This comes as FDA food inspections are cut back because of the shutdown (although the agency said the inspections have resumed using unpaid workers).

The right gut bacteria means no food allergies

How might you prevent a kid from getting a food allergy? Change his gut bacteria. In fact, researchers found, a single bacterium — Anaerostipes caccae — apparently protects against those food allergies, period.

We found that germ-free mice colonized with bacteria from healthy, but not [cow-milk allergic], infants were protected against anaphylactic responses to a cow’s milk allergen.

ICYMI: Yes, the flu is spreading

At least 7 million cases so far, several deaths, lots of sick folks in Georgia, still time to get your shot, yada yada yada. You know the drill. Just making sure you don’t forget.

Slip out the back, Jack

Reader’s Digest has eight, “One Good Thing” has 17, “Crafts by Amanda” has 20, “DIY & Crafts” has 30, but our prize goes to “GameVortexGeck0” in Instructables who provides a whopping “68 Ways to Reuse Old Prescription Medicine Bottles.”

Might as well face it you’re addicted to ___

Imagine you woke up today and thought, “I wonder what the five most addictive substances on Earth are,” but you were feeling too lazy to click on an entire article explaining the methodology.

Wouldn’t you be happy to read this: 1) Heroin, 2) cocaine, 3) nicotine, 4) barbiturates, 5) alcohol.

You’re welcome!

Remember: Nominate someone for a 2019 GPhA award

Don’t forget, it’s that time of year — time for you to nominate a pharmacy professional for one of GPhA’s prestigious awards:

• The Distinguished Young Pharmacist Award
• The Excellence in Innovation Award
• The Generation Rx Champion Award
• The Larry Braden Meritorious Service Award
• The Bowl of Hygeia

Get more information on what each of these awards represents, then nominate someone to receive one — all at GPhA.org/awards!

Drug pricing ups and ups

Johnson & Johnson became the latest major drugmaker to raise its prices for 2019, after foregoing increases for the last part of 2018. The company said its average increase will be 4.2 percent, although most prices went up by six to seven percent. (The U.S. inflation rate is about 2.3 percent.)

And no, despite what you may have heard, drug prices did not decline in 2018. Quite the opposite.

A recent analysis of brand-name drugs by the Associated Press found 96 price increases for every price cut in the first seven months of 2018. At the start of last year, drug makers hiked prices on 1,800 medicines by a median of 9.1 percent, and many continued to increase prices throughout the year.

Opioid deaths hit new milestone

For the first time, death from opioid overdoses have surpassed those by automobile accidents in the U.S. And, according to the CDC, they’re particularly skyrocketing among women.

New sleeping pills

Taking a benzodiazepine to sleep can mean sleeping through a smoke alarm or mass murder. Now some researchers are developing a new kind of drug called DORAs. They put people to sleep … but also let them wake up when they need to, and not feel woozy all day, either.

(That’s the news story. Click here for the published paper.)

Hospitals play games with new pricing rule

Hospitals are now required to post their prices online where patients can access them. So they’re doing that — but in a way that no one can understand.

The data, posted online in spreadsheets for thousands of procedures, is incomprehensible and unusable by patients — a hodgepodge of numbers and technical medical terms, displayed in formats that vary from hospital to hospital. It is nearly impossible for consumers to compare prices for the same service at different hospitals because no two hospitals seem to describe services in the same way. Nor can consumers divine how much they will have to pay out of pocket.

Elsewhere: Louisiana’s idea for hep-C drugs

Louisiana wants to try a new way of paying for hepatitis C drugs: The Netflix model, in which the state pays a provider a flat rate per year for all the hep-C meds it needs.

The long(ish) read: “Bennies”

“The Lost World of Benzedrine — Favored by artists and mathematicians, the drug powered a great deal of innovation in the 20th century.”

Old ideas, new packaging

Check it out: NCPA’s Doug Hoey has the big op-ed in Thursday’s Morning Consult: “Everything Old Is New Again?” It’s about how the services that community pharmacies have offered for a long time are being touted as “new.” Heck, if you haven’t used them, they’re new to you, right?

Quoth Hoey:

Recently, we watched the much-ballyhooed announcement that Walgreens will partner with FedEx to offer next-day delivery service by mail order. The move comes six months after CVS announced the same service. Both charge $4.99 for this “new” benefit.

That sound you hear is the collective yawn of community pharmacists across the nation. A new service? Hardly.

First U.S. phage-therapy research center opens

The University of California San Diego is opening the nation’s first center specifically to research and apply the use of bacteriophages to combat antibiotic-resistant infections.

We’re gonna let this headline speak for itself

“Extensive Facebook Use Linked to Poor Health, Decision-Making”

New Congress begins to tackle drug pricing

As Democrats begin the year in control of the House, they’ve already begun introducing bills to lower drug prices. But will the White House be willing to support them?

From the AP story:

The lawmakers want to:

—Open up generic competition to patent-protected U.S. brand-name drugs that are deemed “excessively priced.”

—Allow Medicare to directly negotiate with drugmakers.

—Let consumers import lower-priced medications from Canada.

(At least one of those bills — allowing Americans to import drugs from Canada for personal use — has some high-powered Republican support.)

Are biological makers trying to scare patients away from biosimilars?

According to FDA commish Scott Gottlieb — and a lot of others — that’s exactly what’s going on.

Elsewhere: Cheesehead edition

Wisconsin’s governor moves to expand Medicaid there. Assuming he’s successful, Wisconsin would be the 38th state to do so.

Technicians’ academy board meets for first time

The new GPhA Academy of Pharmacy Technicians had its first board of directors meeting Wednesday, via teleconference — a great way to make the most of everyone’s time (and save them the trouble of navigating Atlanta’s lovely highways).

We’re always a little apprehensive about using new technology, but this went off without a hitch. And admit it — it looks cool, too:

The reborn Academy of Pharmacy Technicians has been in the works for several months, and we’re excited to see it come to life. GPhA represents all pharmacy professionals, and APT helps us be sure to connect with the thousands of pharmacy techs across the state.

As for the day’s business: Emily Durham was elected chairperson of the academy, and Bre Lowery was elected co-chair. We expect we’ll be hearing a lot more from them soon!

The cost of smoking: Georgia edition

When it comes to paying for smoking, Georgia ranks highest in the country — that is, smoking costs Georgians more than any other state when you take into account the out-of-pocket cash, lost wages due to illness, and the cost to treat smoking-related illness. That’s according to new data from WalletHub.

Get this: The average Georgian smoker spends more than $87,000 over his or her life just paying for cigarettes (and cigars), and will incur more than $120,000 in healthcare costs because of it.

Lilly to publish prices

Getting a jump on a potential new FDA requirement, Eli Lilly is giving the public access to the list price and average out-of-pocket cost of its Trulicity diabetes med — as well as info about patient-assistance programs.

Television ads for the drug direct viewers to a website with the detailed info; the company said it would offer the same transparency with its other drugs soon.

Acne treatment: So that’s why it works

Isotretinon, known as Accutane to most of us, helps clear up acne. Fun fact: Scientists aren’t entirely sure why it works. Now they know more — apparently it actually changes the skin’s microbiome to be more like that of acne-free people.

Microbiomes. Is there anything they can’t do?

More hospitals join to produce their own generic meds

Back in September we told you how several major hospital chains had formed a company, Civica Rx, to produce their own generic drugs — an obvious way to cut costs.

Now, less than a year after that initial announcement, 12 more health systems have joined the group, bringing the total to about 750 hospitals across the country.

Opioid addicts turning to Imodium

The anti-diarrhea medicine helps reduce the symptoms of opioid withdrawal for users who can’t get into a treatment program or don’t have access to (read: can’t afford) Suboxone. That’s led more and more of them to turn to the OTC aisle to self-medicate.

Elsewhere: Washington moves toward universal coverage

Hot on the heels of California and New York City announcing plans to essentially offer free health treatment for all their residents, Washington’s governor is proposing to add a “public option” to that state’s healthcare exchange as a step toward universal healthcare.

How worried should you be about the flu in Georgia?

What to know:

• The season is running late; it looks to be picking up right now.
• Georgia is among the states with the highest prevalence of flu.
• The strain in Georgia — and the South in general — is different than what’s in the rest of the country. It’s the H3N2 version that hit the country so hard last year. (Most of the country is seeing the less-deadly H1N1 strain.)

Georgia Health News has more.

Down, down, down

The U.S. cancer rate, that is — for 25 years in row.

Elsewhere: California’s big drug-pricing change

California’s new governor, Gavin Newsom, signed an executive order on his first week at the job:

It directed California’s massive Medicaid system to negotiate prescription drug prices for all of its 13 million recipients, changing their benefits from a managed-care or HMO approach to one that allows the state to handle all the purchases.

But wait, there’s more: It also allows private companies to ‘piggyback’ on those negotiations, giving the buyer’s block even more clout to demand lower prices.

Elsewhere: NYC guarantees healthcare

The City of New York will guarantee healthcare for all its residents. Every one, including undocumented immigrants.

What’s worse than Zika?

Not a riddle — a new mosquito-borne virus to be afraid of: the Rift Valley fever virus.

Baby it’s hot inside

Inside the van, that is — the one that’s bringing those mail-order prescriptions. And “Extreme Temperatures May Pose Risks To Some Mail-Order Meds.” #anotherreasontouseyourlocalpharmacy

Nominate someone for a 2019 GPhA award

It’s that time again — time for you to nominate a pharmacy professional for one of GPhA’s prestigious awards:

• The Distinguished Young Pharmacist Award
• The Excellence in Innovation Award
• The Generation Rx Champions Award
• The Larry Braden Meritorious Service Award
• The Bowl of Hygeia

Get more information on what each of these awards represents, then nominate someone to receive one — all at GPhA.org/awards!

FluMist is still iffy

Even though it’s been approved this year for kids (after two years of not being approved), new research* says that FluMist doesn’t work as well as a shot. Plus with the shot you get a lollipop.

* Caveat: 20 percent of the research team works for AstraZeneca

The big Merck lawsuit, explained

The Supreme Court is hearing a case this week against Merck. Here’s the gist:

Fosamax, Merck’s osteoporosis drug, can cause fractures. Merck knew this, and asked the FDA if it could change the label to warn patients. The FDA said no.

Thousands of patients ended up with fractured femurs. They sued Merck. The drugmaker said, essentially, “We tried to warn you, but the FDA wouldn’t let us.”

The patients, however, say that the company didn’t try hard enough to change the labels (it could have reworded them, they say, to make the FDA happy), and thus Merck broke state product-warning laws.

And off to SCOTUS we go!

Why is this a Big Deal? First, it puts federal law against state laws. And second, because ‘the FDA wouldn’t approve our warning’ is a common strategy against these suits — in fact, the capital-C Court already ruled that such a defense was legit. But if this case turns out differently … well boy howdy will that open a can of worms.

Researchers, beware the Yellow Peril!

Doing biomedical research? Guard your data from ““Nontraditional collectors of information,” says the government. By which it means “Chinese data thieves.”

In some cases […] Chinese graduate students or visitors have taken intellectual property from American laboratories and given it to Chinese scientists or arms of the Chinese government, which published and commercialized the findings.

Captain Obvious files: “What happens when you remove fluoride from tap water?”

Kids get more cavities.

Georgia sues drug companies over opioids

No, this isn’t part of the Very Big Opioid Lawsuit in Ohio. Georgia Attorney General Chris Carr is filing his own, state-level suit against 14 drug makers and distributors, demanding that they reimburse Georgia for what it’s spent treating people.

The list of defendants: Actavis, Allergan, AmerisourceBergen, Cardinal Health, Endo, J M Smith, Mallinckrodt, McKesson, Par Pharmaceutical, Purdue Pharma, Qualitest, SpecGx, Teva, and Watson Pharmaceuticals.

The deets, according to Carr:

The lawsuit also alleges that the named opioid distributors supplied, sold and placed into the stream of commerce prescription opioids, without fulfilling their legal obligations to monitor, detect, report, investigate or otherwise prevent the fulfillment of suspicious orders. This behavior led to the predictable diversion of these dangerous drugs for illegitimate and/or non-medical purposes.

“And dandelions and devil grass are better!”

As one of those rare people who actually likes dandelions, it’s good to see that they’re chock full of potentially beneficial chemicals — antioxidants, antihyperglycemics, and even anti-inflammatory compounds. File under “More research needed.”

* Because they bend you over and turn you away from all the people in the town for a little while and sweat you and get you down where you remember you got a nose again. And when you’re all to yourself that way, you’re really proud of yourself for a little while; you get to thinking things through, alone. Gardening is the handiest excuse for being a philosopher. Nobody guesses, nobody accuses, nobody knows, but there you are, Plato in the peonies, Socrates force-growing his own hemlock. A man toting a sack of blood manure across his lawn is kin to Atlas letting the world spin easy on his shoulder.”

Hospital transparency

A couple of stories on the topic. First, a new CMS rule took effect requiring hospitals to post their list prices online.

The big deal is in a small part of the rule: Those prices must be machine-readable. So what? you say. It means that people can develop comparison tools: “How much is knee replacement at hospitals within 50 miles of the 30328 ZIP Code?”

Second, Georgia’s non-profit hospitals aren’t exactly transparent about their finances, even when they’re publicly owned. But that might be about to change:

A powerful group of state lawmakers appears concerned about the secrecy and business practices of some nonprofits that operate Georgia hospitals, especially the nonprofits that run hospitals owned by public hospital authorities.

Let Grandpa have his hooch

“Moderate Drinking Not Harmful for Seniors With Heart Failure”

Elsewhere: Lobster edition

Maine became the 36th state (plus D.C.) to adopt Medicaid expansion for its residents, giving about 70,000 more Mainers (Mainians? Mainites?) access to healthcare. Voters there approved the expansion a year ago, but the state’s Republican governor refused to enact it. He was ousted in November, and newly elected Gov. Janet Mills signed Executive Order 1 on her first day in office.

Even better, she made the coverage retroactive to July 2, “so Mainers who applied for Medicaid in 2018 but were denied benefits and incurred expenses that should have been covered by Medicaid will be reimbursed.”

Valsartan recalled

No, this is not a repeat from a month ago. This time it’s Aurobindo Pharma that’s recalling the tablets. Click here for the full list of NDCs and lot numbers affected.

The spice* can flow

Today salt is (flips coin) not bad for you. We say again, “there’s little proof” a low-sodium diet helps with cardiovascular health. See you tomorrow.

*Technically a seasoning, but work with me here.

Maybe they start dancing

Older patients who start taking antidepressants are apparently at greater risk for hip fracture, according to a Swedish study.

Analysis revealed that adults taking antidepressants sustained more than twice as many hip fractures than nonusers in the year prior to (2.8% vs. 1.1%) and following (3.5% vs. 1.3%) treatment initiation. The researchers did not observe a dose-response relationship.

Dueling headlines: promises, promises

Courtesy of MedPageToday:

ICYMI: Mergers and acquisitions edition

Bristol-Myers Squibb is cracking open its piggy bank to buy Celgene for $74 billion.

What’s up with the FDA these days?

In case you’re wondering how the government shutdown is affecting the folks at the FDA, here’s the gist:

• Essential public-health operations are continuing.
• Drug and device reviews already in the pipeline — and thus funded by fees paid BS (before shutdown) — will be processed.
• However, new requests for FDA approval are on hold, even though they aren’t paid for by the government. “The FDA can’t collect FY2019 user fee payments during the shutdown, which means we can’t accept new applications for products under user fee programs,” tweeted FDA Commissioner Scott Gottlieb.

What, you want the gory details? Knock yerself out.

Don’t listen to the caterpillar*

One session of hookah (aka shisha) smoking is as bad as an entire pack of cigarettes.

*If you don’t get the reference, you need to bone up on your liberal arts education.

Elsewhere: east and west

Pharmacies — and stores that contain pharmacies — in New York City are no longer allowed to sell any tobacco products. The City already banned pharmacies from selling e-cigarettes.

And in Hawai’i, terminally ill patients with fewer than six months to live are now allowed to use prescription drugs to take their own lives.