Vitamin D and IBD

Oh, vitamin D, you’re so good for so many things — or at least the lack of you is so bad for so many things. The latest: inflammatory bowel disease.

Bulgarian researchers found that IBD patients who aren’t getting enough vitamin D have more inflammation, and one thing we know is that inflammation is never a good thing. In this case…

“Insufficient vitamin D levels in IBD patients are known to heighten relapse risks and disease recurrence, potentially resulting in complications like osteoporosis and calcium deficiency due to its impact on inflammation and IBD development.

The study has a common caveat: The Bulgarians can’t say if there’s causation or just correlation — there are a bunch of causes of low D, and one of them might also cause those IBD complications. Still, when it comes to vitamin D, “[S]upplementation may complement existing treatments and potentially help manage disease severity and relapse.”

Advocacy ready for in action: 2024’s first legislative update

It’s only about 3½ weeks till the Georgia legislative session begins, but our Melissa Reybold is already gearing up. Check out her first legislative update for the 2024 session, including information about our champions, our bills, what PBMs are up to, and more. Of course she’ll keep you updated throughout the session,

Shout-out to some awesome students

The AACP just announced the inaugural list of Community Pharmacy Student Scholar Leaders — 66 student pharmacists who showed “their passion for serving as leaders and healthcare providers in their communities.”

Not surprisingly, several Georgia students were on that list (and every one of them is a GPhA member):

• Noah Gurr, University of Georgia
• Jonathan “Will” Marquess, University of Georgia
• Natalie Novak, Mercer University
• Jonathan Reynolds, University of Georgia
• Samuel Smith, Mercer University

A big high-five to all of ’em!

Vaccination plans

Most American parents plan to be sure their kids are vaccinated for the two of the Big 3 respiratory viruses going around — flu, and RSV; a smaller number are concerned about Covid-19. That’s the result of a study out of Texas A&M that surveyed more than 5,000 parents across the US.

A statistical analysis found that about 40% of parents intended to vaccinate their children against Covid-19, 63% against influenza, and 71% against RSV.

And there you have it.

Drugmakers to pay the piper

The White House is sharpening its IRA rebate sword, ready to demand payback from pharma companies that raised the prices of their products a bit too enthusiastically.

Although it didn’t release specifics, HHS said there are 48 Medicare Part B drugs whose makers raised prices faster than inflation in the last quarter of 2023 “and may be subject to inflation rebates in the first quarter of 2024 as a result of the Inflation Reduction Act.”

Starting in January, some Medicare beneficiaries who take these 48 prescription drugs – including drugs used to treat cancer and fight infections – will have lower coinsurance than what they would have paid otherwise, and their out-of-pocket costs may decrease by $1 to as much as $2,786 per average dose.

Note that those are Part B drugs — the ones given in hospitals or doctors’ offices. There are an additional 16 drugs that had their prices jacked up over the past year (not just Q4) that might also be subject to rebates.

The only drug the administration named specifically was Signifor, for which Novartis has raised the price faster than inflation for every quarter since the law took effect.

Trigger warning: The above link goes to the White House’s announcement, which is just a teeeeeeeny bit political (but has more detail). For a straight news story, Fierce Pharma has you covered.

mRNA flu vax: Maybe, maybe not

There’s a good chance an mRNA vaccine for the flu is close to being available, but will it take off? Sure, it’ll probably be better than the current egg-grown vaccines (and quicker to deploy), but will insurers pay the higher price? As one expert put it, “Clearly if they are going to be coming with a vaccine at four times the cost, they’re going to have to at least show twice the benefit.”

For more on this, head over to Stat News, which has a great overview of the pros and cons of mRNA flu vaccines.

Medical cannabis in Georgia: the saga continues

The Georgia Access to Medical Cannabis Commission met to discuss the state’s response to those DEA letters threatening the independent pharmacies that are registered to dispense low-THC oil to licensed patients. The gist: The members still expect the dispensing law — the Hope Act — to be fully implemented. But there’s clearly some work to be done to protect pharmacists.

Said the commission’s general counsel:

“I don’t think the state is quiet. I think right now we’re gathering information and seeing what’s the best way to move forward while also keeping in mind the interests of our patients and the industry. I know that’s not super specific, but there are things kind of developing in response to the letter.”

One possibility is a rider on the current federal budget bill that “that bars the federal government from interfering with state-legal medical marijuana programs.” But, as with anything budget-related, there’s no telling how it will end up when the bill is passed.

Numbers, in case you’re curious:

• 23 pharmacists are approved to dispense the low-THC oil in Georgia.
• 120 independent pharmacies have applied to dispense the products.
• About 14,000 Georgia patients are registered to receive it.
• There are so far only 9 licensed dispensaries and 2 licensed producers.

Chains are quick to ignore patient privacy

When the police go to a library to ask for a patron’s borrowing records, they have to pry them from a librarian with a warrant — and even then it’s gonna be trouble.

Pharmacists, though? They apparently hand patient medical records over when police ask nicely. That’s the finding of a congressional investigation into how quickly chain pharmacies were willing to hand over sensitive information.

Three of the country’s biggest chains, CVS Health, Kroger and Rite Aid, instruct pharmacy staff to respond to law enforcement demands immediately.

[…]

Five other chains, Amazon, Cigna, Optum Rx, Walmart and Walgreens Boots Alliance, require legal professionals to review law enforcement demands before responding, but they don’t require warrants unless state law mandates it.

The thing is, HIPAA doesn’t require a warrant to release the records — and that’s something legislators are now looking at. In the meantime, it seems librarians are more protective of privacy than chain pharmacies. (Note: That’s chain pharmacies, not necessarily pharmacists. It’s the pharmacy policies that are the issue here.)

Smoking shrinks your brain

The headline says it all. A new study out of Washington University found that smoking isn’t just horrific for the lungs and heart, it also has significant effects on the brain, leading to smokers having higher rates of dementia.

What’s notable in the study is the link to genetics: “What researchers found was that genetics leads to a predisposition to smoking, which ultimately leads to decreased brain volume.” I.e., genes don’t directly affect the brain shrinkage they measured.

The worse news:

While quitting smoking will stop further brain shrinkage, the damage already done is irreversible, the study says. To prove their point, researchers analyzed people who had quit smoking years before and found that their brains remained permanently smaller than the brains of those who had never smoked.

Morning sickness: Cause (and cure?) discovered

Morning sickness is all about the hormones. That part isn’t surprising, but what’s newsworthy is that USC researchers say they’ve discovered exactly which hormone it is — and (potentially) what can be done about it.

The hormone is called GDF15, and it’s produced by the fetus; it surges in the first trimester.

“[T]he baby growing in the womb is producing a hormone at levels the mother is not used to. The more sensitive she is to this hormone, the sicker she will become. Knowing this gives us a clue as to how we might prevent this from happening.”

Some women are especially sensitive to GDF15 and can have morning sickness that requires hospitalization. (Looking at you, Catherine, Princess of Wales.) Other woman have a genetic blood disorder that gives them chronically high levels of GDF15 so they escape morning sickness.

What can be done? One idea is to exposing moms-to-be-to-be to GDF15 before they get pregnant so their bodies have time to adjust. Another idea is to lower or block GDF15, because what could go wrong when messing with hormones during pregnancy?

Regardless, as always, more research is needed.

New compounding PGY1 residency

Hey, newly minted pharmacists (and P4 students)! There’s a new option for your PGY1 residency: one in community pharmacy compounding out of Kennesaw-based Innovation Compounding.

Innovation is part of the Revelation Pharma network which just launched the Revelation Pharma PGY1 Community-Based Pharmacy Residency, which … well, the name says it all if you read it slowly.

It…

… offers additional training opportunities in sterile and nonsterile compounding, clinical research and formulation development, business administration, and pharmacy advocacy.

There are only two positions a year, and the deadline for the next one is January 16, 2024. You can check out the details, requirements, and so on over at Revelation Pharma.

Diabetics’ adherence issues

When someone with type 2 diabetes has to go beyond metformin, it turns out that whatever comes next is entirely hit-or-miss. Almost 64% of patients end up modifying that treatment by changing drugs or increasing the dosage (found a Northwestern study) — but almost 40% simply stop taking the new meds.

Detail: Patients given sulfonylureas were the least likely to change, while those given GLP-1 RAs were the most likely to quit.

This, the Northwesterners say, is a wakeup call that something’s got to change so patients get the right drug and the right dose the first time.

Asthma without inhalers

What if most asthma patients didn’t need inhaled steroids (and their side effects)? Apparently, researchers at London’s Kings College found, they don’t. All they may need is benralizumab.

The findings […] demonstrated that 92 per cent of patients using the biologic therapy benralizumab could safely reduce inhaled steroid dose and more than 60 per cent could stop all use.

The downside is that benralizumab (aka Fasenra) needs to injected every month or two rather than be carried in a pocket. On the other hand, “Approximately 90% of patients experienced no worsening of asthma symptoms and remained free of any exacerbations throughout the 48 week study.”_

Two pounds off, one pound back

You might think that someone could use one of the new GLP-1 weight loss drugs, lose the pounds (or kilos^* if they’re overseas), then — pinkie promise! — lead a healthy lifestyle and keep the weight off.

Nope! A new two-year study of tirzepatide confirms the anecdotes: It “found that people who stopped taking the medication regained much of that weight within a year.”

• People who stayed on tirzepatide: ended up losing an additional 5.5% of their weight (after losing about 21% in the first 36 weeks).
• People who stopped: regained 14% — about half what they lost.

Big caveat: The study was sponsored by Eli Lilly, so the Weill Cornell Med researchers talk a lot about how important it is to stay on drugs like Lilly’s Zepbound^®.

^* Or “stone” if they’re British — what’s up with that?

A different diabetes cause

Researchers at Case Western think they’ve found a new cause of diabetes. It’s related to an enzyme called SNO-CoA-assisted nitrosylase (SCAN) that attaches nitric oxide to proteins. Normally it helps insulin work, but too much of the enzyme ends up blocking insulin receptors.

Mouse models without the SCAN enzyme appeared to be shielded from diabetes, suggesting that too much nitric oxide on proteins may be a cause of such diseases.

They also think “nitric oxide binding excessively to key proteins” could be a cause of a lot of diseases, but it’s hard to target nitric oxide directly. By discovering the role of SCAN they think they might have a treatment path for a variety of ills.

“Unsupported” drug prices

Drugmakers keeps saying they set their prices high to pay for research and development. Even if that was true, it doesn’t explain annual price hikes, does it?

The good folks at the In­sti­tute for for Clin­i­cal and Eco­nom­ic Re­view have published their annual report on 10 drugs with ‘price in­creas­es un­sup­port­ed by new clin­i­cal da­ta.’

They chose drugs among the 250 biggest-selling drugs in the US (by sales rev­enue), and that had their prices raised by more than 2% above the rate of inflation.

Of the 10 drugs that met those criteria, eight had no additional evidence to support their price hikes, and just those eight “ac­count­ed for $1.27 bil­lion in ad­di­tion­al costs over one year.”

One bit of good news: This was calculated before CMS rebates became law in January. These days drug makers have to refund the government for any drugs that they’ve tried to raise the price of faster than inflation. So we’re being gouged, just not as deep.

Respiratory virus sitrep

Covid-19: Hospitalizations are up for the fourth straight week thanks to the new JN.1 “Pirola” variant — up more than 17% in a week, in fact.

Flu: Cases continue to increase, especially in the South and Southwest. “CDC estimates that there have been at least 2.6 million illnesses, 26,000 hospitalizations, and 1,600 deaths from flu so far this season.”

RSV: Cases are finally started to decrease, although after a few months of increases it’s hard to tell if this is a blip or the start of a trend.

The other cough

Apparently not every cough is related to flu, Covid, or RSV. Who knew? There’s apparently “an uptick in anecdotal reports of a brutal, long-lasting cough going around,” and physicians are reporting more cases of a lingering cough that’s not related to the Big Three.

“This chest cold has a real junky and persistent cough” […] They’ve tested negative for the flu and COVID. Plus, they aren’t responding to antibiotics, which suggests it’s “purely viral.”

No one has yet bothered to test for every possibility, so at the moment it’s likely “caused by the regular viruses that cause colds like rhinovirus, non-COVID coronaviruses or adenoviruses.”

Reps want more kids in drug studies

To make sure that drugs in development for rare disease will be available for kids more quickly, two US representatives have introduced a bill that would require pharma companies to include kids in their studies.

Then to add a little extra incentive, it would allow the FDA to penalize the companies when they don’t complete required pediatric studies on time. Oh, and it would double the funding of the NIH’s Best Pharmaceuticals for Children Act program (from $25 million to $50 million).

And the best part? It’s a bipartisan bill.

Headlines that make you go “Hmmm”

“Drinking During the Super Bowl Linked to More Aggressive Parenting Among Mothers, Unlike Drinking on Valentine’s Day”

GPhA on DEA and low-THC

GPhA has released an official statement regarding the letters from the DEA that were received by independent pharmacies registered as dispensaries for low-THC oil. You can read that statement here.

Cigna and Humana won’t be hooking up

Soon after Taylor Swift was named Time’s Person of the Year, Cigna and Humana announced that they were calling off their proposed merger. Cigna instead will engage in a bit of treating itself with a $10 billion stock buyback (well, stock buyback authorization).

ChatGPT and drugs

If you’ve read anything about ChatGPT, the AI chatbot, you know it’s great at brainstorming ideas and working with text (“Rewrite this letter to my insurance company to make it more forceful”), but it can’t be trusted with facts.

That includes drug info. Sure, ChatGPT might be able to pass the bar, but Long Island University pharmacists found that the free version was was only accurate about drugs about 25% of the time.

For example, when asked about a potential drug interaction between verapamil and Paxlovid, the AI said there were none reported. In reality, the combo can lead to excessively lower blood pressure. (To be fair, the older version they used only had info through September 2021, just a few months after Paxlovid was approved.)

Just to see…

Here’s a little twist: We asked the newer version of ChatGPT — which has access to real-time Internet information — the same thing. It didn’t cite the risk of excessively lower blood pressure, either. Instead, it said that yes, the drugs can interact, but it brought up a different issue:

Paxlovid is metabolized in the body by an enzyme called CYP3A. Verapamil inhibits this enzyme, which can lead to higher levels of Paxlovid in your system. This might increase the risk of Paxlovid’s side effects.

(It then recommends talking with a healthcare provider.)

A new target for MS

Multiple sclerosis is an autoimmune disease, so treatments focus on the immune system. That, after all, is what goes into overdrive and leads to demyelination — damage to the myelin sheaths surrounding nerves.

Medicinal chemists in Canada think they have a better way; they’ve developed a compound that targets the glutamate system instead. It’s currently in the lab only (and in animal models), but test results were encouraging — “a stunning effect” according to one researcher.

Study results showed that the newly synthesized lead compound not only reduced MS-like symptoms, it also may repair the damaged myelin in two different pre-clinical models of MS.

Next up is turning the “drug like” molecules into an actual drug they can set on the path toward human testing.

ICYMI: First CRISPR treatment approved

The FDA has approved the first CRISPR-based treatment for any human illness — two gene-editing therapies for the most severe form of sickle cell disease.

The edited cells produce a form of hemoglobin known as fetal hemoglobin, restoring normal function of red blood cells. While not a cure for the disease, the hope is the therapy, brand name Casgevy, is designed to be a one-time treatment that will alleviate symptoms for a lifetime.

Can chocolate rescue a junk diet?

If you know someone with bad eating habits, you might be able to help their brains with a bit of chocolate. (Technically it’s the cocoa extract, but someone with an unhealthy diet is more likely to go for chocolate.)

Apparently “500 mg per day of cocoa flavanols had cognitive benefits for older adults who had lower habitual diet quality,” according to Mass General researchers who studies 573 adults over two years.

The second part is the interesting bit: It only had those effects on people with bad diets. Healthy folks? No joy. (Except from the chocolate.)

You always kinda suspected it

The crazy^* cat lady? There might be something to it after all. It seems that cat ownership can more than double a person’s risk of schizophrenia, according to Australian researchers who analyzed 17 studies from 11 countries conducted over 44 years.

It might be due to the good ol’ Toxoplasma gondii parasite, but that part isn’t clear. What is clear is that there’s a connection between owning a cat and a risk of schizophrenia, although the cause/effect direction isn’t known — maybe people with schizophrenia risk just like owning cats.

^* Don’t get angry. We’re not saying people with schizophrenia are crazy — that’s just the name of the myth, and “cat lady with a mood disorder” doesn’t have the same ring.

We gave bad advice

Yesterday we wrote about how the DEA is warning Georgia indy pharmacies that are dispensing low-THC oil that, having nothing better to do, the agency is threatening their licenses.

We figured “Talk to your attorney” was always good advice. Oops! It turns out that the Georgia Supreme Court has ruled that “lawyers can be sanctioned for advising manufacturers and sellers of marijuana oil.”

Yep, lawyers are not allowed to talk to you about dispensing low-THC oil.

With cannabis still illegal at the federal level, the court held that legal work related to the state’s burgeoning low-THC oil industry amounts to “counseling and assisting clients in the commission of criminal acts.”

If you’re a serial killer, arsonist, or embezzler, sure — go ahead and lawyer up. But if you’re thinking of selling dispensing low-THC oil, you’re on your own.

“A lawyer can defend you in court if the DEA busts you,” says GPhA’s Melissa Reybold, “but your attorney can’t draft a contract, read a contract, or advise selling it.”

GPhA on the air

Georgia Public Radio — WABE — covered pharmacy deserts in the state, and who d’ya think they had as expert guests? That would be GPhA interim CEO Mahlon Davidson and AIP VP Jonathan Marquess, of course.

Listen to them talk about how GPhA “is responding to the current state of the pharmacy industry, including a rise in pharmacy deserts, worker strikes, and the closures of several big-box pharmacies like CVS, Walgreens, and Rite Aid.

Statins vs. kidney disease

Older folks with chronic kidney disease (but not cardiovascular disease) might want to consider taking statins. A join Israeli-US study found that the cholesterol drugs reduce their risk of dying — from anything.

Zinc vs thrush

Vaginal yeast infections are often caused by a specific yeast called Candida albicans. And British researchers found an interesting bit of information about it.

Candida albicans needs zinc to survive, and when it doesn’t get enough it tries to find more by producing a molecule called Pra1. And it’s Pra1 that triggers the inflammatory response that leads to thrush.

In other words, give the yeast what it wants and no one gets hurt. (But, the researchers say, “[W]e’re not in the position to make treatment recommendations at this stage. We need larger scale trials to confirm the effect.”)

Mercer shout-out

A big high-five from the entire Buzz staff to Alyssa DeAngelo, a P3 student at Mercer’s CoP who was selected for an Advanced Pharmacy Practice Experience rotation at Xcenda (AmerisourceBergen’s pharmaceutical consultancy) — one of just 25 students across the country.

She’s looking forward to it, naturally. “Typically, we think of clinical rotations and in a hospital,” she said, “but this one is outside the box.”

Congrats to Mercer P3 Alyssa DeAngelo (left)

Obamacare update

So far about 7.3 million Americans have signed up for a marketplace plan through the Affordable Care Act, according to the latest CMS data. That includes 1.6 million people who are new to Obamacare plans. Open enrollment runs through January 15, 2024.

Smartphones: the four-hour limit

Once a teen uses a smartphone more than four hours a day, things get dicey — that’s according to a new study out of South Korea.

The research found that smartphone usage for more than 4 hours a day was associated with higher rates of stress, suicidal thoughts, and substance use compared to usage of below 4 hours per day.

The Long Read: CVS Cost-Plus edition

If you’re curious about how CVS’s new “cost-plus” model might affect, well, anyone, Adam Fein at Drug Channels goes in depth into why it may not be a big deal after all.

CVS Pharmacy’s cost-plus model has some notable shortcomings for plan sponsors and is far less “disruptive” than the company would like us to believe.

Insurers game Part D, pharmacists pay

Let’s start with a story designed to get your blood pressure up. Private insurers, it seems, have found a sneaky way to get themselves some extra money out of taxpayers by gaming the Medicare Part D system, according to CMS data crunched by UC San Diego researchers.

It works like this:

An insurer pays a pharmacy more than normal for a generic med — “much higher rates than what pharmacies spent to acquire the drugs.” It then gets reimbursed from Uncle Sam based on that higher price.

Great — more money for pharmacies! Except for those good ol’ clawbacks. After taxpayers have paid the insurer, it then turns around and hits the pharmacy with a DIR bill. “Double-dipping” is a polite way of putting it.

It’s not chump change: “The results are alarming. We are talking about markups of 6000% or 7000% in some cases,” said one of the authors.

And then there’s the copay, which is often tied to the price of the drug. That puts seniors on the hook, too.

As another author put it, “It doesn’t make sense that insurers would overpay for drugs, then use clawbacks to retroactively adjust payments after the patient has paid their co-payment.”

Oh, it makes perfect sense to us … if you’re an insurance company.

Covid and the next generation

If a baby seems to be developmentally delayed during its first year, it could be because mom had Covid-19 while pregnant. A new study out of Brazil compared infants who had been exposed to SARS-CoV-2 in utero to those who hadn’t.

“Over 50% of the SARS-CoV-2 exposed infants presented ASQ-3 [Ages & Stages Questionnaire] scores below the expected cutoff, with about half classified with neurodevelopmental delay, mainly at 4 and 12 months.”

This is in line with previous studies, and it found that 10% of the exposed infants showed signs of a particular type of brain swelling. Yikes.

DEA threatens Georgia pharmacies

More than half of states (and DC) permit marijuana for recreational or medicinal use, but you know the story: It’s still illegal on the federal level. The feds — through the Obama, Trump, and Biden administrations — have mostly kept their hands off.

But then comes Georgia. Unlike other states, Georgia has specially licensed independent pharmacies dispensing low-THC oil to registered patients, rather than relying on Cheech and Ted’s Feel Good Emporium™.

And thus the DEA, like Smaug the dragon, has opened its eye and taken notice. The agency has been notifying those pharmacies that they risk their licenses.

Even low-THC oil is, according to the DEA, as dangerous as heroin or LSD and has no medical benefit.

If you were expecting advice on how to deal with these letters, sorry to disappoint. We’re not lawyers, and that’s who you should be talking with if you’re one of those pharmacies. (You can also reach out to your AIP member service rep for guidance. Not an AIP member? Maybe now’s the time, huh?)

AIP welcomes friends

We love hosting friends from New York and showing them a bit of Georgia hospitality. In this case it was McKesson’s area vice president Roopa Sangani and Pharmacy Sales Consultant James Campbell who visited AIP VP Jonathan Marquess at the GPhA offices.

“We appreciate Roopa visiting Georgia from New York,” Marquess said. “I really enjoyed our dialogue and discussion on ways we can work together more in 2024. Thank you so much for your support of AIP and GPhA!”

When the feds come marchin’ in

The White House has determined that yes, when it comes to high-priced meds developed with taxpayer funds, the federal government does have march-in rights — the authority to seize the patents to make the drugs more available.

That doesn’t mean it’s actually going to do that. This was more of a legal finding — think of it as a friendly shot across the bow to drug companies.

[The new rules] would allow the government to grant additional licenses to third parties for products developed using federal funds if the original patent holder does not make them available to the public on reasonable terms.

Pharma companies have rolled out their usual arguments: It’ll stifle drug development, hurt patients, open rifts to the Dark Dimension, etc. To be fair, that makes sense here — if you might lose a patent, why bother making the drug?

Because it wouldn’t just be willy-nilly. “The price and availability of that product to the public are among the factors the department will recommend that agencies consider.” I.e., keep the pricing reasonable so people can actually afford the drug and everything will be fine.

Surprising tumor fighter

If you add an interleukin-4 drug like dupilumab to chemo^*, it seems to boost patients’ immune systems and help it fight tumors.

Mount Sinai researchers found that when immune cells entered lung tumors, they acted similarly to how they would during an allergy or asthma attack. So they figured they’d see how an allergy med might affect that. It turned out to make the tumor more responsive to the chemo.

“In fact, one patient whose lung cancer was growing despite checkpoint blockade had nearly all their cancer disappear after receiving just three doses of the allergy medication, and his cancer remains controlled today, over 17 months later.”

^* Specifically PD1 inhibitors

People stick with Wegovy

One of the issues with GLP-1 drugs is that people stop taking them after a year or so, probably because of price or side effects. But here’s an interesting bit of data out of the Cleveland Clinic: It turns out that people are more likely to stay on Wegovy than they are on older weight-loss meds.

Only 13% of patients who started taking Contrave from Orexigen Therapeutics and 10% of those who started on Qsymia from Vivus between 2015 and 2022 were still filling their prescriptions a year later.

Don’t miss the other important point there: It was comparing Wegovy to non-GLP-1 meds. So it might well apply to Mounjaro, Ozempic, Zepbound, and others.

A couple of caveats to note: First, GLP-1s are much more effective for weight loss, so that might explain the higher adherence, but the Cleveland folks didn’t look into that. Also, all the study participants had private insurance, so it’s not clear what their out-of-pocket costs are.

CVS unveils new pricing model

So CVS has released a new pricing structure for commercial health plans. It’s going to use the Mark Cuban “cost plus” model, charging a fixed markup above cost plus a fee for dispensing the meds. The idea is to make its pricing more understandable (and, you know, get ahead of the whole ‘Regulations a-comin’’ thing).

By making prices clearer, insurers can, in theory, do their own formulary research to see if they’re getting the best deals. But the fact that the announcement was timed with CVS’s earnings call tells you that it’s probably about the company’s bottom line.

Rejection-free islet transplants

If you give a type 1 diabetes patient an islet transplant — letting their bodies make insulin again — they’ll have to take anti-rejection drugs just like with any other transplant. Unless, that is, a group of Canadian and American researchers’ plan works.

Rather than transplanting islet cells into the liver, they put them just under the skin in a little pocket where the immune system mostly leaves them alone.

The Yankees (at Cornell) brought the device — “a removeable polymer thread containing thousands of islet cells, protected by a thin hydrogel coating”— while the Canucks (at the University of Alberta) brought the islet-transplantation expertise.

The result gave mice six months of glucose control, but the engineers hope to create a version that can last several years. Bonus: Implanting the device is simple enough to be an outpatient procedure if it ever comes to humans.

Respect the drip

You might think that mucus is your friend — protecting you from bacteria and viruses and (when strategically deployed) keeping weirdos from sitting next to you. But it turns out that mucus is not only a bacterial host, but, as Penn State researchers discovered, the place they assemble and plan their attacks.

The thicker the mucus, the better it enables bacteria to colonize and mount a coordinated attack on the immune system. It might also help the bacteria build up resistance to antibiotics.

“There are studies demonstrating that collective motion or swarming of bacteria enhances the ability of bacterial colonies to fend off the effect of antibiotics. The onset of collective behavior studied in our work is directly related to swarming.”

They’re hoping their work helps develop ways to fight the bacteria before it’s able to swarm effectively. The best part is that today you can brag that you read about bacterial swarming in thick mucus. You’re welcome.

In sickness and in health

If you want to sound smart, you can talk about “Spousal concordance of hypertension.” If you want to sound normal you say, “Did you know that when an American has high blood pressure, there’s a 38% chance their partner does, too?”

That’s what a study led by Emory University found after conducting a 33,000-couple study in the US, China, England, and India. Interestingly…

[W]omen whose husbands had high blood pressure were 9% more likely to have it themselves in the U.S. and England, yet they were 19% more likely in India and 26% more likely in China.

The researchers think that’s because China and India have cultures that place more emphasis on “sticking together as a family,” leading to shared behaviors and thus shared health outcomes.

Cannabis and pain

There’s been some anecdotal evidence^* that using cannabis can reduce a person’s need for opioids. People often cite using pot to help deal with chronic pain. But now University of Sydney researchers have finished a 20-year study of 615 heroin addicts, and they say there’s no evidence that cannabis use reduces painkiller dependence.

That’s not to say that cannabis doesn’t help with pain. Rather, that “it may not be an effective long term strategy for reducing opioid use” at least among people with addiction issues.

^* Technically that’s an oxymoron, we know.

The Long Read:

The best way unused meds can be put to use: Giving them to people who can’t afford them. (Georgia is one of the 44 states that allow drug donations.) Read how these programs work and how they’re (hopefully) expanding.

Combos for Lyme

The standard treatment for Lyme is, of course, good ol’ doxycycline. The downside is that it doesn’t always clear the infection completely (especially if it’s taken late), leading to persistent cases — aka “post-treatment Lyme disease.”

Tulane immunologists found that no single antibiotic could completely wipe out persistent Borrelia burgdorferi bacteria, but several combos did the trick. What combos, you ask?

• doxycycline and ceftriaxone (with or without carbomycin or loratadine)
• doxycycline and cefotaxime
• dapsone with either rifampicin or clofazimine

The more you know. (Bonus: It’s a “game-changer”!)

Take your glass half full and…

You know that relentlessly optimistic person whose sunny disposition eventually drives you nuts? Don’t judge so harshly — it might be because they have lower cognitive ability.

Despite what those self-help books might tell you…

Research from the University of Bath shows that excessive optimism is actually associated with lower cognitive skills such as verbal fluency, fluid reasoning, numerical reasoning, and memory. Whereas those high on cognitive ability tend to be both more realistic and pessimistic in their expectations about the future.

Yeah, you read that right: Smarter people are more realistic and pessimistic.

The brains of the 100-Acre Wood

Respiratory sitrep

The latest CDC data show that flu cases are rising across the country, while RSV — which has pounded Georgia’s emergency rooms — appears to be leveling off. Covid-19, meanwhile, “continues to cause the most hospitalizations and deaths among respiratory illnesses — about 15,000 hospitalizations and about 1,000 deaths every week.”

Syphilis drug shortage

While shortages of ADHD and cancer drugs get most of the coverage, the National Coalition of STD Directors is warning that there’s a shortage of Bicillin L-A (aka benzylpenicillin) — the primary treatment for syphilis and the only one for pregnant women.

The CDC says that yes there’s a shortage, but it doesn’t know of any cases where a pregnant woman couldn’t get it. But according to the NCSDDC, “health departments are hearing different information”: Women are getting it, but only 56% get it within a week.

This, of course, in the midst of a surge in syphilis cases across the country.

In the previous three months…

• 46% of clinics have attempted to order Bicillin L-A, but the drug was not available;
• 55% of clinics that had orders completely unfilled had more than half of their orders unfilled;
• 31% of clinics have received partially filled orders; and
• 40% of clinics have had their Bicillin L-A orders delayed.

Lilly’s weight loss drug hits shelves

Eli Lilly’s ticket onto the GLP-1 bandwagon has been punched, and the company’s Zepbound (tirzepatide) is heading to pharmacy shelves. It’s got a list price of $1,060 ($25 per month out of pocket) and will be available for a mere $550 a month to patients who don’t have health insurance but can afford that price tag.

In trials, Zepbound helped people lose more weight than Novo’s Wegovy — a whopping 20% of their weight compared to a measly 15% for Wegovy.

Quick takes

ICYMI: Cantaloupes of doom

If you don’t know where that cantaloupe came from, don’t eat it. That’s the message from the Georgia Department of Public Health in response to an outbreak of salmonella infections in sliced cantaloupe that has sickened at least five Georgians.

Elsewhere: Rite-Aid edition

Rite-Aid has given its pharmacists in California, Maryland, New Hampshire, Nevada, and Oregon permission to prescribe oral contraceptives (because state law permits it).

When mom should take B12

Vitamin B12 is important for infants; they get it from their mothers either in utero or via breast milk. But if you’re going to supplement it, when’s the best time?

It matters, found George Mason public health researchers. To cut to the chase, you need both but one might be more important. Pre-natal supplements give a short-term B12 boost, but it’s the post-natal vitamin that gives the longer-term benefits.

Weirdly, they tend to interfere with each other to some extent:

[T]he effect of the prenatal vitamin B-12 supplement diminished when used together with the postnatal supplement. Likewise, the effect of the postnatal vitamin B-12 supplement diminished when used together with the prenatal supplement.

The Masonites still recommend using the two together, although their findings mean either A) once deficiency is corrected there aren’t any more benefits, or 2) Mom might need a higher dose to overcome that ‘cancellation’ effect. They aren’t sure … yet.

Congress to FDA: What took you so long?

Why did it take so long for the FDA to pull phenylephrine from the shelves? House Republicans want to know.

The FDA “relied upon outdated and insufficient evidence regarding phenylephrine’s use as a decongestant for so many years, despite numerous appeals by the scientific community.”

We, too, would like to hear the answer.

A new drug for Fido

There could soon be a drug available to help your dog live longer. Yes, that simple — a drug to tackle one of the root causes of premature aging on larger dogs.

Veterinary biotech company Loyal for Dogs got FDA blessing to begin clinical trials of its anti-aging drug LOY-001. Right now it’s a four-times-a-year injection for older (7+ years) and larger (40+ pounds) dogs, but the company is working on versions for smaller dogs as well as a pill form.

All versions of the drug work by limiting the power of a growth-related hormone, called insulin growth factor-1 (IGF-1), which as well as contributing to growth is linked to aging and longevity in animals like roundworms, fruit flies, and mice.

IGF-1 is partly responsible for larger dogs growing larger, but it’s also a culprit in their dying younger. So that third “Clifford the Big Red Dog” book? Probably fantasy.

The Long Read: Pharmacists are revolting

It’s more than just about being overworked. The new corporate reality of American healthcare has pharmacists and physicians rethinking their jobs — and unionizing.

Once accustomed to a status outside the usual management-labor hierarchy, many health professionals now feel as put upon as any clock-punching worker.

More older folks are ‘self medicating’

Picture eight of your older patients. Chances are one of them is using some kind of cannabis product — especially the ones who drink a lot of alcohol.

That’s what a new study out of the University of Michigan found: “with 12% [of patients 50–80] saying they’ve consumed a THC-containing substance in the past year and 4% saying they do so multiple times a week.”

That’s up from less than 10% in 2019, and it’s important for healthcare providers to know.

Older adults represent a vulnerable age group for cannabis use due to interactions with medications, risky driving, cannabis-related mental health impacts and increased possibility of falls and memory issues.

So when you think about medication interaction, it’s important to consider that there’s a decent chance that people over 50 are engaging in a little extracurricular activity.

One of the right gut bugs

Oh, lactobacillus, what can’t you do? It seems everyone’s favorite gut bacteria “helps the body manage stress and may help prevent depression and anxiety,” according to UVa researchers.

This is important because while it’s clear that “healthy gut bacteria” is good for you, what exactly constitutes those healthy bacteria isn’t clear. Of the thousands (millions?) of species floating around inside us, it’s hard to tell the good from the bad, making probiotics are hit or miss.

By using a new technique to create mice with and without lactobacillus in their guts, the Virginians were able to tease out exactly why it’s good for mood:

Lactobacilli in the family Lactobaccillacea maintain the levels of an immune mediator called interferon gamma that regulates the body’s response to stress and helps stave off depression.

This could lead to either a targeted probiotic or even a treatment for mood disorders that takes advantage of the same pathway.

Muppets explain addiction

You know the opioid crisis is really a crisis when the Muppets get into the act. As tempting as it is to think that Elmo has a painkiller problem, in fact he and friend Karli are explaining to kids why Karli’s mother is in a special place. (Not Heaven — rehab.)

Spit, don’t prick

Why stick yourself with a needle when you can just lick something? That’s not just good advice for tailgating at the Grateful Dead reunion tour, it might soon be something for diabetics to consider.

Scientists at Canada’s L’Université de Sherbrooke have made a sensor sensitive enough to detect glucose levels in the saliva — something that hasn’t been possible because the concentration was so low. But by supercharging the engineered DNA (called aptamers) used in biosensors, they made a device that can replace a finger-prick with a sensor-lick for measuring glucose.

Not only was the sensor accurate at measuring glucose concentrations in the liquid — providing readings in just 30 seconds — it also retained its sensitivity for up to one week….

Oh, and their new technology can also work with other biomarkers such as one that indicates gum disease.

The snozzberries test for LSD.

The path towards older worms

If you’re tired of your roundworms dying (and having to explain to your kids that Squiggles has gone to live with a nice family upstate), there’s good news out of the University of Liverpool.

It seems that rilmenidine, the blood pressure drug, “at young and older ages increases lifespan and improves health markers, mimicking the effects of caloric restriction.”

So instead of cutting your worms’ diets to the bare minimum, you might be able to help them live longer by adding an Albarel supplement.

Even if that doesn’t translate to humans, they discovered that rilmenidine affects a cellular receptor^* called nish-1, meaning nish-1 could be a target for other longevity drugs.

^* Techically an I1-imidazoline receptor

Novo targets compounders (again)

Instead of claiming they don’t have the right to compound semaglutide (the company lost that fight already), now those shifty Danes at Novo Nordisk have changed tacks. They’re claiming that the compounded semaglutide they found in a few pharmacies isn’t as strong as the real deal — it’s a lower dose.

So yes, Novo is suing two Florida pharmacies for selling a lower dose of the medication they don’t think those pharmacies should be allowed to sell at all. (How this hurts Novo isn’t clear.)

The company is also claiming some of the compounded versions contain a peptide called BPC-157 that isn’t allowed in compounded meds. (If Novo found a shady compounder playing fast and loose with the law, good for them — but that seems like a criminal issue rather than a civil one.)

Speaking of Novo Nordisk…

The company has showered medical pros with $25.8 million over a decade to get them to recommend its weight loss meds.

Example: Dr. Lee Kaplan, chief of obesity medicine at Dartmouth College’s medical school. He’s been pushing Wegovy on the one hand while receiving $1.4 million from Novo “for consulting work and travel between 2013 and 2022,” in the other hand, according to Reuters.

“To prevent and defeat a serious chronic condition like obesity, we need to do more than supply the right medicine,” Novo said. “This is why we work with medical professionals, institutions and other experts to conduct research and educate and raise awareness about obesity.”

Because apparently Americans aren’t aware of obesity. (Keep that $25.8 million in mind next time a drugmaker says its drugs are so expensive in order to pay for research and development.)

Elsewhere: Where the piece of cloth is tyranny

The anti-vax attorney general of Texas is suing Pfizer over its Covid vaccine. He claims that the vaccine wasn’t actually 95% effective as Pfizer’s tests showed, but only 0.85% effective. And, as Reuters reported, “He also said the pandemic got worse even after people started taking the vaccine.”

Uh-huh. Also: The moon landing was fake and birds aren’t real … but that’s another story. He did give us a lovely hyperbolic use of the word “tyrannical”:

“Pfizer did not tell the truth about their Covid-19 vaccines,” Paxton said in a statement. “We are pursuing justice for the people of Texas, many of whom were coerced by tyrannical vaccine mandates to take a defective product sold by lies.”

Captain Obvious doesn’t mix her vices

“Combined use of alcohol and THC can affect rat brains, study finds” —University of Illinois

In other medical news

Plastic surgeons are contemplating one of life’s great mysteries.