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.

CAR-T dangers?

CAR-T is one of the more new and powerful treatments for cancer, but a potential issue is emerging. The FDA is investigating several cases of patients coming down with different* cancers, including lymphoma, being reported after receiving CAR-T therapy.

Notes:

• The risk applies to all existing CAR-T therapies.
• CAR-T labels already warn of a risk of other cancers, so it isn’t a complete shock.
• The FDA says that, based on current information, the benefits outweigh the risks.

At the moment the FDA is just keeping an eye on things, but that could change if more reports come in.

Good cholesterol’s darker side

There’s good cholesterol (HDL) and there’s bad cholesterol (LDL). But, as with chocolate cake and Marvel movies, it seems there can be too much of a good thing.

A new study out of Australia’s Monash University found that “Abnormally high levels of HDL-C, colloquially known as ‘good cholesterol’, are associated with an increased risk of dementia in older adults.”

When they say “very high,” they mean higher than 80 mg/dL — at that level patients had a 27% higher risk of dementia. And when they hit age 75 it jumped to a 42% increased risk.

Why? They have no idea, so you know the mantra: “More research is needed.”

Part D costs: One step forward, one step back

Good news for seniors: Starting in 2025, your Medicare prescription costs are capped at $2,000 for the year. (Currently it’s capped at $7,000.)

The bad news: To help balance the books, private Medicare Part D premiums are going up big time — as much as 57% next year in the states with the highest Medicare populations, which comes to about $25 to $30 more per month. (That doesn’t include Georgia, but you can expect Georgians’ premiums to rise as well.)

And, of course, it means Medicare Advantage plans, which include prescription coverage, will also see premiums rise to offset the cap.

A fix for post-diuretic glucose

Thiazide diuretics have a downside: high blood sugar thanks to lower blood potassium. And to keep things interesting, potassium supplements don’t help.

What’s a patient to do? Maybe take a supplement developed at the University of Texas that’s a combination of potassium, magnesium, and citrate that they gave the memorable name “KMgCit.”

A study of 60 people found that, while taking either KMgCit or plain ol’ potassium chloride raised potassium levels, only the KMgCit also lowered blood glucose.

Although it’s unclear which component in the combination supplement lowered glucose, previous studies have shown that deficiencies in magnesium can have wide-ranging negative metabolic effects. Future studies will examine the effects of magnesium and citrate separately.

Shocking smoking discovery

If you smoke tobacco and smoke marijuana, your chances of getting emphysema are much higher.

Less shocking (and more interesting) is that the risk when you smoke both is higher than if you smoke only one.

This could mean that weed and cigarette smoke might somehow interact with each other to have even worse effects on the lungs and airways, the researchers said.

ICYMI: US life expectancy finally rises

The other day we told you how the life-expectancy gap is widening in the US between men and women. Now there’s new data that’s a bit better: After two years’ of dropping thanks to the pandemic, US life expectancy has ticked up based on 2022 data from the CDC.

We still lag the rest of the highly developed world (and we’re still below our pre-Covid high), but it’s good to see the numbers moving up again.

ADHD treatment: You gotta believe

There have been a bunch of studies on the effectiveness of transcranial magnetic stimulation for ADHD, but there might be a huge twist to all of them. It seems that a lot of the effect of the brain zapping might depend on the patients’ belief in them.

British psychology researchers found that in four out of five studies…

…patients’ beliefs about whether they were receiving real or placebo treatments explained the treatment […] On some occasions, the subjects’ beliefs explained the treatment’s results better than the actual treatment itself.

Captain Obvious loves the Snooze button

“Sleep Loss Impairs Decision-Making”

Cigna, Humana in merger talks

The Wall Street Journal is reporting that the two insurance giants are talking about hooking up. There isn’t any official word yet, as they’re probably trying to write the press releases that will explain how this will somehow be good for patients.

Cigna and Humana have distinct focuses, which could help appease antitrust concerns. Humana sells mostly Medicare Advantage plans to seniors and has said it is going to stop selling employer coverage, where Cigna is strongest. Cigna’s Medicare business is small by comparison.

Shredding cancer with CRISPR

CRISPR gene editing works by seeking out a particular DNA sequence and then replacing it with something else. It’s a great tool for fixing errant genes, but it can also bring death … to cancer.

It’s pretty straightforward, at least to explain.

Instead of fixing ‘broken’ cells, scientists at Gladstone Institutes — including Jennifer Doudna, who shared the Nobel Prize for discovering CRISPR — used CRISPR to screw with the genes of tumors.

Using a novel technique they’ve dubbed “cancer shredding,” the researchers programmed CRISPR to zero-in on repeating DNA sequences present only in recurrent tumor cells — and then obliterate those cells by snipping away at them.

The goal would be to use CRISPR in conjunction with traditional glioblastoma therapy, where some cells could escape treatment. Those escaped cells have genetic markers that look like a big ol’ target to CRISPR — they can run, but they can’t hide.

Don’t forget to think of a great pharmacy pro

Take a few minutes to tell us about a great pharmacist, technician, or student who deserves some big-time recognition at the 2024 Georgia Pharmacy Convention.

Head over to GPhA.org/awards to see the list of awards, the criteria, and how to nominate someone. The deadline for nominations is January 19, 2024, so don’t wait too long!

Chickenpox danger zone

Babies get chickenpox immunity from their moms — at least long enough until they’re eligible for the varicella vaccine, which is usually given when they’re about 12 months old.

Except that it seems that mom’s immunity doesn’t actually last that long, researchers at the University of Toronto discovered.

They found that antibodies protecting against varicella wore off quickly, and that almost 80 per cent of infants were susceptible to infection by the time they were three months old. At six months, all the infants studied were susceptible to chickenpox infection.

While chickenpox is usually (but not always) mild in children, infants are at higher risk of serious complications. The takeaways, per the Canadians, are to keep infants away from anyone who might be infected, and to have any rashes that appear checked quickly.

Semaglutide vs. alcoholism?

GLP-1 inhibitors work (mostly) by slowing down your digestive system so you feel full longer. But they’ve also been shown to have other effects on addictive behavior. In this case, researchers at the University of Oklahoma and Oklahoma State found that semaglutide specifically reduces the symptoms of alcohol use disorder.

This is just preliminary research (and only only six subjects), but the Okies are hoping it can “set the stage is set for future clinical trials [… that] can definitively tell us whether semaglutide is safe and effective for treatment of alcohol use disorder.”

The latest “Alcohol: Good or bad?” has a twist

Is moderate alcohol consumption good or bad for you? Normally the answer comes from the nearest Magic 8-Ball, but now Boston and Tufts university researchers have come to a shocking conclusion: It depends.

What it depends on are the particular metabolites circulating in a person’s blood. There are about 60 of them that are related to alcohol consumption. The researchers found that seven will increase the risk of cardiovascular disease and three will decrease the risk — this among moderate drinkers.

It gets even more complicated. Gender plays a role (“perhaps due to women’s generally smaller body size”) as does whether the drink is beer, wine, or liquor. So next up, of course, are bigger, broader studies.

GLP-1 cage match winner

“Mounjaro is more effective than Ozempic for weight loss” —in other words, tirzepatide is better than semaglutide.

Patients taking Eli Lilly’s Mounjaro were significantly more likely to lose 5%, 10% and 15% of their body weight overall and saw larger reductions in body weight after three months, six months and a year compared with those on Novo Nordisk’s Ozempic.

What makes this story different is that it’s based on a large, real-world study, and that it found a significant difference between the two; previous (small) studies found just a slight difference.

Gov’t declares shortages to be a national security issue, invokes Cold War law

We’ve said before that the federal government can’t force companies to make drugs, but it can encourage them with taxpayer dollars — as it’s taxpayers who are dealing with drug shortages.

Invoking a 1950s law — the Defense Production Act — the Biden administration is essentially declaring those shortages to be a national security issue.

Doing so means the government will be able to invest money “in domestic manufacturing of essential medicines, medical countermeasures, and critical inputs that have been deemed by the president as essential to the national defense.” It’s not waiting, either; HHS has already identified $35 million worth of investments “in domestic production of key starting materials for sterile injectable medicines.”

Other plans announced:

• A new HHS supply chain resilience and shortage coordinator “to strengthen the resilience of medical product and critical food supply chains, and to address related shortages.”
• The Defense Department will also be looking at ways of “reducing reliance on high-risk foreign suppliers.”
• Better monitoring of all aspects of the supply chain, including “supply chain risk assessment tools” out of the Commerce Department that will hopefully “address foreign dependency vulnerabilities and points of failure.”
• A public-private partnership headed by the Department of Transportation to monitor logistics so companies can “avoid bottlenecks, shorten lead times for customers, and enable a more resilient and globally competitive freight network.”

In short, the government will be able to pay to increase production, and to use its gigantic resources to provide information to help reduce disruptions. But there’s only so much it can do in a market-driven economy — at the moment, American companies can simply reap more profits by having foreign manufacturers make their drugs on the cheap.

Trigger warning: The link goes to the White House website, which is a bit … let’s call it rah-rah. It has more detail than a lot of the news stories, though.

A recall you can snicker about

Miami-based Noah Wholesale has recalled its sexual enhancement pill, “The Rock,” because 1) it turns out not to be FDA-approved and 2) it may or may not work. It contains good ol’ sildenafil, but that’s not listed on the package.

Each red 1200 mg capsule was sold solo in a blister pack with red and black lettering on a white piece of cardboard. The recalled lot is No. 03032021, expiration 12/2007 with UPC No. 6 61799 95052 7.

And in the final bad pun, it was distributed by a company called Steele Products.

Long-term use issues

Of ADHD meds

Taking methylphenidate or lisdexamfetamine for three years or more raises a patient’s risk of cardiovascular issues. That’s according to a meta-analysis by Swedish researchers, who found that “each 1-year increase in use of ADHD drugs was tied to a 4% increased risk of CVD,” and this applied to both children and adults.

In particular, hypertension and arterial disease were the big issues. The good news was that they didn’t find a connection to arrhythmias, cerebrovascular disease, heart failure, ischemic heart disease, or thromboembolic disease. So there’s that.

Marketing opportunity: Recommend sphygmomanometers to your patients taking ADHD meds.

Of aspirin

Taking low-dose aspirin used to be a gimme for older people to cut the risk of heart issues. Then it got dialed back because of GI problems. Now there’s a new twist: cancer.

Based on 20 years’ of data, a group of those shifty Danes found that continuous use of low-dose aspirin was associated with…

• Increased risk of lung, bladder, brain, and renal pelvis or ureter cancers

BUT

• Decreased risk of melanoma, as well as non-Hodgkin lymphoma and cancers of the small intestine and liver

And then, to add yet another twist, “The researchers also looked at high-dose aspirin (500 mg) use and found that consistent use was associated with a lower risk of cancer overall.”

The takeaway? “It’s complicated.”

Are you coming to Asheville?

The early-bird deadline for the 2024 Southeastern Pharmacy Leadership Weekend is fast approaching — you only have until this Friday, December 1 if you want the discounted rate for the conference and the hotel.

The former “Women of Pharmacy Leadership Weekend” is now open to everyone — it’s January 12-14 at the Omni Grove Park Inn in Asheville, North Carolina.

Great speakers, tons of CE, and “plenty of time for spa appointments.”

GPhA members get a $100 discount: The early-bird rate till December 1 is just $379 for the weekend; after that it jumps to $479. Use discount code GAMEMBER24.

Full registration includes participation in all events, event materials, Friday night networking reception, and dinner and two breakfasts. It does not include the hotel, which is $259 per night, which includes the resort fee.

Click here for all the details.

Bird flu comes to Georgia

The bird flu (H5N1) has hit a Georgia duck-breeder in Sumter, affecting 30,000 birds. This is the first time avian influenza has hit Georgia.

Used coffee grounds can help treat neurodegenerative diseases

That’s not exactly true, but it makes for a good headline.

What University of Texas chemists found was that chemicals called “caffeic-acid based carbon quantum dots” (CACQDs) can protect brain cells from damage by Alzheimer’s, Parkinson’s, and other neurodegenerative diseases. That’s because caffeic acid has an important property: It can penetrate the blood-brain barrier. Once there, it goes to work.

The CACQDs, the team observed, were able to remove free radicals or prevent them from causing damage and inhibited the aggregation of amyloid protein fragments without causing any significant side effects.

And then there’s the headline. The CACQDs can be easily cooked from used coffee grounds, which are obviously pretty common. So the process is simple, cheap, and green.

The downside: This was only done in the lab, so a lot of further testing is needed.

Meanwhile, in caffeine news…

People who consume caffeine regularly might be giving up brain plasticity in the bargain. Specifically, researchers found, because caffeine is an adenosine receptor antagonist, it can interfere with neurons’ long-term potentiation. That’s kind of important, because long-term potentiation means ‘forming long-lasting connections’ — something you need for learning and memory.

(Note: This is yet another story that confuses coffee and caffeine. The story is about caffeine, although the article’s headline speaks of coffee.)

The bad amino acid

You’re used to hearing about how amino acids can do a body good, but there’s at least one case where cutting down on one helps mice live longer and happier.

The acid is isoleucine, and University of Wisconsin researchers found that cutting it out of mice’s diets helped them live longer and better, even when they ate more.

Mice on the low-isoleucine diet lived longer — on average 33% longer for males and 7% longer for females. And, based on 26 measures of health, including assessments ranging from muscle strength and endurance to tail use and even hair loss, the low-isoleucine mice were in much better shape during their extended lives.

Good luck cutting isoleucine from your diet, though. First of all, you need some of it to live. Secondly, it’s in a lot of foods — you can’t switch to a diet of isoleucine-free mouse chow. But learning the effect of this one amino acid “gets us closer to understanding the biological processes and maybe potential interventions for humans, like an isoleucine-blocking drug.”

Cancer hates lidocaine

Lidocaine, besides numbing skin, activates a person’s bitter-taste receptors. So what? I hear you ask. It turns out that the receptor, called T2R14, is pretty popular with cancer cells, especially oral and throat cancers.

The fun part: When lidocaine hits those cancer cells, it kills them. That’s what UPenn researchers found, and it surprised them: “Lidocaine targets the one receptor that happened to be most highly expressed across cancers.”

“While we’re not suggesting the lidocaine could cure cancer, we’re galvanized by the possibility that it could get an edge on head and neck cancer treatment and move the dial forward.

Simpler, cheaper chemo ingredients

Making cancer drugs is expensive — we’re talking more than the price of gold for just one component. (That’s partly because the manufacturing process requires platinum and gold.)

But now UCLA chemists have made a breakthrough that uses oxygen and copper instead of that platinum or gold to create amines, a building block of a lot of pharmaceuticals. Their process, called aminodealkenylation^*, not only uses cheaper materials, it takes fewer steps — three instead of more than a dozen.

And the final bit of good news is that the technique works for more than just cancer drugs:

“We have used this unconventional transformation for late-stage modification of hormones, pharmaceutical reagents, peptides, and nucleosides.”

That means once it’s out of the lab it could knock down a lot of drug prices.

^* Coincidentally, that’s also the name of one of UCLA’s backup linebackers.

The Long(ish) Read: Stopping Ozempic edition

Can people stop taking GLP-1 inhibitors? Well, they do stop — many people give up after a year or two for various reasons (side effects, insurance coverage). The question is whether people can stop taking them and keep off the weight, and how to help them do that.

Still nothing to see here

While there is absolutely nothing to worry about with the new respiratory illness spreading in China, the Chinese ministry of health has “urged local authorities to increase the number of fever clinics.”

“Efforts should be made to increase the number of relevant clinics and treatment areas, appropriately extend service hours and strengthen guarantees of drug supplies.”

(For its part, the WHO says that this spike in illnesses ‘isn’t as high as it was before the pandemic.’ This makes no sense at all — at some point there were only a handful of Covid cases, just like with the current outbreak.)