A hint of a colon cancer vaccine

Of all the strains of E. coli that might live in your gut, two of them have an interesting adaptation: They produce colibactin, a carcinogen.

Researchers at the Wellcome Sanger Institute were curious about this, especially in light of rising rates of colorectal cancer. So they looked to see who was more likely to have these particular strains in their guts. What d’ya know — they’re more prevalent in Western countries with high (well, higher) rates of colorectal cancer.

This means that if there really is a fairly direct connection between that bacteria and colorectal cancer, it might be possible to develop a vaccine — or simply some probiotics — to reduce or eliminate those strains.

B vitamins and Parkinson’s

It’s a GPhA Buzz axiom that just about every medical condition seems to involve either gut bacteria or inflammation.

Take Parkinson’s. Japanese researchers found an interesting correlation: People with the disease had lower levels of gut bacteria that synthesize vitamins B₂ (riboflavin) and B₇ (biotin). Lacking those vitamins, they found, weakened the intestinal barrier — meaning more toxins could enter the bloodstream and cause Parkinson’s inflammation.

We’d like to say there was a huge breakthrough — that B-vitamin supplements reduced Parkinson’s symptoms. Unfortunately they haven’t gotten that far … yet. They agree, however, that “Supplementation therapy targeting riboflavin and biotin holds promise as a potential therapeutic avenue for alleviating [Parkinson’s disease] symptoms and slowing disease progression.” (And they think their findings might provide more clues to Parkinson’s progression.)

Speaking of Parkinson’s…

There are treatments for the physical effects of Parkinson’s disease, but not for the cognitive decline. That might change, thanks to a protein called PNA5.

According to University of Arizona researchers, it seems to reduce the particular kind of inflammation associated with Parkinson’s; it “dials back the microglia’s overly active immune response and brings it closer to a normal state.”

It’s still in the early stages of testing, but signs, they say, are hopeful.

Short takes

HPV vax is working. A new study out of the Medical University of South Carolina found that, from 2013 to 2021, cervical cancer among American women under 25 declined by 62%, “a finding largely attributed to the wide availability of HPV vaccination for this age cohort.”

The more you know. Did you know that alcohol is a serious risk factor for cancer? If not, you’re in the majority, according to a survey from the University of Pennsylvania. “Six in 10 surveyed were unaware that regular alcohol use increases odds for developing cancer.” (Worse, 20% of people thought alcohol could lower your risk.)

Prostate cancer ‘flip’

One of the ways to fight prostate cancer is to block a particular molecular signalling pathway that seems to help tumor growth. That pathway is started by a protein called glycoprotein 130 (GP130), and it eventually activates a molecule called STAT3 — and STAT3 is critical to tumor growth.

So if you stop GP130, that cuts back on STAT3 and slows the tumor’s growth … right? That was the assumption, until Swedish researchers questioned it. What if STAT3 didn’t do what we thought?

And that’s exactly what they found to be the case. When they deliberately activated that GP130 pathway (in mice), it increased STAT3 levels as expected. But then the twist: “They could then see that the result was that the growth of the tumour was clearly slowed down in the mice due to the activation of STAT3” (emphasis ours).

Then they looked at human tissue samples and found the same thing: “those high levels of GP130 positively correlated with better survival.”

What’s next? That old mantra: More research is needed. In this case, it’s to confirm the results and see if this opens a new, ‘opposite’ way to treat prostate cancer.

Resistance gets worse

According to the WHO, antimicrobial resistance (AMR) is getting so bad that in the next 25 years it could lead to more deaths worldwide than cancer does. One solution might be better vaccinations to reduce the use of antibiotics.

As one virologist put it:

“When vaccines prevent illness, they reduce the need for unnecessary antibiotic use. In the past, antibiotics were frequently prescribed for respiratory infections — typically caused by viruses — leading to misuse and heightened resistance. By preventing viral infections through vaccines, we reduce inappropriate antibiotic prescriptions and, subsequently, AMR.”

Non-pharma cool medical story of the week

The old way of monitoring brainwaves: a whole lot of wires attached to a complicated, finicky head covering, with EEG sensors glued to the patient’s head:

The new way: temporary tattoo sensors printed on the scalp — they can even work through hair. “[O]nce dried, it works as a thin-film sensor, picking up brain activity through the scalp.”

Even better, the tattoos last longer than the traditional sensors, which dry out and lose connectivity after a few hours.

And you thought it was those butter cookies

Those shifty Danes have a lot of eggs in the Novo Nordisk basket. Macroeconomics blogger Joseph Politano explains how “Weight Loss Drugs Continue to Power Denmark’s Economy”. The boom “has been so strong that it has almost singlehandedly made Denmark one of the fastest-growing economies in the European Union.”

Better dieting through chemistry

People may want to believe otherwise because it just feels more … natural? But one doctor looked at the studies and delivers the verdict, “No, Diet and Exercise Are Not Better Than Drugs for Obesity”.

The only reason that the world isn’t comfortable with the eminently provable truth that diet and exercise are inferior to obesity medications for weight management is weight bias. The message is that people simply aren’t trying hard enough.

Kill the pain, leave the treatment

Opioids are often part of cancer treatment to help patients deal with pain. But they can also interfere with the immune system — something you don’t want when you’re giving immunotherapy.

(Science: “[M]orphine binds to an opioid receptor called OPRM1 on CD8 T cells, suppressing their activity and canceling out the invigorating effects of anti-PD1 therapy.”)

Good news out of the University of Pittsburgh, where researchers found a potential work-around. They found that peripherally restricted OPRM1 antagonists (PAMORAs) — methylnaltrexone is one — “blocked opioid-induced immunosuppression and improved response rates to immune checkpoint inhibitor therapy.”

Big ol’ caveat: This was only in mouse models, and specifically head and neck cancers, but it certainly feels like a breakthrough.

ICYMI

Vicious crime, vicious reaction

The healthcare industry may be expressing sympathy for the murder of UnitedHealthcare CEO Brian Thompson, but patients? Not so much. One social post that got the most traction read, “When you shoot one man in the street it’s murder. When you kill thousands of people in hospitals by taking away their ability to get treatment you’re an entrepreneur.”

Side note: UnitedHealthcare denies more claims than any other health insurer — we’re talking a third of them. And the company has been facing protests, lawsuits, and even a Senate investigation for its practices.

Side side note: The vitriol on Twitter/X got so bad that the company — which allows Nazi sympathizers, Russian trolls, conspiracy theorists, and hate speech without blinking an eye — took some of them down.

Should we worry yet?

At least 79 people in the “Democratic” Republic of Congo have died — and almost 400 sickened — from “a mystery flu-like disease” that health authorities there are still trying to identify. They know it’s respiratory and likely airborne, but that’s about it.

Of course, how important can a mysterious flu-like disease be when it’s in a country on the other side of the world?

Embrace the dark side

Yet another study — this one using health data from about 192,000 people over 30 years — has shown that eating dark chocolate, but not milk chocolate, can reduce your risk of type 2 diabetes.

[T]he researchers found that people who ate at least five ounces of dark chocolate per week — equivalent to five servings — had a 21 percent lower risk of developing Type 2 diabetes compared with people who rarely or never ate dark chocolate.

Moving ahead, falling behind

The US already has one of the lowest life expectancies among developed nations. It’s getting better, but a new report finds that it’s slowing compared to the rest of the world. That means we’ll drop even further in the rankings by 2050 thanks to “drug use disorders^*, high body mass index, high blood sugar, and high blood pressure” combined with our well-below-average healthcare access.

Despite the progress the U.S. has made over the last three decades, the country is forecasted to rank progressively lower than other nations globally in the average number of years a person can expect to live in good health. Known as healthy life expectancy or health-adjusted life expectancy (HALE), its global ranking is forecasted to drop from 80th in 2022 to 108th by 2050.

^* “That’s the highest drug use–related mortality rate in the world and more than twice as high as the second-highest country, which is Canada.”

Nine months of flu protection

Don’t want to get a flu shot, ladies? There could be an alternative: Get pregnant. Canadian researchers found that “pregnancy may trigger a natural immunity to boost protection against severe flu infection.

How’s that work? Apparently — at least in mice — pregnancy produces “a powerful molecule^* that boosts the body’s antiviral defenses, especially in the nose and upper airways,” thus preventing the virus from getting to the lungs.

^* Interleukin-17+ γδ+ T cells, since you asked 

Reps to DOJ: Investigate PBMs

A bipartisan group of federal legislators, including Georgia’s Buddy Carter, is asking the Department of Justice to investigate PBMs for their role in the opioid epidemic.

The letter was sparked by an investigative report by Barron’s, “Confidential Files Detail PBMs’ Backroom Negotiations—and Their Role in the Opioid Crisis.” It suggested that “the three largest PBMs colluded and conspired to steer patients towards Oxycontin in exchange for $400 million” in rebates.

Wrote Barron’s:

In total, OxyContin prescriptions sent $85 million to Express Scripts, $146 million to Optum Rx, and $173 million to CVS Caremark, according to one year of sales data between 2016 and 2017. One set of contracts between Purdue and CVS Caremark indicates that rebates increased if health plans covered higher amounts of OxyContin.

The legislators not only want the DOJ to investigate the PBMs, they are also taking aim at the vertical consolidation of the industry, as single companies own insurers, PBMs, and pharmacies, driving up costs and limiting options for patients.

Disappearing pharmacies

In just one decade — from 2010 to 2020 — a whopping 29% of pharmacies in the US closed. That includes both independent pharmacies and chains, and it affected Black and Latino neighborhoods the most.

Why? Low reimbursement rates from Medicare and Medicaid could be one reason, as could indy pharmacies being cut out of PBM networks. And of course there are the chains closing their less profitable locations.

Twist: From 2010 to 2017 the number of pharmacies actually increased, but eventually the rate of closings blew past the rate of new storefronts opening.

Elsewhere: Across the Pond

Tattoo you

If you were thinking of moving to Wales either because you hate vowels or because you want to be able to give tattoos to your patients, we’ve got some bad news. Not about the vowels (they still don’t use them there) — rather, a new Welsh law prohibits pharmacists and pharmacy techs from giving tattoos without a license.

Since 2017, they’d been allowed to provide “tattooing, body piercing, electrolysis, and acupuncture” without a license, but a new law strips that exemption.

At least someone’s preparing

Seeing the writing on the wall, the UK Health Security Agency is buying more than 5 million doses of human H5N1 flu vaccine “to boost the country’s resilience in the event of a possible H5 influenza pandemic.”

Answering the important medical questions

“3 reasons why kids stick Lego up their nose[s]”

Quick reminder

Medicare open enrollment ends this coming Saturday, December 7.

Hormone therapy risks: Not so simple

A lot of older women take various kinds of hormone therapy, especially post-menopause. Lurking in the background, though, is a fear of cardiovascular disease — that’s thanks to a 1990s study that found a risk. It focused on a single kind of hormone treatment, though, so Swedish researchers wanted to see if it still applied to today’s varied therapies.

They looked at seven different hormone treatments, and what they found was nuance. I.e., “Different menopausal hormone treatments pose different risks.”

For example, the synthetic hormone tibolone^* […] was linked to an increased risk of both heart attack and stroke, but not to an increased risk of blood clots.

Combined preparations containing both oestrogen and progesterone instead increase the risk of blood clots, including deep vein thrombosis.

They also found that patches were less risky than other delivery methods, so their next task is to break down the effects by age, medication, and delivery method to uncover that nuance.

^* Not available in the US.

Short takes

Could lung cancer be detected with a nasal swab?

A startup called OncoSwab thinks so, based on the fact that “Tumors shed compounds that can be picked up in screening tests,” and lung cancer obviously affects the airways. Thus the OncoSwab test, which is still in the early stages of development, looks for lung cancer biomarkers that make their way to the nasal passages.

Timing your Covid shot

The best time for a Covid booster, found Yale researchers, depends on geographic location and whether you’ve had a breakthrough infection. “[O]ptimal booster dates precede peak Covid-19 transmission by about 2.7 months,” so in the Northern Hemisphere that means “Administering boosters in September or October can provide up to three to four times more protection against infection compared to booster shots given later in the year.” (But, if you get a breakthrough infection in the fall, it’s best to wait several months for a booster.)

The next long Covid suspect

Health researcher have barely agreed on what long Covid is, and they’re still trying to figure out what causes it. The latest suspect comes from Australia, where immunologists at the Burnet Institute think there’s a “compelling case” that long Covid is actually caused by the virus lingering in the body.

They reached this conclusion after looking at details from several studies on the condition, such as more than one that …

… detected replicating viral RNA and proteins in blood fluid of patients years after their initial infection, a sign that the virus is likely replicating for long periods in some hidden reservoirs in the body, perhaps including blood cells.

In fact, evidence of viral activity seemed to be common in these studies. (The GI tract is “of considerable interest.”) And while they can’t say so conclusively, “we and other scientists argue the cumulative evidence is now sufficiently compelling to galvanise action.”

Pot for thought: kids, psychosis, and cannabis

Earlier this year there was a study that found that kids who used cannabis were a lot more likely to develop psychotic disorders — 11 times more likely, in fact.

Well then.

But now the twist: A new study that looked at 4 years of data on almost 12,000 kids aged 9–10 found that those psychosis-spectrum symptoms tended to appear before they started using cannabis. And “symptoms typically did not increase after initiation.”

In other words, the arrow of causation seems to point to psychosis leading to cannabis use, rather than the other way around.

The Long(ish) Read: Drug-war casualties

The drug crisis has been around for decades, to the point that there are survivors who are now in their 70s. The Wall Street Journal looks at one of them.

When drugs beat surgery

When a kid gets appendicitis, surgery is the obvious solution; appendectomies are a dime a dozen. (Well, not here. In the US, while being incredibly common, they’re “one of the costliest surgical procedures performed during hospital stays.”)

They’re so expensive that surgeons, led by a team at Nationwide Children’s Hospital, looked into whether IV antibiotics are a way for parents to save money on their kids’ care.

And yep, publishing in the Journal of the American College of Surgeons (!), they concluded that it’s more cost effective to use drugs than to use surgery.

“This cost analysis demonstrates that nonoperative management for pediatric uncomplicated acute appendicitis is the most cost-effective management strategy over one year, compared to upfront surgery.”

Side note: Appendectomies cost almost three times as much here as in the UK or Switzerland, so an overseas vacation could be a cost-saving option, too.

Pleasure-free opioids

The problem with opioids is that they have a way of combining pleasure and pain relief, and the result (as we know) is addiction.

What if you could keep opioids’ pain-killing effect, but block its pleasure effect? That’s exactly what a couple of researchers in New York say they’ve done by combining opioids with a drug called an MAGL inhibitor, “which increases the level of an endocannabinoid, known as 2-AG, in the brain.”

Conventional wisdom said that endocannabinoids would increase the opioids’ pleasurable effect, but that turns out not to be the case. Instead, the MAGL inhibitor blocks the release of dopamine, thus removing the pleasure (other than the pleasure of not being in pain).

So far it’s only been tested — successfully — in mice, but if it works in humans it “[has] the potential to meaningfully change pain medicine.”

A better asthma treatment

For a flare-up of asthma or COPD, five days of prednisolone is the standard treatment. But British researchers have found a better option: a single, higher dose injection of benralizumab.

Typically, low-dose benralizumab is used for longer-term treatment, but when given in a higher dose during an asthma or COPD flare-up, it worked better and longer at keeping symptoms at bay.

After 28 days, respiratory symptoms of coughing, wheezing, breathlessness, and sputum were found to be better in those on benralizumab, whether or not they were also on steroids. After 90 days, there were four times fewer people in the benralizumab group who failed treatment compared with those receiving steroids.

They also found that the benralizumab injection’s effect lasted longer, meaning fewer trips to the doctor or hospital. And, of course, it also avoids the side effects associated with steroids.

Bonus: Yes, they do call it a “game-changer.”

Why GLP-1s fail

As many as 20% of people taking GLP-1 agonists don’t respond (or don’t respond well) to the drugs, but the drug makers claimed the number was only 10–15%. What happened?

Sure, the companies exaggerated the effect — they did the same when it came to hyping the amount of weight that’s typically lost. But that’s only part of the issue. A British physiologist explains all the other factors that didn’t appear in the clinical trials, from genetics to simple lack of formal support.

When your only tool is insulin, every problem is a carbohydrate

Automatic insulin delivery systems might have a problem. As British researchers found, there’s a lot more affecting blood glucose levels than just carbohydrates, but insulin delivery systems only have one tool: insulin. If something else is affecting glucose levels — e.g., hormones, exercise, stress — patients will still get a dose of insulin, even when there are no excess carbs to respond to.

The problem is that, while we might have a general idea of these other factors, we don’t have specific information about their effects.

For factors beyond carbohydrates to become more systematically included in clinical practice, scientists need to find a way to measure and quantify their impact and utilise this information in insulin-dosing.

In the meantime, clinicians are left with a single blunt instrument until more research can be done.

ICYMI

The Biden administration is proposing that Medicare and Medicaid cover GLP-1 agonists to help reduce obesity and all the issues that come with it. Although Medicare is prohibited from covering weight-loss drugs (to avoid cosmetic use), CMS’s angle is that the drugs are treatments for obesity.

This sets up a cage match between incoming HHS secretary-nominee Kennedy (anti GLP-1s) and incoming CMS administrator Oz (pro GLP-1s).

Saving you a click

“Need to sleep? Study pinpoints optimal melatonin dosage and timing”

4 mg of melatonin three hours before bedtime maximized the sleep-inducing effects of the hormone.

Bird flu follow-up

Canadian officials have given up trying to figure out where a British Columbian teen contracted bird flu: “an exhaustive investigation of the people and domestic animals the unnamed teen had contact with shed no light on how the teen became infected.”

The kid has improved from critical to serious condition, but still requires a ventilator. He or she is showing signs of recovery, though.

Weird science

Did you have to let it linger? (Press 1 for yes)

Concerned about “excessive flatulence,” the Australian national science agency is asking residents to sign up for the continent-wide “Chart your Fart” campaign. Participants download an app and record their gas-passing ‘events,’ with the option to rate them for (seriously) stench, loudness, duration, linger, and detectability.

The Chart Your Fart app is designed to better understand the flatulence patterns and concerns of Australians as part of our public-led research in the area of health and wellbeing.

Every one of you will look at your hands

Women whose ring finger is significantly longer than their pointer might be more likely to have alcohol-dependence issues. Yep, that’s what a new British study found.

There’s actually a logic behind it. The hypothesis is that a longer ring finger indicates more testosterone exposure before birth, and men tend to have more alcohol issues than women.

In fact, the same lead researcher — who really has a thing for finger length — previously found associations between finger-length ratio and Covid outcomes and oxygen consumption.

RIP, John Tinniswood

At 112 — born August 26, 1912 — the British man was the world’s oldest living man. He died this past Monday.

Handling the fluid shortage

Hospitals are finding new and interesting ways to deal with the IV fluid shortage caused by Hurricane Helene. (Baxter says its North Carolina plant is producing the fluid, but it’s far from full capacity.)

Something you might not think about: As the end of the year approaches, people are scheduling more surgeries to either use up benefits or to avoid a big hit when their deductibles reset in January. That puts an even bigger strain on IV supplies.

Using push medication — IV without the fluid — is one way (although it requires more monitoring). Another is to squeeze every last drop out of a bag before starting another; it adds up. And, of course, there’s simply cutting back on fluids:

Patients may be asked to take more accountability for their hydration, by drinking Gatorade or water rather than the default of hydrating through an IV.

Singulair side-effect update

When Merck launched Singulair (aka montelukast) in 1998, it claimed that the drug had side effects “similar to a sugar pill.” It turned out that wasn’t true (and Merck apparently knew it), and montelukast can have serious neurological effects; in 2020 the FDA added a black box warning to the drug “flagging serious mental health risks like suicidal thinking or actions.”

Now, four years later, the FDA expert group that looked into montelukast’s side effects found that yes, it binds to multiple brain receptors.

“[T]he new data showed significant quantities of montelukast present in the brain. The receptors involved play a role in governing mood, impulse control, cognition and sleep, among other functions.”

They still can’t say for sure that the binding causes those neurological effects, but as one scientist said, “It’s definitely doing something that’s concerning.”

Pertussis vax does more

A new vaccine for whooping cough has a couple of extra benefits. First, it’s nasal — no needles to worry about. Second (and this is the bigger part), it’s also got an “innovative adjuvant called T-vant, [that] boosts the body’s immune response specifically in the respiratory tract.”

So what? That means it not only protects the person getting the vaccine, but also reduces the likelihood of them spreading it to others. As the Tulane University immunologist leading the team put it:

“By developing a vaccine that can not only protect individuals but also prevent transmission, we hope to improve on existing vaccines and limit the spread of whooping cough in communities.”

Of course, with more people believing the nonsense from anti-vaxxers, it’ll fall on more-informed folks to do their part to stop the surge of pertussis.

A peptide for pain

Oxytocin does some interesting things in the body, among them inducing uterine contractions. But it can also treat abdominal pain. The problem is that it’s a peptide, and like most peptides it’s not gut stable; it has to be injected.

Aussie researchers, though, say they’ve found a way to make peptides gut stable, meaning oxytocin and derivatives could be made into pill form, and still have all the benefits of peptide-hood (e.g., few side effects).

The research indicates that the new molecules work in the colon and do not need to cross the gut barrier into the bloodstream to suppress abdominal pain.

Now they just need someone to pay for them to try to make it something they can sell.

Two quick health stats

Deaths from heart disease caused by obesity have gone up 280% from 1999 to 2020 — i.e., nearly tripled — according to research out of Brown University. “Middle-aged men, Black adults, Midwesterners, and rural residents are most at risk.”

—and—

More than 100,000 Americans under 20 have inflammatory bowel disease — that’s both Crohn’s disease and ulcerative colitis — according to a study out of UNC Chapel Hill. And since 2009 that number has gone up 22% (Crohn’s) and 29% (ulcerative colitis).

Elsewhere: Going nowhere

Remember all the hubbub Florida made about importing vaccines from Canada? The state even sued the feds for not moving fast enough. Well, Florida got the green light in January 2024, and since then … nothing.

A Florida health official familiar with the importation program told KFF Health News there was no planned date yet for the state to begin importing drugs.

Speculation was that the fuss wasn’t really about getting the drugs, but, as one analyst put it, “It riles up the crowd.” The reality has always been that it won’t happen because Canada won’t allow it, but that didn’t stop people from having a dream. So while there are lots of excuses, there’s no real plan in the works. Maybe just ‘concepts of a plan.’

Easy BP monitoring

Continuous glucose monitoring is old news, but how about continuous blood pressure monitoring? That’s what bioengineers at UC San Diego have developed and tested.

The patch is a soft and stretchy device, about the size of a postage stamp, that adheres to the skin. When worn on the forearm, it offers precise, real-time readings of blood pressure deep within the body.

For science geeks, it works with a type of ultrasound sonar that can “track changes in the diameter of blood vessels, which are then converted into blood pressure values.”

Not only did they find it as good as a blood pressure cuff, it was as accurate as an arterial line — the kind of sensor inserted into an artery and the gold standard of continuous BP measurement.

We’ve added more Fall Region Meetings!

We’re finalizing times and places for our Fall Region Meetings, and we’ve got three more confirmed. Don’t miss out on a great night of food, drink, and networking with your fellow pharma professionals!

The latest additions:

• Region 6 is Tuesday, 12/10 at 6pm in Macon.
• Region 7 is Wednesday, 12/4 in Kennesaw.
• Region 11 members are invited to attend the Region 10 Fall Meeting on Wednesday, 12/11 in Athens.

Click here for complete details on your region meeting!

Opioids, dementia, and nuance

The bad news: Yes, taking opioids regularly can increase your risk of dementia.

The good news: It doesn’t affect people using the drugs short-term, and may not apply to younger people (the study only looked at people over 60).

It’s about cumulative use. Those shifty Danes found that once someone hits a threshold of about 90 ‘total standardized doses’ — that’s 90 days of treatment on the equivalent of 30 mg of morphine — the risk of dementia increases anywhere from 8 to 29%. (Interestingly, the greatest risk increase was in people aged 60-69.)

The study had a lot of data, too — it included health info on almost 2 million people over 25 years — and to reduce the question of correlation/causation, they incorporated a 5-year lag between prescription and dementia diagnosis. Still, as usual, more research is needed.

Who’s paying for GLP-1s?

So who’s paying for GLP-1 drugs in the US? Medicaid and federal-employee health plans cover the most, according to the rather frighteningly named AXIACI Obesity Coverage Nexus.

Here’s the breakdown:

• Medicaid: 31.6 million Americans get GLP-1 coverage through state programs for low-income people.
• Federal government employees: 13.6 million
• State government employees: 6.0 million
• Commercial insurance: 13.7 million
• Private employers (estimated): 10.7 million

And here’s a chart for you visual people:

More employers are covering them

According to data from Mercer — the financial firm, not the university — GLP-1 coverage from larger employers (more than 20,000 employees) hit 64% in 2024, up from 56% last year.

If you include firms with just 500 or more employees, that coverage drops to about 44% — up from 41% last year.

An even simpler Alzheimer’s test

Alzheimer’s treatments might still be out of reach (or so it seems), but tests for the condition are emerging — for better or worse. The latest comes out of Sweden, and it uses a finger-prick to collect a sample that can be delivered to a lab for analysis.

Like existing blood tests, which are still making their way into the mainstream, this tests for an abnormal protein called ptau217. There are a couple of big differences, though. First, it only requires a few drops of blood from a pinprick — no phlebotomist necessary. (It might even be easy enough for home use.) Second, the sample is sent on a special card that doesn’t require refrigeration, making it suitable for places where transport might be an issue.

It’s now being tested in Europe for potential availability in the next couple of years.

Cocoa in times of stress

We all know that a cup of hot cocoa can help with stress, but it might do more. British researchers found that “flavanol compounds found in abundance in cocoa and green tea can protect vascular function during periods of everyday stress.”

In other words, if the same stress that drives you to cocoa is also driving you to eat high-fat foods (the Brits used butter croissants, cheddar cheese, and whole milk in their study), that cocoa will help alleviate some of the negative vascular effects of the delicious fatty food.

FDA warns Tom’s

Tom’s of Maine has a problem, according to the FDA. It’s in the form of a “black mold-like substance” and tainted water at the company’s toothpaste factory.

The FDA warned in a letter dated Nov. 5, that Tom’s of Maine — which is owned by Colgate-Palmolive — “failed to maintain buildings used in the manufacture, processing, packing, or holding of drug products in a good state of repair.”

I’m not sure which is more disturbing: That the FDA couldn’t identify the “mold-like substance,” that it was near a batch of Tom’s Silly Strawberry kids’ toothpaste,” or the fact that Tom’s of Maine is owned by Colgate-Palmolive.

GPhA awards: Nominations are open!

Who’s the best pharmacist you ever saw? How about technician? Or a student deserving a bit of recognition?

It’s time to tell us about it — to nominate someone for one, two, or more 2025 GPhA awards. They’ll be presented at the 2025 Georgia Pharmacy Convention on Amelia Island, but first we need to know who deserves them.

Head over to GPhA.org/awards to see the list of awards, the qualifications, and how to nominate someone. The deadline for nominations is January 15, 2025, so don’t wait too long!

Cannabis expansion

There are now more than 25,000 people enrolled in Georgia’s medical cannabis program, and that means the Georgia Access to Medical Cannabis Commission can authorize another six dispensaries (one each from the six companies authorized to make the low-THC oil).

Right now there are 13 dispensaries in the state. Authorized independent pharmacies had been dispensing the oil until the DEA stepped in and stopped them because … well, because it could, and because it’s still operating in the 1970s.

A better bumetanide

Sure, you might give a heart-failure patient bumetanide to reduce swelling — either in a pill or via IV. And soon there’s likely to be a nasal spray version that works just as well as the IV but is as convenient as a pill.

A new study out of North Carolina-based Cone Health found that nasal bumetanide had the same outcomes, the same few side effects, and it was absorbed faster and more reliably than the oral version. Sure, the IV version is even faster, but it’s no more effective than this nasal spray and can’t be taken at home.

Bird flu updates

A new mutation in Canada?

The teenager hospitalized in Canada with the H5N1 bird flu might have had a mutated version of the virus that makes it more transmissible among humans.

That could indicate that H5N1 has the capability to become more like a human virus, rather than an avian virus, but it is also not clear yet whether this change is meaningful and more dangerous to people, experts said.

“Ruh-ro.” —Doo, S.

“Still nothing to see, Citizen. Move along”

California has reported its own case of bird flu in a child. As in Canada, the kid had no contact with an infected animal (although he or she may have been in contact with some birds). The good news is that the child’s family all tested negative, so it looks like it’s not human transmissible.

The Long Read: Don’t not worry

An infectious-disease expert considers how much we need to worry about the bird flu. Normally it wouldn’t be a big deal (we’re pretty good at dealing with influenza), but the anti-health, anti-science atmosphere these days means all bets are off.

To quote a different expert:

“It’s great to develop diagnostics, therapeutics, and vaccines, but the problem is: It’s kind of like the ‘Field of Dreams’ phenomenon. […] There was this implicit assumption that ‘If you build it, they will come.’ What happens if they don’t come?”

Two new cholesterol drugs

Two companies have developed drugs — now in phase 2 trials — that they say cut Lp(a) cholesterol by significant amounts. Like really significant.

• Eli Lilly claims its experimental oral drug, muvalaplin, can reduce Lp(a) by about 70% according to the standard test, or almost 86% if they use a new kind of test.
• Silence Therapeutics says its zerlasiran injection led to an 80–85% reduction in Lp(a).

High Lp(a) has no treatments, affects something like 20% of the population, and most of those people don’t even know they have it.

Other injectable Lp(a) treatments in clinical testing include Lilly’s lepodisiran, Amgen’s olpasiran, and pelacarsen from Novartis.

These don’t work

You don’t often hear of negative results in studies, but here’s a double: Two separate groups of researchers, one in New York and one in Australia, found what doesn’t work for osteoarthritis.

Colchicine: The drug and a placebo showed equal effectiveness against pain and function. (Actually, the placebo was a little better.)

Herbal supplements including curcumin, pine bark extract, MSM, and Indian frankincense: As with colchicine, it was slightly less effective than a placebo.

ICYMI: Telehealth prescribing extended

Patients who use telehealth to get controlleds will still be able to do that without an in-person visit, thanks to an agreement between the DEA and HHS. These “telemedicine prescribing flexibilities,” which started during the pandemic, will be in place at least through the end of 2025.

Our number 2 story

Background: Fecal microbiota transplants (FMTs) have been shown to be a disturbingly useful tool for fighting bacterial infections (looking at you, C. diff). It may even help with other conditions, from obesity to depression.

These are done, as Prince might say, ‘in through the out door’ via various techniques, none of which are appropriate for a family newsletter. And it comes with risk, notably that there might be pathogens in the donor stool.

But now a group of those shifty Danes think they’ve found a better way to do an FMT. They’ve managed to use fermentation to cultivate bacteria from feces — and the technique allows them to control which bacteria are grown.

Twist: They’re growing “bad” gastrointestinal bacteria; their plan is to kill those bacteria and leave only the bacteriophages that attack them. Then they’ll put those phages in a pill, which would kill the unwanted bacteria in a patient’s gut.

The long-term goal is for the treatment to evolve into a simple pill that can be prescribed by a doctor or found on a pharmacy shelf — tailored to individuals, but accessible to all.

Three bits of good news

… about drug overdose deaths

They look like they’ll end the year at the lowest level since the pandemic — and this year they’ve dropped for the first time in 5 years (for 12 straight months!), according to CDC data, thanks in large part to federal law enforcement intercepting the drugs. Fun fact: Despite what you might have heard, those drugs aren’t smuggled across the border — they’re shipped in through ports.

… about drug shortages

After hitting an all-time high of 323 meds in shortage, the number dropped to just 277 in the second quarter of this year, according to the American Society of Health-System Pharmacists and the University of Utah. That marks the second quarter in a row where active shortages have decreased.

… about STDs

The nationwide STD epidemic might finally be slowing. The number of sexually transmitted infections is down about 2% from 2022 to 2023. Hopefully it’s the start of a trend, rather than a single downward blip.

More than 2.4 million STIs were reported last year, compared to more than 2.5 million in 2022, with nearly half occurring in adolescents and young adults aged 15–24, according to a report by the [CDC].

Now it’s the carrots

Just as the nation is recovering from the deadly E. coli outbreak from McDonald’s, the CDC is reporting “a multistate outbreak of E. coli O121 infections linked to multiple brands of recalled organic whole bagged carrots and baby carrots sold by Grimmway Farms.”

Brands: 365, Bunny Luv, Cal-Organic, Compliments, Full Circle, Good & Gather, GreenWise, Grimmway Farms, Marketside, Nature’s Promise, O-Organic, President’s Choice, Raley’s, Simple Truth, Sprouts, Trader Joe’s, Wegmans, Wholesome Pantry

How ketamine works

It’s not news that ketamine can treat depression quickly — within hours in many cases. What’s eluded researchers is exactly how that happens. What’s ketamine doing in the brain?

Now biochemists at the University of Buffalo say they know.

Ketamine, they found, works on particular neurotransmitter cells called NMDA receptors. There are several kinds of these, but what the Buffaloians found is that ketamine works on some of them — only the ones that are active for longer periods. (Some are just intermittently active.) Drugs that target all the NMDA receptors, on the other hand, have all sorts of negative side effects.

“[Activating those receptors] results in an immediate increase in excitatory transmission, which in turn lifts depressive symptoms. Moreover, the increase in excitation initiates the formation of new or stronger synapses, which serve to maintain higher excitatory levels even after ketamine has cleared from the body, thus accounting for the long-term relief observed in patients.”

Figuring out ketamine’s mechanism, they think, might lead to even better quick-acting antidepressants.

Elsewhere: Baltimore does it again

Back in September, we told you how Baltimore scored big by opting out of the nationwide opioid settlement and suing drugmakers and distributors on its own. Welp, it did it again, this time scoring a $274 million jury verdict against AmerisourceBergen and McKesson.

But there could be more:

Circuit Judge Lawrence P. Fletcher-Hill scheduled an “abatement” trial in December. That proceeding determines how much the companies must pay to help Baltimore mitigate the ongoing crisis a jury has now ruled that they fueled.

The city will ask for up to $11 billion in abatement.