Autism from antibiotics?

Mess with a child’s gut bacteria in the first year and you could raise the risk that he or she develops autism or ADHD. That’s what Swedish and American researchers found after looking at the health records of 16,000 Swedish children born between 1997 and 1999 — kids the Swedes have studied over the past 25 years.

“We can see in the study that there are clear differences in the intestinal flora already during the first year of life between those who develop autism or ADHD and those who don’t.”

What’s going on? They think something is affecting those bacteria — e.g., antibiotic treatment. For example, “Children who had repeated ear infections during their first year of life had an increased risk of being diagnosed with a developmental neurological disorder later in life.”

In fact, they’ve narrowed it down to two particular bacteria that affect risk — “the presence of Citrobacter bacteria or the absence of Coprococcus bacteria increased the risk of future diagnosis.” That info might lead to a concurrent treatment (some kind of probiotic?) to go with antibiotics. As usual, though, more research is needed.

Fighting asthma’s cause

What if asthma wasn’t caused by inflammation, rather the inflammation was a result of the disease?

That, say British cell biologists, is exactly the case. It’s the mechanical constriction of the airways that leads to an asthma “attack,” including inflammation. Current treatments focus on that inflammation, but that only alleviates symptoms.

The issue may lie in the death of the airway’s epithelial cells: When the airway contracts, a process called cell extrusion kills the epithelial cells lining it. So many epithelial cells dying leads to inflammation and excess mucus — an asthma attack.

Thus blocking cell extrusion might be a way to prevent attacks rather than dealing with symptoms. And guess what? There’s already a chemical that does that.

“[A]n inhaler such as Albuterol opens the airways, which is critical to breathing but, dishearteningly, we found it does not prevent the damage and the symptoms that follow an attack. Fortunately, we found that we can use an inexpensive compound, gadolinium, which is frequently used for MRI imaging, to stop the airway damage in mice models as well as the ensuing inflammation and mucus secretion.”

Two more days!

Don’t forget: Early-bird registration for the Georgia Pharmacy Convention ends this Thursday, April 11. Save $50 by registering by then!

Heart surgery? Skip the aspirin

People who get coronary stents often continue taking aspirin after the procedure. They shouldn’t. A new study out of Mount Sinai found that the standard-of-care guidelines are probably wrong. The best thing patients can do (that we know of) is to use ticagrelor alone.

“Our study has demonstrated that withdrawing aspirin in patients with recent ACS [acute coronary artery syndromes] one month after PCI [percutaneous coronary intervention] is beneficial by reducing major and minor bleeding through one year by more than 50 percent. Moreover, there was no increase in adverse ischemic events, meaning continuing aspirin was causing harm without providing any benefit.”

From the Stupidity Files

Say “Cheese”

What do you someone who tests their partner for STIs by sending a picture of his nether regions to an app? A patient.

Yep, there’s an app called Calmara.ai claiming to detect sexually transmitted infections from a photo of a gentleman’s privates.

In seconds, the site scans the image and returns one of two messages: “Clear! No visible signs of STIs spotted for now” or “Hold!!! We spotted something sus.”

Pro tip: It doesn’t work — “Doctors say it’s a disaster”.

“Stupid don’t get tired.” —Alonzo Bodden

What are infomercials influencers peddling for health now? (spins Wheel of Idiocy) Butter. Eating sticks of butter. Why? “Proponents claim it aids weight loss by contributing to feelings of fullness and has other wellbeing benefits like improved mood and energy.”

Many users [on TikTok] also snack on sticks of butter as a weight loss tactic, with some using butter as a meal replacement.

More semaglutide effects

Add “skin issues” to the list of side effects of taking semaglutide. Specifically, a study out of Brown “found a higher incidence of ‘altered skin sensations’” among patients taking it, including dyses-, hyperes-, or paresthesia (i.e., various unpleasant or abnormal touch sensations) as well as alopecia or other “adverse dermatologic events.”

Xylazine vaccine

Scripps Research chemical biologists have developed a vaccine against xylazine, the latest ultra-potent chemical that’s being added to street drugs (and adding to the overdose crisis).

It works by training the immune system to attack the fentanyl so it doesn’t add its effect to whatever it’s mixed with. That’s important because naloxone doesn’t work against xylazine, so it’s critical to take it out of the equation.

Granted this is still just proof-of-concept, but assuming the technique proves out, it could also be used to create a vaccine against fentanyl — another drug that’s naloxone-proof.

Short take: Pharmacist pay by state

Wondering how your pay stacks up against your peers in other states? The good folks at Becker’s have you covered. (Spoiler: There isn’t that much difference state to state, except maybe between the highest paying (California) and the lowest paying (Rhode Island). )

Heart damage from Tylenol?

When you think of the risks of acetaminophen, you usually think of liver damage. But a new study out of UC Davis found that regular use at moderate doses (500 mg per day) “causes numerous signaling pathways inside the heart to be altered.”

The results suggest that long-term medium- to high-dose acetaminophen use could cause heart issues as a result of oxidative stress or the buildup of toxins that are produced as acetaminophen breaks down. […] While our bodies can usually clear such toxins before they cause damage, it may be harder for the body to keep up when medium- to high- doses are taken consistently over time.

They point out that the study was done in mice, but the lead author still said, “These results prompt me to consider using acetaminophen at the lowest effective dose and for the shortest duration possible.”

GLP-1 drugs’ next trick

They could be used to treat Parkinson’s. In one of the first hints of success against the disease, French researchers found that lixisenatide — a GLP-1 receptor agonist — helped reduce some symptoms in a trial of 156 people with Parkinson’s that lasted about a year.

During that time, Parkinson’s symptoms like tremor, stiffness, slowness and balance worsened in those taking the placebo but not in those taking the drug.

It’s not entirely a surprise, as it’s been known that there’s some connection between diabetes and Parkinson’s. They’re hoping to do a larger study, but Sanofi is pulling lixisenatide from the market because it’s not selling very well.

UGA’s better(ish) Covid test

UGA engineers have developed a better, stronger, faster test for Covid-19. Unfortunately it requires specialized equipment and is only useful (at this point) for large-scale population testing.

Still, it’s faster than the gold standard PCR tests and just as accurate — even better, it gives a reading of a patient’s viral load rather than just a positive/negative reading. It can also be updated easily to test for new variants.

Eventually they hope to be able to cut the price of the equipment to read results so individuals could afford the devices, and those devices could share results with a central database. Because people will be happy to do that.

Robot double-checks

The Brits are turning to AI to cut prescription errors. Oxford University wonks have created “DrugGPT,” which, rather than being trained on the sum total of human knowledge, is specifically fed information about drugs and medical conditions.

It’s meant to be an assistant to clinicians — a kind of double-check before sending patients home.

Doctors and other healthcare professionals who prescribe medicines will be able to get an instant second opinion by entering a patient’s conditions into the chatbot. Prototype versions respond with a list of recommended drugs and flag up possible adverse effects and drug-drug interactions.

Not only does this double-check the docs, it also gives an explanation for its choices, and that explanation (written by a friendly robot) can help with adherence.

Short takes

CVS covers The Pill

CVS Health will cover Opill — the OTC birth control pill — at no cost to most patients on its health plans

Paxlovid limitations

A study by Pfizer (!) found that Paxlovid doesn’t do much to help people who have been fully vaccinated against Covid.

A new antibiotic

The FDA has approved Zevtera (ceftobiprole medocaril sodium for injection) for treating staph infections, acute bacterial skin and skin structure infections, and kids with community-acquired bacterial pneumonia.

Zantac: Some suits settled

Zantac came, Zantac caused cancer, Zantac left^* — and thousands of lawsuits followed. Now drugmaker Sanofi said it’s settled 4,000 of those suits. Actually, it could be as many as 5,000 because the settlement covers 49 states. Only Delaware suits weren’t settled … but there are something like 20,000 of them.

Sanofi won’t say how much it’s paying out, but the company did focus on the important part: It shouldn’t affect the stock price.

^* Zantac returned, reformulated

E-cigs increase heart risk

A preliminary study has found that using e-cigarettes can increase a person’s risk of heart failure by 19%. (That’s based on health data from almost 176,000 Americans, 29,000 of whom said they used vapes.) Worse, if they also use other nicotine products that risk jumps to 59%.

The caveat is that the study was observational and doesn’t explain the relationship — it’s correlation, but not necessarily causation. You know the mantra: More research is needed.

Side note: E-cigs are so risky it’s ethically impossible to do human studies on them beyond this kind of statistical analysis. That says something.

Captain Obvious gets his squirt bottle ready

“Skin Wetting Helps Cool Older Adults in Very Hot, Dry Weather”

The dance continues

After freaking out over the very idea that their biggest customer wanted to negotiate prices like some kind of dirty capitalist, drug companies reluctantly entered negotiations with HHS over a whopping 10 high-priced drugs.

The government made offers, the pharma companies submitted counteroffers, and now the feds have responded — and the pharma companies are saying, ‘Heck, it wasn’t as bad as we expected.’

Next: “Medicare and each drugmaker can meet for haggling sessions as many as three times in the next several months.”

More early birds welcome!

Early-bird registration for the Georgia Pharmacy Convention — save $TK! — has been extended until this Monday, April 10. You have one week to register and get the best rate!

Of course, if you want to spend a little more, please wait until the 11^th, but that’s kind of silly, innit?

ICYMI

Not only did bird flu make the jump to dairy cows, then it jumped from a cow to a human in Texas. His primary symptom was conjunctivitis, but he’s still being isolated while being treated with Tamiflu while awaiting the mockery that will surely come his way.

“So far, there are no signs that the virus has evolved in ways that would help it spread more easily among people, federal officials have said.” Hmm.

Wegovy gets first Part D coverage

The other day Medicare gave permission for part D plans to start covering Wegovy for heart issues (but not weight loss). Now the first private plans — from CVS Health, Elevance (CarelonRx), and Kaiser Permanente — have said they’ll start paying for them.

Again, this is only for “reducing the risk of heart attacks and strokes in people who have cardiovascular disease [and] meet body-weight criteria.” And it’s only Wegovy that’s covered because it’s got a study showing it reduces cardiovascular risk — although with this treasure box opened you can expect the other GLP-1 drugs to have similar studies soon.

Measles continues to spread

Another win for anti-vaxxers as measles cases in the US jumped by 51 percent in just one week.

The really scary part is that more than half of cases (56 percent) “have required hospitalization for isolation or management of virus complications.” And for kids it’s higher: 68 percent. So no, it’s not just a matter of being a bit sick for a few days.

The good news is that the number of cases is still low — about 100 cases nationwide across 17 states.

Well this is slightly embarrassing

The latest version of ChatGPT “Outperformed Physicians in Clinical Reasoning in Head-To-Head Study.” That means it did more than just look up a list of symptoms and make a guess; it was given the patients’ complaints, vital signs and other basic patient info, and the results of diagnostic tests. Then it gave its differential diagnoses, which were compared to those of 21 attending physicians and 18 residents using a test of clinical reasoning called r-IDEA.

[T]he chatbot earned the highest r-IDEA scores, with a median score of 10 out of 10 for the LLM [large language model], 9 for attending physicians and 8 for residents. It was more of a draw between the humans and the bot when it came to diagnostic accuracy—how high up the correct diagnosis was on the list of diagnosis they provided—and correct clinical reasoning.

ChatGPT was, however “just plain wrong” more often when it came to actually providing reasoning for its answers. (I.e., it got the answers correct as often as humans, but didn’t get there the right way. Take from that what you will.)

Elsewhere: Maple Syrup edition

Canada, like most of the world, has universal healthcare for its citizens — but that hasn’t included pharmaceutical coverage. That, though, is changing as the country prepares to roll out prescription benefits nationwide.

And one of the first parts of that rollout is free contraception for women.

The government will pay for the most widely used methods to avoid pregnancy, such as IUDs, contraceptive pills, hormonal implants or the day after pill, for the nine million Canadian women of reproductive age.

(Also part of this initial rollout is complete coverage of diabetes medication. That’s not as big a deal because insulin is, like, two bucks a month up there anyway.)

The Long Read: Go Big or Go Home edition

With all the fuss about weight loss, you know who’s hurting? Companies like General Mills, maker of Cocoa Puffs and Lucky Charms. So what are they doing about it? Jumping on the “anti-diet” movement to convince people that being overweight is just fine^*.

General Mills has toured the country touting anti-diet research it claims proves the harms of “food shaming.” It has showered giveaways on registered dietitians who promote its cereals online with the hashtag #DerailTheShame, and sponsored influencers who promote its sugary snacks.

^* No, we’re not implying that there’s anything wrong with not being a Barbie doll, weight-wise. But from a health perspective there are some serious issues when someone feels it’s okay to dive into the Twinkie box mouth wide open.

Insulin under pressure

The latest needle-free insulin delivery system comes from those thrifty Dutch. (And yes, they call it a “game changer.”) Unlike microneedle patches and such that other universities are developing, the one the Dutchies have developed — they call it “BuBble Gun” — uses high pressure to force the drugs through the skin.

Apparently this doesn’t hurt, despite the description:

With BuBble Gun, a laser beam is directed at the fluid medicine in a glass cartridge, heating it until it boils and creates a bubble. This bubble grows until it squeezes the liquid at high velocity—30 to 100 meters a second—out of its tube and, in the case of a medicine, into the skin.

Rather than piercing the skin, the way a needle would, the drug is pushed between skin cells.

Their biggest hurdle right now is adjusting the pressure to account for different skin thicknesses.

Salt really does kill

Here’s an eyebrow raiser: Up to 30% of cardiovascular-related deaths may be attributed to salt intake. Based on a cohort study of 64,000 patients over 7 years, Vanderbilt University researchers found that not only does excess sodium increase the risk of death from by 7 to 13 percent, it seems that just a 1,000 mg increase in salt intake was responsible for …

• 10 percent of all cardiovascular disease deaths;
• 13 percent of all coronary heart disease deaths; and
• 30 percent all heart failure deaths.

Maybe a bit of salt substitute (or simply potassium chloride) is in order.

Diseases on the march

Grandma and grandpa are letting their guards down

STIs for people over 55 are on the rise, big time.

Rates of chlamydia, gonorrhea, and syphilis in people ages 55 and up more than doubled in the U.S. over the 10-year period from 2012 to 2022, according to data from the Centers for Disease Control and Prevention.

“The trend is prompting doctors to call for more discussions with older people about sexual health.” We’ll leave those discussions to you.

Consumption is jumpin’

Cases of tuberculosis in the US shot up by 16% from 2022 to 2023 to hit the highest level in more than a decade, probably due to more cases worldwide, as well as a post-pandemic jump. (The good news is that we still have one of the lowest rates in the world.)

Big ol’ study: Chronic fatigue is real

No one is entirely sure what causes chronic fatigue syndrome, but at least one mystery about it has been cleared up: It’s “unambiguously biological,” not, as some clinicians said, a psychological condition.

“It’s a systemic disease,” wrote the authors (“75 multidisciplinary scientists and clinicians”), “and the people living with it deserve to have their experiences taken seriously.”

They compared healthy people to those who reported chronic fatigue syndrome and found those with CFS had testable biological differences in the immune system and the fecal microbiome, as well as “Reduced neurotransmitter metabolism” and “Autonomic nervous system dysfunction,” among several other markers.

What’s still unclear is how CFS develops, and whether there will be simple biomarker they can find (rather than a list of checkboxes).

Short takes

Managing cannabis expectations

An oncologist’s reminder: Cannabis is not a cure for cancer. Never has been. It might help alleviate some symptoms, but the potential side effects — an wide variation in strengths and types — mean patients need to tread (or, rather, toke) carefully.

Respiratory virus update

Covid, flu, and RSV are all on the decline (although flu numbers are still above normal).

Patients can’t get Zepbound

The next drug in shortage is Eli Lilly’s Zepbound, the hottest of the GLP-1 weight loss drugs. It’s simply because of “unprecedented demand.” While the FDA hasn’t (yet) officially listed it as in shortage, patients are having a hard time getting it.

“It’s like The Hunger Games,” said the president of the Obesity Medicine Association. “Well, actually more like the anti-Hunger Games.”

Shocker: Investing pays returns

A new report from the Global Health Technologies Coalition and Australia’s Policy Cures Research — two organizations that look at how biomed investment affects poorer countries — found that when the US government invests in health research around the world, it not only helps in the short term, it pays some serious long-term dividends.

Our $46 billion in healthcare-research spending (over 15 years)…

… gave rise to $104 billion in economic activity, created 600,000 new jobs, and is expected to spur another $102 billion in industry investments in the United States and beyond.

And that’s on top of preparing us at home for various tropical diseases that are making their way north. Not to mention that, you know, healthy people produce more, create jobs, and of course pay taxes.

Today’s TikTok dopiness

“Oatzempic’ — how drinking watery oatmeal with lime can help you lose 40 pounds in just a couple of months. (Spoiler: It can’t.)

“Believing what is being said on social media can be like believing everything that people say on dating app profiles.”

The crazy cost of GLP-1s

GLP-1 drugs are still not approved by Medicare for treating obesity, but they are approved for treating diabetes and cardiovascular issues. And that alone means that “Medicare Spending on Ozempic and Other GLP-1s Is Skyrocketing.”

• In 2018, Medicare Part D spent about $57 million on Ozempic (the only GLP-1 available at the time).
• In 2022 it spent $5.7 billion-with-a-B on Mounjaro, Ozempic, and Rybelsus. That’s 100 times the amount.

Ozempic alone accounts for 2% of the entire Medicare Part D budget. Think about that — and think about what’s going to happen when GLP-1s are approved for more conditions.

Meanwhile….

A new Yale study found that …

The blockbuster diabetes drug Ozempic could be manufactured for less than $5 a month, even as Novo Nordisk charges almost $1,000 per month for the injection in the U.S. before insurance, a new study suggests.

Researchers found that a month’s supply of the treatment could be made for an estimated 89 cents to $4.73, figures that include a profit margin. (Emphasis ours.)

Double-whammy immunization training

Pharmacists! Technicians! Get yer immunization training! GPhA is offering the two most popular courses in our library on the same day: Saturday, April 20 at the Marriott City Center in Macon (map).

Both include in-person and home study, and both give you the training you need to keep up with the latest in immunization best practices.

For pharmacists: The live portion of “APhA’s Pharmacy-Based Immunization Delivery: A Certificate Program for Pharmacists” is from 8:00 am to 5:00 pm. It’s $349 for GPhA members ($499 for non-members). Click here for more info.

For technicians: The live portion of “GPhA Immunization Training for the Pharmacy Technician” is from 3:00 to 5:00 pm. It’s $199 for GPhA members ($249 for non-members). Click here for more info.

And both give you a nifty certificate for your wall that you can use to impress you boss and your patients. Sign up now before they fill up!

Reward!

If you have any info about the hackers that attacked the Change Healthcare network, there’s a $10 million reward “for information that would lead to the identification or location of anyone who engaged in the ‘malicious cyber activities’ against U.S. infrastructure on behalf of a foreign government.”

The latest cause of long Covid

According to UVA researchers, long Covid might be caused by “abzymes” — antibodies the body produces in response to the disease, but that act like enzymes. They end up interfering with processes that you probably don’t want interfered with, like blood pressure, clotting, and inflammation.

If patients with long COVID make abzymes that activate proteins that control processes such as coagulation and inflammation, that could explain the source of some of the long COVID symptoms and why long COVID symptoms persist even after the body has cleared the initial infection. It also may explain rare side effects of COVID-19 vaccination.

Right now this is still in the “hypothesis with some evidence to support it” stage, so — as always — more research is needed.

Half-help for rural folks

In rural areas, people can have multiple addictions — having both alcohol- and opioid-use disorders isn’t uncommon. The problem, found UCLA researchers, is that even though both disorders can be treated at the same time, most patients were only treated for one or the other.

In all, 85.3% of patients with a dual disorder were prescribed a medication for only one condition, compared to patients struggling with opioid use only (63.7%) or those battling alcohol issues only (10.3%), the study found.

And it’s not as if treating both is complex. Naltrexone does the trick. So what’s happening? They don’t know. They do know that these folks need more support than they’re getting, but medical care is hard enough to come by in a lot of rural areas.

Short takes

Coffee’s latest trick

It can help prevent the recurrence of colorectal cancer. A new Dutch/French study of 1,719 patients with colorectal cancer found that “[C]onsuming >4 cups/day of coffee compared to an intake of <2 cups/d was associated with a 32% lower risk of CRC [colorectal cancer] recurrence.”

Still nothing to see here, citizen. Move along

Bird flu has jumped to dairy cows in at least three states. That is all.

Questionable egg news

“Eggs May Not Be Bad for Your Heart After All” reads the headline. They might not affect cholesterol, and they might even be good for people with diabetes.

Who woula thunk? It’s been appearing in various news outlets, too, just in time for Easter.

One thing, though: The study was funded by Eggland’s Best — a brand of eggs. It also refers to fortified eggs, not your run-of-the-mill eggs.

Your grain of salt

Be careful out there

Scammers are targeting pharmacists, and they’re sophisticated enough to fool even the smart ones. One pharmacist in Ohio lost her life’s savings when scammers posing as the board of pharmacy — even with the BoP’s Caller ID — convinced her she needed to put up a $500,000 bond to avoid arrest from a narcotics investigation.

The caller said that her pharmacist license had been linked to a narcotics investigation in Texas and there was a warrant out for her arrest.

Her license – which pharmacists need to work – was at risk, the caller said. She would need to post a $500,000 bond or work with the FBI to clear her name. […]

Over three months, she was terrified and followed the directions of people she thought were agents of the pharmacy board and other authorities.

The scam went pretty far, including having a dark SUV to follow her occasionally. In the end, the pharmacist lost nearly everything. (And no, there’s no way to get that money back. It’s gone.)

“Gift card” scams are obvious, but when your professional life seems to hang in the balance, it’s easy to miss any signs of shenanigans … if there are any. When in doubt, contact the office directly (in this case the Board of Pharmacy), using a phone number you’re certain is correct — not what the scammer gives you.

And we won’t get into how AI is being used to sound like someone you know pleading for help….

Ozempic … babies?

Women are reporting getting pregnant while on GLP-1 drugs, even though they use birth control (or in some cases thought they were infertile).

But before you raise your eyebrow, keep in mind these women are on TikTok, so you can’t really take what they say at face value. (Were they on real birth control? Were they really infertile, or just hadn’t conceived yet? Was is just a coincidence they got pregnant while on Ozempic?)

That said, there is the possibility — raised by actual scientists — that GLP-1s interfere with birth control by slowing the drugs’ absorption, but it’s more theoretical than proven.

All that said, keep in mind that being pregnant while taking GLP-1s is risky, “and women need to be monitored very closely.”

Economics is never simple

As the out-of-pocket price of insulin has finally dropped thanks to pressure from various governments, you would assume insulin use would increase as more people could afford it. Strangely, though, those insulin price caps haven’t increased insulin uptake.

One reason might be that the people who it affects most — those with commercial insurance — are more likely to be able to afford it, and thus less affected by price caps. (“Previous studies found Medicare enrollees’ prescription fills rose after Medicare implemented a new $35 cap on monthly insulin costs.”) But that’s just speculation. Markets are complicated beasts.

The X for Y files

Taking statins, it seems, can reduce your risk of gum disease. And considering gum disease can raise your risk of cardiovascular problems, it’s a double bonus.

Researchers at the College of Dental Medicine at the Medical University of South Carolina found that statins (specifically simvastatin) turned down the responses of macrophages in the gums, meaning there was less inflammation and thus less chance of Bad Things like tooth loss of the need for root canal.

Should statins be prescribed for people at risk for gum disease? Or could they tease out the mechanism and create a more-targeted drug? You know the mantra: More research is needed.

Guys, maybe you shouldn’t be reading this

“Positive Causal Link ID’d Between Computer Use, Erectile Dysfunction”.

What’s interesting is that it’s not as simple as ‘more computer = less rising to the occasion.’ What Chinese researchers found is that men who were genetically predisposed to “leisure computer usage” were more likely to have trouble — how shall we put it? — leveling up.

Interestingly, it’s only computer use that’s a problem, not sedentary behavior overall:

There was no evidence seen of a link between watching television or driving for leisure and an increased risk for ED.

Short takes

Old drugs, new uses

A Philly-based company called Every Cure is into drug repurposing, but in a big way. Rather than seeing if Drug X can be used for Condition Y (or even “What conditions might Drug X treat?”) it’s using AI “to compare all drugs and all diseases.”

While other organizations doing this kind of work may focus on a specific drug or disease, Every Cure looks at all cases, with the goal of making the connections that will impact the greatest number of patients.

Chickenpox mimics

Chickenpox has been reduced so much in the US (at least until anti-vaxxers target it) that “the disease is now so rare in the US that doctors are misdiagnosing it half the time, according to a report from the Minnesota Department of Health.”

What patients turned out to have was usually an enterovirus or simply “some other skin lesions or infection that was mistaken for chickenpox.”

You definitely want to choose your notification sound carefully

“Gotta go? New bladder device lets you know”

The Long Read: Pre-Ozempic edition

It seems that with GLP-1 drugs being all the rage, people have forgotten that there have been other weight-loss drugs available for a long time. They’re “Half as Good as Ozempic for One-30th the Price,” but as one obesity doctor put it, when they came out “We didn’t have TikTok.”

Those older drugs might have issues, of course, but they’re also usually covered by insurance and available as generics. They just don’t have the buzz.

Learning the limits of cyberattack insurance

One thing a lot of providers are learning after the UnitedHealth attack is that they need to think more about their cyberattack insurance.

This sounds like I’m going to try to sell you something. I’m not.

The gist is that their insurance might cover if something happens to them, but not if it happens to, say, their payment provider. So when patients sue, their insurance company will say, “We’re not paying because we don’t cover United Health. We cover XYZ Pharmacy.”

(Here’s an analogy: Imagine your brakes are defective and you get into an accident, but your insurance company says it won’t pay because it covers you, not the company that made your defective brakes. It’s your problem to deal with BrakeCo — but meanwhile the guy you hit wants payment.)

Thus even companies with cyberattack insurance are finding the limitations of those policies, while they’ve got patients demanding recourse. Eventually UnitedHealth will probably make everyone good, but that may be too late for a lot of small practices.

Convention CPE course list released

It’s out! The CPE courses list for the 2024 Georgia Pharmacy Convention! That means instead of saying, “We have tons of CPE,” now we can say, “Check out the list of CPE courses you can take!”

That full course list for the convention is right here, and more importantly the registration link is here:

Remember: Early-bird registration for the convention ends March 31, so there’s not much time left to get the best rate. Go forth and register now!

A pharma AI to cut readmission

Medication errors are too often the cause of hospital readmissions — the transfer of patient data from inside pharmacist to outside pharmacist isn’t always smooth, especially when there are multiple specialist prescribers involved.

A transition-of-care pharmacist can cut down medication errors, but that’s a lot of hours (30 to 50 minutes per discharge, multiplied by dozens of patients). Humans are slow. That’s why West Virginia University pharmacy researchers are developing an AI tool to take their place help reduce their workload.

The AI will do more than review a list of meds for potential interaction. It’ll be able to read clinician notes and medical history as well. “[I]n each patient’s profile, the tool will also be able to determine the risk of readmission and create an alert system for pharmacists.”

The latest legislative update

As the 2024 legislative session winds down, we had some good news and some bad news in a very busy week. Check out Melissa Reybold’s latest Legislative Update for the details.

Short takes

Eli Lilly says its 10 mL vials of Humalog and Lispro injections are both in temporary shortage — meaning through the beginning of April. “Patients who need insulin immediately and cannot access their healthcare provider for an alternative treatment option should seek emergency care.”

THIS drug I’ll stick with

Adherence is a problem with any drug that needs to be taken for the long-term, but there seems to be one exception: the new obesity drugs. The limited amount of anecdotal reports so far indicate that “Patients seem to take them faithfully, week in and week out.” (Side note: A lot of patients didn’t start using them once they learned they had take them forever.)

Slimy goodness?

If you’ve ever caught or eaten catfish, you’ve undoubtedly asked yourself, “What can be done with all this lovely mucus?” Scientists at UC Davis decided to find out. Turns out there’s “a compound with powerful antibacterial properties” in there. It’s even safe (in general) for mammalian cells, but whether it could lead to a drug for humans is another question entirely.

Better buses, better students

Kids who ride in newer school buses do better academically than the ones stuck in the older ones. What makes this study out of the University of Michigan interesting is that the buses were replaced randomly — i.e., it’s not as if kids in affluent districts did better. It was all about the bus.

[A]mong districts randomly selected by the EPA to receive funding to replace the oldest, dirtiest, buses (pre-1990) with newer, cleaner buses, educational performance improved after the new buses were in use. Replacing newer buses, however, did not show the same benefits.

So how did cleaner buses mean better test scores? Kids who rode cleaner buses were out sick less often. (Especially those with asthma, not surprisingly.)

As for the affluence thing, the UMich folks said the improvement was equivalent to moving to a richer neighborhood (10% and 4% higher for reading/language arts and math, respectively) or having classes that were reduced by 7 to 10 students.

(Because the US isn’t wealthy enough to upgrade old buses across the country, the EPA has an annual funding lottery to choose randomly which school districts can get them.)

ICYMI: Face the face

A study out of Dartmouth is getting a lot of airplay even though it’s about a condition that affects fewer than 100 people. It’s called prosopometamorphopsia or PMO, and people who have it see faces as freakishly distorted. (Live ones, anyway. Photos and drawings look normal.)

The CNN story goes into a lot more detail, including an interview with a patient who explained “It’s like staring at demons. Imagine waking up one morning and suddenly everybody in the world looks like a creature in a horror movie.”

Yeah, that’s right — it happened all of a sudden when he was about 56 years old.

Some people with PMO see their own faces as distorted or even damaged. Two patients, “while standing in front of the mirror, saw one eye popping out of its socket and slithering down the cheek.” […] one patient described the right side of his doctor’s face in which the “eye became a ghastly staring hole, cheek bone a cavity; he had teeth on the upper lip, often had two ears.” Others with PMO have eloquently described faces as “like clocks in a Dalí painting” or “kaleidoscopically changing.”

Medicare to cover Wegovy

It’s the first GLP-1 weight-loss drug the program will cover, because it’s not technically a weight-loss drug — it’s only been approved for treating heart problems by CMS following the FDA’s approval of the drug for that purpose. So don’t be surprised to see some wink-wink from prescribers on this one.

Short takes

Sure, why not?

Apparently being double-joined increases your risk of long Covid.

Who woulda thunk?

What do you call a woman who gets her birth control information from TikTok?

“Mom.”

Another inhaler price drop

Following in the footsteps of Boehringer Ingelheim and AstraZeneca, now GSK says it will cap the prices of its inhalers at $35 out of pocket … well, starting in 9 months.

Drug-delivery contact lens

If someone’s got a corneal abrasion, why give them eye drops they must put in manually when you can have ’em pop in a contact lens that delivers antibiotics automatically* — while also acting as a bandage?

That’s just what Canadian scientists developed because (unlike you and me) the lead researcher “knew there was a market for a drug-delivering bandage contact lens that could simultaneously treat the eye and allow it to heal.”

If delivering drugs via contact lenses isn’t cool enough, here’s a twist: It reacts to an enzyme in the eye^* that’s released during wound healing. Thus the lens…

“… releases the drug in a way that is proportional to the amount of enzymes present at the wound. So, the bigger the wound, the higher the amount of drug released.”

And yes, someone did call it “potentially a game changer.”

^* Matrix metalloproteinase-9 (MMP-9), as you probably guessed

The acid that makes you fat, frail, and sick

Usually you hear about amino acids having a positive effect on health — precursors to proteins and all that. But University of Wisconsin researchers found the opposite: Mice that cut down on their intake of isoleucine lived longer, got thinner, were less frail as they aged, and didn’t have as much cancer or as many prostate problems — even when their calorie intake was higher. The UW folks also found that obese people had more isoleucine in their bodies, confirming their suspicions.

So what foods contain isoleucine? Yeah, that’s the problem: “Isoleucine is plentiful in foods including eggs, dairy, soy protein, and many kinds of meat.”

Rather than count on people changing their diets, the scientists hope to figure out the mechanism at work and use it as a treatment target (or possibly find a way to block isoleucine absorption).

How you doin’?

APhA and the National Alliance of State Pharmacy Associations released their 2003 “Pharmacy Workplace and Well-being Reporting,” highlighting what pharmacy staff report are the biggest issues in their pharmacies.

You can read the full report here (PDF), or just check out the news release here. Or you can cut to the chase and ponder the 10 most-reported issues:

1. Staffing/scheduling (491 reports)
2. Volume/workload expectation mismatched to available staffing and shift hours (485)
3. Working conditions (420)
4. Pharmacy metrics (399)
5. Training or education (165)
6. Medication error — near miss with no patient harm (142)
7. Professional judgment restricted or supported when caring for a patient (139)
8. Personal safety concerns (123)
9. Technology/automation (80)
10. Insurance or billing issues (80)

Fighting fungus with fungus

The Candida albicans fungus can be a big problem in hospitals. Usually it’s benign, sometimes it causes thrush, but too often it can lead to invasive candidiasis, where it infects the blood or the organs. If that happens, there’s a 25% mortality rate.

There aren’t any great treatments for candidiasis, and killing C. albicans is tough — although that may have changed. Rather than a drug, Israeli researchers have found another fungus that outcompetes C. albicans, clearing it out of the intestines and reducing the risk of runaway infection.

They named the new fungus Kazachstania weizmannii, and they found it living happily in human guts. In fact, where there is K. weizmannii you don’t find C. albicans, and vice-versa, meaning it sure looks like it could be weaponized.

Never too early

There are only 276 days till Christmas, so the folks at Drug Store News are wondering, “What will consumers’ shopping behavior look like for the 2024 holidays?”

The answer: deals, discounts, and online shopping with free shipping and customer reviews. But don’t you worry — “[N]early 60% of all U.S. and U.K. respondents plan to attend Black Friday and Cyber Monday^* physical events during the holiday 2024 season.”

^* Sure, shopping in person for Cyber Monday. That makes sense.

Antidepressant fatigue

There are a lot of competing explanations for chronic fatigue syndrome (CFS) and a good chance it’s got several possible causes. The latest one, though, is interesting: SSRIs.

Korean researchers think CFS might be caused by excessive levels of serotonin in the brain. Thus SSRIs, by their very action, keeps those levels higher. To test this, they gave some mice high dozes of Prozac and others plain ol’ saline. Not surprisingly, after a month the brains of the Prozac group had higher levels of serotonin. But the interesting bit:

They also developed behaviors that resembled the main symptoms of ME/CFS seen in humans, including unrefreshing sleep, PEM and orthostatic intolerance, but not cognitive impairment. These behaviors disappeared six weeks after the drug was stopped.

Next up: Figuring out the molecular mechanism at work.

The new worst conditions

Move over, cardiovascular disease. The latest research (out of US and Australian universities and the WHO Brain Health Unit) finds that neurological conditions have taken the top spot — that’s “stroke, brain injury, migraine, Alzheimer’s disease and other dementias, and nerve damage.”

What’s going on? We’re getting older. Oh, and there’s “increased exposure to environmental, metabolic and lifestyle risk factors,” which is why diabetic neuropathy is skyrocketing.

The good news? Despite the rising levels of neurological disease, both deaths and years “lost” to disability are down, thanks to better treatments … in the developed world, at least.

Short Takes

Glucose monitors go mainstream

Thanks to health infomercials influencers and corporate marketing, diabetics aren’t the only ones looking to buy continuous monitors. They’re turning into TKTK

The cranberry boost

Athletes who want every little edge possible might want to look at everyone’s favorite Thanksgiving side dish: cranberries. Yep, apparently taking cranberry extract means “better oxygen extraction by the muscle, improved lactate clearance, and slower muscle deoxygenation,” according to Quebecois researchers. (They might be a bit over-enthusiastic, though, calling cranberries “A runner’s best friend.”)

There is no news here

A group of Welsh, Canadian, Chinese, and American researchers have reached the conclusion that if you have a mild case of Covid-19, it’s fine to take over-the-counter drugs to relieve the symptoms.

But…

Researchers at Florida Atlantic University say ‘not so fast’ — talk to a professional before doing something rash like taking Tylenol.

They suggest that selecting an OTC medication to alleviate mild symptoms of Covid-19 should be based on the entire benefit-to-risk profile of the patient. Moreover, they say clinical decisions should be made by the health care provider for each of his or her patients.

Suppress the acid, get the allergies

Acid-suppression meds and infants don’t mix, and it’s especially true for proton-pump inhibitors. Apparently those kinds of meds can increase the risk of a kid developing a food allergy.

Based on data from…

• more than 56,000 patients under 1 year old who were given PPIs
• 169,000 who got histamine-2 receptor antagonists
• 887,000 who received one or more antimicrobials

… Cleveland Clinic researchers found that “early exposure to acid-suppressive medications was associated with five to six times higher risk of food allergy and anaphylaxis, with similar trends observed for antimicrobials.”

Yeah, five to six times the risk. That’s not small potatoes. And PPIs had the highest risk — 640% higher than average. Why? Dunno — someone else will have to figure that part out. For now, though, it’s a risk worth telling patients about.

We’re losing the ability to digest plants

Humans can’t digest plants directly, but we’ve got gut microbes that do it for us. Here’s the problem (according to a study by Israeli researchers): Western diets are so low in the fiber that cellulose-eating bacteria need, we’re reaching the point that we can’t process plants at all.

They looked at gut bacteria today and from humans more than 1,000 years ago, as well as in non-human primates. Back then (and in today’s wild primates), about 30-40 percent of gut bacteria was the stuff that could digest cellulose.

Today, it’s down to 20 percent at best— and that’s in hunter-gatherer cultures (and people living a rural lifestyle with high-fiber diets). For people living modern lifestyles, only 5 percent of their gut bacteria can process plants.

What does that mean? It means that we’re not getting as many of the nutrients in plants as we used to, and it’s getting worse. How will that affect health? You know the mantra: More research is needed. But for sure we need more fiber either in our diets or, well, maybe via supplements you have down this aisle right here….

D₂ is for diabetes

When someone is diagnosed with type-1 diabetes, they often still have functioning pancreatic beta cells that keep working for years. They’ve got a “honeymoon period” before full-on diabetes sets in — time to make lifestyle changes to try to keep the diabetes at bay.

Just like with marriage or a new job, being able to extend that honeymoon is a Good Thing, and a group of researchers (from too many institutions to list) think they’ve found a pill that will do it: ergocalciferol, aka vitamin D₂.

They ran a trial on 36 kids who had just been diagnosed and…

… found that those volunteers given the vitamin D2 supplements saw improvements in insulin secretion capacity in beta cells—they observed decreases in the PI:C ratio compared to a placebo.

Of course the trial was small (more research is needed), but considering that vitamin D₃ gets all the love, it might be a chance for D₂ to shine.

Apnea drug for mouth breathers

As much fun as it is to wear a CPAP and make Darth Vader sounds^*, Aussie researchers may have found a pharmaceutical solution. It’s a potassium channel-blocking nasal spray that has “the potential to increase the activity of the muscles that keep the upper airway open and reduce the likelihood of the throat collapsing during sleep.”

They started with a small test — 10 volunteers — and got some good results:

Seven out of the 10 people responded to the potassium channel blocker nasal spray showing a reduction in the frequency of upper airway collapsing episodes during sleep and lower blood pressure the next morning.

Side note: With nasal-only breathing (we presume they taped shut the mouths of some volunteers), the spray didn’t help.

^* Or mimic Bane’s voice, for you Dark Knight fans

Short takes

First drug for MASH (aka NASH)

The FDA has approved Madrigal’s Rezdiffra (resmetirom, to be technical) as the first drug ever for metabolic dysfunction-associated steatohepatitis (MASH), aka liver inflammation.

AZ offers more inhaler coupons

Following in the footsteps of Boehringer Ingelheim, AstraZeneca now says it’s also going to offer a savings program so no one has to pay more than $35 a month for any of its asthma inhalers.

This isn’t the same as lowering the price — perish the thought! — rather the company is making coupons available. Whether pharmacists and patients will be aware of those coupons … well, that’s another matter. As we’ve seen with insulin, it’s not even close to 100%.

More drugs in shortage

FYI, nine more drugs are in shortage (other than the ones you probably already know about) according to suppliers:

• Acyclovir injection
• Cyclopentolate and phenylephrine ophthalmic solution
• Estradiol vaginal system
• Flumazenil injection
• Mesna injection
• Naltrexone hydrochloride tablet
• Progesterone vaginal insert
• Succinylcholine injection
• Vasopressin injection

Experts: Don’t trust biome tests

We know that your various microbiomes are important, and that there are “good” and “bad” bacteria living in and on you, but the details are still being sussed out. Which bacteria are important for which people in which nooks and crannies is not 100% clear.

But that doesn’t stop nefarious companies from offering at-home tests to tell you whether a particular biome is healthy or not … and, of course, selling you something to “fix” it.

Thus a group of medical and pharmaceutical researchers has written an article in Science calling for more regulation of those tests, lest consumers be “financially exploited or harmed by inappropriate use of test results that neither they nor their doctors understand.”

“There is no scientifically agreed-upon definition of a ‘healthy’ microbiome; the microbiome is dynamic and changes frequently; there is no clinical proof that these products work; and no standardization in the processes involved.”

Respiratory update

What’s the current respiratory virus situation? Here, have a chart:

Captain Obvious has dusted off his Tumblr account

“Using X (formerly Twitter) has a negative impact on well-being”

“…it was associated with an immediate drop in positive emotions such as joy and a surge in outrage, political polarization, and boredom.”

The Long Read: Postpartum med remains elusive

Way back in August 2023 we told you how the first pill for postpartum depression — Zurzuvae (aka zuranolone) — got FDA approval and would be hitting pharmacies soon.

Well that happened, but there’s a catch. Sage Therapeutics set Zurzuvae’s price at $15,900 for the 14-day regimen. And that means insurers are iffy about covering it or even offering guidance. Meanwhile, patients are waiting.