Ozempic ripples continue

Semaglutide drugs are still relatively new, and already Walmart is reporting a “slight pullback in the overall basket” of food purchases, and snack companies are rethinking their products. Could smaller Slim Jims be on the horizon?

But not everyone is freaking out.

[One exec] said snack companies “are talking about making smaller pack sizes and things like that, and that’s kind of nutty thinking because it’s just too early to know how much it’s going to impact consumer behavior.”

Speaking of semaglutide….

Novo Nordisk stopped its test of semaglutide for chronic kidney disease early because the results were so good. That trial “is looking at whether semaglutide can stall progression of CKD and curb the risk of death from kidney failure and cardiovascular issues.”

I guess it can. The full results will be released in the first half of 2024, after which you can assume Novo will apply for a new label for Wegovy.

A different kind of Covid vax

A new, non-mRNA Covid vaccine has passed its phase 1 trials. The interesting bits: It’s a nasal vaccine using a live-attenuated (i.e., weakened) virus, meaning storage and transportation are easier. And it works differently:

The idea was to produce an immune response to the entire virus rather than the frequently mutating spike protein. This could potentially provide broader protection against variants, the researchers said.

Unexpected opioid side effect

Odd finding: Of 60,000 patients admitted to hospital in Rhode Island, 5% carried a nasty bug in their guts: vancomycin-resistant Enterococci. But of those, 16% hadn’t taken any kind of antimicrobial in the past year. Something else was afoot.

That something else, according to Brown University researchers, was opioids. When they crunched the numbers, they found that individuals exposed to opioids faced a nearly four-fold higher risk of harboring antibiotic-resistant bacteria in their intestines.

Why? It could be that opioids create an environment in the digestive system that those bacteria find particularly hospitable.

Walgreens’ bottom line hit by lawsuit, less vaccination

Thanks in large part to the double whammy of Covid vaccines sales dropping and having to shell out $4.8 billion for its role in the opioid crisis, Walgreens Boots Alliance reported a $180 million loss in Q4, bringing its total loss in 2023 to more than $3.1 billion with a B.

But don’t you worry — not only is that a smaller loss than Q4 last year, the company is planning big cost cuts and forecasting a profitable 2024.

Turning and Alzheimer’s

People with Alzheimer’s have trouble turning, it seems^*. A study by neuroscientists at University College London found that…

… people with early Alzheimer’s consistently overestimated the turns on the route and showed increased variability in their sense of direction.

^* No, we’re not going to make a joke about Florida drivers who leave their turn signals on.

The Long Read: Saving the Crabs edition

Horseshoe crab blood is used to make limulus amebocyte lysate (LAL), which is used to guarantee that IV drugs are free of endotoxins.

Producing LAL requires harvesting horseshoe crabs from oceans and beaches, draining up to 30% of their blood in a laboratory and returning the live crabs to the ocean. There’s dispute about how many crabs die in the process.

Death is bad for the crabs, and also for the birds that feed on their eggs … and so on, up the food chain.

That might change. (Not the part about death — that’s still bad for the crabs.) Lab-made replacements for LAL exist, and even the LAL companies have them. And next year USP might move these synthetic products from “alternative” status to full approval, and that could be the spark to get drug makers to give up their crab-draining ways.

Weird science

Buy a home. Renting, apparently, makes you age faster, according to data from an Australian study.

The negative health impacts of renting were shown to be greater than those of experiencing unemployment or being a former smoker.

Correlation/causation: It could be that people who rent have lower incomes overall and thus age faster because of that.

It’s also a non-dessert topping

We hear “a drug for X can also treat Y,” so often it can seem like a chicken throwing darts at diseases. The latest example: Metformin (the diabetes drug) can prevent gum disease.

British dental researchers found that metformin reduced inflammation and sugar levels in both the body and the mouth^*.

Metformin led to significant prevention of bone-loss during induced periodontal disease and age-related bone-loss in vivo (in living mice). […] The [human] trial showed improved clinical outcomes in the gum disease treatment, and control of sugar levels and inflammation in the mouth and body, even in high levels of bacteria.

* * *

Advertising inside pharmacies

As pharmacies provide more healthcare services, that hasn’t gone unnoticed by advertisers looking for new ways to interrupt our lives. They’re starting to put money into ads inside retail pharmacies. Some are low-tech (shelf signs) and some are high-tech (trans­forming the glass on bev­er­age cool­ers in­to ad­ver­tis­ing screens).

“We’re re­al­ly ex­cit­ed about this and see a great op­por­tu­ni­ty for many of our brands in the space,” said one advertising exec.

“Our hope is that con­sumers will see our in­for­ma­tion at their lo­cal phar­ma­cy and have that con­ver­sa­tion. We al­so plan to sup­port phar­ma­cists with re­sources and pa­tient ed­u­ca­tion to help fa­cil­i­tate dis­cus­sions and ul­ti­mate­ly vac­ci­na­tions.”

He forgot to add “…in their copious free time.”

(One ad-tech company did at least give lip service to bombarded consumers: “If you’re go­ing to a phar­ma­cy or pri­ma­ry point of care in the store, you don’t want to feel like you’re be­ing sold to.”)

Captain Obvious obeys the law

“Kids in state with flu vaccine mandate more likely to be vaccinated, study finds”

There’s a new heart syndrome in town

The American Heart Association has named a new medical condition — one that “reflects the strong links among obesity, diabetes, and heart and kidney disease.” It’s called cardiovascular-kidney-metabolic syndrome, or CKM.

Essentially, it defines the criteria for various issues (e.g., high blood pressure, high triglycerides, kidney failure) that can eventually lead to heart disease, with the goal of focusing doctors on seeing the larger picture to prevent heart disease.

[W]hen you look at the organs together, “you can detect disease early and you’re going to prevent bad cardiovascular outcomes, like heart failure, heart attacks and stroke.”

In case you’re curious, “More than 90% of adults fall on the CKM spectrum.” But yes, someone did call it a “game changer.”

Mom’s Tdap vax protects newborns (to a point)

The other day we told you how moms who get the Covid vaccine while pregnant can protect newborns for the first few months. The same seems to be true for Tdap vaccines.

Based on data from almost 280,000 mom-baby pairs, Aussie scientists found that maternal vaccination protected infants for at least the first few months, although it wore off by 8 months.

Twist: Getting the vaccine during pregnancy seems to blunt the effect of the vaccine when the baby gets the third shot (after mom has two).

Protecting the chickens

As bird flu continues to spread to millions of birds and jump to humans — three cases in Cambodia recently, including one death — scientists have turned to the acronym drawer.

The possible solution: CRISPR, the gene-editing tool. Scottish embryologists^* were able to create chickens that have at least some resistance to bird flu. If they’re able to move beyond proof of concept, it could be another tool to help prevent spread beyond vaccination.

If scientists could engineer resistance into chickens, farmers would not need to routinely vaccinate new batches of birds. Gene editing “promises a new way to make permanent changes in the disease resistance of an animal. […] This can be passed down through all the gene-edited animals, to all the offspring.”

Of course, you would have to convince a heck of a lot of people that genetically engineering millions of birds is a safe thing….

^* That’s a new one

1918 flu victims weren’t young and strong after all

Based on death records, we know that the 1918 flu killed young, healthy adults at a crazy-high rate. It’s always been kind of a mystery.

Well it’s not any more — and it’s also not true. A team of Yankee and Canuck researchers looked not just at the records, but also at the bones. Based on the lesions they found, they concluded…

…that the most susceptible to dying of the flu had exhibited signs of previous environmental, social and nutritional stress.

Lesions form for a lot of reasons, including physical trauma or infection. The team found that the people most likely to die had active ones, meaning they were currently suffering from something and thus more frail than the average Joe. (Assuming Joe didn’t also have lesions.)

Walgreens walkout

By the time you read this, Walgreens pharmacy staff across the country will have walked out for three days over their working conditions. This follows walkouts from CVS pharmacies that started last week in Kansas. (Read the Reddit thread here.)

What about you?

Take our anonymous survey. (And when we say “anonymous,” we mean it — we do not want any personal information, period.) It’s all of four questions, plus a chance to tell us about your working conditions.

We want to share this information with the Board of Pharmacy so it will be crystal clear the kind of conditions Georgia pharmacists and technicians are dealing with.

Please go to GPha.org/workingconditions and take the 5 minutes to share your story.

Contraceptives vs arthritis

An interesting twist to contraceptives: Apparently The Pill can protect women from rheumatoid arthritis. It’s not a small effect, either, according to the Swedish researchers who did the study. Taking contraceptive pills lowered the risk of arthritis by 19% while they were taking them, and 11% after they stopped.

Then another twist: Getting hormone treatments for menopause increases the risk. Yep, “women who were treated with hormones ran a 16% higher risk of rheumatoid arthritis than those who never received such treatment.”

Why the difference? Well, they’re hormones, sure, but they’re different hormones, and of course there are the physiological changes that comes with menopause. But for that, more research is needed.

Indy pharmacies line up to dispense THC oil

It seems that about a quarter of Georgia’s independent pharmacies — about 100 out of the 400 in the state — have signed up with the Georgia Access to Medical Cannabis Commission to dispense low-THC oil to the 27,000 people who hold Low THC Oil Registration cards.

(Shout-out to Atlanta News First for correctly calling it “low-THC oil” and not “medical marijuana.” Looking at you, ABC News.)

I know there are some strong opinions about the subject, so please don’t read this as an endorsement for any particular point of view. GPhA does not have an official opinion on the sale of low-THC oil by pharmacies.

Short takes

Where sleep disorders and ADHD meet

The narcolepsy drug Solriamfetol, aka Sunosi, seems to work against adult ADHD, according to a small trial by Mass General researchers. That’s likely because it …

… increases the amounts of certain natural substances in the brain — specifically, dopamine and norepinephrine — that control sleep and wakefulness, thus sharing some of the properties of current ADHD medications.

HRBs and PPIs affect MMFs

Patients taking mycophenolate mofetil (MMF) should be careful if they’re taking either esomeprazole of ranitidine for acid reflux. A study out of India found that either of those drugs reduced the bioavailability of MMF. If they need those acid-reflux drugs, they should monitor their MMF levels or switch to enteric-coated mycophenolate sodium instead.

Best Buy will sell glucose monitors

Best Buy is dipping its toe into the healthcare waters — it’s planning to offer the Dexcom G7 glucose monitoring system.

It’s a simple process: A patient signs up with virtual healthcare company Wheel, and is then assigned a physician. The physician prescribes a glucose monitor and sends a prescription to pharma-tech company HealthDyne which processes it and sends the Dexcom G7 directly to the customer.

Best Buy said will sell the G7 for $179.99 with a 30-day insulin supply, but its involvement isn’t clear. (Why can’t patients go directly to Wheel?) Maybe Best Buy’s job is to tell you that you have a serious virus and the Geek Squad will clean it up for just $79.99.

Why antidepressants take so long to work

Most meds start working right away, but SSRIs and SNRIs can take a week or more. As Jerry Seinfeld would ask, “What’s up with that?”

The answer, according to an international group of researchers led by those shifty Danes, seems to be that the drugs actually get the brain to build new synapses in the neocortex and hippocampus. And that’s not something that can happen overnight.

That’s not to say they’re 100% certain that greater synaptic density is how these drugs work, but PET scans did show noticeable changes after several weeks on an SSRI. That would seem to point to those brain changes as the mechanism … or at least part of it.

Bitter coffee can help you lose weight

Drinking coffee, it seems, can help you lose weight — with or without caffeine. A team of Harvard researchers discovered this … and the huge caveat: It seems that a single teaspoon of sugar will counteract the weight-loss effect. Milk or cream doesn’t make much of a difference, though.

[A]n increase in coffee consumption of one cup of unsweetened coffee was linked to a decrease in weight of around 0.12 kilograms (0.26 pounds). On the other hand, when people increased their daily sugar intake by one teaspoon in any food or drink, they gained 0.09 kilograms (0.20 pounds).

Why does it work? It might help burn calories or it might suppress appetite, but some of the suggestions (e.g., “ enhancing physical performance”) apply to caffeine rather than coffee, and this study was about both caff and decaf varieties. So, as always, more studies are needed.

Compounders can compound

A judge has dismissed Novo Nordisk’s lawsuit — the one that tried to stop compounding pharmacies from making versions of semaglutide (ruling PDF). Novo had claimed that the compounded versions weren’t FDA-approved … but compounded medication is never FDA approved, although the ingredients are.

Compounding pharmacies, by law, are allowed to create compounded versions of medications when the branded drugs are in shortage — as semaglutide is.

Putting childhood T cells to work

Here’s a nifty trick: Almost everyone’s had a bunch of childhood vaccinations, right? Most of the time the T cells are hanging out doing nothing unless you’re exposed to measles, mumps, or whatever. So UMass chemical engineers decided to give them something to do: attack tumors.

The idea is simple (at least to explain): Have a modified salmonella virus deliver an antigen to the inside of tumor cells. That would trigger bored T cells to attack the tumor, thinking it was a virus.

And what d’ya know, it worked (in mice):

The therapy cleared 43% of established pancreatic tumors, increased survival and prevented tumor re-implantation [….] “We had complete cure in three out of seven of the pancreatic mice models.”

Not only that, but the mice essentially developed an immunity to the cancer. Their planned first target, if and when human trials can start, is liver cancer.

Betaxolol recall

KVK-Tech is recalling a batch of its 10mg betaxolol tablets (batch 17853A) “due to a single oxycodone HCl tablet 5 mg foreign tablet found on the packaging line.”

Like mice, cockroaches, or hipsters, if you see one oxycodone tablet on the production line, there are probably more.

Pharma investment opportunity

While McDonald’s might be on the losing end of the boom in weight-loss meds, you know who’s doing well? Companies that fill syringes — a segment known as “fill-finish.”

Research firm The Insight Partners predicts the fill-finish market will more than double between 2019 and 2027, to $12.5 billion. That is about twice the pace for tablets or capsules, an industry expert said.

[…]

The U.S. Inflation Reduction Act is also boosting development of biologic drugs, some of which are injected. Injectables are increasingly used in elderly care settings, and some new Alzheimer’s and generic arthritis drugs are administered by injection.

Running for happiness

It seems, based on a new Dutch study, that running for 45 minutes a day, twice a week, is as effective as SSRIs for depression — plus it has the added benefits of a good physical workout.

The hassle of taking a daily pill vs. running 45 minutes twice a week. I wonder what people will prefer?

You really don’t want long Covid

Getting Covid itself is probably not a big deal these days — although it’s still putting some people in the hospital. The scary thing is rolling the dice over long Covid, where symptoms persist for months … or longer. But it’s worse than that.

A new study out of the UK found that long Covid has effects throughout the organs:

MRI scans revealed that people with long Covid were 14 times more likely to have lung abnormalities than people who never had the disease, three times more likely to have brain abnormalities and two times more likely to have kidney abnormalities.

The good(ish) news is that the severity of those symptoms is usually linked to the severity of the disease itself, so a minor bout might only give you minor brain fog.

It’s not always Covid that’s long

A different British study found that other respiratory illnesses can persist long after the infection is cleared, which they call a long cold — “long-lasting health effects from other respiratory infections, such as colds, flu, or pneumonia, that are currently going unrecognised.”

It’s not quite the same as long Covid, e.g., there aren’t issues with brain fog or taste or smell, but it’s still out there.

Here, something to worry about

Dengue. The warming climate means that the mosquitos that carry it will be moving north from the (current) tropics to the southern USA.

Dengue is spread by infected Aedes aegypti mosquitoes, which behave differently to the malaria-carrying kind. For example, they bite people indoors, and they bite all day rather than overnight. They also breed in very shallow water.

The good news is that there’s a vaccine for it. The bad news is that people will have to get vaccinated.

Cancer-drug shortage eases … a bit

Fewer cancer centers are reporting shortages of critical, platinum-based drugs, but the supply-chain issues haven’t been solved — and the shortages are far from over.

For example:

• 93% of cancer centers reported a carboplatin shortage earlier this summer; that’s down to 72%.
• 70% reported a cisplatin shortage this summer; that’s down to 59%.

The good news: “Nearly all reported being able to treat patients who needed carboplatin or cisplatin with the drugs despite reduced supply.”

The bad news:

Today, 66% of cancer centers reported ongoing shortages of methotrexate, 55% reported shortages of 5-flourouracil, 45% reported shortages of fludarabine, and 41% reported shortages of hydrocortisone.

More than a pinworm drug

Like most people, you’ve probably wondered, “Can pyrvinium do more than just treat pinworms?” The great mystery may have been solved. According to medical researchers at Vanderbilt University, pyrvinium can prevent stomach cancer by killing precancerous lesions. Well, in the lab.

Still, as it’s already FDA approved and has few side effects, next up could be human trials on people at high risk of stomach cancer.

Infection to prevent miscarriage

Woman who are infected with cytomegalovirus while pregnant are much more likely to miscarry. Worse, the virus is fairly common.

It turns out (found Tulane researchers) that the danger only exists if their infection while pregnant is their first infection. In other words, getting infected with the virus before pregnancy means reinfection won’t raise their miscarriage risk.

While it might make logical sense, then, for women to seek out cytomegalovirus before they plan to get pregnant, the Tulanians hope it can simply be made into a vaccine.

They look like us now

We’ve seen lab-grown organs and lab-grown brain cells, and in the latest move to create bodies for our coming AI overlords, Wake Forest researchers have developed “full thickness human bioprinted skin.”

When transplanted in pre-clinical settings, the bioprinted skin formed blood vessels, skin patterns, and normal tissue formation. Additional arms of the study demonstrated improved wound closure, reduced skin contraction, and more collagen production to reduce scarring.

The artificial skin has “all six major primary human cell types present in skin combined with specialized hydrogels as a bioink.” (What raised eyebrows at Buzz HQ was how casually they used the word “bioink.”)

They claim the goal is to create a better alternative to current skin grafts for burn victims. Mm hmm.

ICYMI: Weight loss drugs and GI issues

People taking semaglutide (e.g., Ozempic, Wegovy) or liraglutide (e.g., Victoza, Saxenda) have a notably higher risk for some serious GI issues.

Patients taking either of these glucagon-like peptide-1 (GLP-1) receptor agonists had nine times an elevated risk for pancreatitis. They were also four times more likely to develop bowel obstruction and over 3.5 times more likely to experience gastroparesis.

What that actually translates to is “an approximately 1%–2% chance of experiencing these events.” Not too big a deal, but worth remembering that one or two people out of a 100 will have to worry.

Parkinson’s cause: rogue DNA

Now there’s another clue that the root of Parkinson’s might be in the mitochondria^* — specifically, fragments of mitochondrial DNA.

Small fragments of [DNA] from the mitochondria are released into the cell. When these fragments of damaged DNA are misplaced, they become toxic to the cell, prompting nerve cells to expel this toxic mitochondrial DNA.

Given the interconnected nature of brain cells, these toxic DNA fragments spread to neighboring and distant cells, similar to an uncontrolled forest fire sparked by a casual bonfire.

The shifty Danes who discovered this hope it can lead to a simple blood test for Parkinson’s — but first they have to determine if the DNA fragments even make it into the blood. Stay tuned.

^* The powerhouse of the cell

Elsewhere: Smoke-free UK?

Britain’s prime minister wants to ban cigarette sales for anyone born after December 31, 2008.

Proposed new legislation will make it an offence for anyone born on or after 1 January 2009 to be sold tobacco products – effectively raising the smoking age by a year each year until it applies to the whole population.

Cholesterol Goldilocks zone

High HDL cholesterol seems to increase the risk of dementia.

Low HDL cholesterol seems to increase the risk of dementia.

This bit of unexpected data^* comes out of Boston University, and it’s based on data from about 184,000 older-ish people.

People with the highest levels of HDL cholesterol had a 15% higher rate of dementia compared to those in the middle group. Those with the lowest levels had a 7% higher rate of dementia compared to those in the middle group.

But those are the highest and lowest HDL levels. In general, when it comes to the risk of dementia from HDL, “these increases are small, and their clinical significance is uncertain,” per the lead author. (Side note: LDL levels didn’t seem to have any effect.)

^* Yes, technically it’s a datum. Hush, you.

Prebiotics aren’t for preemies

Apparently it’s not uncommon to give preemies a dose of probiotics (e.g., Evivo with MCT Oil). But that can cause complications, and now one infant has died from “sepsis caused by a type of bacteria that turned out to be a genetic match to the bacteria contained in the probiotic.”

Ergo, the FDA is warning hospitals: Don’t give probiotics to preemies.

GPhA out and about

GPhA’s VP of the AIP, Jonathan Marquess joined interim CEO Mahlon Davidson for a trip to UGA’s College of Pharmacy to explain to students (and faculty and staff) why legislative advocacy is so important to keep the pharmacy profession movin’ and groovin’^*.

Here they are flanking UGA COP Dean Kelly Smith:

^* They did not use these exact terms, but the sentiment was similar.

MRSA vaccine?

USC scientists have made what they describe as a vaccine against MRSA — something they suggest giving to patients going into hospital to help prevent catching an infection there.

Rather than getting the body to make antibodies against Staphylococcus aureus or Acinetobacter baumannii, this vaccine — which lasts about 28 days…

… gooses the body’s preexisting supply of pathogen-gobbling immune cells called macrophages, which engulf and digest bacteria, fungi and other bad actors. These activated fighters, found in all tissues, quickly neutralize incoming invaders which might otherwise multiply rapidly and overwhelm the body’s defenses.

They’ve already taken the most important next step: Getting a patent and forming a startup (ExBaq LLC) to eventually sell it. Oh, and working to begin clinical trials.

Speaking of MRSA…

It seems — per Duke researchers — that ceftobiprole (the pneumonia drug) also works against MRSA, and just as well as daptomycin. If the FDA approves it to treat S. aureus, that would be the first new drug for that indication in more than 15 years.

Keeping a nano eye on vancomycin

When someone’s given vancomycin, they, and it, have to be monitored carefully — we’re talking hourly blood tests to ensure it’s killing the bad stuff (the infection) and not the good stuff (the patient). It’s not an antibiotic to be trifled with.

Nanoscience might have a better way, courtesy of Sandia National Laboratories. Researchers there have developed a ‘microneedle patch with nanoscale sensors’ that can turn vancomycin levels into electrical impulses, enabling real-time monitoring using a patch the size of a silver dollar^*.

So far, like many grad students, it’s successful in the lab but still needs to be tested in the real world.

^* Whether they mean the big ol’ Eisenhower silver dollars or the newfangled ones isn’t clear. 

Covid vaccines quickies

Put it in a scrapbook

The CDC has stopped printing Covid-19 vaccination cards.

Two weeks, four million

In the two weeks of September that the new Covid vaccines were available, about 4 million Americans got their shots “even as some people have found it difficult to book vaccination appointments or find the vaccines at no cost.”

Younger women, lower diabetes threshold

The HbA1c threshold for type 2 diabetes should be lower for pre-menopausal women. That’s the conclusion of British researchers who looked at health data from almost a million women. The reason is simple: “natural blood loss through menstruation can affect blood sugar levels in women.”

This mechanism behind this could be shorter erythrocyte (red blood cell) survival which results in shorter exposure of hemoglobin to glucose compared with individuals who do not menstruate.

This might also explain why women are typically diagnosed with type 2 diabetes later than men (5 years later!), delaying their treatment and leading to higher mortality.

Combo vaxes are coming

Flu/Covid combo from Moderna

Moderna reports that its combination flu/Covid-19 vaccine worked just great in a phase 1 trial. “Moderna said the combination generated antibodies similar to or greater than currently marketed flu vaccines, and was similar to its previous standalone Covid booster shot against the coronavirus.”

If all goes well, the company thinks the vaccine could be available in fall 2025.

MMR … C?

Meanwhile at an Ohio State University, scientists unveiled a vaccine that protects against measles, mumps, and Covid and is delivered via nasal spray.

They believe it will provide lifelong protection against measles and mumps, and at least four months of protection against Covid (and possibly more).

They did it by adding Covid’s spike protein to the measles and mumps vaccines, which is either a really smart idea or the setup for a new HBO show.

A drug for chemo fatigue

If you have mice being treated for cancer, fighting the fatigue that comes with that treatment is tricky; you don’t want to interfere with the treatment itself. Now Yale researchers think they’ve got a drug that’ll work: dichloroacetate, aka dichloroacetic acid or DCA.

The data suggests that DCA treatment may have several positive effects, including reducing oxidative stress in muscle tissue of tumor-bearing mice. The researchers said DCA could be a practice-changing approach in the future, when used as an adjuvant therapy to treat cancer-related fatigue.

The good news is that dichloroacetate is already FDA approved, so clinical trials (on humans) should be easy.

Third Covid vax approved

The FDA has given emergency use authorization to Novavax’s updated Covid-19 vaccine — that’s the non-mRNA shot. Because the CDC has already approved all new Covid vaccines, this means it won’t need to wait for separate CDC approval. It should be rolling out toot sweet.

Releasing your drug all over the place

Knowing that some cells can be stimulated by sound, Swiss bioengineers had an idea — an idea So. Crazy. It. Just. Might. Work. They found a way to create a version of good ol’ E. coli that, when affected by the right level of sound, releases insulin.

(The science: “… vibrations triggered an influx of Ca2+ ions into the cells, which led to insulin release.)

But the fun part is that the E. coli doesn’t need just any sound — it needs some classic rock, specifically “Low-bass pop songs like ‘Billie Jean,’ ‘Hotel California,’ and ‘We Will Rock You’.” And no, you can’t just do a Muzak version; it’s got to be the real deal. (“We Will Rock You” got the best response, in case you’re curious.)

This is all in the lab and very preclinical, but they’re already asking the important question: “whether attending concerts or other music events would inadvertently trigger insulin release even if blood glucose levels are normal.”

Now they want to quit

If you help people with quitting smoking, there’s a new market opening up. In a shock to no one, lots of teenagers who have become addicted to nicotine through vaping want to quit. Per a University of Nebraska study…

[N]early 70% of teens who have been vaping regularly, meaning at least a few times per month, had tried to quit in the past year. Of those, over 60% did not use any resources or support to help with this.

And even fewer (just 4%) asked a healthcare pro for help. There are plenty of programs to help adults quit smoking, but these kids don’t have those options.

CDC backs doxy after sex

Back in April we told you how UCSF researchers found doxycycline could be used as a morning-after pill against STIs. Now that’s gone from the lab to the real world as the CDC has a draft recommendation to prescribe doxy for that very use. Well, sort of. “Doxycycline […] would only be recommended for men who have sex with men and transgender women, according to the proposed guidelines.”

Considering that GP of Buzz has prescribed it to keep on hand in case of tick bites, it seems some folks — no matter their orientation or whatever — might want a conversation with their prescribers regardless of the official recommendations.

J&J talc verdict tossed

Back in July we told you how Johnson & Johnson was suing some of the experts that testified at the talc/asbestos trials, claiming their testimony was false and done for their personal gain.

Well. Seems a New Jersey appeals court agrees that there are possible shenanigans going on, and has tossed out the $223.8 million verdict against the company, ordering a new trial.

[A] three-judge panel of the appeals court found that the trial court failed to fulfill its “gatekeeping role” of assessing whether the plaintiffs’ experts based their testimony on sound science.

In their opinion, the judges found that three experts had not explained the facts or methods they used to support their opinions that the plaintiffs got cancer from being exposed to asbestos in talc products.

Why moms need to vaccinate

Moms-to-be who get a Covid vaccine are protecting their newborns — at least for the first few months.

The CDC crunched the numbers based on last year’s vax data and found that “Maternal vaccination was 54% effective against Covid-19 hospitalization in infants younger than 3 months old.”

Put another way, “Getting vaccinated while pregnant cuts your baby’s risk of severe Covid by more than half.”

How C auris sticks around

Candida auris is an annoying fungus to try to clean out of a hospital room — standard cleaning and disinfection often don’t get rid of it. That’s one reason C. auris leads to so many infections in hospitals, no matter how much they scrub.

But now a breakthrough: Researchers at Michigan Medicine have figured out how C. auris is able to stick to everything. It seems that, along among fungi, it uses an adhesin — the same kind of protein that barnacles and mollusks use to stick to … everything.

Called Scf1, they’ve never seen a protein like it. (“[W]e don’t know where it came from evolutionarily.”) And it’s particularly sticky. To get into the chemistry, “The bonds formed by Scf1, they revealed, are cation-pi bonds, which are among the strongest non-covalent chemical bonds in nature.” Oh, and it’s also responsible for helping C. auris form colonies and cause disease.

Now that Scf1 has a huge target on its back, it’s time to develop some weapons.

Come to the light! (But not the artificial light)

A small Dutch study found a couple of interesting tidbits about type 2 diabetes and sunlight. First, “misalignment” of circadian rhythms can increase the risk of type 2 diabetes, so getting out into the sun can actually help prevent it.

But, they claim, it only works for actual sunlight, not artificial light. After some extensive testing (with a small group of subjects) they found that…

Blood glucose levels were within the normal range (4.4–7.8 mmol/L) for longer during the natural daylight intervention than in the artificial light intervention.

There’s a big oversight, though. The artificial light they used was a constant 300 lux — about as bright as a low- to medium-bright desk lamp. Nor did they mention the color temperature of the light. Was it warm white? Cool white? Daylight? So the actual conclusion is “Being in bright sunlight can help control glucose better than sitting in a poorly-lit office.”

Open enrollment opens soon

Just a reminder that Medicare open enrollment begins October 15 and runs through December 7.

The typical person gets to choose from more than 40 plans — traditional Medicare plus a bunch of private Medicare Advantage options. When it comes to prescriptions, it pays to compare those plans and their coverage — the feds offer a handy plan-comparison tool for that.

Is the hygiene hypothesis wrong?

The OG Hygiene Hypothesis: Exposure to bacteria as an infant can reduce the chance of allergies and other autoimmune issues when you’re older.

Hygiene Hypothesis 2.0: Exposure to certain specific bacteria as an infant can reduce the chance of allergies and other autoimmune issues when you’re older.

And now this: Swedish researchers tested the hypothesis on mice and found that “mice with high infectious exposures from birth have the same, if not an even greater ability to develop allergic immune responses than ‘clean’ laboratory mice.” I.e., life is worse for dirty mice.

We await the next twist.

Needle alternative sucks

This alternative sucks, literally — it uses suction to stick to the inside of the cheek, where it “allows for the painless administration of medications that previously could only be injected.”

The technology, developed by Swiss bioengineers, is designed for people who need meds that can’t be taken by pill but who also don’t like injections.

Patients press the suction cup — which measures around ten millimetres in diameter and six millimetres in height — onto the lining of their cheek with two fingers. This produces a vacuum that stretches the lining, making it more permeable to the drug contained within the cup’s dome-shaped hollow.

It takes a few minutes for the drug, which has been treated with “an endogenous agent that fluidises the cell membranes” to make its way into the bloodstream.

Congrats to Valerie!

GPhA member Valerie NeeSmith, pharmacist at Kroger in Marietta (the fightin’ 479), was named one of SingleCare’s Best of the Best in its annual pharmacy awards list that “honors the exceptional work of pharmacists, pharmacy technicians, and pharmacy teams nationwide.”

[insert fist-bump here]

Hot flashes and Alzheimer’s risk

Hot flashes during menopause or perimenopause are fairly common, but they might — stress on the word “might” — be an indication of Alzheimer’s. University of Pittsburgh researchers found there’s a connection, not necessarily a causation, between the two.

“The study indicates that women who have hot flashes, or vasomotor symptoms, particularly those that occur during sleep, may have a higher risk for Alzheimer’s.”

It’s possible — possible — that having those hot flashes during sleep could indicate an extreme response by the hypothalamus, but how that could translate to (or indicate) the higher risk of Alzheimer’s is unclear. As usual, more studies are needed.

* * *

FDA wants to verify those tests

The FDA is planning to begin regulating laboratory tests for various diseases and conditions; it wants “to treat tests made in laboratories like medical devices.” (CMS currently regulates testing labs but not the validity of the tests themselves. Theranos is the most obvious example of selling an unregulated test.)

There was bi-partisan support in Congress for formally giving the FDA authority to do that — a bill called “VALID” — but … well, Congress. So the FDA is going ahead with its plan until someone tells it to stop.

The lab-testing industry, of course, opposes being regulated, but consumer groups like the idea that people will know the tests they take are accurate.

ICYMI #1: Judge allows drug-price negotiations to continue

A federal judge — one appointed by Donald Trump — refused to block Medicare’s ability to negotiate the prices of 10 high-price drugs. The process will now play out in court, and negotiations will begin.

Drug companies and the US Chamber of Commerce argued that it was unconstitutional to ‘force’ drugmakers to negotiate their prices. But U.S. District Judge Michael Newman pointed out that participation in Medicare is “completely voluntary.”

“As there is no constitutional right (or requirement) to engage in business with the government, the consequences of that participation cannot be considered a constitutional violation,” he wrote.

ICYMI #2

The 2023 Nobel Prize in Physiology or Medicine went to Katalin Karikó and Drew Weissman of the University of Pennsylvania who did the pioneering work^* allowing the development of mRNA vaccines … 15 years before the Covid pandemic.

^* They made it possible to create mRNA in the lab that the immune system didn’t attack, taking the technology from interesting to useful.

Wash behind your ears

When it comes to grandma’s advice, George Washington University researchers believe in “trust but verify.” Specifically, how important is it to wash behind your ears, between your toes, and in your belly button — the washing “hotspots”?

So they tested what they called “the Grandmother Hypothesis.”

There’s a reasonable view out there that washing less frequently preserves your skin microbiome (and we all know now how important our microbiomes are). But it seems grandma was right.

The researchers found that forearms and calves which are often cleaned more thoroughly at bath time had a greater diversity and thus potentially a healthier collection of microbes compared to the samples taken in the hotspots.

Healthy microbes, in this case, can mean less chance of eczema or acne.

Your sort-of medical-ish story of the day:

Up the waterspout

Who needs Viagra when you can use a gel made from the Brazilian wandering spider^*? Sure, if you get bitten by the spider it can kill you, but it seems that while men are dying from a bite — experiencing rapid heartbeat, seizures, and shock — they often experience an erection.

Kudos to the Brazilian scientists who saw that silver lining and decided to try to make a drug out of it. Not try, in fact. They did, and “BZ371A” is already doing well in phase 1 trials.

Preliminary tests demonstrated that the topical application of BZ371A leads to vasodilation and increased local blood flow, facilitating penile erection. This promising result suggests that BZ371A could offer an effective solution to the 30% of patients who cannot use existing oral remedies, such as Viagra and Cialis, due to contraindications like hypertension or severe diabetes.

^* aka the banana spider or wood tree spider, but you don’t care, do you?

Amoxicillin shortage continues

As winter approaches and kids are swimming around those Petri dishes they call classrooms, amoxicillin liquid remains in shortage (although “Amoxicillin capsules and tablets have not been affected by the shortage, according to the FDA.”)

If you’re thinking, “I know a compounding pharmacist who can make a liquid form,” think twice: It’s the basic ingredient, amoxicillin powder, that’s in shortage, so compounders are out of luck.

At least there are alternative antibiotics, but it’s another case of “We need to think about the pipeline.”

Rabies cure on the horizon (?)

Rabies is a horrific disease. By the time you show symptoms, there’s a 100% fatality rate^*. But now there might be a treatment.

Researchers at the federal government’s Uniformed Services University of the Health Sciences found that a monoclonal antibody, created from a close cousin of the rabies virus, “appears to prime the immune system to effectively fight the virus in the brain and spinal cord.”

While the treatment itself can’t pass through the blood-brain barrier, the antibody…

… appears to spur the immune system to create smaller immune cells that can pass through the blood-brain barrier and into the nervous system, where they effectively target and destroy rabies virus.

Even better, a single dose “effectively reversed rabies infection even after it had reached the nervous system.”

Downside: This was only shown in mice. But still….

^* Don’t tell me there was one woman who survived. She was severely brain damaged so it barely counts.

A different twist on Alzheimer’s

The latest ‘it’s not amyloid plaque’ hypothesis about what causes Alzheimer’s comes from Australia, where researchers theorized that “broken connections (synapses) between brain cells may lie behind the condition.”

They discovered a molecular switch that helps regulate cell connections. By flipping it on, they stopped brain connections from breaking down and leading to dementia.

This worked without having to remove any beta-amyloid from the animals’ brains, they add, and the process restored lost memory in the mice, suggesting it may be useful in treating humans with Alzheimer’s memory loss.

Elsewhere: KC walkouts

Pharmacists in the Kansas City area walked out of their jobs at CVS, complaining about understaffing and general bad working conditions.

CVS has already blinked once; Prem Shah, CVS’s chief pharmacy officer, sent a written letter “apologizing for failing to address their concerns sooner and promising a series of measures to alleviate their concerns.” But that wasn’t enough, and the pharmacists plan another walkout — with the support of APhA and the KPhA.

Meanwhile CVS is trying to keep those walkouts from spreading.

Although the focus this week is on Kansas City, [a company spokesman] said, CVS will address staffing and similar concerns “wherever additional help is needed” across the country.

And then there’s this

What is the dumbest TikTok trend you can imagine? Now dial it up to 11. May I present to you … bone smashing. Beat your face with a hammer because that will make the bones grow back stronger and reshape your face.

Have a good weekend, everyone.