DEA delays telemed rule on controlleds

After pushback from, like, the entire world, the Drug Enforcement Administration has said it will continue to follow its pandemic emergency telehealth policies. Translation: People who are getting controlled meds via telehealth prescription can continue to do so without an in-person visit … at least for now.

“We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities while we work to find a way forward to give Americans that access with appropriate safeguards.”

Mix it up for hypertension

As Americans, we love the idea of one pill to cure our ills, but when it comes to hypertension, taking smaller doses of several medications seems to be better than taking one larger dose of a single med. (A low dose means less than half of a standard dose, by the way.)

Researchers from India and Australia found that…

People treated with low-dose drug combinations saw their systolic blood pressure decrease on average by 16 to 28 millimeters of mercury (mm Hg) over 4 to 12 weeks, the analysis showed.

In contrast, systolic blood pressure decreased 12 to 18 mm Hg on average in the group taking one drug or receiving usual care.

That effect continued for at least up to a year, reduced side effects, and saw more people dropping their BP below 140/90.

Join in on the DPH meeting

The next Board of Public Health virtual meeting is comin’ up: Tuesday, May 9, from 1:00 – 3:00 pm via Zoom.

What’s on the agenda:

• 2023 legislative session update
• 2024 Appropriations Act summary
• Bond sale resolution approval

Have your allergy advice ready

Why yes, allergies are getting worse as climate change makes allergy season last longer.

Spring allergy season in the U.S. typically starts in late March and lasts through early June. But in recent years, the spring allergy season has expanded on the front and back end in some places: starting early in late February and lasting into late June.

Longer seasons also mean higher pollen counts — up 21% from 1990 to 2018 nationwide. It’s also making fall and summer pollens mix, as the fall season begins earlier.

HPV vax: One dose’ll do ya

The standard dose of the HPV vaccine is two doses, but a study out of the Kenya Medical Research Institute and Mass General found that a single dose “was highly efficacious in preventing HPV, the virus that causes cervical cancer, in girls and women ages 15 to 20.”

The effect was tested for 36 months and was just about 100% effective.

Women, stress, and Alzheimer’s

Be kind to your girl mice. It seems that stress — i.e., the level of stress hormones in the blood — increases their brains’ levels of amyloid beta, but doesn’t affect the males. And amyloid beta is the protein linked to Alzheimer’s.

That’s a finding out of Washington University School of Medicine, where they found that female (mouse) brains absorb the stress hormone corticotropin, but male brains don’t. And corticotropin “trigger[s] a cascade of events that results in increasing levels of amyloid beta in the brain.”

There are of course other factors that make women more susceptible to Alzheimer’s, but it seems clear, at least to the WU folks, that stress is an important one.

The Long(ish) Read: Pharmacies are upping their games

Specialized drugs used to require specialized pharmacies, but nowadays specialized is becoming more the standard — and pharmacies, big and little, are evolving for the new world. Or, as Forbes put it:

[P]harmacies are preparing for the coming wave of emerging complex drugs derived from biotechnology that treat everything from autoimmune diseases and cancer.

Sure, there are still plenty of bottles to fill, but thanks in part to Covid-19 and how pharmacies stepped up to help, “Today pharmacies handle medications that require injection, infusion by staff that often needs specialized training and licensure.”

Fighting against Parkinson’s

Australian researchers have found that boxing is apparently helpful for relieving symptoms of Parkinson’s disease. The trick — before you take a swing at a patient — is that it’s without an opponent. (Test subjects “did battle against a Fightmaster boxing unit.”)

After the 15-week program, nine of the 10 participants improved their score on the Unified Parkinson’s Disease Rating Scale, a tool used to measure the progression and severity of PD. The group also reported a reduction in fatigue and improvements in sleep.

An Edith Cowan researcher during the study

Short Takes

PBM bill will have to wait

Bad news about the Senate’s PBM bill: Action was postponed by politics. No, that’s not the bad news — the bad news is that the politics were entirely reasonable, no one is really angry, and there’s nothing to argue or finger-point about. The markup part of the bill process has just been shifted until after a hearing with in­sulin makers and PBM ex­ecs.

First RSV vax approved

The FDA has approved Arexvy, GSK’s vaccine to prevent respiratory syncytial virus in people 60 and old — the first RSV vaccination, well, ever. (More are on their way.)

Diet pill or demon?

Back in January we told you about “Ozempic face,” where Ozempic and other GLP-1 agonist users were finding their faces turning gaunt and old.

Now there’s a new side effect: the Ozempic burp. It’s not just burping more often — it’s burping sulfur, like someone who orders black candles by the carton. Experts understand the burping part; gastrointestinal issues aren’t surprising with these drugs. But sulfur?

One theory: “[S]emaglutide boosts the number of bacteria in patients’ digestive tracts that produce hydrogen sulfide, a gas that can be expelled from either end of the digestive tract, and that smells […] like rotten eggs.” Or maybe it’s diet change. Or, in the case of TikTok celebs, maybe it’s simple demonic possession. More research is needed.

One month till convention!

The Georgia Pharmacy Convention is just a month away, so if you haven’t registered yet, get on it! — registration closes May 24!

And remember, if you want to attend the annual PharmPAC reception, you need to have made made at least a 250 dollar contribution to PharmPAC before May 24.)

Register Now!

ADHD kids are still missing out

Kids with ADHD aren’t getting the help they need. Only about 26% of them got any kind of outpatient treatment (found a new study led by Columbia University), and only 12.9% are getting medication. It’s worse for girls — only 7% are getting meds to treat it.

Could it be income? Could some parents be concerned about cost? Nope.

The results showed children with parents who had higher salaries and a higher educational degree were less likely to receive outpatient mental health care compared to those whose parents had lower salaries and a lower educational degree. (Emphasis ours.)

So what’s up widdat? It’s likely that parents (and even teachers) “are unaware of what symptoms to look out for or even how to recognize that their child may have a condition like ADHD.” He’s just rambunctious. She just daydreams.

What’s worse it that this isn’t news, and it might be getting worse. Almost 17 years ago a similar story came out of a study by Washington University. Back then it found “Only about 58 percent of boys and about 45 percent of girls who had a diagnosis of full-scale ADHD got any medication at all.”

Cannabis clears chemo brain fog

One of the side effects of chemotherapy is brain fog — kind of like what patients with long Covid get. And you know what might help with it? Cannabis.

Researchers at the University of Colorado — where, let’s be honest, they aren’t strangers to the herb — worked with patients who took marijuana in the form of their choice. (Federal law won’t allow the researchers to provide the pot, but because it’s legal in Colorado they just let patients purchase it themselves. I know, wonky.)

Sure, the pot gave them a high and eased their pain….

But longer term, a different pattern emerged: After two weeks of sustained use, patients reported improvements in pain, sleep quality, and cognitive function. Some objective measures of cognitive function, including reaction times, also improved.

Because of the way the study was conducted it’s not the highest quality data, but it certainly has an observational pattern worth studying … outside the US, most likely.

Merck was just collateral damage

A Russian cyberattack that hit Merck doesn’t count as a “hostile/warlike action” for insurance purposes a court has ruled — and the company’s insurer must pay up. The logic: Merck is a private company, and the attack was against Ukraine; Merck wasn’t at war.

The insurance companies contended that any state-backed action that “reflects ill will or a desire to harm” falls within the “hostile/warlike action” exclusion. But the judges said they “stretched the meaning of ‘hostile’ to its outer limit.”

Elsewhere: Aussies ban vaping

Yes, you read that headline right: Recreational vaping will soon be banned on an entire continent.

Under the plan, which [Health Minister Mark] Butler said would address the “biggest loophole in Australian healthcare history”, the importation of non-pharmaceutical vaping products will be prohibited, meaning they will only be able to be purchased with a prescription from pharmacies.

And — ka-ching! — the continent is also raising its tobacco tax, which will generate an estimated AUS$3 billion in additional revenue to help fight the plague of drop-bears*.

^* But not emus. They learned their lesson.

Fentanyl oopsie

Pro tip: If you’re going to have a labeling error and have to recall a product, you really don’t want it to be fentanyl.

A labeling problem has forced Teva to recall 13 lots of fentanyl buccal tablets. Safety updates on the product insert were omitted, leaving the possibility of misuse that “could lead to life-threatening adverse events,” the FDA said.

Click here for the recall details, including NDC and lot numbers.

Short Takes

The clouds are not our friends

Those friendly puffs of white harbor a dark secret: They carry bacteria with antibiotic-resistant genes.

“Our study shows that clouds are an important pathway for antibiotic-resistance genes spreading over short and long ranges. Ideally, we would like to locate emission sources resulting from human activities to limit the dispersal of these genes.”

Elsewhere: It’s 7,000 miles away

The WHO says it’s only ‘moderately’ worried that a bio lab in Sudan — one “holding cholera pathogens and other hazardous materials” — has been captured by one of the sides in the country’s civil war.

This glioblastoma treatment sounds both unreal and very satisfying

Brain cancer is hard to treat by just cutting it out, and it can become resistant to drugs. So what’s left? I dunno … how about shredding it from the inside?

A group of Canadian researchers came up with this idea. They took carbon nanotubes and filled them with iron oxide (please don’t call it “rust”). They coated the outside with an antibody that would bind to glioblastoma cells. Then they injected it, and the cancer cells gobbled up the tubes.

Remember the iron filling?

[B]y activating a magnetic field near the cancer cells, the tubes were made to spin, wreaking havoc to the internal structure of the cells — particularly to their mitochondria, which fundamentally provides cellular energy. In effect, the tubes acted like thousands of mini scalpels that sliced up the cancer cells from the inside.

This may be one of the most satisfying ways to kill cancer. As Son of Buzz put it, “It’s like a pipe bomb in the mailbox.” It worked on mice (it always does, doesn’t it?), but needs more fine-tuning before it can be tested on humans.

Poor diet, too much diabetes

There are — per a giant “research model of dietary intake” out of Tufts University — something like 14 million cases of type 2 diabetes across the world were caused by poor diet. And that was in 2018.

But “poor diet” is a bit general. When they drilled down, they found that it’s specific eating habits that are the biggest problem.

Insufficient intake of whole grains, excesses of refined rice and wheat, and the overconsumption of processed meat [had the biggest impact].

In contrast…

Factors such as drinking too much fruit juice and not eating enough non-starchy vegetables, nuts, or seeds, had less of an impact on new cases of the disease.

So switch from white rice to brown, whole wheat is better than white bread, and go easy on meat that’s been salted, cured, fermented, smoked … you know, more than just meat. And then convince your patients to do the same.

Why don’t people take statins?

Sure, you can ask patients why they don’t take their meds, but — to quote House, MD — patients lie. To healthcare pros, at least. But where might they tell the truth? Social media.

That was the premise of Stanford U researchers. So they asked an AI to analyze statin-related posts and comments on Reddit, the big ol’ public collection of message boards. In a shock to absolutely no one, “They found that discussions about statins on the platform are mostly negative and rife with misinformation.”

As one Standforian put it, “[W]e saw a lot of misunderstandings about side effects and unproven alternative treatments to lower cholesterol.”

In general, people were iffy about statins because they thought pharma companies had manipulated clinical trials of the drugs, or that the danger of LDL cholesterol was overblown because they felt better after losing weight using a high-fat, low-carb keto diet.

The research paints a troubling picture of patient sentiments toward potentially life-saving drugs and evidence-based medicine generally.

Small study suggests phages work as a last resort

When antibiotics fail due to resistant bacteria, there’s not a lot left in the toolbox. Bacteriophage therapy is one possibility, though — finding the virus (i.e,. the phage) that matches the problem bacteria. If you can do that, you might have another treatment option.

This isn’t news, and it’s been done. (The US Navy in fact has one of the largest phage libraries in the world.) But there’s not much data on how effective it is.

Now Israeli doctors have at least a small study. Since 2018, they received 159 requests for last-ditch-effort phage therapy — compassionate-use treatments. They were able to find and use a matching phage in only 18 cases, though. We told you it was a small study. That said…

Of the 18 patients who received intravenous phage therapy, 14 (78%) achieved clinical remission, and 4 (22%) were classified as treatment failure. No major side effects were reported.

There is no official protocol for phage treatment, and matching phages to bacteria is hit-or-miss, so for the moment this kind of data ‘drip’ is the best we can hope for.

60-second schizophrenia test

What if you could diagnose schizophrenia in less than a minute simply by having a patient stare at a fixed object? That’s what Chinese scientists say they can do, using high-speed camera and a bit of artificial intelligence.

The gist: They measure saccades — tiny eye movements — while a patient stares at a target for about 60 seconds.

They found that patients with schizophrenia exhibited significantly more vertical saccades and a greater vertical deviation of horizontal saccades.

It got even more detailed: The longer a horizontal saccade lasted, the lower the patient’s cognitive performance, and the more it deviated vertically the more severe were the symptoms.

How accurate were these measurements? Fed the saccade data, the AI’s diagnosis was correct 85% of the time. Whoa.

Short Takes

Electric bedside manner

When patients have questions about their health conditions, responses from an AI were rated (by healthcare pros) to be better than those of a human physician 79% of the time. Not only did the AI respond “with nuanced and accurate information that often addressed more aspects of the patient’s questions than physician responses,” but…

ChatGPT responses were rated significantly higher in quality than physician responses: good or very good quality responses were 3.6 times higher for ChatGPT than physicians. The responses were also more empathic: empathetic or very empathetic responses were 9.8 times higher for ChatGPT than for physicians.

Sleep, dementia, and dogs

Dogs who have dementia suffer from the same kind of sleep disturbances as humans. And when they do sleep, it’s not really sleeping: “[W]e saw their brain activity during sleep was more akin to wakefulness.” (As we mentioned in a Short Take a week or so ago, there’s a vicious cycle for sleep disturbance and symptoms of dementia.)

Side note: Play with AI yourself

You can create a free account and play with ChatGPT, the OG of artificial intelligence, at chat.openai.com.

Want it to write something for you? Give it detail: “Compose a letter to XYZ Corporation asking for more data about their ZYX medication, specifically how it affects older patients with cognitive decline” or something similar. The result won’t be perfect, but it will probably give you a good start.

You can also ask it to analyze text. Paste in a paper and write, “Summarize this text in 150 words or fewer.” Just for fun, we pasted in a couple of Buzz items and asked it to “Describe the writing style and quality of this blog post.”

The writing style in this blog post can be described as informative, concise, and conversational. The author presents various medical findings and breakthroughs in a straightforward manner, using simple language and short paragraphs to keep the reader engaged. The author also injects some humor and personality into the post, as seen in the parenthetical comments and witty titles for each section. Overall, the style is easy to read and understand, while still conveying important and interesting information about medical research.

Not as resistant as you think

Old antibiotics might be the answer to superbugs. UC Santa Barbara scientists decided to ignore what standard tests show and actually simulate the conditions in the body. Result: About 15% of the time, the standard test was wrong, and an old antibiotic would work against a resistant bacteria.

“People are not Petri plates — that is why antibiotics fail. Testing under conditions that mimic the body improves the accuracy by which lab tests predict drug potency.”

Now it’s time to reevaluate already-approved drugs for conditions like sepsis — no time-consuming human trials needed.

A carrot for antibiotics

A metaphorical carrot, that is. The problem with new antibiotics is that pharma companies don’t want to make them. They simply aren’t profitable, and it takes a lot of work to bring one to market. That’s why there are lots of stories about breakthroughs, but not a lot of new drugs.

So for the third time, a bill with bipartisan support is coming to the table (also metaphorical). The Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act would essentially guarantee pharma companies a market while also guaranteeing citizens the meds if they need them.

Under the model, companies that develop innovative new antibiotics for drug-resistant infections would receive contracts from the federal government valued between $750 million and $3 billion to make the antibiotics available at no charge for patients covered by federal health insurance programs.

Bonus: One of the bill’s co-sponsors is Georgia’s Drew Ferguson.

New Covid variant causes pink eye

It’s nicknamed Arcturus and it causes (among other issues) pink eye and fever, especially among children.

As of the week of April 22, the CDC reports Arcturus makes up 9.6% of all U.S. cases, the second most prevalent subvariant behind XBB.1.5., which makes up 73.6% of cases.

It seems to be a little more virulent than earlier Omicron XBB strains, but no more deadly. As long as you’re vaccinated it shouldn’t be an issue. That said, the CDC recommends that kids who develop itchy, red eyes get a Covid test, just in case it’s not an allergy.

Smoking rates keep dropping

Cigarette use in the US was down to about 11% in 2022 (down from 12.5% the year before), continuing a decline that’s been going on since the ’60s when it was about 42%.

Don’t you worry, though — people are still getting addicted to nicotine. E-cigarette use is continuing to rise, with about 6% of adults and 14% of high school students admitting to vaping.

Diabetes surgery?

It’s possible a simple outpatient not-quite-surgery could allow type 2 diabetics to stop taking insulin. An early-stage study by Dutch researchers zapped the duodenum in the patients (it takes about an hour) and then had them only take a maintenance dose of semaglutide after that.

The study was small, but 12 of the 14 patients who got the treatment kept their blood sugar under control for at least a year sans insulin.

Twist: They’re not exactly sure why it works. Hypothesis: “[C]hronic exposure to a high-sugar, high caloric diet results in a yet unknown change to this portion of the small intestine, making the body resistant to its own insulin.” The procedure reverses this so the body is no longer insulin-resistant.

Next up: A larger, double-blind randomized controlled trial.

Coming soon to a TikTok video near you

Could inhaling ethanol prevent respiratory diseases like you-know-what? Maybe, say Japanese scientists, who tested a low-concentration dose of ethanol vapor. On mice. Against the flu.

Using a humidifier to produce ethanol vapor in a small container, they found that when mice infected with influenza A inhale the vapor for ten minutes, the virus is inactivated.

The trick was to find a concentration that was high enough to affect the lung’s protective fluid layer without being too high that it killed the lung cells. That’s easy to get wrong, and “may lead to serious side-effects or explosion risks.”

Short Takes

+13

Pfizer’s pneumococcal Prevnar 13 vaccine has been upgraded Prevnar 20, and was just approved by the FDA. It’ll soon be available to children from 6 weeks to 17 years old.

Maybe skip the fries

A study of more than 140,000 people found that “regular consumption of fried foods carries a 12% and 7% higher risk of anxiety and depression, respectively.”

The likely culprit: acrylamide, a contaminant in fried foods that can “trigger neuroinflammation and lipid metabolism disturbance.”

Blood thinners sans bleeding

One of the downsides to blood thinners is that they can cause internal bleeding. But now an unholy alliance of American and Canadian researchers say they’ve found a compound that splits the difference, preventing blood clots but not causing internal bleeding.

Their trick: “[T]argeting a specific molecule^* involved in clot formation without disrupting the natural clotting process.” Of course it’s still in the lab, but clinical trials could be on the horizon. As always, though, “further research will be needed.”

^* polyphosphate, if you’re interested

A better weapon against pancreatic cancer

One of the reasons pancreatic cancer is listed among the worst is that immunotherapy often doesn’t work for it. There’s some good news, though, out of the University of Colorado, where cancer specialists have developed a new type of antibody treatment — one that “was able to boost the number of immune cells capable of fighting cancerous ones.”

Combined with radiation, it worked well against not only the main tumor site, but also in locations where it has metastasized. Downside: It’s only been tested in animals.

Still, the lead researcher was happy:

“I’ve never been more hopeful about the possibility of improving the survival rate for this disease. In just one radiation session, we saw a remarkable immune response that could change how we treat pancreatic cancer patients.”

New pill beats the, um, other way

Fecal transfusions can be (and are) used to treat C. diff infections, but there’s a certain stigma and, dare we say, discomfort involved. There’s good news, though: Seres Therapeutics has received FDA approval for the first orally administered drug that accomplishes the same reboot of the gut biome. “[B]ased on bacterial spores purified from human stool […] The therapy will be marketed under the brand name Vowst.”

In a pivotal Phase III study, taking a course of a dozen capsules over three days helped 88% of patients clear infections and prevent recurrences at eight weeks, compared with 60% of patients who got a placebo.

It’s expected to be available by June.

Side note

A new review out of the University of Minnesota “found that stool transplantation is significantly more effective at resolving recurrent Clostridioides difficile infection than antibiotics.”

One of the reasons that [fecal microbiota transplantation] is increasingly seen as a preferred option for rCDI [recurrent C. diff infection] is because antibiotics […] can wipe out both the good and bad bacteria in the gut microbiome, creating an imbalance that enables C difficile to flourish and attack the colon. As a result, repeated antibiotic treatments for rCDI can lead to more recurrences.

Tau blocker for Alzheimer’s

Alzheimer’s work continues around the world, with breakthroughs taking different angles against the disease. The new one: British scientists have found a way to block the formation of tau proteins by silencing a gene that codes for it.

They’ve tested this on humans and it’s worked … to cut down on the protein formation. No other treatment targets tau, so this could be an important step, or just another small breakthrough. As with all things Alzheimer’s, there’s a lot of missing info. To quote: “Further trials will be needed in larger groups of patients to determine whether this leads to clinical benefit.”

Leqembi follies

FDA: This July, we’re probably going to give full approval to the Alzheimer’s drug Leqembi.

CMS: Okey doke. If you do, we’ll cover it.

Alzheimer’s patients: That sounds grea—

CMS: … as long as doctors put the patient information in a registry run by private corporations.

Congress and patients: Wait, what? What registries?

CMS: Privately owned registries.

Congress: But whose — who is setting them up?

CMS: “All that we are indicating is that individuals who are taking the drug, their doctors will put that information in a privately owned registry.”^*

Congress and patients: But … what? Where are these registries?

CMS: “Private sector entities right now can start setting them up.”^*

Congress and patients: (makes angry blubbering sound)

CMS: Our goal is for the registries to be running by July 6.

Congress: But you just said you’re leaving it to private industry. So how do you know? And how will doctors know what to do‽ How will patients‽

CMS: (hums quietly to itself)

^* Actual quote

Prostate cancer is getting worse … or is it?

“A Disturbing Rise in Prostate Cancer” is the headline, but the details are a bit murkier. It seems that yes, prostate cancer rates are rising, as are diagnoses of advanced forms. But the big takeaway seems to be that a lot of it is a result of changing (and confusing) guidelines for PSA testing. More testing, more cases. Less testing, fewer cases but more of them are later stage.

So what’s it all mean? We need clearer guidelines and better tests — and more determining who’s at higher risk.

Short Takes

Vampires in danger

Garlic can somehow affect the gut biome to reduce the risk of colorectal cancer. How it does that is still up in the air; the Italian researchers who did the study say only, “The study adds data on the protective effect of dietary garlic on [colorectal cancer] risk” and they believe it’s via the microbiome.

Don’t get bitten by a black widow

Black widow spider antivenom is one of the 20 critical drugs that have been in shortage, on and off, for at least 8 years. There’s only one manufacturer — Merck — and it’s had trouble meeting demand.

How to handle a rude patient

The three words to say when someone is rude to you: “Are you okay?” That from a “Harvard-trained etiquette expert.”

“I’m not being offensive back,” she says. “I’m coming from a place of care and that is usually to put the other person in check.”

Let me print that vaccine for you

Instead of transporting vaccines to a region that needs them right now, why not take advantage of 21st century technology and print them on site?

That’s what MIT engineers have come up with: a mobile vaccine printer, not much larger than an office printer, that could produce hundreds of vaccine doses every day.

The printer produces patches with hundreds of microneedles containing vaccine. The patch can be attached to the skin, allowing the vaccine to dissolve without the need for a traditional injection. Once printed, the vaccine patches can be stored for months at room temperature.

Microneedle patches aren’t new, and neither are 3D printers. The trick was creating a shelf-stable “ink” that contains the vaccine while also being sure to include the word “nano” in the description. In this case, they were able to use lipid nanoparticles to not only contain the bits of mRNA, but that also keep them stable for long periods of time at room temperature (or even higher).

The GPhA annual member survey is still waiting for you

Please don’t forget to give us a few minutes of your time so we can serve you better. Most importantly, we need to know how you practice and what you like and don’t like about what GPhA is doing.

It’s all in GPhA’s annual member survey and waiting for your input!

Trust me on this: Your answers are read and talked about, and they really do make a difference in GPhA’s priorities over the next year.

• If you like GPhA Buzz, click here to take the survey.
• If you don’t like GPhA Buzz, please click here.

Anti-PBM alliance solidifies

Senators Bernie Sanders and Bill Cassidy, representing both side of the aisle in the Senate Committee on Health, Education, Labor, and Pensions, have reached an agreement for a package of bills that would…

… increase transparency for plans to use PBMs as well as impose transparency measures on PBMs, as well as ban spread pricing and mandate that PBMs pass 100% of the rebates collected from drug makers to the health plans.

And if the story has “as well as” twice, you know it’s a comprehensive package.

It’s not the only one; it follows on the heels of a separate plan out of the Senate Finance Committee has some of the same goals: increasing transparency and eliminating practices that increase drug prices. And the House has its own bills in process to rein in PBMs by, among other measures, eliminating spread pricing. Stay tuned.

More reasons to take Vitamin D

…if you’re pregnant

Low vitamin D levels during early pregnancy could result in obese boys, according to a study out of Spain.

…if you have allergic asthma

Being deficient in vitamin D could make asthma symptoms worse, found German researchers.

[C]hildren and adults who took vitamin D3 supplements had less pronounced asthma symptoms and presented with less severe asthma, at the same time as requiring fewer steroids for inhalation.

They “still do not fully understand how exactly this vitamin influences the cellular inflammatory reaction in the body,” but clues point to a protein called blimp-1, which can affect the response of some T cells.

I went to the immune cell to hide my face,
but the mAbtyrins called out, “No hiding place”

Some S. aureus bacteria is smarter than others, and when antibiotics come calling the smart ones drill into, hide inside, and eventually burst out of immune cells when the coast is clear. They become resistant to treatment: They’re MRSA.

But now NYU biotech researchers have developed a weapon — a new molecule called mAbtyrins — that combines a human monoclonal antibody (to mark the S. aureus for death) and proteins called centyrins that prevent the smart bacteria from doing their hiding trick.

By taking away one of the weapons the S. aureus uses to survive, it allows the immune system to take care of business while preventing the formation of resistant strains.

Dog eye therapy can help humans

The same gene that can cause one eye disease in dogs can cause a related condition in humans — one that leads to blindness. But now Michigan State veterinary researchers have developed a treatment for dogs that treats the gene (cyclic nucleotide-gated channel beta 1, or CNGB1). Ergo:

Because the gene therapy works in dogs with progressive retinal atrophy due to CNGB1 gene mutations, and because humans develop retinitis pigmentosa due to CNGB1 gene mutations, the therapy is now ready to be developed to help people with CNGB1-retinitis pigmentosa. (Emphasis ours.)

“Stupid is as stupid does” —F. Gump

1) No, despite what anti-vaxxers say, no one is putting Covid vaccines in the food supply. I mean, really?

1a) As a UGA prof points out, it couldn’t even work.

2) If you get your medical news from TikTok, you’re an imbecile^*.

3) Someone should buy AP reporter Angelo Fichera a drink for taking the time to talk to experts to debunk a conspiracy theory that stupid.

^* This statement does not necessarily reflect the opinion of the Georgia Pharmacy Association, its staff, or its members.

Short Takes

Sometimes drugs aren’t the answer

Sure, Ozempic and other GLP-1 agonists are getting all the hype for weight loss, but, as the Atlantic points out, they’re a lot more expensive and not always successful as bariatric surgery.

Out of pocket, surgery costs $15,000 to $25,000—not cheap, but still cheaper than shelling out more than $1,000 a month indefinitely.

Weird science story of the week

Walking a dog on a leash is more dangerous than you might think. Sure (found Johns Hopkins University researchers) broken fingers were the most common injury, but sitting in second place is traumatic head injury. Shoulder sprain or strain was #3.

But for anyone age 65 and older, traumatic head injury was the most common injury. Oh, and “Notably, women with injuries related to dog walking were 50% more likely than men to sustain a fracture.”

Captain Obvious patiently awaits the McRib

“Junk food ads trigger positive emotions, healthy foods not so much”

That might be more than itchy skin

If you’ve got someone who starts coming in for calamine lotion, hydrocortisone, Benadryl cream, and all that other skin care stuff, you might want to ask if they’re dealing with skin lesions or psoriasis they haven’t had before.

It seems that skin lesions — especially if they’re painful or accompanied by other symptoms (e.g., fever, sensitivity to light, joint swelling) — might be a sign of a more serious rheumatic disease.

“If the lesions progressively get worse, patients should try to get in to see their doctor sooner for an evaluation.”

As to how you can have that ‘Are your skin lesions getting worse’ conversation … that’s on you. Good luck.

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Do you like craft beer and a chance to network and share stories? Of course you do! So come have a beer or soda (or even water) with us^* at Monday Night Brewing! Mark your calendars for Thursday, June 1, from 4:00–7:00 pm. Click here for the details and to sign up, and don’t miss out on a night of fun! (If you feel guilty, tell yourself it’s good for your career. It is.)

^* “Us” being the Academy of Employee Pharmacists, their friends and relations — including students!

With pain relief, topical is … topical

Standard NSAID pain relievers are still wildly popular, but there’s a trend emerging: Consumers are moving toward topical pain relief, according to a pair of recent market-research reports. (Scroll down to the subhed “A topical push”.)

[G]rowth drivers for topical pain-relief solutions include fewer adverse effects than those of traditional oral medications, rising demand among athletes, an increasing number of elderly people and the prevalence of arthritis.

Or, as one exec at a topical-analgesic maker put it, “Customers have pill fatigue. They don’t want to take multiple pills that can damage their liver and will conflict with other treatment options they are doing.”

Here’s a twist: The biggest topical segment isn’t creams or lotions — it’s patches. No mess. (Roll-on treatments are also getting popular.)

Naloxone news: Who can pay?

One of the issues with naloxone going over-the-counter was that now people will have to pay out-of-pocket for it — and that might put it out of reach of a lot of the folks who need it.

The good news (sort of) is that Narcan maker Emergent says “it is aiming for an out-of-pocket price of less than $50 for its nasal spray product.” (Currently its official wholesale price is $125 for a kit with two 4-milligram doses.)

The bad news is that $50 is still unaffordable for a lot of people, and with fentanyl lacing so many drugs, 8mg might not be enough to save someone’s life.

Emergent’s response? Find someone to pay for it.

Emergent emphasized the importance of continued federal funding for substance abuse treatment and prevention programs, including opioid response initiatives that distribute Narcan, and for private insurers, Medicare and Medicaid to consider their coverage of the medication.

Glioblastoma breakthrough

Good news if you have mice with glioblastoma. A new gel — yes, a gel — developed at Johns Hopkins cured 100% of mice with the brain cancer.

No, it’s not as simple as rubbing the stuff on their heads. It’s used after surgery removes the tumor to get rid of any remaining cancer cells that are hidden way.

The Hopkinsians combined an anticancer drug­­­ (paclitaxel) and an antibody (called aCD47) into a gel that can “fill the tiny grooves left after a brain tumor is surgically removed” and slowly release the medication.

The gel can reach areas that surgery might miss and current drugs struggle to reach to kill lingering cancer cells and suppress tumor growth.

Next up is finding a path to clinical trials on humans.

Short takes

That stable mate

Let’s say you just got out of a relationship and you’re hoping to find someone a little more … stable, but also in healthcare (so you have something in common). Based on a Swedish study, you might want to think about an obstetrician or gynecologist.

ADHD can break you

Kids with ADHD are 18% more likely to suffer from fractures than kids without, found Israeli researchers, possibly from chasing squirrels. Once they start treatment, though, the risk goes down.

Oh, that money!

Oopsie — the National Academies of Sciences, Engineering and Medicine, which is supposed to be about as open and unbiased as the best of ’em — turns out to have received $19 million from the Sackler family (you know, the Purdue Pharma folks) while it was giving policy advice on the opioid epidemic.

Being given money is one thing, but failing to, you know, mention this fact while making recommendations … that’s a problem.

One pain researcher summed it up nicely:

“It sounds like insanity to take money from principals of drug companies and then do reports related to opioids. I am really shocked.”

Express Scripts offers “opportunities”

Express Scripts says it’s going to start offering rural independent pharmacies … well, not necessarily higher reimbursement rates, but “increased reimbursement opportunities.” It will apply to independent pharmacies ‘that are the only location within 10 or more miles of an Express Scripts customer.’

So what are these opportunities for better reimbursement?

This includes enhancing performance- and incentive-based programs that pay pharmacies more when they drive better outcomes, such as prescribing 90-day supplies of prescription drugs that improve adherence.

The PBM also says it wants to help independent pharmacies offer more preventative services, from vaccines to testing to substance-abuse counseling.

And the biggest news: It’s forming a committee to think of yet more ideas to help indy pharmacies.

A faster skin patch

MIT researchers are all excited about an electronic patch that can deliver drugs through the skin. Why yes, they even call it “game-changing.” It uses battery-powered ultrasonic technology to deliver drugs as opposed to the microneedles in existing patches.

What’s different? Well, it can deliver drugs to different depths in the skin, and in theory it can deliver large molecules because it uses sound to open pathways through the skin. And it works faster than microneedles: “The researchers found that their patch was able to deliver the same amount of niacinamide in 30 minutes that could be delivered with microneedles over a six-hour period.”

You can hardly notice it.

Help them deprescribe

People over 50 are open — quite open — to cutting down on their prescription meds. They just want someone to tell them it’s okay.

A new poll out of the University of Michigan found that 80% of older adults would be willing to stop taking one or more prescription meds if their health care provider said it was possible.

What do they want to stop, if they can? Hypertension or cholesterol meds top the list, followed by diabetes meds and pain management. But they need someone to talk to them about their meds, their conditions, and their options. Any ideas?

Sometimes ignorance is bliss

There’s a big downside to taking a genetic test (an APOE4 test) for Alzheimer’s risk — it might turn out you’ve got those risky genes.

Yes, there are more options for earlier treatment now, but just because they exist in news articles doesn’t mean practitioners are aware of them or how to help you take advantage.

[F]ew support services are available to help people deal with the implications of APOE4 testing, according to interviews with more than a dozen neurologists and genetic counselors. Alzheimer’s patients and caregivers face a shortage of genetic counselors to explain the tests and help them navigate the psychological, medical, financial and legal consequences.

Before you send in the swab, think about what you’ll do if you don’t get the result you’re hoping for.

Short takes

Bless you, prebiotics

What can we add to the list of “conditions caused by an imbalance in the gut biome”? How about hay fever?

[R]educed diversity of gut bacteria can lead to an increased risk of hay fever makes sense since the gut microbiome plays a key role in regulating the immune system, and we know the immune system influences allergies.

Is your future cashless?

More and more places are going cashless — accepting only credit and debit cards to avoid the hassle of bank visits and security worries. Part of the solution: “Reverse ATMs” that turn customers’ cash into credit cards.

A smell test for depression

A test to evaluate someone’s sense of smell might also indicate whether they’ve got depression.

Indian researchers, presenting at the American Physiological Society meeting, found that people who did poorly identifying smells (via the standard sniff tool called the Brief Smell Identification Test or BSIT) were more likely to have been diagnosed with depression.

In fact, “All the members of the depression group identified fewer smells than the control group.” The test has 12 scents; identifying fewer than 9 is abnormal; people with “recurrent depressive episodes” averaged 5.2 scents.

Our number 2 story: counterattacking Montezuma’s Revenge

Boston University researchers have made an important step to controlling traveller’s diarrhea without using antibiotics that can mess with the good gut bacteria. They’ve figured out how the troublesome E. coli. bacteria attaches itself in the gut.

The bacteria, it seems, “use long, thin filaments called ‘pili’ to bind to cells in the gut, allowing an infection to start.” In fact, they found, the pili will change depending on the environment. This is important because finding a way to keep the bacteria from attaching would be better than killing them.

“Therapeutics that disrupt pili and allow bacteria to be washed away have advantages over current antibiotics, as physical removal would not lead to the evolution of resistant strains and only the pathogens would be targeted.”

Don’t miss the GPhA annual survey!

Who are you? What’s your practice area?

What do you like about what GPhA is doing, and what do you wish would change?

Now’s the time to let us know. GPhA’s annual member survey is online and waiting for your input!

Trust me on this: Your answers are read and discussed across the association, and they really do make a difference in GPhA’s priorities over the next year.

• If you like GPhA Buzz, click here to take the survey.
• If you don’t like GPhA Buzz, please click here.

One Senate, two insulin-price proposals

There are now two bipartisan proposals in the Senate for lowering insulin prices (“and for other purposes”).

The existing one comes from Georgia’s own Sen. Raphael Warnock (and John Kennedy of Louisiana), and it “would ensure maximum costs of $35 per month for all insulin products, and would also lower costs for uninsured patients.”

The new proposal, though, takes into account that pharma companies have already said they’ll lower insulin prices, and it takes that a bit further:

[It] would cap insured patients’ insulin costs at $35 per month for at least one insulin of each type and dosage form, and require pharmacy benefit managers to pass through rebates they collect from insulin manufacturers to the insurance plans that employ them.

It would also make it faster and easier for the FDA to consider biosimilars and for Medicare plans to get them into the hands of patients.

The good news is that the proposals are similar enough that it seems they could be merged, and they both have blue and red support. For now, at least.

Speaking of insulin prices…

When drug companies suddenly lowered some of their insulin prices earlier this year, the conventional wisdom was that they did it because they knew they’d have to, with new regs coming down the pike. Might as well make it sound like it was their own idea.

But the reality, it seems was more complicated, as a new analysis in the New England Journal of Medicine explains. We don’t have access to the journal itself, but the folks at Fierce Pharma have done a great write-up of how “The price cuts can be explained by a mix of factors.”

In case you’re curious, here’s some supplement-use data

A CDC study — part of the National Health Statistics Reports — gives some detail about who’s using dietary supplements these days. The basics:

• 35% of children and adolescents and 59% of adults used at least one supplement in the past 30 days (from 2017 to 2020, which the survey covered).
• Multivitamin use: 24% of kids and 32% of adults
• Vitamin D use: 3% of kids and 19% of adults
• Use of multiple supplements increased with age.
• Except for little kids, use was higher among females than males.
• Supplement use increased with income and education.

For all the detailed details, check out the paper itself (14-page PDF).

It seems cranberries work after all

Apparently it’s not a myth — according to Aussie epidemiologists, cranberry juice really can prevent urinary tract infections. They did a meta-analysis of existing research, so Big Cranberry probably^* wasn’t involved.

Now, they say, there are 50 studies on the effects of cranberry products on recurring UTIs, and they point the same way:

These data support the use of cranberry products to reduce the risk of symptomatic, culture‐verified UTIs in women with recurrent UTIs, in children, and in people susceptible to UTIs following interventions.

Caveats: 1) They didn’t test whether cranberries were better than antibiotics or probiotics for prevention, and 2) “The data also doesn’t show any benefit for elderly people, pregnant women or in people with bladder emptying problems.”

^* The paper doesn’t list the source of funding, but that may not really matter for this kind of analysis.

The Long Read: xylazine balancing act

The latest drug to Plague America’s Streets is (in case you missed it), xylazine — the common animal tranquilizer that’s being used to cut heroin … and ends up killing users.

The problem: As we learned from the knee-jerk reactions to the opioid crisis, knee-jerk reactions cause as many problems as they solve. As the government ponders xylazine limitations, legit users, i.e., veterinarians, are legit concerned:

[A]ddressing the threat is proving to be a tricky balancing act involving stakeholders in areas as disparate as addiction medicine, commercial livestock and law enforcement. The challenge is to walk a careful line by managing a drug that is essential for veterinarians but is fueling a public health crisis.

Insurers heart specialty pharmacy

Hospitals and physicians’ offices jack up the prices of medications far beyond what they would cost at specialty pharmacies. That’s according to new data from America’s Health Insurance Plans.

“See what insurance companies say” is often good advice. They tend to ignore politics and focus strictly on their bottom line, for better or worse. So when they point fingers at what’s costing them money, it’s worth listening.

In this case, their data found that, of the 10 highest-cost drugs, physician offices marked up prices by $1,559 and hospitals marked them up by $8,278.

“Specialty pharmacies lower a patient’s health care costs by preventing hospitals and physicians from charging exorbitant fees to buy and store specialty medicines themselves,” the study explained. “Secure, direct delivery is more efficient and effective and reduces health care costs.”

Click here for the AHIP’s report (2-page PDF).

Congrats to Smita (and UGA)!

Congrats to UGA postdoctoral researcher Smita Rawal, winner of a Best Poster Award at APhA’s Annual Meeting in Phoenix! She was among the UGA College of Pharmacy’s faculty and students presenting posters and serving as delegates to the Academy of Student Pharmacists at the meeting. W00t!

(Another) potential insulin capsule

Another team — this one out of Australia — says it’s cracked the problem of oral insulin.

That problem: Proteins like insulin (and monoclonal antibodies) tend to get destroyed by the digestive system, hence the need to inject them

The Aussies’ solution is pretty simple: “a special coating designed to not breakdown in the low pH environment of the stomach, before the higher pH levels in the small intestine trigger the capsule to dissolve.”

But not to miss out on using nano in their work, the insulin itself is encased in “a fatty nanomaterial within the capsule.”

Result: It works well for slow-acting insulin, but only so-so for the fast-acting stuff. Their next step is to try tweaking the capsule to release the dose on a particular schedule.

Gamers would call this “sus”

Four of the FDA officials involved in the controversial approval of Biogen’s Alzheimer’s drug Aduhelm were being … well, we won’t say investigated, so how about looked into? They were being looked into for their overly close ties with the company.

And, not being suspicious at all, all four have now left the agency — three to work for drugmakers. (The fourth’s landing spot isn’t yet known.)

This isn’t to say they’ve done anything wrong, but … seriously guys.

Should the FDA study opioids?

Why would people complain if the FDA wants to study how effective opioids are for chronic pain?

Proponents of the study say it will prove that opioids don’t work well for the long term and thus shouldn’t be prescribed that way.

But people opposed to the study say we already know that opioids do work long term so the study is “an awful lot of work for a very predictable answer” that will play into the hands of pharmaceutical companies.

Did you follow that? One side is certain that opioids don’t work long-term (and wants the study to prove it), and the other is certain that they do work (and doesn’t want the study to prove it).

And then, just to add to the mess, there are people who say that the study itself might get people addicted. Get your popcorn.

Money for nothin’

Congress to NIH: Here’s $1 billion. That’s a thousand million dollars. Investigate long Covid and help develop treatments.

NIH: (hums quietly to itself)

Congress, later: So, whatcha got for us?

NIH: Well, we did some “broader, observational research.”

Congress: Got any patents? Started any patient studies?

NIH: (rubs neck, looks embarrassed)

Patients: [expletives deleted]

The Long Read: Long Covid Remains edition

First the idea of long Covid was just ignored or denied entirely. Now, says Ed Yong*, it “has morphed into a subtler dismissal.”

Yet long COVID is a substantial and ongoing crisis—one that affects millions of people. However inconvenient that fact might be to the current “mission accomplished” rhetoric, the accumulated evidence, alongside the experience of long haulers, makes it clear that the coronavirus is still exacting a heavy societal toll.

^* He won the Pulitzer Prize for his coverage of the pandemic.

Short Takes

Can Rite-Aid survive?

The chain lost $241 million the past quarter — even on revenues of $6.1 billion. Non-Covid scripts are up, but Covid vaccines and testing are down, as is business for its Elixir PBM.

Sleep aid for Alzheimer’s

A small study out of Washington University in St. Louis suggests that taking suvorexant (or other sleep aids — but suvorexant is what they used) can help break the cycle of ‘brain changes – sleeplessness – brain changes’ that Alzheimer’s patients can experience.

No, it’s not a treatment, but it’s at least a bit of small arms in the arsenal if further studies pan out.