More proof the End Times are here

Laugh? Cry? Bang your head against the wall? Your call: There is a nationwide laxative shortage that’s even affecting hospitals because (deep breath) TikTok ‘influencers’ are pushing laxatives as a ‘budget Ozempic’.

(Wife of Buzz: “Next up: Strong surge in the bidet market.”)

[ I considered putting an image here, but honestly there’s nothing that would be in remotely good taste. ]

Well that didn’t take long

The very day the FDA concluded that phenylephrine is ineffective as a decongestant, a lawsuit was filed against Johnson & Johnson and Procter & Gamble saying they should have known their products didn’t really clear stuffy noses.

The plaintiff, Steve Audelo, said he bought Johnson & Johnson’s Sudafed PE and Benadryl Allergy Plus Congestion, and Procter & Gamble’s Vicks NyQuil, based on the companies’ “false and deceptive” claims that the products worked. […] He is seeking at least $5 million in damages for people who bought the products in the United States in the last five years.

(Before it requires phenylephrine products to be pulled, the FDA is asking the public whether it still wants to be able to buy ineffective decongestants.)

Georgia’s health emergency

In case you’re not aware, HHS has declared a public health emergency in Georgia in the aftermath of Hurricane Idalia. This “gives the Centers for Medicare & Medicaid Services’ (CMS) health care providers and suppliers greater flexibility in meeting emergency health needs of Medicare and Medicaid beneficiaries.”

The gist: Penalties are suspended for not following certain HIPAA privacy regulations but “only with respect to hospitals in the designated geographic area that have hospital disaster protocols in operation during the time the waiver is in effect.”

The PHE also means deadlines for some of the “required activities” are waived in case hurricane damage makes it hard to send in certain forms and such.

If you’re affected, do not use those previous two paragraphs as a guide. The details that you need are here, courtesy of HHS.

AIP meets and greets

l to r: Marquess, Sherrer, Hamrick

GPhA’s AIP does a lot of good for its members, but it can do even more when it partners with organizations like CPESN. That’s why AIP VP Jonathan Marquess met with pharmacist and CPESN director Jonathan Hamrick, PharmD to discuss ways they could work together to help AIP members. (As a bonus, Marquess also got a chance to meet face-to-face with GPhA board member Thomas Sherrer.)

Night owls in danger

The Brigham and Women’s Hospital headline says it all: “‘Night Owls’ More Likely Than ‘Early Birds’ to Develop Diabetes.” Well, night women; the study is based on data from almost 64,000 women over the course of 8 years.

Regardless, it’s sad. Normal people (that is, those who don’t enjoy getting up at the crack of dawn^*) have — get this — “a 19 percent increased risk of diabetes after accounting for lifestyle factors.”

Among those in the study with the healthiest lifestyles, only 6 percent had evening chronotypes. Among those with the unhealthiest lifestyles, 25 percent were evening chronotypes.

* Kidding! Kidding! 

A different antidepressant mechanism

Antidepressants may not only affect how serotonin or norepinephrine is absorbed, but could even reduce a patient’s negative memories. Or, as the Rice University psychology researchers put it, the drugs “shift memory dynamics toward healthy function.”

In (very) rough strokes the idea is that antidepressants might keep the brain from retaining more detail about negative memories than about positive ones (‘enhanced discrimination of negative stimuli’) —which is apparently something a misbehaving brain can do.

Why don’t diabetics’ wounds heal?

It’s common knowledge that having diabetes also means some wounds take longer to heal, but only now has the mechanism been uncovered. Thank you, University of Pittsburgh scientists.

The Buzz Rule: In 95% of cases, the problem is either inflammation or gut bacteria. In this case it’s inflammation.

Normally a wound has some inflammation as macrophages do their healing bit. Eventually, though, the cells involved send a signal via exosomes: ‘Okay, you can chill now’ and the macrophages stand down. The inflammation goes away.

But in diabetics, those exosomes are defective — i.e., the messenger loses some of the messages in route, like a Confederate soldier before the Battle of Antietam^*. The macrophages don’t stop, the inflammation continues, and the wound doesn’t heal.

“If signals contained within exosomes are correct, the macrophage knows how to resolve inflammation in the wound. In diabetes, crosstalk between keratinocytes and macrophages is compromised, so macrophages keep driving inflammation and the wound can’t heal.”

* Google “Special Order 191” if you’re confused. 

Endoscopy in a pill

Engineers in the Boston area (MIT, BU, and others) have developed a small pill that can diagnose possible bowel disease in real time, as a potential alternative to procedures that end in “-scopy.”

The pill contains engineered bacteria, a transmitter, and a battery. When the bacteria encounter nitric oxide (“a short-lived molecule that is associated with many inflammatory bowel diseases”) they glow, and at different levels depending on the nitric oxide concentration.

The pill electronics then convert that light into a wireless signal that can be transmitted through the body to a smartphone or other computer in real time as the pill travels through the gut.

Result: A way to detect an IBD without sticking anything anywhere. And why yes, they do call it a “game changer.”

A new flu vax

Moderna says its mRNA-based flu shot works better than traditional vaccines based on a late-stage trial that shows it’s safe and effective. The company is hoping to make the vaccine available for the 2024–25 flu season.

Loneliness, guts, and health

People who are lonely often get depressed, and people who are depressed often end up with a digestive disease — so found a team of University of Michigan gastroenterologists and hepatologists. People with a digestive disease are then more likely to say they have “poor or fair” overall health.

The worst part is that loneliness and being alone are different things; plenty of people “are socially connected, yet suffer from low psychological wellbeing and loneliness.”

The study’s conclusions were targeted toward gastroenterologists, but they apply to all healthcare providers:

“Being aware of the link between loneliness, depressive symptoms, and digestive diseases can really benefit your patients from a holistic perspective.”

ICYMI: Vaccines for everyone

CDC advisors recommended the new Covid-19 vaccines for everyone aged 6 months and older. “While the benefits appear to be greatest for the oldest and youngest people, the benefits of vaccination exceed the risks for everyone.”

That said…

Because the federal government is no longer buying and providing Covid vaccines, it’s up to insurers, including Medicare/-caid, to pay for them. But there is also the HHS Bridge Access program that will pay pharmacies and other providers to give the vaccines to the 25 million+ Americans without insurance.

CVS and Walgreens are the two chains providing the vaccines through that program, and other pharmacies can reach out to eTrueNorth, which is also participating.

What’s up with UGA CoP

UGA grads and others who might be interested: The UGA College of Pharmacy’s annual report, UGA Script, is out now with everything you might want to know about what the college has been up to.

Most importantly, starting on page 40 you can read about GPhA President (and UGA CoP 1992 grad) Joe Ed Holt and his philosophy of giving forward.

Keeping ferrets safe

q

If you’re like most people, you’ve probably asked yourself “What drugs work best to treat ferrets with Covid-19 and also reduce transmission of the SARS-CoV-2 virus?” Thankfully, Georgia State and Emory University researchers have that very answer: While both molnupiravir and paxlovid (nirmatrelvir/ritonavir) can help prevent severe Covid, “only molnupiravir efficiently blocked SARS-CoV-2 transmission.” The more you know.

The Long Read: Phages update

Bacteriophages, known since 1915, are a hot contender to fight antibiotic resistant infections. Forbes has an overview of some of the latest developments in harnessing these bug killers.

It takes just 2.5 weeks on average […] to find a phage that covers a bacteria we previously couldn’t cover. […] [T]heoretically, within just a few of months, the world has an answer available to a previously drug-resistant bacterial strain. By contrast, the development of a new antibiotic takes anywhere from eight to 20 years.

Phenylephrine gets unanimous downvote

The FDA’s 16-member advisory committee voted unanimously that there’s no evidence phenylephrine is effective ‘when taken orally at recommended doses’ and that it’s not even worth doing studies at higher doses.

If the agency follows the panel’s recommendation, it could next begin a process to remove the drug from the market, forcing manufacturers, including P&G, Kenvue Inc. (Sudafed) and Reckitt Benckiser Group (Mucinex), to reformulate many popular cough and cold products.

Oi! You! Register for your Region Meeting!

Time is running out! If you live in one of the following GPhA regions, it’s time to sign up for your fall Region Meeting!

• Region 2 (Moultrie area): Tuesday, September 26
• Region 4 (Peachtree City area): Wednesday, September 27
• Region 5 (Atlanta area): Tuesday, September 26
• Region 10 (Athens area): Wednesday, September 27
• Region 11 (Augusta area): Thursday, September 28

And the rest of you? Your meeting will be virtual, and we’ll be sending out info soon!

For just $10, GPhA members get a chance to hang out with other local pharmacy pros for a great dinner, an update on Georgia pharmacy, and a fun and low-pressure networking opportunity.

Sign up for your region meeting dinner now! Details and sign-up links for all the meetings are at GPhA.org/regionmeetings.

Walgreens settles

Remember Theranos, the company that promised a zillion tests from a drop of blood that turned out to be a fraud? You may recall CEO Elizabeth Holmes going to prison, but you may not remember that Walgreens was working with the company.

Now the pharmacy chain has settled a class-action lawsuit in Arizona and California by patients who took the tests and got faulty results. “Each eligible plaintiff will be reimbursed for double the cost of the original tests […] plus a base payment of $10.”

Attorneys in the case, which “involved 7.8 million pages of documents, 26 fact witness depositions, and six expert depositions,” didn’t comment, as Internet service has yet to be established on their new private Caribbean islands.

AIP meets dispensary owners

AIP VP Jonathan Marquess represented GPhA at the grand opening of the first Botanical Sciences Medical Cannabis dispensary in Metro Atlanta. He’s already met with pharmacist Tony Singletary, general manager of the Pooler dispensary, and on Tuesday’s grand opening in Marietta, he met with Botanical Sciences employees including founder Robin Fowler, MD, and CEO Gary Long.

The best smoking cessation

What’s the best way to quit smoking? (Yeah, yeah, “Never start.” We know.) But if you’re already smoking, a British-led team has figured out what’s your best bet for quitting. The answer is to use two forms of replacement therapy.

Based on their literature review, they found there are good and bad ways to try to quit.

• Quitting without any aid: a 6% success rate
• Quitting using one form of nicotine replacement therapy, e.g., e-cig, patch, or gum: 9%
• Quitting using two forms of nicotine replacement therapy: 12% success
• Quitting using e-cigarettes and varenicline or cytisine: 14% success

The study did not look into the effects of long-term nicotine use, because that can’t be nearly as bad for you as actual smoking.

I won’t tell them if you won’t

It seems that turmeric, the bright yellow spice that pairs nicely with curry, might be an effective treatment for acid reflux — as good as omeprazole, in fact.

After a two-year, scientifically rigorous trial, Thai researchers found that turmeric’s active ingredient, curcumin, worked as well as proton-pump inhibitors against pain, burning, bloating, gas, and nausea.

And the curcumin doesn’t come with a risk of infection, fractures, or dementia. So there’s that.

Don’t sell fake eye drops

The FDA has warned CVS, Walgreens, and six other companies about selling “illegally marketed, unapproved ophthalmic drug products” that it says could actually be dangerous because they contain silver.

The agency doesn’t say what these products are (the list is apparently in the letters), but they’re apparently marketed “to treat conditions such as conjunctivitis (‘pink eye’), cataracts, glaucoma and others.”

Not only might there also be sterility concerns, but they can apparently turn eyes blue or blue/gray permanently.

So if you see eye drops from Boiron, DR Vitamin Solutions, Natural Ophthalmics, OcluMed, Similasan, or TRP Company, you should probably pull them from the shelves.

Not your dad’s invisible ink

With track and trace rules still coming (even if they’ve been delayed), it’s important to find ways to authenticate meds — ways that are both effective and cool enough to write about.

On that note, engineers at Sandia National Laboratories have developed the mother of all invisible inks. (Technically it’s more of a material than an ink, but they call it an ink so we will too.) It can be used to not only mark goods invisibly (duh), but “with a special pattern or signature that only emerges under certain kinds of light.”

For example, shining an ultraviolet light on a Sandia-designed ink might cause one pattern to become visible, while also revealing a second, hidden pattern that can only be seen with an infrared camera. The patterns can even morph, revealing a signature animation instead of a static image.

Try to counterfeit that.

FDA finally considers pulling phenylephrine

The FDA admits that phenylephrine doesn’t work — it said so last week^*. In fact, the world has known since at least 2006 that it’s simply not a decongestant. It looks a lot like pseudoephedrine on labels, though, so a lot of consumers didn’t know better.

Now, finally, an FDA advisory committee is meeting to look at the data and decide recommend “whether the oral nasal decongestants phenylephrine hydrochloride and phenylephrine bitartrate should be reclassified as not Generally Recognized as Safe and Effective due to lack of efficacy.”

That would mean that phenylephrine would come off the market, leading to “significant downstream effects” for both manufacturers and consumers, who would be left only with pseudoephedrine as a decongestant — and that’s behind the counter.

[P]eople will need to learn to “make the appropriate choices for alternative treatments,” the FDA document noted, albeit without spelling out what that should be.

^* The agency said after more than 15 years, “[W]e have now completed a thorough review of all those data.”

Bullet dodged

Hurricane Lee is headed north — now targeting New England instead of the mid-Atlantic coast.

FDA recommends Covid boosters

The FDA is officially recommending that everyone who can should get an updated Moderna or Pfizer/BioNTech Covid vaccine this year (sorry, Novavax); the CDC is expected to approve it.

Interesting note: Experts don’t think it’ll make much of a difference because most people have been vaccinated, exposed, or both. That said, they agree FDA approval is important because it means insurance companies will cover the shot for the people who need it or want it.

The next anti-PBM bill

There are, at last count, 42,681 bills in Congress (±42,678) aimed at reining in PBMs one way or another. It’s difficult to keep track because there are multiple committees and subcommittees at work in two chambers and 535 egos.

That said, the latest bill is a bipartisan piece that … honestly, it’s hard to see exactly what’s different about this bill than the others that have been introduced.

The 231-page bill, known as the Low­er Costs, More Trans­paren­cy Act, in­cludes pro­vi­sions that would ban spread pric­ing in Med­ic­aid and re­quire PBMs to se­mi-an­nu­al­ly pro­vide em­ploy­ers with de­tailed da­ta on drug spend­ing, out-of-pock­et spend­ing, for­mu­la­ry place­ment ra­tio­nale and ag­gre­gate re­bate in­for­ma­tion.

Eventually all these PBM bills will probably be narrowed down to either a single bill or part of some other piece of legislation. Until then, we’re just watching the sausage being made.

Eyes on CCBs

If you’ve got patients taking calcium-channel blockers, here’s a note: They seem to be associated with a higher risk of glaucoma. British researchers found that the glaucoma risk increased with the use of CCBs, but, interestingly, not with other antihypertensive agents.

“This,” they said, “warrants further investigation.”

Testosterone and transitioning: Don’t wait

The sooner a transgender adult starts taking testosterone, the better it is for their mental health. Aussie researchers found that “there was a significant decrease in gender dysphoria in individuals who began testosterone treatment immediately.”

“We also report a clinically significant decrease in depression, and an over 50 per cent decrease in participants with suicidality with immediate testosterone therapy.”

By immediate they mean “following extensive clinical assessment” — i.e., once the decision has been made, don’t wait three months as the current standard of care would do.

ACA enrollment sets record

Enrollment in Affordable Care Act marketplace insurance plans is up yet again, setting another record since Obamacare took effect.

After rising from 2017–2020, the number of uninsured Americans has continued to drop, but ACA enrollments are likely to increase as states remove millions from Medicaid rolls … and so will the uninsured rate.

Apropos of nothing….

UGA and Georgia Tech researchers have found that Generation X — the generation that gave us personal computer revolution, “The Silence of the Lambs” and “Jurassic Park,” the Internet^*, ’80s music, cell phones, and much of what’s good in the world — is also responsible for the end of the Southern accent in Georgia. (The change is actually happening across the South and even other parts of the country.)

The researchers observed the most notable change between the baby boomer generation (born 1943 to 1964) and Generation X (born 1965 to 1982), when the accent fell off a cliff.

[…]

The team found that older Georgians pronounced the word “prize” as prahz and “face” as fuh-eece, but the youngest speakers use prah-eez and fayce.

^* But not social media. Blame the millennials. 

Painkillers, contraception, and blood clots

There’s a slight extra risk of blood clots for women on hormonal contraception who are taking NSAIDs. In any given week (according to a study by those shifty Danes)…

• .004% (that’s 4/1000^ths of a percent!) of women not taking hormonal contraception will have a blood clot.
• .011% (1/100^th of a percent) of women using “medium-risk” contraception will.
• .023% (2/100^ths of a percent) of women using “high-risk” contraception will.

High risk: estrogen/progestin patches, vaginal rings, and pills containing either 50 mcg estrogen or third-or fourth-generation progestins.

Medium risk: all other combined oral contraceptives and the medroxyprogesterone injection.

Low risk: progestin-only tablets, implants, and hormone intrauterine devices.

So it seems to fall into “something to be aware of” rather than “something to be afraid of.”

Lie down for your BP

Take blood pressure readings while lying down. It seems (per a study out of Harvard Med) that even if your blood pressure is normal while seated, your risk of heart attack, stroke, heart failure, or premature death is greater if your BP is high while you’re lying down.

“If blood pressure is only measured while people are seated upright, cardiovascular disease risk may be missed if not measured also while they are lying supine on their backs,” said the lead researcher. (Is there any other way to be supine^*?)

^* As opposed to incline or alpine

At home, dentist-free tooth test

This is not just a shameless plug for GPhA’s upcoming point-of-care certificate course. It’s also pretty interesting.

University of Cincinnati engineers have developed a prototype test for tooth decay. Yep, no dentist required — it uses saliva, and it tests for the specific bacteria that causes gingivitis and periodontitis.

They hope it can eventually be turned into an at-home test. (So be ready for it and all the other tests that are available. Register for the NASPA Pharmacy-based Point-of-Care Test & Treat Certificate Program on October 8!)

Two outta three ain’t is bad

Covid is on the rise again, and now the CDC is warning that the second of the seasonal respiratory disease squad — RSV — is on the rise “in Florida and Georgia, particularly.”

In mid-August, Georgia saw RSV hospitalization for kids under 4 more than triple. (The good news is the numbers are still low; the bad news is that the data are several weeks old; the worse news is “the majority of those hospitalizations were among children less than a year old.” 😓)

Remind your patients that there are now RSV vaccines for pregnant women that are designed to protect their babies.

Vaccine quickies

Vaccine cuts flu risk in half

Early data from the southern hemisphere’s flu season show that this year’s vaccine was about 52% effective, which is usually at least something of an indicator of how well it will perform here.

Two birds, one stone

It’s safe and effective to get the flu vaccine and Covid booster at the same time, according to Israeli researchers. There might be a slight loss of effectiveness (emphasis on “slight”), but that’s more than made up for by increased adherence.

Hepatitis: If C, then B

If you know someone who’s got hepatitis C, you might suggest they get revaccinated for hep B. It seems (say Minnesota Medical School researchers) that having hep C makes the hepatitis B vaccine less effective — even after the hep C is cured.

The research team recommends individuals with hepatitis C be checked for hepatitis B immune protection. If none is present, they should be offered a vaccine after treating hepatitis C.

A human(ish) kidney in a pig

Xenotransplantation — putting a pig’s organ in a human — would be great if it worked. So far, though, no joy. But now scientists in China have done something new: For the first time, they’ve grown a solid (mostly) human organ inside another species, a major step to someday being able to grow organs for human transplant.

More than 1,800 embryos were then transferred into surrogate sows, of which five were harvested for study within the first 28 days. All five had normal kidneys consistent with their level of development, and the organs contained 50 percent to 60 percent human-derived cells. That’s the highest percentage of human cells yet observed in any organ grown inside a pig.

Sleeping off addiction

Could opioid addiction be treated by … sleeping? Insomnia is linked to both stress and cravings, so Scripps Research researchers “wondered whether treating the insomnia associated with opioid withdrawal might help prevent relapse.”

To find out, they gave opioid-dependent rats an experimental sleep aid^* similar to suvorexant so they could get a good night’s sleep.

“The idea behind testing this treatment was that if people or animals sleep better during that withdrawal period, then when they wake up, perhaps they won’t feel so much craving and won’t be as likely to relapse.”

Well it worked. The rats that slept better not only didn’t show withdrawal symptoms, but they acted like they were no longer dependent on the opioids even when given the chance to take a hit. And it worked for days.

Weird side note: The treatment worked better for male rats. Why? Dunno. ‘More research is needed.’

* They don’t explain why they need to use an experimental drug. ¯\_(ツ)_/¯

Hurricane Lee: Be prepared

On the off-hand you haven’t paid attention to the weather, now is the time to prepare for the (possible) arrival of Hurricane Lee. It’s already a category 4, the water is extra warm, and it’s headed for the east coast. Looking at you, Savannah. (It’s possible it will veer north, as these storms often do.)

The Board of Pharmacy may activate Policy 14, which loosens some restrictions on dispensing, using out-of-state pharmacists and technicians, and more. You can read about it here, in our 2019 post on Hurricane Dorian — we’ll repeat it if Lee looks like it’s going to threaten Georgia or nearby states.

Important: Keep up with the details on the Board of Pharmacy’s site rather than taking what we say at face value. To be clear: Policy 14 has not been activated, but it may be.

Students in the news

Shout-out #1: To UGA student pharmacists (and others) who helped bring some healthcare to the migrant workers who A) don’t have any health insurance and 2) pick the fruits and veg we all love to eat — a job no one else wants to do, especially in this heat.

Shout-out #2: To Mercer CoP P4 student Ashlea Gordon, named national vice president of the Student National Pharmaceutical Association. (She was Mercer chapter president for the 2022-2023 academic school year, too.)

Semaglutide’s latest latest trick

New weight loss drugs are good news for type 1 diabetics — dropping the pounds can go a long way to managing the disease.

But what if those drugs went even further? A new study out of the University of Buffalo found that “Treating newly diagnosed Type 1 diabetes patients with semaglutide […] may drastically reduce or even eliminate their need for injected insulin.”

Considering that these drugs were originally meant to treat type 2 diabetes, this isn’t a huge shock — but it’s at least a surprise, especially the part about eliminating the need for insulin.

They think that because type 1 diabetics still have some insulin reserve, semaglutide stimulates that insulin secretion. But the study was small, so you know the drill: More research is needed.

Covid boosters coming real soon now

‘Knowledgeable sources’ say the FDA is about to approve this year’s Covid-19 boosters, which will then need to get CDC approval before hitting the streets. So if the sources are correct, it could be next week that shipments will arrive.

Side notes: Hospitalizations continue to rise and while the boosters have been shown to work against the new Pirola variant, they haven’t been tested against Fornax (FL.1.5.1), which is the latest Omicron subvariant and already accounting for 15% of US infections.

Lyme vax: Another small step

Pfizer/Valneva say their experimental Lyme disease vaccine has passed its first phase 2 study and “showed a strong immune response in both children and adolescents a month after a booster shot.”

Money from menthol

If for some reason the FDA doesn’t get around to banning menthol cigarettes (as it’s expected to), states would do better to levy higher taxes on them rather than ban them outright, at least according to a study out of the University of Washington.

The logic: If you ban them, people will just go across the border to buy them. But not as many people will travel just to save a few bucks, and the state can cash in on the tax revenue.

The Long Read: Origins edition

Check out the surprising origins of some of the drugs you work with every day.

Another Alzheimer’s clue

With amyloid protein no longer the only game in town when it comes to Alzheimer’s causes, researchers are opening up other avenues. For example, scientists at Oregon Health & Science University have uncovered a new connection involving iron.

Microglia are the body’s cleaning ladies, removing damaged cells. But sometimes people have excess iron in their brains’ myelin. When those myelin cells are damaged, the microglia that come along to clean them are are killed by being exposed to the iron — it’s called ferroptosis^*.

Dead microglia can’t do their job, and that means damaged myelin builds up like trash in an office building when a lot of the cleaning staff is gone. And that, they think, could lead to the development of Alzheimer’s and vascular dementia.

“We’ve missed a major form of cell death in Alzheimer’s disease and vascular dementia,” one researcher said. “We hadn’t been giving much attention to microglia as vulnerable cells.”

^* Fantasy-novel readers can make their own comments about death by cold iron.

Comparing Part D plans can save big

Patients may not realize it, but finding the right Medicare Part D plan can make a huge difference in what they spend on meds. Looking just at treatments for prostate cancer, University of Michigan researchers used the federal Medicare plan finder^* to see how much of a difference it made.

One example: “Out-of-pocket costs for abiraterone prescriptions ranged from $1,379 to $13,274 among all Part D plans.” Yeah, that’s almost $12,000 difference. (Enzalutamide ranged from $9,854 to $13,061 out of pocket.)

Medicare open enrollment runs October 15 through December 7.

^* Medicare.gov/plan-compare

The secret painkiller algorithm

Back in 2021 we told you about how AI is being used behind the scenes to deny people access to pain meds based on what’s called a Narx score, named for the company that provides the service — but that doesn’t reveal how it calculates that score.

It’s been a while, but the issue is getting some more coverage, this time by KFF Health News (by Andy Miller of Georgia). Once again, the issue isn’t just that a computer is making decisions about people’s lives, but that the company refuses to disclose how those decisions are calculated.

Lacking the ability to see inside these systems leaves only clues to their potential impact. Some patients say they have been cut off from needed care. Some doctors say their ability to practice medicine has been unfairly threatened.

Almost a Captain Obvious story

If you permit it, they will use it. UMass research: “States that enacted laws permitting children to carry and apply sunscreen at school experienced an increased interest in sun protection and a higher rate of sunscreen use.”

But seriously: There are states (Georgia is one) where schools or school districts can ban the use of sunscreen or require students to get a doctor’s note to use it. It’s not that these states are against allowing sunscreen, it’s just that no one has pushed to have a law passed.

By passing statewide laws allowing sunscreen use, more people read up on sunscreen and more kids start using it. That kind of law not only tends to have broad bipartisan support, it’s “linked to an 8.3% increase in sunscreen use by high school students.”

Short Takes

Is it safe to kiss your pet?

Yes, almost certainly. (Except for turtles or chickens.)

Vaping shrinkage

Good news for male rats whose underwear is too tight.

Elsewhere

In Texas

Texas no longer considers menstrual pads and baby diapers to be “luxury items” and thus will not tax them as such. (Side note: 16 of the 174-member Texas legislature voted to keep the tax.)

In several states

Not content to wait for the federal government’s drug price negotiations to take place, states are starting to pass their own limits on what their Medicaid programs will pay for certain drugs, as well as what state-regulated commercial and employer plans are allowed to pay.

(What’s not clear is whether they’re limiting what co-pays plans can charge, or whether they’re looking to limit what the plans can pay drugmakers for these meds.)

Aspirin vs. diabetes

The ups and downs of low-dose aspirin continue. The latest comes from Australia’s Monash University, where researchers, after analyzing previous study data, determined that “low-dose aspirin could lower risk of type 2 diabetes in people over 65.”

Caveats! First, there’s the word could. Second, they say they aren’t sure if it affects people who already have diabetes. Third, there’s that big ol’ downside: The same study they reanalyzed found that “aspirin conferred a 38% increased risk of major hemorrhage in older adults.”

So the bottom line is that aspirin’s effects need a bunch more study.

Remember to renew!

You should have received your GPhA dues renewal info in the (paper) mail by now, so if you haven’t sent it in, here’s your gentle reminder to please do that so Membership Director Mary Ritchie can get a good night’s sleep.

If you don’t want to use a stamp, you can always renew online: Just head to GPhA.org/renew or…

Good news about Pirola (but…)

The latest Covid variant, Pirola (aka BA.2.86), might not be a big deal after all. Sure, it’s got plenty of mutations, but two US labs — as well as those in China and Sweden — have said it looks as if our immune systems can fight it off more easily than the various XBB strains going around.

The early results paint BA.2.86 as more of a paper tiger rather than the looming beast it first appeared to be, although that impression could change as more results come in.

Yay!

But wait:

While the focus has been on Pirola, it’s the Fornax (FL.1.5.1) variant, which currently causes about 15% of US infections, that might be a problem. In the lab, at least, it was the most immune-evasive. Only time will tell how bad it is and how well this season’s vaccines will work.

Stop the presses!

Kenvue (formerly J&J’s consumer division) has introduced a new pain-relieving cream it claims doesn’t smell funny or feel greasy. And it doesn’t just have one rollerball — it’s got three “uniquely designed rollerballs” to spread that lidocaine and menthol. Whee!

Boosting chemo

Some head and neck cancers can resist chemotherapy, but now British scientists have found a way to lower those defenses (or defences).

1. The cancer’s resistance is caused by two particular genes.
2. Turning off those genes’ expressions makes the cancer susceptible to chemo.
3. There are two substances “that could target the two genes specifically and make resistant cancer cells almost 30 times more sensitive to […] cisplatin.”

Those two substances: sirodesmin A (a fungal toxin) and carfilzomib (an existing cancer med). Next up will have to be human testing, but that’ll be easier because these aren’t new chemicals.

Keeping an eye on the animals

Canadian researchers were curious about how Covid-19 is transmitted from humans to animals (and possibly back again). So off they went to look at the sequenced viral genomes. What they found:

• Humans transmitted SARS-CoV-2 to cats, dogs, minks, and deer — a lot.
• Cats and dogs rarely gave it back.
• Minks, though, gave it back plenty of times, likely as revenge for the whole “coat” thing.
• The virus collects the most mutations in deer, but it’s not clear if those mutations might affect how it transmits to humans.

Goodbye, menthol

The end of menthol cigarettes in the US is coming later this year, although — in a huge shocker — the FDA says it’s behind schedule. And by behind, we mean by about 14 years — that’s when the law banning flavored cigarettes was passed, and “Many public health leaders say that regulations on the last flavor allowed in cigarettes can’t come soon enough.”

Studies have found that children who smoked menthol cigarettes were more likely to become regular smokers than occasional smokers. More than half of kids who smoke use menthol cigarettes, according to the [CDC].

(What’s likely to happen? Cigarette makers will switch to making “cooling sensation” products as RJ Reynolds has already done, or start marketing flavored cigars to kids instead. “In 2020, more young people said they tried a flavored cigar every day than tried a cigarette, according to the FDA.”)

Register for your Region Meeting!

If you live in one of the following GPhA regions, it’s time to sign up for your fall Region Meeting!

• Region 2 (Moultrie area): Tuesday, September 26
• Region 4 (Peachtree City area): Wednesday, September 27
• Region 5 (Atlanta area): Tuesday, September 26
• Region 10 (Athens area): Wednesday, September 27
• Region 11 (Augusta area): Thursday, September 28

And the rest of you? Your meeting will be virtual, and we’ll be sending out info soon!

Region Meetings are the twice-a-year chance to hang out with local pharmacy pros for a great dinner, an update on Georgia pharmacy, and a fun and low-pressure networking opportunity.

It’s all for a mere $10 for GPhA members ($25 for non-members).

The details and sign-up links for all the meetings are at GPhA.org/regionmeetings.

The formula for better formula

It’s pretty much common knowledge that “breast is best” when feeding a baby, but not every mom is able to breastfeed for a list of reasons. Still, breast milk has nutrients that bottled formula doesn’t. But now University of Kansas researchers, working with their friends in China, say they’ve found an important ingredient that can be added to infant formula to “contribute to the long-term structure and function of the brain.”

The ingredient? Milk fat globule membrane (MFGM). The explanation:

All forms of mammalian milk contain large fat globules that are surrounded by a membrane composed of a variety of nutrients important to human nutrition and brain development, Colombo said. When milk-based infant formula is manufactured, the membrane has typically been removed during processing.

Adding MFGM for just one year “raised IQ by 5 points at 5 ½ years of age” most noticeably in the kids’ info processing, visual-spatial skills, and on tests of executive function.”

Get the point-of-care testing training mom would want you to have

Attention pharmacists and technicians: With point-of-care testing for seemingly every drug, disease, and condition you can think of, from marijuana use to lycanthropy, patients will need your help.

Be there for them! GPhA is offering the gold-standard class: the NASPA Pharmacy-based Point-of-Care Testing Certificate Program, which not only gives you that nifty certificate for your wall, but 20 hours of CPE with the combo of the in-person and home-study program.

The next live session is Sunday, October 8, from 8:30 am to 12:30 pm in the GPhA Sandy Springs classroom [map]. (The home portion is, you know, at home.) No more sessions are scheduled this year, so don’t miss out!

CLICK HERE FOR MORE INFO

The Oppenheimer treatment is worse

Sure, you probably think a procedure called “Barbie botox” sounds perfectly safe (especially if it’s trending on TikTok). Oddly, so-called “experts” are advising caution before having botulism poison injected into the muscles of your upper back to make your neck look thinner.

Just remember that the same “experts” warned about drinking borax, eating Tide Pods, and cooking chicken in NyQuil.

Score another for traditional meds

The latest traditional medicine that’s passed the laboratory test (and started fights at Scrabble tournaments) is qiliqiangxin.

A Chinese trial of more than 3,100 patients with serious heart issues found that qiliqiangxin cut the risk of hospitalization and heart failure from about 30% (for those just taking standard treatment) to 25% (for those taking the qiliqiangxin supplement).

At least that’s what the European Society of Cardiology press release seems to be saying:

In a pilot study, qiliqiangxin reduced N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels and improved heart failure symptoms in patients with HFrEF when added to established heart failure treatment.

Weird science story of the day

Trouble with math? How about zapping the front of your brain? British and Dutch researchers found that if someone’s brain isn’t excited about math (in the “Woo-hoo, math is fun!” sense), then a bit of electrical excitement can improve their skills.

In other words — and it helps to say this in a mad scientist’s voice — “We will make you excited about math.”

Even easier Parkinson’s test

Breakthroughs in tests for Parkinson’s disease keep coming, and that’s good news. The sooner it’s detected, the sooner treatment can start.

Back in April we told you about a test that uses cerebral spinal fluid and looks for certain misshapen proteins to diagnose Parkinson’s years in advance. And in October 2022 we told you about a skin-swab test that can diagnose it in minutes, but only when someone already has it.

Now another bit of good news comes out of Duke. It’s a simple blood test for Parkinson’s that can help detect the disease earlier and could even help identify treatments that may or may not work for a particular patient.

The test looks at specific damage to mitochondrial DNA — damage that only occurs in people with (or who are likely to get) Parkinson’s. It’s extremely accurate, and while it might not give years of warning, it does make earlier diagnosis and treatment possible.

Our number 2 story

You know those people who can eat a ton of junk and never get diabetes? It might be thanks to a bacteria in their guts that lowers their insulin resistance — Alistipes indistinctus.

Conversely, there’s the bad stuff: Lachnospiraceae. which is in the guts of people with high insulin resistance, like (pre)diabetics.

This means two things, suggest Japanese researchers. First, a fecal microbiota transplant (yes, a poop capsule) of A. indistinctus might be a way to treat people with insulin resistance. It worked on mice, but it’s not an easy bacteria to culture because it’s sensitive to oxygen.

Second, measuring the levels of Lachnospiraceae in a patient’s poop could be an indicator of prediabetes. But first, as always, more research is needed.

Why we yawn

No one is sure why we yawn. It’s just one of those things — lots of guesses but no firm answers. Now, though, a group of Dutch researchers think they’ve uncovered the reason. And ironically it’s pretty boring.

Put simply, yawning is a way to help reset and rebalance the muscles of the throat to ensure proper functioning.

That’s why we yawn when we’re tired (to reopen air passages) and after eating (to reset the muscles after chewing) and when stressed (to counter the muscle tension of gritting your teeth). And there you have it, without a single bad pun.

All things in moderation…

…including, it seems, antioxidants. Getting rid of those free radicals is a good thing, but Swedish researchers found that there’s a down side to having too many antioxidants. They can actually make tumors grow by helping them form new blood vessels.

The good news is that learning how the process works can help find a way to attack tumors. And there’s nothing wrong with antioxidants in general. But, the Swedes suggest, people with (or at risk of) cancer should probably avoid supplements.

Moderation, schmoderation

Imagine, if you will, eating all you want but never gaining weight. Korean researchers studying how the brain regulates energy found a nifty fact: It seems that activating certain brain cells in the hypothalamus, called GABRA5 neurons, increases the energy consumption of brown fat. That is, the fat burns calories instead of accumulating them.

Teasing out the mechanism, they created a drug called KDS2010 that was able to^* activate those neurons. Result: “the mice were able to achieve a successful weight reduction.”

But the cool part is that the fat mice lost weight even while on a high-calorie diet, leading to the headline, “A new breakthrough in obesity research allows you to lose fat while eating all you want.”

^* It “[suppresses] the expression of the MAO-B gene in reactive astrocytes [to] decrease GABA secretion, thereby reversing the undesirable  inhibition of the GABRA5 neurons.”

Strongly worded letters

GOP governors to Congress: Fix drug shortages

A group of 11 Republican governors (not including Georgia’s Brian Kemp) sent a letter to Congress demanding that government take action to deal with the issue of drug shortages.

They want more transparency regarding the chain of raw materials, more information from the FDA about the state of shortages, and “Waivers to allow purchasing of medications from Canada to expand our supply chain capability quickly^*.”

They also ask for “Increased diversity in the manufacturing of generic medications with regards to both raw materials.” While obviously Congress can’t do that directly, the governors suggest “Creation of a regulatory environment that is more favorable to U.S. manufacturing to include instituting shorter ‘cure periods’ for U.S. manufacturing plants.”

(There’s more, of course. The full letter is here.)

^* Although no one has asked the Canadians how they feel about this.

Senators to insulin makers: You didn’t lie to us, did you?

Two US senators want to know why drug companies, which had promised to lower insulin prices, have made the process of actually getting those lower prices so difficult.

They pointed out “that to enroll in the drugmakers’ insulin programs, patients had to go through a lengthy and complicated process that required them fill out five to 10 pages of documentation and wait an unknown amount of time for approval.”

The Long(ish) Read: Grapefruit Interactions edition

You know that grapefruit or grapefruit juice can interact poorly with a bunch of meds. But if you’re curious about why that’s the case, ScienceAlert has you covered.