Pharmacists are burning out

In what must come as a complete shock to you, it seems that “Growing workloads and stresses lead to well-documented exhaustion, subsequent staffing shortages.”

But while the pandemic slammed pharmacists, as it did many other health-care workers, pharmacy groups say working conditions are generally more stressful and demanding now than they were before the pandemic.

The Washington Post has the story.

Drug takeback (half) day is coming

The next DEA’s National Prescription Drug Take Back Day is coming up: April 22 from 10:00 am to 2:00 pm across the state.

If you don’t have a drop-off box in your pharmacy, your patients have two options: They can use the DEA drive up collection-box locator at DEA.gov/takebackday

=OR=

They can find a pharmacy with a drop box using the locator at prescriptiondrugdisposal.com. Let ’em know!

Georgia Gwinnett College gets fast track to Mercer

Good news for students at Georgia Gwinnett College: If they’re looking to get a PharmD at Mercer, their applications will get priority reviews thanks to a transfer admission agreement between the schools.

The students will do their prereqs at GGC, then enroll in Mercer’s PharmD program. Their first year of Mercer credits will transfer back to GGC so they end up earning their bachelor’s degrees a year early. It’s like fuzzy math!

Alcohol doesn’t help

Once again it’s time to answer the question that never gets an answer: Is a bit of alcohol good for you? Today’s answer comes courtesy of Canada’s University of Victoria, and it is … no.

Not that it’s necessarily bad for you — that’s not what the study was about — but rather that studies showing a benefit to a glass of beer or wine were flawed. “[A]fter adjusting for study flaws and biases, ‘the appearance of the benefit from moderate drinking greatly diminishes and, in some cases, vanishes altogether’.”

Again, this study didn’t find any harm, just no benefit.

The combined adjusted data from the [previous] studies showed that neither occasional drinkers (less than 1.3 grams of alcohol, or one drink every two weeks) nor low-volume drinkers (up to 24 grams a day, or nearly two drinks) had a significantly reduced risk of death.

Captain Obvious would rather call a friend

“ChatGPT doesn’t have all the answers on cancer screening”

The responses were appropriate for 22 questions, or 88%. But one question was answered incorrectly with outdated information, and two others had inconsistent responses that varied significantly each time the same question was posed.

Lithium and autism?

Could lithium in drinking water mean a higher risk of autism? That’s what UCLA researchers, working with a group of those shifty Danes, concluded: “Pregnant women whose household tap water had higher levels of lithium had a moderately higher risk of their offspring being diagnosed with autism spectrum disorder,” they wrote.

Essentially, they compared health records of almost 64,000 Danish kids and cross-referenced autism diagnoses with mom’s address when they were born. The bottom line: “As lithium levels increased, so did the risk of an autism diagnosis.”

Oh, and they note that it could become a bigger issue as more electronic devices — with their lithium batteries — are discarded and leach into the environment.

Elsewhere: OK has had enough

Strange as it may seem, apparently corporations — in this case CVS/Caremark — can only ignore the law^* so long before the Powers That Be take action. Over in Oklahoma, Insurance Commissioner Glen Mulready has filed an “administrative action” against the pharmacy/PBM, claiming it repeatedly ignore the state’s law against PBMs steering patients to the pharmacy it owns.

“I am convinced that CVS/Caremark does not want to follow Oklahoma law and wants to find every opportunity to skirt their responsibility,” Mulready said. “I am extremely frustrated with the misinformation and confusion presented to Oklahoma consumers.”

^* For people it’s “break the law.”

Short Take

Long acting time-release tech

Time release meds are nothing new, and super-fancy ones using microtechnology isn’t, either. But now Rice University bioengineers say they can do that one better — an injectable payload of medication that can be tweaked to adjust when the drugs are released.

Said one engineer: “With this, you’d give them one shot, and they’d be all set for the next couple of months.”

It’s not your father’s testosterone patch

For the first time, women prescribed testosterone might have a more convenient and appropriate option at their neighborhood pharmacy: a patch.

Clinical trials of a testosterone patch designed for women — i.e., with a dosage more appropriate for them — are beginning in Britain, and could lead to a better treatment for all those symptoms that go with menopause.

Although testosterone creams and gels are available to help women with loss of sex drive in some countries, they have to apply the correct amount to their skin themselves, and in some cases have to use products originally designed for men.

The article doesn’t mention compounding pharmacies, though, which have been creating this kind of custom-dose, custom-delivery medication for a long time — just on a much smaller scale than the British patch would be.

The other danger with antibiotic overprescribing

That other danger is patient harm — like, direct patient harm, not just the long-term threat of antibiotic resistance.

A big retrospective study out of Intermountain Health and Stanford University — looking at the insurance and medical records of 23 million people — found that getting the wrong antibiotic, or an unnecessary one, often ended up sending people back for help dealing with side effects from a medication that didn’t do them any good anyway.

Researchers found that some of the most dangerous antibiotics were rarely indicated and commonly used, leading to one in 300 of those patients experiencing side effects dire enough to require a follow up doctor’s visit—or even hospitalization.

Addiction, use, or maintenance?

If someone uses a drug therapeutically, is that considered a ‘use disorder’? Probably not — you don’t hear about “insulin-use disorder” or “fiorinal-use disorder.” That means, argues a Rutgers researcher, that we need to start rethinking how we diagnose cannabis-use disorder.

“[T]he manual used to define substance-use disorders was developed before the sharp rise in cannabis use for therapeutic purposes. This means that the diagnostic manual considers cannabis to be an illicit substance, even if a person reports cannabis use only for therapeutic purposes.

Furry cuteness of doom

You might know that having pets from an early age can help kids grow up without food allergies. But there’s one big exception. Hamsters.

According to Japanese researchers, while “exposure to dogs and cats might be beneficial against the development of certain food allergies,” when it comes to hamsters, kids who grew up with them were actually more at risk of developing a nut allergy.

Jumping fungus

I could write a whole bunch about “another thing to worry about” or make a reference to The Last of Us, but I think I’ll just let this stand on its own:

In what researchers suggest is the first reported case of its kind, a 61-year-old Indian mycologist appears to have contracted a rather serious case of silver leaf disease in his own throat.

The Long Read: Everything you need to know about how the feds are tackling PBMs

From the Senate Committee on Commerce to the FTC to bipartisan House groups, the federal government is starting to wake up and see the writing on the wall. (It says, “PBMs are not our friends.”)

Short Takes

Carter launches bipartisan pharma group

Meet the Domestic Pharmaceutical Manufacturing Caucus for the 118th Congress. Its goal:

[A]dvancing legislation that incentivizes more domestic production for essential medicines to reduce American reliance on foreign adversaries, head off potential supply chain disruptions, and ensure a steady supply of pharmaceuticals in the event of public health emergencies or natural disasters.

It’s over when it’s over

“WHO tracking Omicron XBB.1.16 subvariant, rising cases in some countries”:

“So this is one to watch. It’s been in circulation for a few months. We haven’t seen a change in severity in individuals or in populations, but that’s why we have these systems in place.”

One is enough … for now

The CDC says that, at least for now, having a single bivalent booster — e.g., the Omicron booster — is enough, even if you got it more than six months ago. Health officials’ focus, the San Francisco Chronicle explained, “is shifting from preventing new infections to reducing the severity of the disease.”

But doesn’t the shot only last a few months? True, but there hasn’t been a spike in infections lately, so the CDC is cool just chilling for a while.

Hologram of John Pemberton to speak at convention

John Stith Pemberton, the Georgia pharmacist who invented Coca-Cola in 1886, will be a featured speaker at the Georgia Pharmacy Convention thanks to a pair of modern technologies. Sort of.

A hologram of Pemberton will be projected onto the podium at the Thursday general session, using similar technology to what brought Tupac Shakur to the stage in 2012, more than 15 years after the singer’s death.

More interestingly, though, is that Pemberton’s presentation will be generated by a pharmacy-specific version of the ChatGPT AI software that was developed just for GPhA’s convention.

“The technology has matured enough that we’re able bring Pemberton to the stage using a machine about the size of a PC,” said Robert April, CEO of HistoryAlive Technologies, the Augusta-based company that’s providing the technology. “With ChatGPT, we’re able to add a new layer of realism.”

Pemberton will talk about his role as a pharmacist and how it shaped his development of what would become Coca-Cola. The details of his presentation aren’t pre-written, though — they’ll be generated by ChatGPT based on Pemberton’s own writings and biography.

“We’ll have to remember that he was a Confederate army veteran, a Freemason, and a morphine addict,” April cautioned, “So we can’t be entirely sure what will come out of his mouth.”

PS: Happy April Fools Day from GPhA. See you at convention!

Double-duty heart/apnea med

It’s a heart failure med! It’s a sleep apnea treatment! It’s both! A new drug developed in New Zealand can prevent continuing damage after heart failure and also treat sleep apnea. In fact, were it to come to market, it would be the only pharmaceutical treatment for apnea. (More on that in a moment.)

The drug, called AF-130, can do both because “The part of the brain that sends nervous impulses to the heart is also controlling respiration.” So when AF-130 tells the brain to get out of “fight or flight” mode after heart failure, that same signal helps stimulate breathing. Kind of like yelling “Fire!” could cause one person to flee a building and another to launch a torpedo.

As for coming to market, the Kiwis say that AF-130 is about to be approved by the FDA for a different condition (they don’t say what, unfortunately), so they can jump into human trials for these new indications quickly.

Someone thought this was a good idea

What happens when you combine a gut-muscle stimulant with a relaxant? You get Starbucks new olive oil-infused coffee.

Sine Die

By Melissa Reybold, vice president of public policy

’Twas the last night of session,
And all through the House,
The representatives waited their turn,
To speak on bills they espouse.

Speaker Burns at the podium,
With gavel in hand,
His brief breaks were covered,
By the eloquent Speaker Jan.

Lobbyists outside each chamber,
Waiting for their bills to be called,
While lawmakers read pleading texts,
From those “friends in the hall.”

Some bills took quite a while,
So lawmakers checked their cells,
While others delayed the vote,
Speaking down in the well.

Bills got added to others,
Like cannabis and hemp,
Unfortunately, that one got gummed up,
And won’t make its way to Kemp.

White baggin’ was waiting,
After thinking it was dead,
But it wasn’t called for a vote,
So, no votes green or red.

Some passed the time,
Listening for the lingo,
Waiting to cross it off,
On the Sine Die Bingo.

The tech vaccine passed,
Earlier that day,
Now Governor Kemp has to sign it,
Before the 11^th^ of May.

All ACIP vaccines,
For 18 and above?
This is one law passed,
That our pharmacists will love.

Low volume pharmacies,
Will be thrilled to see,
A line item in the budget,
For an increased dispensing fee*.

* $11.50 Medicaid dispensing fee for stores under 65,000 scripts/year

Your pharmacist legislators,
Fought for you under the Dome,
Thank you Butch and Ron,
Now, enjoy your time at home.

Bills that didn’t make it and
not voted on this year,
Are eligible in 2024,
When they can reappear.

For an in-depth discussion on session,
And networking with food and drink,
Register for your spring region meeting,
When we send you the link!

A new kind of weight-loss med

A new drug can help your fat rats become thinner by getting them to stop eating — and without nausea and vomiting. A new weekly injectable peptide treatment out of Syracuse University targets “three different weight-loss and glucoregulatory receptor pathways at the same time,” meaning the rats don’t want to eat.

This is a benefit, the researchers say, because you don’t end up with rats who want to eat but can’t. Rather, they feel full. “[W]e aim to chemically replicate the benefits of surgery without patients having to undergo surgery.” And it works:

The drug caused obese rats to eat up to 80% less than they would typically eat. By the end of one 16-day study, they lost an average of 12% of their weight.

(Sharp-eyed readers may wonder how they can say it doesn’t cause vomiting in rats, when rats can’t vomit. They tested it in shrews, too.)

Opioid abuse: red flags to watch for

So, to keep out of the DEA’s crosshairs you’re on the lookout for “suspicious prescriptions for controlled substances.” Good for you. There are obvious signs, like a handwritten script that spells “Rx” wrong, but what else should you be looking for?

The good folks at Pharmacy Practice News have the answers to that very question, as well as some advice if the feds come a-knockin’.

Bad and good mutations; bad and better flu shots

A single problematic protein in a flu vaccine can make it less effective. That’s what scientists at St. Jude Children’s Research Hospital found, and it could lead to creating annual flu shots that are more effective.

It seems that, while the virus is being grown in chicken eggs to make that year’s vaccine, a mutation in its hemagglutinin can make it less “human like” and thus less effective. And that, they say, could be why many season’s vaccines don’t work very well even when they match the current strain.

Luckily, not every virus has that mutation. In fact, some have a different mutation that not only doesn’t destabilize the hemagglutinin, but also prevents that first mutation from occurring.

Bottom line: Before they start growing virus strains to make a vaccine, pharma companies should test those strains to see if they have the ‘good’ or ‘bad’ versions of hemagglutinin.

Get the worm!

Today — March 31 — is the last day to get the early-bird rate for the Georgia Pharmacy Convention! The price goes up $50 tomorrow at midnight, and it’s $126 more at the door.

Save some money while you can! Head over to GPhAConvention.com/register before 11:59 pm tonight to grab that early-bird rate, and we’ll see you at the beach!

Antibiotic ups and downs

The good folks at the University of Minnesota’s Center for Infectious Disease Research and Policy have two noteworthy stories about antibiotics:

First, when antibiotics kill: Not only do antibiotics not reduce the chance of death from a viral respiratory infection (obviously), but Norwegian researchers found the opposite: “[P]atients with viral respiratory infections who received antibiotics at any point during their hospitalization were more than twice as likely to die as those who didn’t receive antibiotics.

Second, when antibiotics save: A combination of ceftolozane and tazobactam works a treat in “complicated, multidrug-resistant infections in outpatient settings.” There had been some data about inpatient use, but now it’s confirmed that the combo works for outpatients with a variety of conditions, including bone and joint infection and UTIs.

Georgia transparency FTW

A big Buzz high-five to the state of Georgia for being one of the minority of states promising to be open about how it’s planning to spend the $636 million coming in from the Big Opioid Settlement.

Georgia will share how 75% of that $636 million will be spent — that’s the part controlled by the state. The other 25% is controlled by local municipalities, which may or may not reveal their plans. That makes Georgia one of the 23 states that will report more than half of its spending plans; only 12 (not including Georgia) will report how they’re spending every cent.

Most of the settlements stipulate that states must spend at least 85% of the money on addiction treatment and prevention. But defining those concepts depends on stakeholders’ views — and state politics. To some, it might mean opening more treatment sites. To others, buying police cruisers.

Telehealth helps opioid abusers quit

While the DEA wants to force people to cut back on telehealth services, especially for opioid-abuse treatment, the data say that’s a bad idea.

A new study out of the CDC found that when telehealth visits were available, more people got medication to treat opioid-use disorder — and that saved lives.

“The expansion of telehealth during the Covid-19 pandemic appears to have had positive effects on patients receiving MOUD^* [medications for opioid use disorder], improved retention among patients who received MOUD, and lowered risks for both nonfatal and fatal overdose.

Perhaps someone should tell the DEA.

^* Does everything have an abbrev. these days?

ICYMI: Insurers can nix preventative coverage (for now)

A conservative Texas judge has ruled that health insurance plans do not have to cover preventative care as required by the Affordable Care Act. That means insurers will be able to sell plans that don’t cover basic care like cancer screenings, pregnancy care, diabetes tests, vision screenings for children, mammograms, and more.

The lawsuit was brought by a Christian group that argued their religion forbids the use of contraceptives and HIV PrEP, and thus they shouldn’t have to pay for health insurance that covers it. But because the ruling affects preventative care across the board, it was opposed by, well, just about every medical organization in the country. (Ironically, the judge upheld the ACA’s contraceptive mandate.)

More than 60 health organizations, led by the American Medical Association, issued a joint statement in July warning about the potential ramifications of a ruling from O’Connor that struck down the preventive services mandate.

The ruling is based on the idea that the U.S. Preventive Services Task Force itself, which develops the list of preventative services insurers must cover, has no power because its members weren’t approved by the Senate. It’s certain to be appealed before most new policies take effect in 2024; this is the same judge who once ruled that the Affordable Care Act was unconstitutional only to have that ruling overturned.

Coffee vs diabetes

And the latest health benefit from coffee is…

[spins wheel]

Reducing your type-2 diabetes risk! Oh, wait. This isn’t new. What’s new is that Dutch and Scottish epidemiologists think they’ve found the mechanism. Keeping in mind the Buzz theory that it’s always either inflammation or gut bacteria, the answer here isn’t surprising — it’s inflammation:

Higher coffee consumption was associated with lower levels of CRP and leptin, pro-inflammatory markers, and higher levels of interleukin-13 and adiponectin concentrations, which have anti-inflammatory effects.

Short Take

The next worry

This year’s tick season has a higher risk of babesiosis (bah-bee-see-OH-sis), as the CDC is warning that there’s a lot more being reported. It comes from good ol’ deer ticks (you know, the super-tiny ones that are all but impossible to spot), and it joins the ranks of anaplasmosis and Lyme disease as reasons to soak your socks in permethrin.

Narcan goes OTC

The FDA has approved the first OTC version of naloxone — a 4mg nasal spray of Emergent BioSolutions’ Narcan.

When will your wholesaler have it? “The timeline for availability and price of this OTC product is determined by the manufacturer.”

Of course, one of the issues with an OTC Narcan is affordab

[Insert boilerplate description of the opioid crisis here, along with how naloxone is used — all stuff you already know.]

In other OTC news

An FDA advisory committee is scheduled in May to discuss making certain birth control pills available over the counter (Perrigo’s daily Opill). It has the enthusiastic blessing of medical organizations across the country, including the AMA, which has been pressing for at least five years.

Another May committee meeting will consider a nasal-spray version of epinephrine from ARS Pharmaceuticals.

Swinging the other way

A bipartisan group of US senators and representatives is calling for the animal tranquilizer xylazine to be designated a controlled substance “to better allow authorities to track it and prosecute traffickers.” (That link is for Republicans. Democrats click here.)

Xylazine, aka “tranq,” is being mixed with opioids with the idea of giving some kind of better high. Unfortunately, it’s likely to “depress breathing, blood pressure, heart rate and body temperature to critical levels,” according to the Substance Abuse and Mental Health Services Administration. It can also lead to a job as an extra on “The Last of Us”:

Additionally, people who inject drugs containing xylazine can develop severe skin wounds and patches of dead and rotting tissue that easily become infected and, if left untreated, may lead to amputation.

Finding connections

Bacteria that causes MS

A gut bacteria called Clostridium perfringens could be a trigger for the onset or relapse of multiple sclerosis.

A multi-university study found that the C. perfringens produces a toxin that “opens the blood vessels of the brain allowing inflammatory cells to gain access to the central nervous system and cause demyelination characteristic of MS.”

Confirming the connection, they found higher levels of it in the intestines of people with MS. The question is, can they use this information to create a treatment? Time will tell.

Overactive immune systems and osteoarthritis

People with asthma or eczema are more likely to develop osteoarthritis, found Stanford researchers, “signaling that there may be an allergic pathway that can be targeted with existing drugs.”

It’s a pretty strong correlation, too.

The authors found that if a patient had asthma or eczema, there was a 58% increased risk of developing osteoarthritis over about 10 years. If they had both asthma and eczema, the risk increased to 115%.

It’s all about tryptase, which can be released (along with histamine) by mast cells. In other words, osteoarthritis is essentially caused by inflammation from an allergic reaction. And with both asthma and eczema involving overactive immune systems, it makes sense that having one might cause the other.

Next step: Testing existing asthma meds as a treatment for osteoarthritis.

Body-powered insulin delivery

German engineers have created a nifty implantable device to treat type-1 diabetes. Nifty on two counts. First, it’s able to use the body’s own glucose to generate the power it needs — no batteries required.

Second, the fuel cell turns on when it detects excess glucose

As soon as the fuel cell registers excess glucose, it starts to generate power. This electrical energy is then used to stimulate the cells to produce and release insulin into the blood. As a result, blood sugar dips to a normal level. Once it falls below a certain threshold value, the production of electricity and insulin stops.

This is just a prototype at this stage — it works in mice. Bringing it to market will require “an industry partner with the appropriate resources and know-how.”

The Long Read: Influenza D edition

It’s out there. Mostly in cows, but in other mammals too — including people who work with animals, such as dairy farmers.

“This doesn’t seem to be something, right now, that the general public is exposed to in a large way. But it’s something that’s a concern for these front-line workers exposed on farms.” [And] there’s a real risk that the virus could adapt to people as more and more workers are infected.

Short Takes

At-home flu and Covid test

California-based Lucia launched its combo flu/Covid test for home use. While Covid tests are common, this is first time patients can test for influenza A or B at the same time.

The test involves nasal swabbing and runs on two AA batteries, delivering a result in about 30 minutes. The introductory price is $34.99, and the product is available on the company’s website.

If you’re into aspirin’s chemistry…

… then you might be interested in what University of Texas researchers have discovered about how the drug actually works — something we’re still not 100% certain of. (Warning: Definitely not for non-chemists.)

The team found that aspirin controls transcription factors required for cytokine expression during inflammation while also influencing many other inflammatory proteins and noncoding RNAs that are critically linked to inflammation and immune response.

Puff, the magic injector

The idea of sending an injection through the skin isn’t new, but it’s always been a bit painful and inexact. Now University of Texas engineers have developed a system that not only delivers a payload through the skin painlessly, but can encapsulate that payload (e.g., vaccines, cancer treatment) as a powder, eliminating the need for refrigeration.

They put the “cargo” inside a metal-oxide framework (MOF) that’s relatively simple and cheap to make. Then a puff of gas delivers a dose — as they’re in Texas, they call it a “bullet.”

Neat trick: By changing the gas used to propel the therapy, they can adjust how quickly the coating dissolves. “If you shoot it with carbon dioxide, it will release its cargo faster within cells; if you use regular air, it will take four or five days.”

They’re testing the system to treat melanoma now, and of course, “research is still ongoing.”

A grad student receives an injection via UT’s “MOF-Jet”

The Georgia DCH is moving…

…to a deluxe apartment in the sky-y-y. Specifically, to 2 Martin Luther King Jr. Drive SE, East Tower, Atlanta, GA 30334. Please make a note of it.

A new omega 3 for the eyes

One of the hallmarks of Alzheimer’s and diabetes is vision loss, but there may now be a treatment for that — a new omega-3 fatty acid that can enter the retina.

University of Illinois researchers have created a new form of docosahexaenoic acid (DHA) that, unlike the kind people can get from fish oil or fish-oil supplements, is able to cross from the bloodstream into the retina, where it “successfully increased DHA in the retina and reduced eye problems associated with Alzheimer’s-like processes.”

(The chemistry: The DHA you know and love is a triacylglycerol or TAG-DHA. This new for is a lysophospholipid or LPC-DHA.)

In case you didn’t know, DHA helps maintain photoreceptors in the retina:

People with Alzheimer’s disease, as well as those with diabetes, retinitis pigmentosa, age-related macular degeneration and peroxisomal disorders, frequently have abnormally low levels of retinal DHA, and visual impairments are common as a result.

The downside: So far this has only been tested in mice, but the UI folks hope it can someday be available as a supplement for we humans.

White House pushes bio development

As part of its plan for a growing US “bioeconomy,” the Biden administration wants to see the country a lot less dependent on drug ingredients from China and India.

The official goal is, “In 20 years, produce at least 30% of the U.S. chemical demand via sustainable and cost-effective biomanufacturing pathways,” and that includes more than just pharma. It’s part of a transition from petroleum-based to bio-based … well, everything.

Calm down there, ACS

The American Chemical Society headline: “Marijuana-derived compounds could reverse opioid overdoses”.

The reality: There are some CBD-based compounds that seem to reduce fentanyl’s ability to bind to opioid receptors, thus — in theory — boosting the effects of naloxone. It’s only been tested in mice, and a lot more research is needed.

The latest coffee research

Drinking a lot of coffee does a body good … and bad. Which of it applies depends on the latest study. That latest one is out of Germany, and it finds that high coffee consumption increases LDL cholesterol but lowers blood pressure — effects that, cardiovacularly, cancel each other out. Sort of.

[M]ajor cardiovascular diseases including heart failure and its diagnostic precursors were not associated with coffee consumption, connoting a neutral role of coffee in the context of cardiovascular health.

Is Himalayan sea salt better for you than store-brand table salt?

No. “Salt is sodium chloride, and Himalayan salt, pink salt, rock salt or sea salt, all of these are also sodium chloride.”

The Long Read: Fentanyl Fear edition

Fentanyl — or, rather, the fear of it — is a boon for pharmaceutical companies, which are coming out with new forms of naloxone with questionable benefits.. But it’s not just pharma companies; law enforcement is getting carried away as well:

The drug’s dangers have, however, have spawned a number of highly misleading, fear-driven narratives. The DEA warned last year of “rainbow fentanyl” disguised to appear like candy, implying that it was meant to target children (the drugs’ bright colors, experts said, have nothing to do with appealing to young people). Numerous police officers have claimed to have overdosed on fentanyl simply from touching it — medically speaking, a near-impossibility.

Short Takes

Pharma R&D: In case you’re curious

Fierce Biotech has the latest rankings of pharmaceutical company research and development spending, which has few surprises — that’s why it’s down here in Short Takes.

Roche spent the most as usual ($14.7 billion) followed by J&J ($14.6 billion) and Merck (a mere $13.6 billion).

Nuts — with a grain of salt

“Eating peanuts and peanut butter could have a beneficial impact on vascular health in young and healthy people” … according to a study funded by the Peanut Institute.

But …

Blueberries — thanks to their anthocyanins (which give them the “blue” part) — might help the body burn more fat during exercise, while decreasing the use of carbohydrates. And that’s according to a study NOT funded by Big Blueberry.

A biomarker for type 1 diabetes

It’s possible to know if a baby is likely to grow up to develop type 1 diabetes. Swedish researchers found that “several microbial biomarkers associated with future disease may be present as early as one year” in the gut bacteria of infants, and then take 10 years or more to actually manifest.

The big question they’re hoping to answer next: Does that mean it’s possible to change that biome with, say, prebiotics, and prevent the diabetes from becoming established?

Pharmacy technicians: You need this training

We’ll spell it out for you:

A) People need immunizations this year — and every year. It’s kind of a big deal these days.

B) If you have training giving immunizations, you stand out from the crowd. You’re worth more.

C) The best immunization training you can get comes from the Georgia Pharmacy Association.

This is the smart move to help your career and your bank account. (And your decorations — you get a nifty certificate, too.)

Get training. Improve your résumé, power up your career.

Important details:

• The entire program is six hours (that’s 6.0 hours of CE) — 3 hours in the classroom, 3 hours of home study.
• That live training is Saturday, April 15 in Sandy Springs, from 9:00 am till noon .
• Space is limited. Don’t wait. Click the button for the details and to register:

PBM companion bill advances

You hopefully know about the House’s bill to make PBMs behave (see Friday’s Buzz) — the Drug Price Transparency in Medicaid Act. Across the Capitol, the Senate’s version (the Pharmacy Benefit Manager Transparency Act) is moving along as well.

Although the bill had bi-partisan support and passed the Senate Commerce Committee with an 18-9 vote, the PBMs jumped on the fact that the vote wasn’t unanimous, calling the bill “contentious legislation” and saying, “the legislation risks increasing prescription drug costs and would take away—” but the rest was cut off as the PBM spokeperson’s pants caught fire. Well, metaphorically.

The bill should now head to the full Senate.

Who Covid hit hardest

The Lancet just published the largest state-by-state analysis of the impact of the Covid pandemic to tease out what affected Covid’s impact.

It revealed some obvious connections: “States that imposed more protective mandates […] and maintained them for longer, experienced lower infection rates.”

But with a twist: Those mandates didn’t affect death rates — only vaccination coverage made a difference there.

There were some political differences (higher infection and death rates in states that voted heavily Republican in the 2020 presidential election) and some racial differences (higher infection and death rates in areas with the highest populations of Black people).

It also revealed what didn’t make a difference: higher state public health spending and more public health personnel per capita.

And then there’s nuance — having a great healthcare system didn’t always affect outcomes; it depended on the people:

[O]ur results suggest that the more robust a health system, the better a state performed in the pandemic, but only in states where the public was willing to make use of health care services for vaccination or to get early treatment.

FDA: Not so fast, there

Responding to criticism of its accelerated-approval process being a bit too accelerated, the FDA floated draft guidance that would — if it becomes real guidance — require cancer drugs to undergo more rigorous trials before (possibly) getting that accelerated approval.

Osteo drugs also prevent other death

People with osteoporosis have a risk of dying after a fracture, but it turns out that certain drugs for the condition also help reduce patients’ overall risk of death.

The drugs (to cut to the chase) are alendronate/risedronate, denosumab, and zoledronic acid. Sure, they can reduce the risk of hip fracture, but what’s unusual is that those drugs reduced the chances of patients dying from other conditions. Why? They don’t know yet.

As one endocrinologist not part of the study wrote separately:

This plus other evidence has led to the hypothesis that drugs for osteoporosis, particularly bisphosphonates, might have salutary effects on tissues other than bone.

While we’re talking about bones…

A Dutch study found that when people have weak bones, they’re also more likely to be diagnosed with dementia. Although it’s not entirely clear why there’s a connection, two (of many) possibilities are that poor nutrition results in both conditions, or that the poor bone mass is a result of dementia via a yet-unknown mechanism.

Covid Short Takes

It’s that time of year

It’s been so long since Covid boosters were a talking point that … welp, now it’s time to think about the next round of boosters. Britain and Canada gave them the A-OK, but the US is weighing options.

A preventative, but not a vaccine

Finnish researchers have developed a nasal spray that prevents Covid-19 infection and works against every known variant. The downside: It only works for a few hours. The upside: That’s long enough for, say, dinner and a movie during a future pandemic.

One thing that doesn’t increase Covid death

Old wisdom: Having a substance-abuse disorder increases someone’s risk of death from Covid-19. New data out of Boston Medical: Nope.

In this retrospective cohort study of patients admitted to a safety net hospital during the early phase of the Covid-19 pandemic, [substance-abuse disorder] was not associated with the primary outcome of Covid-19-associated inpatient mortality.

Magnesium vs brain shrinkage

Getting at 550 mg of magnesium a day seems to reduce a person’s risk of dementia and make their brain younger — that’s according to Aussie researchers’ study of about 6,000 people.

[P]eople who consume more than 550 milligrams of magnesium each day have a brain age that is approximately one year younger by the time they reach 55 compared with someone with a normal magnesium intake of about 350 milligrams a day.

It doesn’t make magnesium a cure, but it does imply that “a higher intake of magnesium in our diets from a younger age may safeguard against neurodegenerative diseases and cognitive decline by the time we reach our 40s.”

Long Covid notes

Risk factors

There are plenty of mysteries around long Covid — who gets it, why the symptoms are so varied, how to treat it — but a new analysis by British researchers may have some clues.

Based on 41 studies of more than 860,000 patients, they’ve teased out who’s most at risk.

[insert drumroll here]

The answers, in order of the amount of risk (per the study, not the news article):

1. Previous hospitalization with Covid
2. Other medical conditions (e.g., immunosuppressive conditions, COPD, heart disease, asthma, anxiety, depression, chronic kidney disease, or diabetes)
3. Being female
4. Being over 40
5. Obesity
6. Smoking

And, not surprisingly, being vaccinated cut the risk substantially.

Nirmatrelvir helps

The antiviral that’s half of Paxlovid can cut the risk of long Covid by 26% in patients who had at least one risk factor (see above, although gender wasn’t a factor).

It can also cut their risk of death by 47%, which implies that, when it comes to Paxlovid, nirmatrelvir is doing a lot of the heavy lifting.

It’s changing our genome

Specifically, it’s messing with the chromatin architecture of cells — that’s what holds the genetic material together. When the chromatin is changed by the SARS-CoV-2 virus, that’s “known to exert long-term effects on gene expression and phenotypes,” as the University of Texas researcher explained.

More research is needed (always!), but they’re thinking this might be a clue to what causes long Covid.

Take note, but maybe not worry

The headline: “Hormonal Birth Control, No Matter Which Kind, Linked to Breast Cancer”.

The reality: Progestin-only contraceptives are linked to a slight increase in the risk of breast cancer. Previous studies had found that same slight risk with progestin/estrogen combos.

Better sleep, less harm

Young people at risk of suicide or self harm might do well to take melatonin to get better sleep. Swedish researchers doing an observational study found a connection between melatonin use and reduced self-harm rates.

The risk of self-harm increased shortly before melatonin was prescribed and decreased by about half in the months following the initiation of treatment. Risk reduction was particularly evident among adolescent girls with depression and/or anxiety disorders.

They were careful to point out that they’ve only found an association between reduced self-harm and melatonin, so they can’t assign cause and effect. You know the drill: More research is needed.

Yesterday, bird flu; today, cat poop

While you’re thinking about the possibility of bird flu jumping to humans, here’s another concern. Scientists in California have found a “particularly unusual strain” of Toxoplasma gondii — a parasite common in cat poop (and that pregnant women need to be wary of).

Unusual in the fact that it “appears to be capable of rapidly killing its host.” And when it doesn’t, T. gondii in humans is “linked to higher rates of suicide, rage, traffic accidents and schizophrenia.”

The new strain has already infected sea otters, so … yeah, add it to the list.

Short Takes

Elsewhere: And then there were 40

North Carolina became the 40th state to expand Medicaid to more lower-income people.

Dogs are getting resistant hookworms

Dogs in the U.S. are increasingly being infected by parasitic hookworms that are resistant to the normal benzimidazole treatment. (Benzimidazole is also used to treat hookworm infections in humans, although those worms are a different species.)

Women fight better, not harder

We’ve known for a while that men are more vulnerable than women to infection. (Here’s an article from 11 years ago.) But why? A new study might have the answer — it’s all about a gene called UTX.

It’s weird, see, that men have more natural-killer (NK) immune cells, but women fight infection better. The reasons (UCLA researchers think) is that women’s NK cells are more efficient than men’s, thanks to an extra copy of that UTX gene.

UTX acts as an epigenetic regulator to boost NK cell anti-viral function […] “It turns out that females have more UTX in their NK cells than do males, which allows them to fight viral infections more efficiently.”

And that means, they say, “[W]e will need to incorporate sex as a biological factor in treatment decisions and immunotherapy design.”

Congress takes on PBM spread pricing

A big shout-out to Georgia’s US representatives Buddy Carter and Rick Allen — they were part of the bipartisan group that introduced the Drug Price Transparency in Medicaid Act, which would ban PBM spread pricing in Medicaid programs. I.e., no longer would PBMs be allowed to charge Medicaid more for a medication than it paid to pharmacies.

Said Carter:

“PBMs have been allowed to rob patients, small businesses, and taxpayers blind for decades. […] With this bill, we can hold PBMs accountable for their role in increasing the cost of health care and pocketing taxpayer money.”

Captain Obvious needs at least an hour

“Thirty-Minute Lecture Not Enough for Residents to Develop a Thorough Understanding of Spinal Cord Injury Emergencies”

Today Ozempic, tomorrow … something else

A not-always-healthy fixation not only on weight loss, but on quick-fix weight loss, won’t end with Ozempic. So muses a Northeastern U psychologist.

“There have been weight loss drugs since the 1930s. They inevitably are shown to have dangerous side effects. They are typically popular for a short term and then are revealed to be dangerous and are replaced with something else.”

Then again, anecdotes are pretty powerful

Got low-back pain? Pop an ibuprofen or Tylenol, right? Or maybe don’t bother. A new analysis in the BMJ found that there’s actually very little evidence (of the non-anecdotal variety) that analgesics actually work for acute low- back pain. In fact, that even extends to muscle relaxants and anti-convulsants.

That’s not to say they don’t work, just that there’s “considerable uncertainty around effects for pain intensity and safety.”

Help for hamsters

With all the effort put into human vaccines against Covid-19, you’re probably wondering “What about the hamsters?” Fear not, dear reader, for UCLA researchers were also concerned, and they’ve gone ahead and developed not only a Covid-19 vaccine for hamsters, but one that’s inexpensive, universal, and given orally.

Unlike current human vaccines, this one is based on the nucleocapsid protein — that’s important because it tends to evolve more slowly than other proteins, giving the vaccine its “universal” feature — “the vaccine is resistant to the incessant mutations of the SARS-CoV-2 spike protein upon which virtually all current vaccines are based.”

The Long Read: Cannabis and brain formation

Smoking while pregnant: bad. Alcohol while pregnant: bad. So why would cannabis (or its derivatives) be any different?

They’re not, as a psychiatrist and neuroscientist explains — they’re dangerous for developing brains, period.

Short Takes

Breaking (up) bad

The Biden Administration will be breaking up the Congress-created United Network for Organ Sharing (UNOS) — the almost 40-year-old non-profit that has been running the nation’s organ-transplant network … poorly.

Shortages are widespread

New drug shortages rose 30% in just a year — between 2021 and 2022. “Towards the end of 2022, a peak of 295 individual drugs were considered in short supply — impacting treatment for everything from colds to cancer.”

Side note: Somatropin, the growth hormone, is the latest to get press.

A tune full of music helps the chemotherapy go down (maybe)

The right music might reduce the nausea from chemo. And by “right music” Michigan State researchers mean “your favorite tunes.”

Their hypothesis: Music can improve a mood and thus reduce pain an anxiety, i.e., it has neurological effects. And, the MSU folks figured, “Chemotherapy-induced nausea is not a stomach condition; it is a neurological one.”

The small study (12 patients, 64 “events”) found that nausea severity did in fact decrease with the music, although they caution that it could be “the gradual release of the medication doing its job” rather than the music. Thus the next step will be to measure serotonin levels at the same time to determine the music’s effect.

Eat what you want!

Look out, Ozempic. University of Texas medical researchers have tested a drug that lets mice eat a Western high-sugar, high-fat diet and still lose weight.

The trick is cutting down the amount of magnesium that mitochondria can transport. When magnesium is plentiful, the mitochondria produce less energy and store more for later — as fat, of course. (And yes, the article is sure to explain that mitochondria “are cells’ power plants.”)

Deleting MRS2, a gene that promotes magnesium transport into the mitochondria, resulted in more efficient metabolism of sugar and fat in the power plants. The result: skinny, healthy mice.

The drug, which the researchers call CPACC, accomplishes the same thing. It restricts the amount of magnesium transfer into the power plants.

First they filed for a patent. Now they’re doing more research, including seeing if the results carry over to humans.

New drugs, positive trials

For ovarian cancer

Upifitamab rilsodotin has been considered as a treatment for ovarian cancer, and now it’s showing serious promise — it passed its phase-2 trials (it’s safe and effective) and is now going into phase-3 to find the right dosage and determine just how well it works in the real world.

For leukemia

A small, early trial found that revumenib, an experimental drug, achieved complete remission in 18 patients with leukemia.

“Revumenib works by inhibiting the activity of a protein called menin, which scientists say plays an important role in certain forms of leukemia.”

(But wait. If menin sounds familiar, that’s because it’s the target of a supplement that hopes to increase menin levels — low levels have been associated with low bone mass and skin thickness, cognitive decline, and even reduced lifespan.)

Good news about long Covid

For most people now, catching Covid-19 means at worst a dose of Paxlovid and a really bad cold. The big fear isn’t Covid itself, but long Covid — brain fog and muscle aches and worse for a year or more.

Good news: It seems that catching Omicron means having a much lower risk of long Covid.

A group in the United Kingdom, Spain, and Italy reported this month in The Lancet Oncology that the risk of Long Covid among cancer patients fell from about 17% in 2021 to 6% more recently, as cases shifted to Omicron.

Is it “an intrinsic property of Omicron”? The fact that that many people have been vaccinated or exposed? They aren’t sure, and one researcher point out that low risk isn’t no risk. “ “I definitely don’t want to get the virus.”

It could be a tick bite

People with unexplained gastrointestinal issues might have been a victim of a bite from the lone star tick … months ago.

The American Gastroenterological Association is letting healthcare folks know that it’s worth checking if “unexplained digestive symptoms are due to alpha-gal syndrome” caused by the tick. (Alpha-gal syndrome essentially makes you allergic to meat from mammals — the best kind of meat.)

Clinicians should consider alpha-gal syndrome in patients with unexplained gastrointestinal symptoms of abdominal pain, diarrhea, nausea and vomiting, particularly those who live or have lived in an alpha-gal–prevalent area (this includes the Southeast, mid-Atlantic, Midwest and East Central U.S. regions)

Not creepy at all

You go to the hospital and get a routine(ish) ECG. No big whoop. But then the robotic voice of the hospital’s AI says, “You will die within 8 months. Accuracy: 85 percent.” And worse, it’s in a Canadian accent.

A research team at the University of Alberta has developed just such a system. Trained on 1.6 million ECGs done on 244,077 patients over 12+ years…

The algorithm predicted the risk of death from that point for each patient from all causes within one month, one year and five years with an 85 per cent accuracy rate, sorting patients into five categories from lowest to highest risk.

And if it has age, sex, and other lab results it’s even more accurate.

Short Takes

The feds won’t be marching in

No, the National Institute of Health won’t use the federal government’s “march-in” rights to essentially take over Astellas and Pfizer’s Xtandi patent. Xtandi is widely available and “NIH does not believe that use of the march-in authority would be an effective means of lowering the price of the drug.”

P&G gets NyQuil warning

The ingredients are supposed to be acetaminophen, dextromethorphan HBR, phenylephrine, and guaifenesin.

The ingredients on the label are acetaminophen, dextromethorphan HBR, doxylamine succinate, and phenylephrine.

The FDA is … displeased.