Change is back (sort of)

UnitedHealth Group reports that its pharmacy systems are back online, more than three weeks since it was attacked by an unnamed foreign government.

The healthcare conglomerate expects the payment platform to be functional and begin restoring the medical claims network starting mid-March. UnitedHealth is likely to need several months to make a full recovery, according to security experts.

Colon cancer: no more probes or bottles?

There are some people, surprisingly, who don’t like either the idea of a colonoscopy or pooping into a cup. There’s good news on the horizon, though, as researchers at Seattle’s Fred Hutchinson Cancer Center have developed a blood test that’s as accurate as at-home poop-in-a-bottle tests.

Of the 7,861 people included in the report, 83.1% of those with colorectal cancer confirmed by colonoscopy had a positive blood test for circulating tumor DNA. Meanwhile 16.9% had a negative test — in which a colonoscopy indicated colorectal cancer but the ctDNA test did not.

It’s not as good as a colonoscopy, but it’s “an early effort” and could very well get more accurate over time. More importantly, it could mean a lot more people get screened and a lot more cancer gets caught early.

The company that developed it, California-based Guardant Health, says the FDA will be reviewing the pre-market application in late March. If approved, Guardant will charge $895 for the test, which will hopefully be covered by insurance.

A fond farewell…

…to Mercer College of Pharmacy’s Dean Brian Crabtree, who will be stepping aside at the end of July. He’ll be succeeded by Pamela Moye, currently a clinical professor of pharmacy practice, effective August 1.

Short takes

Put the distilled water next to the neti pots

If the risk of a brain-eating amoeba isn’t enough to keep you from putting tap water into a neti pot, how about two brain-eating amoebas^*? Yep, the CDC has confirmed that Acanthamoeba, although extremely rare, can be found in tap water — and if it gets into your nose it can eat your brain.

^* Amoebi?

Why do they even sell this stuff?

You might want to stop giving licorice to kids as a punishment. Swedish researchers have found that even a small amount can raise blood pressure. “This is mainly due to a substance called glycyrrhizic acid that affects the body’s fluid balance through effects on an enzyme in the kidney.” (Previous research suggested that it took a large amount to have the hypertensive effect.)

Insulin-making cow

A cow in Brazil has been genetically engineered to make human insulin in its milk. What makes this attempt different is that the technique only affects the DNA of the mammary tissue. Oh, and it worked:

“Our goal was to make proinsulin, purify it out to insulin, and go from there. But the cow basically processed it herself. She makes about three to one biologically active insulin to proinsulin.”

It’s still proof of concept, but the concept was proven. Next up will be to perfect the technique; this first cow couldn’t be impregnated, so they had to use hormones to induce lactation, resulting in less milk (and insulin) production.

Money quote: “The mammary gland is a magical thing.”

Tryptophan’s good side

The other day we told you how when tryptophan is broken down in the gut, it produces byproducts that can lead to arthritis.

But don’t give up on Thanksgiving turkey just yet. It turns out that tryptophan has another (good) trick up its sleeve: It can protect you from E. coli.

Apparently (found Cornell researchers) some of the metabolites it breaks down into can make it harder for E. coli to attach to the lining of the gut and cause an infection. Instead, thanks to the tryptophan, “the pathogen benignly moves through and passes out of the body.”

US maternal deaths

We all know that the maternal death rate in the US is awful, way behind other modern countries, and has been getting worse. Or do we? A group of Canadian researchers looked more closely at the data and conclude that the sky is, in fact, not falling.

In short, the National Vital Statistics System counted any death where the victim was pregnant as a maternal death. Pregnant and killed in a car accident? Maternal death. Cancer? Maternal death. It’s even worse than that; sometimes that “Pregnant” checkbox was ticked by mistake:

For example, hundreds of decedents, 70 years of age and older (including 147 women aged 85 years and older in 2013), were certified as pregnant at the time of death or in the year prior.

The good news: Recalculated, the US maternal death rate is about 10.4 per 100,000 live births — half what the NVSS reported.

The bad news: In contrast, Norway’s is 1.66. (Canada’s is 11.0 and Portugal’s is 11.8, so we’re not at the bottom of the barrel.)

The Long Read: Missing Out on Paxlovid edition

Paxlovid is far from perfect, but it’s still pretty good at keeping mild Covid from becoming not-so-mild Covid, and just as important for reducing the risk of long Covid.

So why aren’t more people using it? There’s not one answer, but lack of knowledge — by patients and pharmacists — is high on the list.

No, you won’t be seeing ADHD drugs anytime soon

It’s been 18 months since Adderall officially went into shortage, and since then other stimulants have joined the list. Bad news: “[C]linicians and advocates alike say there is no apparent end in sight.”

The good news is that there’s plenty of time for finger-pointing and plenty of places to point: manufacturers, PBMs, prescribers, the DEA, the FDA, telehealth, and of course politicians from The Other Side.

Interesting side note: The shortage primarily affects generic versions of the drugs — in several cases (Vyvance, Concerta) the branded version is available, just much costlier.

… which is too bad, because they might reduce the risk of death

Yep, people with ADHD who are on medication can have their risk of death cut by a quarter. And that’s not just from natural causes, but from unnatural causes as well, including accidents and overdoses.

To reach this conclusion, Swedish researchers (with help from US and UK colleagues) “followed nearly 150,000 Swedes aged 6-64 who were diagnosed with ADHD between 2007 and 2018.” They can’t say for certain exactly what the causal relationship is, but the connection is clear.

Considering that people with ADHD are among the brightest and most productive, it’s important to keep them alive lon—

Tryptophan might lead to arthritis

When everyone’s favorite Thanksgiving-sleepiness punching bag is broken down by gut bacteria, some of the byproducts — particularly indole — can lead to inflammation.

“We found that when indole is present, the mice start to develop autoreactive T-cells that are more inflammatory. They have less of those regulatory T-cells that help maintain balance in the immune system, and they start to develop antibodies that are more pathogenic. We found that the antibodies had flags for being more inflammatory when indole was present.”

So wrote University of Colorado researchers who made the discovery. There’s good news: Knowing that “indole generation” can lead to arthritis means it might be a therapeutic target. Even better, tryptophan is also broken down into some anti-inflammatory compounds, so blocking indole would mean two steps forward.

A coming “breakthrough” drug … based on acid

The FDA has given a breakthrough designation to Mind Medicine’s LSD-based drug, MM120. It still has to go through the whole approval process (and get its forever name), but at the moment it’s new and different enough to get the red carpet treatment.

Said one researcher, “I’ve conducted clinical research studies in psychiatry for over two decades and have seen studies of many drugs under development for the treatment of anxiety. That MM120 exhibited rapid and robust efficacy, solidly sustained for 12 weeks after a single dose, is truly remarkable.”

Quick Takes

• Aspirin used to be recommended for older people to help prevent heart disease, but those guidelines have changed. Lots of seniors are still taking it, though — people who maybe shouldn’t be — because they’re relying on outdated information.

• Leprosy is slowly making a comeback in the US, notably in the South (Florida in particular). Epidemiologists used to think it was due to interacting with armadillos, but newer cases don’t have that connection — in fact, they aren’t entirely sure why it’s becoming more common. (No, we’re not going to make a “give their right hand to find out” joke. Please. We have some dignity.)

Kids keep OD’ing on melatonin

Back in May 2023 we told you how kids were overdosing on melatonin thanks to parents being unaware of the dangers of giving them too much. (It doesn’t help that what’s on the label and what’s in the drug don’t always jibe.)

It’s bad enough when unwitting parents are overdosing their, but the OD trend is apparently being compounded by kids getting their grubby little hands on high doses of melatonin accidentally. The fact that the drug comes as gummies and without childproof packaging certainly makes that easier.

All this comes from the latest of the CDC’s Morbidity and Mortality Weekly Report, which found that a whopping 70% of kids’ visits to the ER for medication exposure was for “unsupervised melatonin ingestion.” That was about 11,000 kids from 2019 to 2022, and gummies were their preferred method of dosing.

Fun fact: Despite what 70% of primary care physicians think, melatonin is not recommended for insomnia.

RIP, Paul Alexander

Having contracted polio in 1952, he was the last person to be kept on an iron lung. He died this week at age 78.

Salt can carry folic acid (and why that’s important)

Adding minerals to table salt is an easy way to get people the nutrients they need. In 1924, the US started adding iodine to salt to help tackle iodine deficiency, which can lead to stunted intellectual development. IQs literally rose after iodized salt was introduced.

All that said, a new study (that included Emory University) found that adding folic acid to salt can reduce major birth defects, notably spina bifida and anencephaly.

In the US and a bunch of other countries we add folic acid to grain for just this reason, but other countries can’t afford to do that. This new study proved that using salt worked just as well, while being a lot cheaper.

“We proved that folic acid can get into the blood through salt. Hopefully countries that have not already implemented fortification programs can now look at their infrastructures and realize that salt fortification is cheap and it’s really easy to add in the amount of folic acid needed to save lives.”

Rural diabetes danger

For people who live in rural areas, diabetes brings a much bigger risk of end-stage kidney disease, heart failure, and heart attacks. That’s on top of already being at a higher risk of diabetes in the first place.

What’s going on? While the University of Maryland researchers say “our study didn’t address why these differences exist,” but …

“…we do know that people living outside of city areas are less likely to receive care from diabetes specialists, to receive diabetes self-management education, and to be monitored for diabetes complications.”

Twist: People in remote locations — that is, outside even small towns — seemed to have lower risks of diabetes complications like heart failure or dangerously high blood sugar.

Untwisted: The UM folks think it might be because those folks are much less likely to see a doctor or visit an ER and be diagnosed in the first place.

HB 1363 CALL TO ACTION

IT’S TIME TO REACH OUT TO YOUR STATE SENATORS.

GPhA’s bill — HB 1363, which would require Georgia’s State Health Benefit Plan to pay independent pharmacies fairly for dispensing medication^* — is headed to the Senate.

The bill passed the House unanimously, but time is running out to get it heard in the Senate and the session could end without the bill being passed.

How bad is the payment problem? Check out our flyer that explains the issue. Trigger warning: If you have an ounce of fairness in you, you’re going to be outraged.

PLEASE take a moment to click here and read the details of how you can help with a simple phone call or email. And yes, we’ve included all the info and links you need.

This is urgent — pharmacies and patients are relying on us to protect them!

^* This is obviously the broad-stroke explanation. The bill would require an actuarial study first, and it would use an index-based ingredient cost reimbursement plus a fair dispensing fee to determine payments.

Memory supplements

One of the issues with gut health is that it’s tricky to take supplements or probiotics and know if they’ll do any good. How can you help the “good” gut bacteria without also helping the “bad” stuff?

British researchers have cracked a small part of the code. They’ve found two supplements that are apparently good for the good bugs; they seem to help improve memory and cognitive function: inulin and FOS (fructooligosaccharides). And both of them are cheap and available in supplement aisles — maybe even yours.

They found the fibre supplement led to significant changes in the participants’ gut microbiome composition, particularly an increase in the numbers of beneficial bacteria such as Bifidobacterium.

While there was no significant difference in muscle strength between the groups, the group receiving the fibre supplement performed better in tests assessing brain function […] together with tests of reaction time and processing speed.

Antibiotics: a Trojan horse to kill bacteria

Bacteria secrete extracellular vesicles (EVs) — essentially a growth on the outside of the cell that acts “as a cell-to-cell communications system” carrying instructions to grow the biofilm that surrounds and protects the cell.

Now Washington State University researchers have found a way to trick the cells by creating “death EVs” that look like the real thing but actually send the message, “Yeah, you can take down that pesky biofilm now,” which is double-plus ungood for the germ.

Why yes, a Trojan horse analogy fits perfectly.

“Adding the death extracellular vesicles to the bacterial environment, we are kind of cheating the bacteria cells. The cells don’t know which type of EVs they are, but they take them up because they are used to taking them from their environment, and with that, the physiological signals inside the cells change from growth to death.”

Quick takes

• A vaccine to treat cancer in dogs— an immunotherapy developed by a Yale rheumatologist — is poised for approval by the USDA. Even better, the novel treatment could make the leap to humans.
• The Georgia Board of Public Health is holding a meeting today, March 12, to offer updates on Covid, flu, measles, and RSV, including the latest CDC isolation guidance.
• The FDA has approved adding cardiovascular benefits to the label for Wegovy, which will probably add a bunch of insurance coverage.

P3 students! Have you applied for the Jeff Lurey Independent Community Pharmacy scholarship?

There’s $5,000 up for grabs — that’s the annual award given to a P3 student pharmacist at one of Georgia’s four pharmacy schools thanks to the Jeff Lurey Independent Community Pharmacy Scholarship.

Who is eligible

• P3 students who are current GPhA members and enrolled at either Mercer, PCOM, South, or UGA’s school/college of pharmacy
• Someone who has expressed an interest in owning an independent pharmacy after graduation

What judges will consider (these aren’t requirements, just considerations)

• Have you worked in or completed a rotation in an independent pharmacy?
• Have you attended a GPhA region meeting or the Georgia Pharmacy Convention?
• Have you taken business or entrepreneurial classes?
• Do you have a family member who owns or operates an independent pharmacy?
• Are you able to attend the Georgia Pharmacy Convention to receive the award?

Applications will be judged by the AIP Executive Committee, and the final three applicants will be asked to present to the AIP Board of Directors at AIP’s Macon meeting on April 20, 2024 for final selection.

Applications are due by this Friday, March 15, 2024. (The winner will be notified by May 1 so he or she can make plans to attend the convention.)

Don’t wait! Click here to apply today!

Nothin’ but water

If you want to lower your risk of atrial fibrillation, drink only water and fruit juice … and think twice before the fruit juice. That’s the conclusion of a data review by Chinese scientists who found that more than 2 liters a week of any kind of sweetened drink “is associated with 10% increased risk of incident atrial fibrillation (AFib) compared to non-consumers.”

Sweet tea? Out. Diet Coke? Out. Coffee with sugar? Out. Water, it seems, is the only safe thing to drink because even fruit juice is loaded with sugars.

We know that sugars are bad, but how can diet drinks lead to Afib, you ask? They contain MSG and aspartame, which “are found to be excitotoxins of cardiac tissue leading to ‘lone’ atrial fibrillation.”

Side note: You probably want to avoid bottled water, too, because of all the extra nanoplastics.

The only way to be safe

The Long Read: Ransomware Rebound edition

Everyone and his mother, especially the federal government and UnitedHealth Group, is trying to A) bring UHG’s network back from the cyberattack, and 2) Get payments to the people who need them most, like small pharmacies and providers. But it ain’t easy.

Unexpected(ish) skin-gut connection

The more severe someone’s psoriasis is, the more likely they are to have some type of inflammatory bowel disease. That’s what Israeli researchers looking at the health records of 61,000 patients found. In fact, someone with psoriasis is 47% more likely to have IBD than someone without it.

More importantly, perhaps, was the connection with severity: “Patients with severe psoriasis exhibited a notably higher risk of developing IBD compared to those with mild psoriasis.”

Why? The details aren’t clear, but it’s likely because the two conditions “share common underlying inflammatory pathways.” Regardless, they say, it’s worth keeping an eye on folks with psoriasis in case they develop Crohn’s disease or ulcerative colitis.

Low iron, long Covid?

The long-Covid mystery continues, and the latest suspect is iron. Well, the lack of it. A team of researchers from Cambridge and Oxford universities found whether someone contracts long Covid seems to be determined by how quickly their iron levels recover after their infection.

People who took a longer time to demonstrate regulation, and had more severe initial infections, were at an increased risk of long Covid.

Iron levels drop during infections, but the body’s method of making more red blood cells to compensate is thwarted by Covid’s inflammation. (That also explain why long-Covid sufferers are so tired.)

Treating the inflammation might help, but iron supplements won’t: “It isn’t necessarily the case that individuals don’t have enough iron in their body, it’s just that it’s trapped in the wrong place.”

Move over, Wegovy

Why lose only 6% of your weight in a few months (and have to use an injection) when you can lose twice that with a pill, Jetsons-style? Novo Nordisk wondered the same thing, and now the company says it’s got that high-powered pill. Well, in testing. The company claims that early data show its Amycretin “helped patients in the trial drop 13% of their weight over 12 weeks” with just a daily pill that “targets two hormones involved in regulating hunger and blood sugar levels: GLP-1 and amylin.”

Of course, this was just an early trial; phase 2 testing won’t begin until later this year. It was enough to send Novo’s stock price soaring, though, and that’s what really matters.

ICYMI: Clearasil releases benzene

Independent lab (and product watchdog) Valisure says it “found high levels of benzene formed in acne products containing benzoyl peroxide,” and if you remember your 9th grade chemistry, benzene is something you want to avoid.

Valisure tested dozens of prescription and over-the-counter benzoyl peroxide products and found that they were “fundamentally unstable and can generate unacceptably high levels of benzene when handled or stored at higher temperatures.”

And by “unacceptably high,” they mean 800 times the FDA’s “conditionally restricted” concentration.

The issue isn’t with impurities or the quality of the products, but the chemistry of benzoyl peroxide itself — that fundamental instability means it breaks down into benzene. Said the company, “This means the problem broadly affects benzoyl peroxide products, both prescription and over-the-counter, and necessitates urgent action.”

40Hz is the frequency, Kenneth

“[S]ensory gamma rhythm stimulation clears amyloid in Alzheimer’s mice,” reads the headline. What it means in English is that a combo of flickering lights and clicking clicks at the right frequency — 40 Hz, aka the brain’s “gamma rhythm” — “can reduce Alzheimer’s disease (AD) progression and treat symptoms in human volunteers as well as lab mice.”

That’s not from some shady website, either: It’s from a study out of MIT that found his particular frequency had surprising beneficial effects. Why it works … well, that they’re not clear about, although they think stimulating particular neurons at 40 Hz might improve the brain’s waste-removal — specifically “promot[ing] increased amyloid clearance via the glymphatic system.”

But, as always, more research is needed.

Inhalers: the price of a deep breath

After CFCs were banned as propellants in asthma inhalers in the 1980s, drug makers used the switch to new propellants to extend their patents, especially for HFC inhalers. That means high prices for people without insurance … well, in the US anyway.

The same asthma medication for which US patients pay top dollar is available elsewhere at much cheaper prices. Consider the following case for inhalers. The pharmaceutical company Teva sells QVAR RediHaler, a corticosteroid inhaler, for $286 in the US.

In Germany, Teva sells that same inhaler for $9.

Some uninsured patients cross the border to Canada or Mexico to get , but that’s not possible for most people — they’re stuck with un- or barely-affordable asthma meds.

The good news

Following the introduction of a generic version of its Spiriva HandiHaler — and accusations by the FDA of patent shenanigans — Boehringer Ingelheim has suddenly announced that starting in June it will cap the out-of-pocket prices of its inhalers at $35 per month.

The Long Read: A different psychedelic

Low doses of ibogaine, a seriously powerful psychedelic, might be a major tool to fight opioid addiction. Lots of people around the world swear by it, but there’s one problem: It’s not legal in the US … yet.

In the United States, the renewed interest in ibogaine has largely been fueled by the thousands of Americans who have sought treatment abroad and returned home with tales about overcoming addiction after a single session. The fact that many of them are military veterans has helped ease some of the longstanding institutional resistance to psychedelic medicine.

Capitalism in play

Last month HHS made its first offer for what Medicare would pay for 10 expensive drugs. The drugmakers have now spit on the ground, implied that the offers insult the memories of their dear grandmothers, and made counteroffers that are still cuttin’ their own throats … but acceptable (barely) because HHS is a dear friend of uncle Horace.

HHS will now roll its eyes, point out that it could do better in the back alley of a Detroit street market, and respond with a counter-counteroffer that’s still way better than those nogoodniks deserve.

And so it will go.

How GLP-1 drugs really work

Old assumption: GLP-1 drugs slow down the workings of the digestive system, which is what makes people feel full — they are full.

New reality: That’s true of natural GLP-1, but the artificial stuff lasts a lot longer in the body; that’s why it’s a weekly injection and not a daily one.

By indiscriminately flooding the body with long-lasting molecules, the injections likely allow engineered GLP-1 drugs to penetrate parts of the body that the natural gut hormone cannot—namely, deep in the brain.

The brain also has GLP-1 receptors that respond to the drugs. That’s why mouse studies have shown that Ozempic and kin suppress more than the desire to eat (e.g., the desire for alcohol), something that’s echoed in anecdotes from patients who say they’ve quit addictive behaviors. As the headline says, “Ozempic Is a Brain Drug.”

Speaking of Ozempic …

Novo Nordisk says it might also slow the progression of chronic kidney disease. Those shifty Danes report that a phase 3 trial found Ozempic “[cut] the risk of death from that and major cardiac events by 24%.”

First OTC CGM

The FDA has approved the first over-the-counter continuous glucose monitor — the Dexcom Stelo Glucose Biosensor System. It uses a wearable sensor (replaced every two weeks) and a smartphone app and, well, continuously monitors their glucose levels. The company says it’ll be available this summer, but hasn’t disclosed the price.

The caveat: It’s not for people taking insulin. It’s only approved for people who have diabetes but are managing it via lifestyle changes, e.g., losing weight, exercising more, skipping the Oreos, etc.

Free Covid tests end March 9

March 8 is the last day people can ask for them — at least until the feds start the program again in the fall.

Double trouble for fatty liver

A new drug fights fatty liver disease with “a one-two punch that shuts down triglyceride production and fatty acid synthesis.”

Punch #1: The drug inhibits an enzyme called DGAT2^* that the liver needs to make triglycerides.

Punch #2: It also decreases the amount of a protein called SREBP-1^†, that regulates the expression of genes required for the liver to make fatty acids and triglycerides.

The combined effect of stemming DGAT2’s role in triglyceride synthesis and blocking SREBP-1’s role in activating genes involved in fatty acid and triglyceride synthesis stops fat from depositing in the liver, reversing MASLD [metabolic dysfunction-associated steatotic liver disease, aka nonalcoholic fatty liver disease].

The University of Texas Southwestern Medical Center folks who developed the drug are already looking at phase 3 trials “in the near future.”

^* diacylglycerol acyltransferase 2, since you asked
^† sterol regulatory element binding protein 1, of course 

Quad flu vax will probably be retired

The US will probably be switching from quadrivalent flu vaccines to trivalent ones, as it’s been four years since we’ve seen the influenza B/Yamagata virus — one of the four ‘quads.’

Not seeing that strain means there’s no point including it in the vaccine, and removing it “gives us the space to replace B/Yamagata virus with a component that will give improved protection against the circulating influenza viruses.”

Not the most well-thought-out headline, if you think about  it

“Firearm ownership is correlated with elevated lead levels in children, study finds”

Chillin’ with CBD

Marijuana can help with anxiety — insert cliché comment here — but it might not be the THC that does the job. According to Colorado University researchers, CBD alone works even better.

They split about 300 participants with anxiety into four groups, each using a product with a different combination of THC and CBD. After a month…

… all four groups reported decreased anxiety. But the cannabis groups saw greater reductions in perceived anxiety than the non-cannabis group, and those using CBD-dominant products showed the most improvement of all.

Fun fact: The research had to be done in students’ homes because federal law prohibits the possession of cannabis on college campuses, even for research.

* * *

ICYMI: Opill OTC

The first OTC contraceptive, Opill, is now shipping to retailers — drugstores, convenience stores, and supermarkets — nationwide.

Infliximab for Crohn’s — don’t wait

British researchers looking for a Crohn’s disease biomarker made a surprising finding. Newly diagnosed patients who were given infliximab showed dramatic improvement.

This is surprising because infliximab isn’t typically a first-line treatment; it’s given when patients experience flare-ups that don’t respond to other treatments. But the Brits found that it’s best not to wait. Instead, a “top-down” treatment, starting with infliximab, was a heck of a lot better.

80% of people receiving the top-down therapy had both symptoms and inflammatory markers controlled throughout the course of the entire year compared to only 15% of people receiving the accelerated step-up therapy.

Getting infliximab sooner meant fewer ulcers, “higher quality-of-life scores, less use of steroid medication, and lower number of hospitalisations” — and were less likely to need abdominal surgery.

The X-for-Y Files: TB vax and liver cancer

If you have mice with liver cancer, make sure they’ve been vaccinated for tuberculosis. Just one dose of the BCG TB vaccine reduced liver tumors and helped mice live longer.

UC Davis researchers found that the BCG treatment boosted immune T cells — notably helping them (and macrophages) get into the liver tumors. Or, turning up the science….

“It also activated the body’s immunity and enhanced IFN-γ signaling, which contributes to an anti-HCC [hepatocellular carcinoma] effect.”

As the vaccine is a century old and absolutely safe, and liver cancer is notoriously difficult to treat, this can be used right away while more research is done on improving its effectiveness.

Captain Obvious plays the kazoo

“Study finds more pleasant-sounding medical device alarms could reduce annoyance without compromising effectiveness”

The scent of therapy

Here’s an interesting finding: UC Riverside researchers found that exposing fruit flies to certain scents actually changes the expression of some of their genes.

What was even stranger was that the compound they used — diacetyl, which can add a bit of buttery flavoring to food — made these changes in cells that don’t have olfactory receptors. Next they tried it on mouse and human cells. Same thing: The odor affected gene expression.

Well, huh.

Then it gets better. They found that not only did a sniff of diacetyl affect genes, it affected them in a good way. In fruit flies…

…exposure to diacetyl volatiles substantially slowed degeneration of photoreceptor cells linked to Huntington’s disease. In transgenic mice […] gene levels that are upregulated in cancers like neuroblastoma showed a significant reduction in mice exposed to diacetyl.

This is all proof-of-concept stuff, but the idea that there’s a chance of using scents as medicine on the genetic level … well, that’s intriguing, isn’t it?

Face-palm of the day

Prepare to sigh deeply and shake your head in wonder that humanity has made it this far. There are, it seems, people on TikTok who are promoting “budget Ozempic.” That should be a red flag right there. So what are these people suggesting? Are ya ready? If you can’t afford Ozempic, just use laxatives and stool softeners instead!

Spoiler: This is a bad idea.

CONVENTION REGISTRATION IS OPEN

You got that right: It’s time to sign up for the 2024 Georgia Pharmacy Convention — June 13 to 16 on, of course, beautiful Amelia Island, Florida.

If you’ve been to the convention, you can just click here to register for this year’s extravaganza — you know you don’t want to miss out.

Never been? Get the deets about the event and why it’s the biggest one of the year: Click here to check out the convention website. Then you can register — and don’t forget to grab your hotel room or villa at the same time.

Lots of Optum/Change Healthcare news

1. Optum is rolling out a temporary loan program — sorry, “funding assistance program … to help with short-term cash flow needs.”

For clarity, this is not a program for providers who have had claims submission disruptions but rather for those whose payment distribution has been impacted.

2. The company has also set up “a new instance of Change Healthcare’s Rx ePrescribing service” — kind of a parallel version of what was taken down. “[W]e have enabled this service for all customers effective 1 p.m. CT, Friday, March 1, 2024.”

3. Hackers say they’ve extracted 6 terabytes of data from Change Healthcare “including information like medical records, insurance records, and payment information.”
4. The Justice Department is looking into the company from an anti-trust angle.
5. An opinion piece from Axios: The cyberattack against Change Healthcare isn’t just a problem for patients now, it “exposed a major vulnerability facing health care: consolidation.”

Small but mighty legislative update

Not only did one of our most important bills sail through committee, we’ve also signed on a hot new advocacy champ to help us in the state senate. Read all about it in Melissa Reybold’s latest legislative update.

Some tetanus shots about to be in shortage

The CDC is urging healthcare providers to conserve their supply of the Td vaccine (aka TdVax) for tetanus and use the Tdap vaccine instead.

The new guidance follows a recent announcement from the vaccine’s manufacturer, MassBiologics, that it would discontinue production of the shot. Grifols, the sole supplier of TdVax, anticipates running out of the vaccine by June 2024.

The good news is that the two vaxes are used interchangeably, and the Tdap also protects against pertussis.

ICYMI: Spring Covid boosters

As expected, the CDC is recommending a spring Covid-19 booster shot — but just for people 65 and older. That is all.

Another Alzheimer’s flop

First Biogen and Eisai released Aduhelm as a treatment for Alzheimer’s. But the price tag was so high and the benefit so small that it failed like a Bills’ field goal attempt.

But the companies bounced back with Leqembi — another Alzheimer’s drug that was supposed to be even better than Aduhelm.

And now that’s flopping too, as neurologists give it a big ol’ shrug. According to life sciences consultancy Spherix, “few surveyed neurologists consider Leqembi to be a significant medical advance over other historical AD treatments.”

And the people who did get it weren’t happy:

It also found that satisfaction with Leqembi “is relatively low,” with the average satisfaction rating being a full 15% lower than the typical rating for a new neurology market entrant.

If at first (and second) you don’t succeed….

Congratulations to the aorta

It’s been upgraded to a full-fledged organ, no longer just part of the heart. So say the European Association for Cardiothoracic Surgery and the US Society of Thoracic Surgeons.

Why does this make a difference? It means that aortic specialists can be a thing now, rather than a branch of cardiologists or vascular surgeons. Whether these, um, aortacists will be invited to the same golf games has yet to be determined.

The two types of prostate cancer

The headline says it: There are, it seems, two overall types of prostate cancer, according to a British AI run by scientists at two universities across the pond.

Said one of the humans taking credit:

“This study is really important because until now, we thought that prostate cancer was just one type of disease. But it is only now, with advancements in artificial intelligence, that we have been able to show that there are actually two different subtypes at play.”

At the moment this is filed under “That’s interesting,” but soon they hope it’ll lead to tailored treatments dependent on which subtype is in play.

You don’t have to put out the red light, but it might actually help your blood sugar

It might be the oddest bit of diabetes news you hear this week: “Shining a specific frequency of red light on a person’s back for 15 minutes can significantly reduce blood sugar levels.”

You read that right. And it comes from actual researchers (neurobiologists) publishing in a legit journal (the Journal of Biophotonics) from a real place (the UK).

“Explain how!” I hear you say.

It’s all about the mitochondria^*, which are affected by red light. Specifically, light in the 650-900 nm range (i.e., red through near-infrared) increases the amount of ATP the mitochondria produce “which reduces blood glucose and also improves health/lifespan in animals.”

That in mind, the Brits did a small study (30 people), shining 670 nm red light onto some and no light on others.

People who received red light exposure 45 minutes prior to drinking glucose exhibited a reduced peak blood glucose level and reduced total blood glucose during the two hours.

The interesting side note is that in the modern world with its blue light everywhere, people’s ATP production might be skewed — “the authors suggest that this may be a potential public health issue.”

^* Obligatory “the powerhouse of the cell.”

Time is running out!

Apply or nominate someone to the 2024–25 GPhA Board of Directors — the deadline is Wednesday, March 6!

You have a week to step up! Apply to join the board members and help set the direction for GPhA’s advocacy efforts, choose the issues to focus on, and create the association’s agenda. It’s a chance to make a difference to the entire pharmacy profession in Georgia.

Click here to read more about qualifications, responsibilities, and the process — then apply or nominate someone quickly!

Speeding sperm

No man wants to think his sperm are slow, but sometimes you have to confront reality: Sluggish sperm accounts for almost a third of couples’ infertility. Aussie researchers, though, think they’ve found a way to stomp on the metaphorical accelerator.

The trick? Ultrasound. High-frequency ultrasound waves, it seems, make sperm more motile.

20 seconds of ultrasound at 800 mW and 40 MHz increased measures of sperm motility by up to 266% and reduced the proportion of inactive or ‘nonprogressive’ sperm from 36% to just 10%.

[…]

“Ultrasound not only increased the swimming velocity of sperm but also promoted almost two-thirds of lower-grade sperm to a higher motility grade.”

Teens and meds

Weight loss drugs

There’s a surge of kids — teens and pre-teens — turning to the new crop of weight loss drugs. They’re dealing with the damaging effects of obesity, both physically and psychologically, and now there’s an easy(ish) treatment.

Getting kids on semaglutide, tirzepatide, or their kin has the blessing of the American Academy of Pediatrics (which still suggests starting with lifestyle changes). The AAP is primarily concerned with the health issues of obesity, and understands that genetics can play a major role. There’s been some pushback, though — mostly concerns about unknowns (will they affect growth?) and cost.

Note the transformation that occurs with a combination of GLP-1 drugs, better lighting, a clean background, a touch of makeup, clothes that fit, losing braces, and a new hairstyle.

Antidepressants

During the pandemic, girls and young women went all in on antidepressants. A new study out of the University of Michigan looked at data covering the vast majority of US prescriptions and found that…

While a growing number of young people ages 12 to 25 were receiving antidepressants before the pandemic, the antidepressant dispensing rate rose nearly 64% faster after March 2020.

And yes, it was the girls. For boys and young men the antidepressant dispensing rate “changed little” and even declined among younger boys. Why? The researchers don’t know, but they speculate that boys may have skipped more doctor’s visits during the pandemic, so they just weren’t diagnosed with depression as often.

Respiratory virus update

Covid-19 and RSV cases continues to drop, but flu just won’t go away; outpatient visits held steady nationwide. (Georgia was one of the states that saw a small decline, though.)

The next next GLP-1 drug

This one comes from Viking Therapeutics, and looks to be a biggie. Unlike others, “VK2735” is a dual agonist against both GLP-1 and GIP that also sports a longer half-life than current GLP-1 drugs.

Test results show that VK2735 helped people lose up to 14.7% of their weight after just 13 weeks, which is a lot faster than semaglutide — after 13 weeks those patients hadn’t lost even 10%. (And “Viking believes further weight loss is possible beyond Week 13.”)

The data come from a phase-2 trial, so there’s still a bit of work to do before this gets out into the public.

The Long Read: GLP-1 Coverage edition

Which insurers will cover semaglutide and tirzepatide for weight loss is still shaking out. At last check (in October 2023) only about 27% covered them, “But 13% of plan sponsors indicated they were considering coverage for weight loss.” The devil is in the details of cost, premiums, and making plans attractive. Read the details from CNBC.

The X for Y Files: brain cancer

Patients taking glitazones for cholesterol or diabetes could be seeing an extra benefit: They might lower the risk of brain cancer.

Or, put another way, glitazones “could be repurposed to prevent brain metastasis in cancer patients who are at high risk of secondary cancers.” That’s what British neuropathologists concluded after a study of more than 10,000 patients, including 7,500 with brain tumors:

The researchers found long-term glitazone drug use by diabetic patients was associated with reduced primary and secondary brain tumour risk compared with diabetic patients on other medications.

Interesting bits about the flu vaccine

October is the sweet spot

Kids tend to be vaccinated in their month they were born — that’s when they’re likely to go back for an annual checkup. And that led researchers at Harvard Med to check out how well they were protected from the flu.

Based on how many of those kids got sick, they were able to figure out that “The lowest rate of influenza diagnosis was seen for children born in October,” suggesting that October is the best month to get vaccinated.

Effectiveness fades

After about 41 days, the flu vax loses about 9% of its effectiveness every month.

That’s what Canadian researchers found based on “data from lab and health administration databases in the province [Ontario] from the 2010-11 through the 2018-19 flu seasons.”

The twist: That only applies to adults; the Canucks found the vaccine didn’t lose effectiveness in kids (i.e., people through age 17) at least up to about 153 days after vaccination.

The next big cancer treatment

CAR-T treatment was a major milestone for blood cancers, but now come tumor-infiltrating lymphocytes, or TIL — a potential Very Big Deal for solid tumors.

TIL works by taking immune cells from a patient’s tumor, beefing them up (“giving them the Club Med treatment,” as one researcher put it), then reinserting them into the tumor — kinda like the little weakling leaving the corrupt kingdom only to return as a conquering hero.

TIL isn’t new in the lab, but for the first time the FDA has given accelerated approval to a TIL therapy called Amtagvi.

Granted, the therapy isn’t simple — it involves chemo, the weakening of the immune system, and interleukin-2 — but this is just the beginning.

Drug interaction science

Which drugs might interact with one another? A lot of what we know is based on experience, but now there might be a way to determine interaction ahead of time.

It’s all about the transporter proteins that take the drugs out of the GI tract. Researchers at MIT, Brigham and Women’s Hospital, and Duke have found a way — using tissue samples and, of course, AI — to determine which transporters carry which drugs.

Identifying the transporters used by specific drugs could help to improve patient treatment because if two drugs rely on the same transporter, they can interfere with each other and should not be prescribed together.

Right now this process is pretty much in the proof-of-concept stage, but it could mean an easy way to flag interactions before they occur.

The Long Read/Elsewhere: Portugal

While the U.S. struggles to contain the opioid epidemic, Portugal took an entirely different tack. While here we turned to arrests and prison sentences, there they focused on “health care, drug treatment, job training, and housing.” And it’s working.

The contrast is striking. In the U.S., drug deaths are shatteringly common, killing roughly 112,000 people a year. In Portugal, weeks sometimes go by in the entire country without a single fatal overdose.

Here’s a comparison: Georgia, which has about the same population as Portugal, averages about 1,408 overdose deaths per year. (In 2021, more than 1,700 Georgians died of opioid-related overdoses.) Portugal sees about 80.

One word

Every single placenta tested by University of New Mexico Health Sciences researchers contained microplastics. Every. Single. One.

The researchers found the most prevalent polymer in placental tissue was polyethylene, which is used to make plastic bags and bottles. It accounted for 54% of the total plastics. Polyvinyl chloride (better known as PVC) and nylon each represented about 10% of the total, with the remainder consisting of nine other polymers.

In unrelated news, endocrine issues — including obesity, metabolic syndrome, and early puberty — have been rising steadily and concerningly over the past decades.

Quick Colorado follow-up

Just in case you’re interested: The other day we told you how Colorado’s Prescription Drug Affordability Board determined that the price of Enbrel was too high for patients to afford. Now the board has taken the next step and approved setting a price cap for the drug. Not the actual dollar amount, just the idea of a price cap.

The vote by the Prescription Drug Affordability Board kicks off a six-month process to determine what price would be appropriate for Enbrel. The board also has the option to ultimately vote against a price ceiling at the end of the process.

In case you’re somehow unaware….

UnitedHealth Group’s Change Healthcare division has been hit by a cyberattack from a “suspected nation-state associated cybersecurity threat actor” — e.g., Russia, China, or North Korea … not that we’d point fingers.

The cyberattack has thrown a wrench into the healthcare system’s operations, leaving many pharmacies unable to verify patient insurance coverage or determine copayment amounts.

And then comes the understatement of the day: “This inability to process prescriptions has caused considerable distress among pharmacists and patients alike” because pharmacies can’t verify insurance coverage or copays and thus some patients can’t get their meds.

Check out the story from Fox 5 Atlanta, featuring GPhA’s own Jonathan Marquess, VP of the Academy of Independent Pharmacy, or read the Reuters story for a bit more detail.

The X-for-Y Files: Propecia edition

Check it out, guys: The same drug that fights male-pattern baldness and enlarged prostate (finasteride, known as Propecia on the streets) also seems to reduce cholesterol, delay atherosclerosis, and lower liver inflammation.

Well, definitely in mice and probably in humans.

University of Illinois researchers noticed that men taking finasteride had cholesterol levels — 30 points lower than men not taking it. That was based on a survey, though, not a study. So off to the lab, where they tested the drug on mice. And it worked.

“Mice that were given a high dose of finasteride showed lower cholesterol levels within the plasma as well as in the arteries. There were also fewer lipids and inflammatory markers in the liver.”

Next up is a more thorough trial to prove the same effect on humans, but hopefully at a lower dose.

GLP-1 drugs are so effective…

How effective are they? So effective that Goldman Sachs thinks they’ll make workers much more efficient — enough to potentially boost the country’s GDP by a full 1% in the next few years. (“Academic studies find that obese individuals are both less likely to work and less productive when they do.”)

Elsewhere

Rocky Mountain High Prices edition

For the first time ever, a state — Colorado — has determined that a drug is officially unaffordable for patients. The drug is Enbrel, an injection that treats autoimmune diseases.

The state’s All-Payer Claims Database found Enbrel cost more than $46,000 a year per patient, with patients responsible for an average of $2,295 in 2022 if they were covered by commercial insurance or Medicare Advantage. The database found at least 3,400 people in the state used Enbrel that year.

That leaves it open for the state’s Prescription Drug Affordability Board to set a maximum price for Enbrel in Colorado, “which would be the first time any state took that step with any prescription drug” and will of course lead to months or years of court battles.

California tackles pharmacist overload

The Golden State has passed a new law “aiming to address understaffed chain pharmacies and reduce medication errors” by giving pharmacists an extra bit of clout.

The gist of the Stop Dangerous Pharmacies Act is making pharmacists in charge actually in charge. It starts by giving them the right to make staffing decisions “to ensure that the right personnel or at least enough personnel are present in the store.”

And if there aren’t enough staff (or there’s another dangerous situation)? The PiC is required to notify management, and management is required “to take immediate and reasonable steps to address these issues and resolve these conditions” within 24 hours. If that doesn’t happen, there’s a centralized reporting system for pharmacists to notify the state board.

There’s more to it, including reporting requirements for medication errors — hit the link above to read the Pharmacy Times article for the deets.

FDA: If it don’t prick, the results don’t stick

Smart watches or rings or bracelets or any other doodad that says it can monitor your glucose without a needle? No way, says the FDA — it hasn’t evaluated, let alone approved, any such device; patients can’t trust the readings.

Such devices are manufactured by dozens of companies and sold under multiple brand names. Their makers often claim the gadgets can measure blood glucose levels without requiring users to prick their skin.

The danger, of course, is that a patient would use a device like that to manage diabetes, and who know what would happen?

Long-Covid breakthroughs

Irish researchers have found what they think is the cause of long Covid’s brain fog: leaky blood vessels in the brain.

Using a new type of MRI scan, they discovered “that there was disruption to the integrity of the blood vessels in the brains of patients suffering from Long COVID and brain fog.”

Meanwhile, British researchers have found what they think is the cause of long Covid: a protein called interferon gamma (IFN-γ), that appears during an immune reaction. It usually disappears once the infection clears, “but the researchers found that high levels of IFN-γ persisted in some long Covid patients for up to 31 months.”

“Interferon gamma can be used to treat viral infections such as hepatitis C but it causes symptoms including fatigue, fever, headache, aching muscles and depression. These symptoms are all too familiar to long Covid patients. For us, that was another smoking gun.”

They aren’t sure if IFN-γ levels are the direct cause of the symptoms or a biomarker of some other process. Regardless, it’s something clear that can be tested for.

The Long Read: Empty Adderall Factory edition

Ascent Pharmaceuticals in New York makes generic Adderall, Concerta, and opioids. But the DEA, to show it was doing something about the opioid epidemic, shut the factory down because of “discrepancies” in record-keeping. Like what?

For example, orders struck from 222s [forms] must be crossed out with a line and the word cancel written next to them. Investigators found two instances in which Ascent employees had drawn the line but failed to write the word.

Horrors! Despite not a single pill going missing, the DEA shut down the plant, refusing to distinguish the ADHD-med production from opioid production. Now the company is suing, while other federal agencies are pressuring it to help ease the Adderall shortage … which it can’t.