Careful with that low-dose aspirin

First they told us that everyone of a certain age should take a daily low-dose aspirin for cardiovascular health. Then they said that the risks (GI bleeding) outweighed the benefits for healthy people. Now there’s a new potential downside: anemia.

A group of Aussie and Yankee researchers found that…

Using low-dose aspirin was associated with a 20% increased incidence of anemia and decline in ferritin, or blood iron levels, in otherwise healthy older adults.

As there was no visible bleeding, the culprit, they think, is occult (i.e., invisible) blood loss.

Glucose, lipids, and depression

There aren’t a lot of biomarkers for depression, including major depressive disorder. That’s one of the reasons treatment can be so difficult and hit-or-miss. Chinese researchers have made an interesting breakthrough, though.

What they found is that patients with major depressive disorder — who were at higher risk for suicide — had both “abnormal levels of thyroid hormones” and “higher levels of fasting blood glucose and blood lipids.”

While the current understanding of MDD is rooted in various genetic, biological, environmental, and psychological factors, the research team posited that more subtle physiological aspects, such as thyroid function and metabolic markers, could provide a deeper understanding of the disorder and its symptoms.

They point out that there isn’t necessarily a causal connection, but they hope that finding these kinds of biomarkers can lead to new paths for treatment.

Senate tackles drug shortages … sort of

We’ve said before that there’s only so much the government can do about drug shortages while still making sure our meds are safe — you can’t push a button and eliminate ingredient shortages and force manufacturers to manufacture.

But that doesn’t stop legislators from at least making it look like they’re trying.

A bi-partisan group of senators has introduced the Pharmaceutical Supply Chain Risk Assessment Act. It essentially requires federal agencies to look into the problem and make “plans to address the issue that has been brewing for years.”

And Senator Chuck Schumer has outlined his somewhat vague solution: “‘maximizing’ drug imports, boosting domestic manufacturing, and sharing between regions.” And, of course, asking the federal government to better predict shortages “and boost incentivizes for domestic drug manufacturing.”

Says he: “If we can do these things, then the drug shortages will be a thing of the past.” Well that’s that, then. (To be fair, better sharing among regions isn’t a bad idea. But boosting incentives is already on the table.)

Easy treatment for endometriosis

A whopping 10% of women between 15 and 49 suffer from some form of endometriosis, but now Japanese researchers say they’ve found what appears to be the cause — and which leads to a simple, non-hormonal, non-surgical treatment.

It’s all about Fusobacterium bacteria. It seems that antibiotics that target just that germ reduce the endometriosis lesions big time. They started by discovering that “the [uteri] of mice infected with Fusobacterium had more and heavier lesions,” and surmised it made a good target. And they were right. Now they’re testing the targeted treatment on humans.

The state of Alzheimer’s “vaccines”

There are a bunch of Alzheimer’s treatments being developed at the moment, for use at various points in a diagnosis. (They’re referred to as “vaccines” even if they’re more like treatments.)

The goal is to give a vaccine as soon as Alzheimer’s disease is identified in a person to slow or prevent the disease’s progression. As we continue to learn more about the disease, researchers hope to identify it before the start of symptoms by monitoring various biological markers.

So who’s making what and how do they work? The folks at Healthline have the overview.

…for a given definition of counterfeit

The headline says “Wegovy maker Novo Nordisk sues spas over counterfeit drugs,” referring to medical spas and wellness clinics that are offering compounded versions of semaglutide — the main ingredient in Wegovy, Ozempic, and their kin.

Here’s the thing: If the spas claim they’re offering “Ozempic” or “Wegovy,” yeah, there’s clearly a problem there — those are brand names. But semaglutide — or, specifically, semaglutide salts — is a different story. Compounding pharmacists can buy that ingredient from the same companies that Novo does, then use their own excipients to create a drug for patients.

Is what they make “Ozempic”? Nope. But is it counterfeit? That’s a different question. (So is the question of how whether and how semaglutide salts are different from plain ol’ semaglutide, but we’ll let the chemists argue that.) And the FDA allows for compounding of drugs that are in shortage … which Ozempic certainly is.

If I build a car out of 95% Ford parts that looks and performs like a Ford … is it a Ford? Nope. But if just sell it as a “car,” is it counterfeit? Discuss amongst yourselves.

Important: If you’re thinking of compounding semaglutide, there’s a legal minefield awaiting. You’ll want to read this PDF on what the Alliance for Pharmacy Compounding has to say on the matter.

Hookworms in the medical news

Why are there two stories about using hookworms as medical treatments? No idea — let’s just call it a happy coincidence.

For inflammatory bowel disease

There are people with ulcerative colitis who self-medicate with, as you might have guessed, hookworms. They swear by them, but we all know that “the plural of anecdote is not data.” So Kiwi researchers went out and got that data.

It turns out hookworms do in fact work to manage symptoms — and they do it better than medication for one simple reason: They’re “infect and forget.” A single treatment is all they needed rather than daily or twice-daily doses of medication.

“One of the key findings from this study was that a single dose of hookworm can reside in the body for several years, if not longer. […] The worms just sit there in the background and do their thing.”

This research didn’t look into exactly how it works, but one idea is that the hookworms help ‘distract’ the immune system and keep it from overreacting.

Which leads us to the second hookworm story:

For multiple sclerosis

If hookworms can help keep the immune system in check, it makes sense that they might help a disease like multiple sclerosis. Thus some British researchers did a nine-month study of 71 patients to see how the worms might affect the brain lesions that are a hallmark of MS.

They found two effects. First, more than half the patients receiving the hookworm treatment (25 of the little buggers) showed no new brain lesions. And that might be related to the second effect: an increase in the number of regulatory T-cells, which keep the immune system from attacking the body.

[T]he presence of hookworms in the body switches off the mechanism by which the body’s immune system becomes overactive — the main cause of MS — reducing both the severity of symptoms and the number of relapses experienced by the patients.

The effects, they admit, are minor; existing MS treatments are much stronger. However, “some patients with milder disease or more inclined for natural treatments may consider this as an option.” And, of course, more research is needed.

A statin alternative does more

Using bempedoic acid as an alternative to statins isn’t new — the FDA approved it three years ago because it can lower LDL cholesterol without the muscle-pain side effects. But it turns out that bempedoic acid also has another effect: It can reduce cardiovascular events overall, especially heart attacks.

That’s the conclusion from Cleveland Clinic researchers, who studied BA’s effect on 14,000 people who were statin-intolerant.

People who took daily doses of bempedoic acid for more than three years had about a 23% lower risk of having a heart attack, in that period, compared to those taking a placebo.

That makes bempedoic acid not just a good alternative to statins, but — thanks to the lack of muscle issues — a really good alternative.

Caveat? Yep. The study was partially funded by Esperion Therapeutics, maker of the brand-name version, Nexletol. It costs $400 per month (sans insurance) compared to about $3 for something like simvastatin.

A post-stroke nose drop

Mice who’ve had a stroke have some good news: a nasal drop that can help them recover faster and more thoroughly. Swedish researchers have tested a new treatment — a molecule called C3a — that helps nerve cells recover by increasing connections among the mouse brains’ nerve cells. The mice “recover[ed] motor function faster and better after stroke compared with mice that had received nasal drops with placebo.”

The best part: It can be given even a week after the stroke. (In fact, it can’t be given too soon because it might cause dangerous inflammation.)

In a conceivable future, most stroke patients could thus be included — even those who do not reach hospital in time or who, for other reasons, are not helped by clot-dissolving drugs (thrombolysis) or mechanical clot removal (thrombectomy).

Questionable testing

…for vitamin D?

This comes out of Australia, but it might very well apply to kids here in the US. A study out of the Australian Institute of Health Innovation found that vitamin D testing in kids has skyrocketed.

We all know that having enough vitamin D is important for a host of reasons — study after study shows that it can reduce susceptibility to diseases, protect the heart and brain, and of course prevent rickets. But, the Aussies found, it’s better to simply supplement kids’ diets longer rather than subject them to unnecessary tests (unless there’s a good reason to think there’s a problem).

“GPs need more education about the latest evidence-based global guidelines, so that prevention rather than testing is their first choice, and patients get best-practice care,”

…for hormone levels?

Sure, you’re probably happy to help a patient treat a hormone deficiency, but we also bet you’d probably like to avoid giving someone unnecessary medication.

The thing is, found the Atlantic, there are a lot of people who jump to the conclusion that their hormones are out of whack. Why? One guess. It’s thanks to advice they get on (wait for it …) social media. So they turn to home test kits they buy online.

Problem: Those home tests are unreliable — the technology isn’t there yet. That doesn’t mean they’re wrong, just that they can’t be completely trusted. At best they can start a conversation with a legit healthcare professional. At worst, they can delay treatment for a real issue, or suggest (and sell) unnecessary medication.

Short Take

Semaglutide: So many body parts, so little time

“Wegovy Butt” and “Ozempic finger” have joined the list of side effects (e.g., “Ozempic face”) from semaglutide. Yay!

Georgia’s indy pharmacies will be allowed to sell cannabis oil

The Board of Pharmacy has approved a plan to allow independent pharmacies in the state to get licenses to sell cannabis oil.

No, not to anyone. These are regs “that will allow Georgia’s independent pharmacies to dispense cannabis oil to eligible patients enrolled in a registry maintained by the state Department of Public Health.”

It’s not a total surprise — the 2019 law had a provision allowing this, but it’s only now that the BoP has taken action.

But when?

Andrew Turnage, executive director of the state’s Access to Medical Cannabis Commission said “the board plans to roll out a draft application form next week that will include the proposed fee schedule. He expects the first pharmacies licensed to sell cannabis oil to begin selling the medicine in late August to early September.”

GPhA member Ira Katz, owner of Little Five Points Pharmacy, told Atlanta News first…

“Medical cannabis needs to be in the hands of independent pharmacies. So that way we can do a good job consulting with our patients. Whether it be a tincture, gummies, or soft gels, whatever the patients need.”

Fun: The story even made it to High Times magazine.

The latest anti-PBM bill

It’s been more than a week since we’ve seen an anti-PBM bill, so it’s about time. And lookee here — it’s the seventh such bill introduced in Congress. This one has the best name, though: the Patients Before Middlemen Act. (Take that, PBMs!) And like most of these, it’s bi-partisan. (Kumbaya!)

In short, it would stop PBMs from being paid based on a drug’s list price, which gave them an incentive to put the more expensive drugs in their formularies.

Eventually someone’s gonna have to roll all these bills into one lovely package, but at the moment it’s kind of a free-for-all.

CCBs? Watch your eyes

Got patients taking calcium-channel blockers? They might want to keep an eye on their eyes. It seems that “patients with a history of CCB treatment had a 23% higher likelihood of developing glaucoma as compared with individuals who never used the antihypertensives.” (That’s according to British researchers.)

On the other hand, patients taking beta blockers had a reduced risk of glaucoma thanks to “modestly reduced intraocular pressure.”

How much did your town score?

The data from the Big Opioid Settlement(s) are out, and now you can see how much your state, city, town, or village is going to be getting over the next three or so years.

For Georgia there are four numbers — two for the settlement from the drug distributors (Allergan, CVS, J&J, Teva, Walgreens, and Walmart) and two for the settlement with Janssen.

The state has promised to disclose how it’s spending its portion of the funds, but municipalities have not. Regardless, they’re required to report any spending on programs not related to the opioid crisis.

How much did your local government get? Look for the links to municipality details below.

From the distributors

$68.5 million total over three years:

• $51.4 million to state coffers
• $13 million to municipalities
• $4 million “backstop”

Municipality details are in two PDFs: distributors years 1 & 2 and distributors year 3

(Numbers are rounded, so they won’t add up perfectly. Also, “Math is hard.” —Barbie)

From Janssen

$104.7 million total over two years

• $78.6 million to state coffers
• $22.1 million to municipalities
• $4.1 million “backstop”)

Municipality details are in two PDFs: Janssen year 1 and Janssen year 2

(Numbers are rounded, so they won’t add up perfectly. Also, I might be bad at math.)

A step to understanding long Covid

We know long Covid exists (even if the list of symptoms is a bit, er, flexible), but the exact cause hasn’t been clear. Scientists at Seattle’s Allen Institute think they’ve found a big clue, though.

Remember the way to bet: It’s either inflammation or gut bacteria. In this case, it’s inflammation.

The Allen folks found that people suffering from long Covid have a particular set of skills protein molecules that persisted in their blood, but weren’t in patients who had completely recovered.

The potential good news: These protein biomarkers “point to a flavor of inflammation similar to that seen in autoimmune diseases like rheumatoid arthritis.” How is that good? Because it’s possible that JAK inhibitors, used for rheumatoid arthritis, might treat it, and no one has bothered to test them on long Covid.

As you might imagine, that’s next on the agenda, as well as narrowing down those biomarkers to create an objective long-Covid test.

Working harder, not smarter

If you take Adderall or Ritalin and you don’t have ADHD, you might be hurting your cognitive performance. So found a study out of Australia’s University of Melbourne.

It seems that taking a stimulant when you don’t need one does make you try to work harder — hello, dopamine — but “[W]e discovered that this exertion caused more erratic thinking” and didn’t increase performance.

“Our research shows drugs that are expected to improve cognitive performance in patients may actually be leading to healthy users working harder while producing a lower quality of work in a longer amount of time.”

Don’t do this, but here’s how

MIT researchers are warning that AI can be used to create new, potentially pandemic viruses — and they give instructions for how to do it.

Giving non-science students some instructions and access to ChatGPT and other AI chatbots, the preprint’s author, one Kevin Esvelt, asked them to find a way to, essentially, start a new pandemic.

After only an hour, the class came up with lists of candidate viruses, companies that could help synthesize the pathogens’ genetic code, and contract research companies that might put the pieces together.

But don’t worry. Esvelter said he tested the process himself and “it wouldn’t come up with truly threatening suggestions” so obviously other people couldn’t either.

A better, plant-based insulin

The artificial insulin most diabetics take has a drawback — it’s missing one of the three peptides found in natural insulin. That means when it’s in pill form, it’s processed in the stomach … and processed quickly. That can lead to a see-saw^* effect on blood sugar as the insulin is absorbed too quickly.

But now dental researchers at UPenn have developed a way to add human insulin genes to lettuce, so the plant’s germline is altered to produce insulin— specifically proinsulin — that contains all three of the peptides found in the natural variety.

The resulting seeds permanently retained insulin genes, and subsequently grown lettuce was freeze dried, ground, and prepared for oral delivery following FDA regulatory guidelines.

The big advantage is that the extra peptide protects the insulin so it’s absorbed in the gut rather than the stomach. That means it’s a bit slower acting and “it works just like natural insulin, which minimizes the risk of hypoglycemia.”

^* Aka “teeter-totter” or “pendulum.” Pick your metaphor.

A laxative for brain function?

Many people with mood disorders also suffer from cognitive defects. Antidepressants target serotonin, but British researchers found that (not surprisingly) “resolving mood disturbances often does not resolve cognitive symptoms.”

Here’s the interesting bit: They found that taking low doses of prucalopride — yes, the laxative — saw patients’ cognitive symptoms reduced, and the improvement even showed up in brain scans.

Apparently prucalopride helps by adjusting the connectivity between specific brain regions, increasing some (those involved in information processing) and decreasing others (those “activated during mind wandering”).

You want the heavy science? Sure thing.

Participants who received the medication displayed more functional connectivity in their resting-state (rsFC) between major cognitive networks. This included more rsFC between the central executive network, a brain network used for processing thoughts, and the posterior and anterior cingulate cortex — brain areas that regulate information processing and attention in the brain.

Bottom line: It’s worth considering prucalopride “as a pro-cognitive treatment in disorders such as depression.”

Short Takes

Now semaglutide has a stigma

People who lose weight are saying that now there’s a stigma for using drugs to do it.

Wegovy and other drugs expose a social tension between a quest to medicate illness and a stigmatizing belief that obese people lack sufficient willpower to lose weight.

Choosing the booster

An FDA advisory panel has recommended that this year’s Covid-19 booster shot focus on a single variant — XBB. “If the F.D.A. agrees, the advice would start the manufacturing of millions of shots.”

Metformin fights long Covid

Waaaaay back in 2021 we told you how diabetics who were taking metformin had a lower risk of dying from Covid-19.

Now a new study out of the University of Minnesota found that metformin can also help prevent long Covid.

Patients who had tested positive were given either metformin, ivermectin, fluvoxamine, or placebo, and only metformin showed any effect: a 39.4% lower incidence of long Covid than those who took a placebo, and it was even better if they started on the metformin sooner (a 63% lower risk).

“Without an alternative treatment of SARS-CoV-2 infection to prevent subsequent long Covid, some providers may choose to prescribe metformin to patients presenting with Covid symptoms and a positive Covid test.”

Coming to a shortage list near you

Penicillin. Yep, Pfizer reports that the OG antibiotic — at least in its Bicillin prefilled syringe forms — is going to be in shortage for at least a year.

Pfizer attributes the supply hiccup to “complex combination” of factors, including “significant” demand increases and a rise in syphilis infection rates.

The company is working to increase production, and it expects the long-acting version to be available by the mid-2024 and the combo doses in the fall of that year.

The editor would remove any good headline we came up with

The name sounds like a joke, but it’s real: The FDA has approved Futura Medical’s Eroxon as the first OTC gel for treating erectile dysfunction. Not only is “Eroxon” the winner of the Best Product Name So Far in 2023, even better, it’s over-the-counter.

The important bits: Eroxon is rubbed on where it’s needed and works in about 10 minutes — long enough to say, “Be right back, honey, lemme make sure the kids are asleep.” According to the company, it “lasts long enough for successful sex in about 65% of people and should naturally subside.” (We take note of the words “successful” and “should.”)

Eroxon sells for the equivalent of about $31 in Belgium and the UK, and it could be available in the US of A in 2025.

Don’t look so surprised

In what should be a shock to absolutely no one, when the feds outsource Medicare to private companies, it overpays for treatment. In fact, an analysis out of USC found that taxpayers overpay those private companies to the tune of $75 billion a year — much higher than the $27 billion the Medicare Payment Advisory Commission had estimated.

Why so?

First, “coding intensity”: Private companies will come up with all sorts of conditions, tests, and treatments they can bill for — much more than traditional Medicare does.

Second, “biased selection”: Medicare Advantage payment rates are based on the assumption that beneficiaries are, overall, about average when it comes to their health. But MA patients tend to be healthier, so they need much less treatment.

All this means that the government needs to continue to audit the private companies to check those diagnosis codes, and — the USC folks recommend — revisit the idea of basing Medicare Advantage rates on what those sicker fee-for-service patients pay, calling that “increasingly problematic and costly to the government.”

Short Takes

Do we get a cut of the profits?

A new study out of Harvard found that prescriptions for oral minoxidil skyrocketed after a GPhA Buzz story in August 2022 touting the off-label (but effective) use of the hair-loss drug.

The weekly rate of first-time low-dose oral minoxidil (LDOM) prescriptions per 10,000 outpatient encounters was “significantly higher 8 weeks after vs. 8 weeks before article publication.”

Repeat after me

“Cutting back on social media reduces anxiety, depression, loneliness” — this time it’s from an Iowa State study.

Facebook spies on suicide hotlines

You can promise patients anonymity all you want, but when Facebook sticks its nose in, all bets are off. The company, it seems, has been collecting data from people who visit websites connected with the national 988 suicide-prevention hotline.

Many of the sites included buttons that allowed users to directly call either 988 or a local line for mental health help. But clicking on those buttons often triggered a signal to be sent to Facebook that shared information about what a visitor clicked on. A pixel on one site sent data to Facebook on visitors who clicked a button labeled “24-Hour Crisis Line” that called local crisis services.

Another day, another vitamin D story

This time it’s about mothers and kids. Moms — well, mice moms — who are vitamin D deficient are more likely to have kids who develop diabetes sometime in their lives. That comes out of Washington University in St. Louis, where researchers think the lack of vitamin D affects the development of certain stem cells — stem cells that develop into immune cells in the babies.

Not only does that mean the offspring are more likely to develop diabetes, by the time they’re born it’s too late to fix.

“In studies of mice born to vitamin D-deficient mothers, we have found that the animals go on to develop insulin resistance and diabetes later in life. That was true even when pups were treated with adequate amounts of vitamin D after birth. Those animals improved their glucose control, but they never normalized.”

Just two days left!

You only have until 11:59 pm this coming Thursday — the day after tomorrow! — to cast your vote for members of the 2023–24 GPhA Board of Directors.

You should have received your electronic ballot from AssociationVoting to the email address GPhA has on file for you. Can’t find your ballot or have a question? Reach out to Lia Andros, GPhA’s governance manager, at (404) 419-8173 or landros@gpha.org.

Our national nightmare is over

“FDA Approves First Treatment for Constipation in Kids”

(The FDA “has expanded the indication for linaclotide to children as young as age 6 years with functional constipation, making it the first approved treatment for pediatric functional constipation. The recommended dosage in pediatric patients is 72 mcg orally once daily.”)

Hypertension and the Pill

Swedish researchers have confirmed what’s long been suspected: Oral contraceptives can raise the risk of depression, especially for teenagers. Raise by how much? For adults, about 92%. (Yes, that’s almost double the risk.) But for teens it’s “a 130% higher incidence of depression symptoms.”

Worse, the symptoms persist for teens even after they stop using the Pill.

This is based on medical records of more than a quarter of a million women “from birth to menopause.” So … yeah, pretty comprehensive. The good news is that risk is only confirmed with progestogen/estrogen pills:

“Since we only investigated combined contraceptive pills in this study, we cannot draw conclusions about other contraceptive options, such as mini pills, contraceptive patches, hormonal spirals, vaginal rings or contraceptive rods. In a future study, we plan to examine different formulations and methods of administration.”

Captain Obvious knows how time works

“Going to bed a little earlier greatly increases total sleep time for teens”

Keep the soap gentle

A new study out of the UK’s University of Sheffield found that — despite what you might think — gentle soaps are as good at killing viruses and bacteria than harsh ones.

The problem was that healthcare workers were using harsh soaps, getting contact dermatitis, and either washing less or switching to a quick dab of sanitizer — neither of which is as good as washing properly. But now it’s confirmed that you don’t need something harsh to kill SARS-CoV-2. In fact, additives designed to make the soaps less harsh didn’t affect their virus-killing ability one whit.

The one big caveat: Non-enveloped viruses like the norovirus aren’t killed by soap, harsh or otherwise. “Bleach was the only agent [that] affected the virus.” So come winter, clean those surfaces (and still wash your hands).

Oh, the other caveat? The study was funded by CeraVe, the moisturizer maker.

Short Take

Doesn’t even taste like chicken

About one in four — a quarter! — of people who contracted Covid-19 still don’t have their senses of smell and taste back at full power. (24% of patients reported only partial recovery of smell, while over 3% had no recovery at all.) The worse the initial symptoms, the less likely the sensory recovery.

Senate tackles drug pricing

This is funny: There’s a fight brewing in the Senate over drug-pricing legislation. What’s funny about that? The two political sides are handling it like adults^* — disagreeing while remaining civil — while the PBMs and pharmaceutical companies are bickering, sniping at each other, and predicting the end of the world as we know it if they don’t get what they want.

The main provisions of the bill would try to prevent pharmaceutical companies from making minor tweaks to a drugs’ chemistry in order to extend the patents, and to cap the price of insulin at $35 a month for private insurance the way it is for Medicare and Medicaid.

^* Kids, ask your parents about the Long, Long Ago when the major parties disagreed on issues, but didn’t think the Other Side was actually evil.

ICYMI: Alzheimer’s drug

An FDA advisory panel voted unanimously to recommend full approval of Eisai’s lecanemab Alzheimer’s treatment. If approved, it stands a good chance of being covered by Medicare and Medicaid, so expect costs and premiums to shoot up for both Medicare/caid and private insurance.

Eisai is charging $26,500 per year per patient for the drug, which means it would cost Medicare $17.8 billion per year if only 10% of older Alzheimer’s patients take lecanemab. Perspective: NASA’s entire budget is only $23 billion.

Twist: CMS said it would cover the drug, but only for patients whose “physician and clinical team participate in the collection of evidence about how these drugs work in the real world.” That would mean using a trial registry of some sort, which as you might imagine has caused some consternation.

This was just a committee vote; a decision from the FDA is expected by July 6.

More Part B rebates a-comin’

Drug manufacturers will have to pay rebates on 25 more drugs if they raise prices faster than the rate of inflation. That brings the total to 43 drugs covered under that section of the Inflation Reduction Act, which allows the federal government to levy fines against drug manufacturers who raise the cost of Part B drugs higher than the rate of inflation.

That means, explained HHS, that Part B patients could see lower co-pays, co-pay rebates, or both.

Alcohol cuts stress

Moderate drinking, good or bad? It’s time to spin the ol’ wheel of destiny!

[whirrrrrr click click clack]

Today’s answer, courtesy of Mass General researchers, is that, “Alcohol in moderation may lower stress-related risk of heart disease.” How? By reducing the amount of stress signalling the brain does.

Brain: Aieeeeeee!!!

Alcohol: Yo, chill.

Brain: Oh, right. Mmmmmmm.

Cardiovascular system: Whew!

That said, they’re quick to point out that no, alcohol isn’t a good method of protecting your heart because it has plenty of detrimental effects that probably outweigh any stress reduction. Instead, they hope they can mimic the calming effect through non-alcoholic chemistry.

Drug shortages at 10-year high

The latest data from the American Society of Health-System Pharmacists shows that, as the headline says, drug shortages in the US have hit a 10-year high thanks to a combination of … well, we don’t know the reason for more than half the shortages. But of the ones we do know about, demand outstripping supply is the biggest issue, followed closely by manufacturing issues (e.g., a plant in India with, shall we say, contamination problems).

The FDA has said it will relax some of its rules to allow probably-just-fine meds into the country to help ease the shortages, but there’s not much else it can do. Cheap, safe, plentiful — pick any two.

The Long Read: Joy to the World? edition

How do you measure when a medication or treatment plan is working? There are obvious signs — the infection clears, the pain stops, the bone heals — but what about patients’ happiness?

The idea of measuring not just physical recovery but the overall effect on quality of life is gaining traction, as are ways to objectively measure that.

Experts are finding that a critical missing ingredient of modern health research is the ability to objectively measure changes in happiness over the long term, including throughout peoples’ experiences with illness, diagnosis and recovery.

Non-pharma interesting medical story of the day

You don’t often find a major discovery in the world of dentistry and yet Penn researchers have done just that.

A bacteria called Streptococcus mutans causes cavities — we’ve known that forever. (Technically it’s not S. mutans, but its acidic excretions.) But now it seems it has a partner in crime: Streptococcus sputigena.

S. sputigena is no saint — it can cause gum disease — but the Penn folks found that it also “can work as a key partner of S. mutans, greatly enhancing its cavity-making power.”

So what does this mean?

The findings […] show a more complex microbial interaction than was thought to occur, and provide a better understanding of how childhood cavities develop—an understanding that could lead to better ways of preventing cavities.

An “elixir of life”?

Taurine — which is added to energy drinks and taken by coffee drinkers to keep down the caffeine jitters — might be more important than we thought. According to Columbia U researchers, it might be not only essential to healthy aging, but also “taurine supplements can slow down the aging process in worms, mice, and monkeys and can even extend the healthy lifespans of middle-aged mice by up to 12%.”

So let’s see … if you’d normally be reasonably healthy till age 80, it could give you an extra 9.6 years before you welcomed the cold embrace of death.

Hyperbole? Probably, but the lead author did say, “This study suggests that taurine could be an elixir of life within us that helps us live longer and healthier lives.”

Another breast cancer drug success

Novartis’s breast cancer drug Kisqali cut breast cancer recurrence risk by 25% — at least when it’s diagnosed early. (And it’s often caught early, too.)

This isn’t quite as good as Lilly’s similar Verzenio^*, but Kisqali has fewer side effects, and as it’s a long-term med that’s kind of important.

At this point Verzenio is approved for women at high risk of recurrence after surgery, while Kisqali is approved only for cancer that has spread. This new study might change that.

^* I could swear that’s the name of a Shakespearean character.

High-five me, Kate!

A welcoming high-five to Kate O’Reilly, who was just named senior director of development at UGA’s College of Pharmacy. Look for her signature on the letters you’ll be getting asking for money, and based on her creds you’ll have trouble saying No.

Kate will be at the Georgia Pharmacy Convention — if you see her, say hello and deliver our high-five in person — she looks like this:

Captain Obvious just uses it for the cat memes

“Have anxiety? Social media not the best source for coping advice, researchers say”

Locust brains find cancer

If you were looking for a new way to detect cancer, chances are you wouldn’t think, “What if we performed brain surgery on a locust and inserted electrodes into the brain regions that process smell and used that to detect the scent of cancer cells?”

Yeah, well, you’re not Michigan State bioengineer Debajit Saha and team, who “tapped into the odor-sensing circuitry of the locust brain to detect the scent signatures of human oral cancers.”

They wafted the gas samples—each of which contained a distinct mixture of VOCs from the corresponding cells—over the locust’s antennae and recorded the brain’s electrical activity. After pooling the results from multiple locusts, Saha’s team found that their brains produced a distinct electrical pattern for each of the different cell types. The locusts not only distinguished cancer from healthy cells but discriminated between the subtle scent fingerprints of the different oral cancers.

Short Takes

Take it easy on Monday (and maybe Sunday too)

“Serious heart attacks are more likely to happen at the start of the working week than at any other time,” according to an Northern Irish study based on an analysis of more than 10,000 patients.

The researchers found a spike in rates of STEMI [ST-segment elevation myocardial infarction] heart attacks at the start of the working week, with rates highest on a Monday. There were also higher rates of STEMI than expected on a Sunday.

RSV vax coming to infants (probably)

The FDA’s Antimicrobial Drugs Advisory Committee voted unanimously to recommend AstraZeneca/Sanofi’s mRNA RSV vaccine for infants. “The panel also voted 19-2 to recommend a second dose of the treatment to children up to age two that are prone to severe infections.”

Talkin’ scope of practice

The gathering storm

In the wake of the pandemic and its expansion of the care pharmacists can provide to patients, there’s trouble a-brewin’ between the folks who have traditionally provided those services (and been paid to do so) and the pharmacists who are finally being recognized as true healthcare providers.

Pharmacy companies in particular feel they’ve proven what they can do in a crisis. They are seeking to capitalize on that, but the evolution of their business still depends on whether or not they can get paid for it.

Axios takes a broad look at all those brewing issues — and there are plenty.

Half empty, half full

The editor of Drug Store News worries that expanding pharmacists’ scope of practice — even though it’s objectively led to better outcomes — will lead to more bickering between pharmacists and physicians, and “is only the tip of the iceberg of a larger issue that is brewing between retail pharmacy and the medical community in the United States.”

Still, the magazine’s cover story (read it here — 4-page PDF) has a more positive spin and looks at the ways physicians and pharmacists can and should work together.

Semaglutide just keeps on giving

It’s not only a diabetes drug, a weight loss drug, a floor wax, and a dessert topping, now it seems semaglutide might treat alcohol dependence.

We wrote last month about anecdotes that it cut addictive behavior like shopping, gambling, and yes, drinking. Now Swedish researchers have tested that theory hypothesis on rats. They found that “[semaglutide] significantly reduced their alcohol consumption and even reduced the drinking of alcohol in conjunction with relapses. And by “significantly” we mean in half.

Of course what works on rats might not translate to humans, but when combined with those anecdotes it seems that something is going on. More tests will, of course, be needed to suss out the details.

Covid brain fog explained

Why does long Covid cause brain fog? It’s the signature symptom of the condition, but the cause is unclear. Aussie researchers, though, might have figured it out.

SARS-CoV-2, it seems, “can infect the brain and cause brain cells to fuse together and either malfunction or stop working completely.”

Yep, you can add “Are your brain cells fused today?” to your list of insults.

As an analogy, Professor Hilliard [of the University of Queensland] likened the role of neurons to that of wires connecting switches to the lights in a kitchen and a bathroom. “Once fusion takes place, each switch either turns on both the kitchen and bathroom lights at the same time, or neither of them,” he said. “It’s bad news for the two independent circuits.”

But wait, there’s more. From a scientific point of view it adds a third possible outcome to a viral brain infection: fusion (the others are cell death and inflammation). And it also explains other symptoms like loss of smell and headaches — and why the virus can still be detected in some patients months after infection.

Boosting cancer treatment

Some cancers are resistant to immunotherapy because a patient’s T cells aren’t up to the task of destroying them. As the news is teaching us, you can give an army an order but it won’t win many battles if it’s too weak to follow it.

But what can boost that T cell army are blood-pressure drugs. One of the drugs’ mechanisms, found Ludwig Cancer Research researchers, can alert T cells of abnormalities and trigger an immune response — waking them up and giving them a boost.

[A]longside their known hypotensive and anesthetic effects, α2AR agonists can also stimulate macrophages in their role as sentinels, making T cells more reactive and more effective at rejecting cancer cells.

They don’t recommend just adding BP drugs to immunotherapy because there are issues of toxicity. Instead, this is opening a door to a better cancer treatment once more research is done.

Non-pharma (but interesting) health news

New method means more hearts for transplant

A new method of heart transplants can make more organs available — maybe as much as 30% more. It’s already in use in some places around the country, and proponents would like it to be the new standard.

Rather than waiting for donors to be brain dead and putting their hearts on ice, the new method removes life support earlier — right after cardiac death — then removes the heart and uses a machine to keep it alive while it’s being transported. By not waiting until brain death, more hearts are viable and the pool of available organs increases — and even better, there’s a higher survival rate for recipients.

Detach today, have a better tomorrow

Had a long day? A rough one? If you want tomorrow to be better, you need to unwind properly — that’s according to a study out of Germany, where unwinding isn’t exactly a way of life.

The trick, based on interviews with and diaries of 124 people over more than two years, is using psychological detachment. In other words, disconnect from work — no emails, no texting the boss, no “I’ll just work a little…”. Detach.

“The findings indicated that that psychological detachment was indirectly related to the next day wakefulness, calmness, and pleasantness via sleep quality — meaning that detaching from work was linked to better sleep quality and sleep quality was related to positive mood states.”

It’s stuff like this that keeps Gwyneth Paltrow in business

Tennis star Novak Djokovic wears a patch that he (and the manufacturer) claim boost performance as “nanocrystals emit photons towards the body providing several health benefits.”

This is the guy who claims he’s gluten intolerant because a doctor told him he had less strength when holding a piece of bread.

Hormones: Don’t swallow, rub

Taking estrogen might cause high blood pressure, but here’s the kicker: only in pill form. So found a study published by the American Heart Association of 112,000 women^* 45 and older. Given transdermally, it’s no problemo. In fact, the safest way to get it is, um, down yonder:

Oral estrogen was associated with a 14% higher risk of high blood pressure compared to transdermal estrogen creams and a 19% greater risk of high blood pressure compared to vaginal estrogen creams or suppositories.

Why so? Because the oral form is metabolized via the liver, which has an effect on blood sugar levels.

If you feel like channeling Santa from Miracle on 34th Street, you could refer your patients taking oral estrogen to a compounding pharmacist, or at least suggesting they monitor their BP.

^* “a large group of [more than]112,000 women,” as opposed to a small group of 112,000 women. Or a group of 112,000 large women.

Support Buddy at the convention!

Coming to the Georgia Pharmacy Convention? Get out your checkbooks and come to the fundraiser for Buddy Carter’s 2024 reelection campaign.

The deets:

Saturday, June 17, 2023, 2:15 – 3:15 pm Sapelo Room at the Omni Amelia Island Resort

• Sponsor $3,3,00 per person
• Friend $1,000 per person
• Attendee $250 per person

Click here for the reservation/contribution form.