The real Covid killer

All through the pandemic, we thought it was a cytokine storm that killed patients — an overwhelming inflammation throughout the body. But when Northwestern University scientists asked their computer to look into it, a different culprit emerged: unresolved secondary bacterial pneumonia.

What the AI teased out of the data points a pretty clear finger:

• “Nearly half of patients with Covid-19 develop a secondary ventilator-associated bacterial pneumonia.”
• “Those who were cured of their secondary pneumonia were likely to live…”
• ”… while those whose pneumonia did not resolve were more likely to die.”

So the virus itself doesn’t do the killing directly, but rather causes that secondary bacterial pneumonia, which is often deadly. They hope knowing this can save lives by giving physicians a better target for treating Covid patients.

Needed: a new kind of pharmacy tech

In case you haven’t noticed, technology — especially information systems — is (are) playing a bigger role in how pharmacies run. And that means a pharmacy can’t rely on the 12-year-old wunderkind to stop by on her way home from school to fix your computer problems.

And that’s why Becker’s Hospital Review covers “The growing demand for pharmacy informatics technicians.”

Pharmacy informatics technicians […] provide “oversight and integrity of computer systems and software applications involved in pharmacy order entry, dispensing, compounding systems, automation, telehealth and digital and virtual care.”

And that’s why pharmacy techs should think about tweaking or adding to their training. Here’s what pharmacies need — your choice whether you see it as an overwhelming list, or a deep pile of opportunity (and résumé lines): experience in “predictive analysis, process improvement, budget expectations, cost containment, standardization, inventory control, governance, and automation education and training.”

Wengovy and friends

Yeah, I’m getting tired of these stories too, but GLP-1 agonists are in the news and we’re all stuck with that until a celebrity dies of some rare disease.

More than just a lifestyle drug

Novo Nordisk would love its Wegovy to be classified as having a medical benefit rather than as a ‘lifestyle drug.’ So it’s focusing on showing the heart benefits: “It doesn’t take a lot of leaps of faith to understand if you lose weight, you will have a lower risk of heart disease.”

A five-year study “to assess whether Wegovy reduces the risk of major cardiovascular events” is ending this summer, and the results could change who gets the drug … and who’s willing to pay for it.

But there’s a downside

Losing weight (when it’s healthy) is a good thing, but there’s a side effect if it happens quickly like, say, with a drug like Ozempic: hair loss. The body treats it as a major stressor, and (as one dermatologist explained), “Telogen effluvium is a diffuse shedding of hair that occurs approximately three months after a major stressor.”

The good news is that it generally goes away. The hair loss, that is, not the hair itself. But weight-loss-drug users should be prepared.

Drops could be dropped

A new eye spray just got FDA approval for dilating pupils — Eyenovia’s Mydcombi, “a fixed-dose combination of the two popular dilating meds tropicamide and phenylephrine.”

The thought is that having a chemical sprayed into your eye is more comfortable than getting drops.

All right, there’s more: It uses a much smaller dose, a much smaller overall spray (“about a fifth of the volume of a traditional eye drop”), and fewer preservatives.

The gut-Parkinson’s link

Finnish researchers have found a cause of Parkinson’s disease: a bacteria called Desulfovibrio that can be found in the gut. This could be big news — the exact cause of Parkinson’s is unknown. Until, perhaps, now.

What they found is that “The disease is primarily caused by environmental factors, that is, environmental exposure to the Desulfovibrio bacterial strains.” But not every strain — there are certain strains of Desulfovibrio that didn’t cause any issues, while the troublesome ones created larger aggregates of the alpha-synuclein protein that’s a hallmark of the disease.

And genetics? “Only a small share, or roughly 10%, of Parkinson’s disease is caused by individual genes.”

Caveat: This was only tested in C. elegans worms, but still they hope that targeting this particular bacteria could lead to “potentially alleviating and slowing the symptoms of patients with Parkinson’s disease.”

The Long Read: Skeeter Beater edition

For people who seem to be mosquito magnets, help is on the way in the form of new repellants that are safer, longer lasting, and even better than the DEET gold standard.

Short Takes

What else can they do?

Weight-loss drugs could be brought to bear against Alzheimer’s and other diseases. How? By “improving glucose utilisation and tamping down inflammation in the entire body — including the brain.”

Depression and anxiety can make long Covid worse

Anxiety and depression can cause “thinking deficits,” and people with thinking deficits are more likely to suffer from long Covid. “This perception of cognitive deficits suggests that affective issues — in this case anxiety and depression — appear to carry over into the long Covid period.”

We’ll check in in about five years

Japanese researchers say they’ve had success with a different kind of antidepressant. One of these delta opioid receptor agonists, a drug called KNT-127, had “significant anti-depressant activity, quick action, and minimal side effects.” Not surprisingly with antidepressants, they don’t know why it works.

Unexpected A1c fighter^*

Here’s a surprising potential treatment for type-2 diabetes: Cialis. Apparently (found Swedish researchers) PDE5 inhibitors like tadalafil taken daily…

… caused a clear improvement in metabolic control, based on measurements of HbA1c in blood samples. On average, the level of HbA1c fell by 2.50 mmol/mol.

This was only a pilot study, so — you know the drill: More research is needed.

And the lead researcher warns about patients reading too much into this: Self-medication with PDE5 inhibitors must never take place,” he said.

^* What, you expected some bad pun? Writing those is … difficult.

Congrats to the 2023 PharmDawgs!

A big shout-out to the UGA PharmD Class of 2023, commencing their new lives today with an average GPA of 3.5 and almost three-quarters already having secured their next steps — jobs or “other postgraduate opportunities.” Congrats, all 136 of you!

And also….

… to GPhA members William Huang and Jordan Khail (as well as Sharmon Osae and Brian Seagraves) who will be hooding the grads as part of the ancient tradition of commencement. W00t!

The new polypharmacy guide for seniors

The American Geriatrics Society has released the latest version of its AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults — the combined list of meds that older people should use with caution, use differently, or avoid altogether, “because they often present unnecessary risks for this population.”

The link above is for the news release. Click here if you want to skip right to the full paper/report.

The best message to combat Covid vax-hesitant parents

There are reasonable parents who, perhaps scared by anti-vax misinformation, are iffy about getting their kids vaccinated against Covid, especially if it might mean Bill Gates will control their minds.

The folks at the Children’s Hospital of Chicago did some research and found that some messages worked better than others to convince parents to protect their kids.

What doesn’t work: Explaining that the vaccine is “well-tolerated” and has few side effects, even when delivered by the child’s doctor or nurse. Ditto for trying to counter all the misinformation spread by anti-vaxxers.

What does work: Hearing from other parents they trust that they vaccinated their kids. And hearing…

Some of them say that they weren’t sure at first about whether the vaccine is safe for kids. But they ended up deciding that it was the best way to fight COVID-19, and the vaccination went fine. They want to keep their kids protected.

So knowing other parents struggled with the decision and ultimately decided it was important to protect their children — that’s the ticket. (And hearing that the vaccine is safe can even help after they get that message.)

Better eggs with Prozac

Have you considered giving your pet roundworms fluoxetine? You might want to — apparently SSRIs can improve the quality of their eggs and “[decrease] chromosomal abnormalities in surviving offspring by more than twofold.”

But what if you’re more of a fruit fly person? It works for them, too.

How? They aren’t 100 percent sure, but they think the cells involved in egg development use serotonin as a messenger, so they take advantage of serotonin’s hanging around longer.

Coffee for your vision

How thick are your retinal nerve fibers? If you drink coffee or tea (two to three cups of coffee or more than four cups of tea per day) it appears to increase the thickness of the macula’s nerve layer — that’s the part of the retina that handles our central (as opposed to peripheral) vision. That’s per some new research from Chinese and Australian scientists.

Thicker is better in this case: “The thinner the layer, the higher risk of neurodegeneration.” So think of coffee and tea drinking as a way to protect those nerve cells … and your vision.

Short Takes

Covid-19 deaths down

Yes, we know they’re down in general, but the big picture is that, while in 2021 Covid caused 12% of deaths in the US, in 2022 it was down to just 5.7% — and it’s undoubtedly lower this year. In raw numbers, Covid “was the underlying cause of” the deaths of 417,000 Americans in 2021, but 187,000 Americans in 2022.

Perspective: 292,000 Americans died in all of WWII.

And that’s why…

The WHO has officially declared that, after killing 7 million people around the world, the Covid-19 pandemic is no longer a public health emergency.

Alzheimer’s drug — how big a deal?

Eli Lilly announced that its experimental anti-beta-amyloid drug donanemab cleared away brain plaque while patients “showed 35% less decline in thinking skills compared to those given a dummy drug.”

This is obviously big news. It doesn’t just show a chemical benefit, but a life-changing one. Approval may come later this year or early 2024; pricing hasn’t been set.

Caveats:

• The info was only in a press release, not trial results, so experts haven’t had a chance to pore over the details.
• At least two trial participants died, likely due to the drug. Will that deter patients? Probably not, but it might affect approval.
• On that same note, similar drugs have been linked to brain damage and other nasty side effects.
• The slowing of cognitive decline was important because it’s still not clear how much of a role beta-amyloid or tau plaques actually play in the disease.

Coming up fast: Spring Cleaning with Mollie

Now’s the perfect time to look ahead and give your pharmacy business the boost it needs to thrive.

This two-part virtual course will give you the tools you need (and the enthusiasm to use them!) to know where you are and where you want to be and then take smart, actionable, realistic steps to get there.

Each part is just an hour long — and gives 1 hour of CPE credit — but it’ll pay years of dividends.

• Part 1: Where Am I, and Where Do I Want to Be? — Wednesday, May 10; 7:00 – 8:00 pm via Zoom
• Part 2: How do I Get Where I’m Going? — Wednesday, May 17; 7:00 – 8:00 pm via Zoom

Each part is just $35 for GPhA members and $45 for non-members.

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LINK IMAGE: https://www.gpha.org/springcleaning

Alzheimer’s: Beyond drugs

Go online, old man

An NYU study of 18,000 patients for up to 17 years found that, while 4.68% of participants were eventually diagnosed with dementia, “Regular internet usage was associated with approximately half the risk of dementia compared with non-regular usage. This link was found regardless of educational attainment, race-ethnicity, sex, and generation.”

… then go to sleep

A simple way to fight Alzheimer’s memory loss might be to get a good, deep sleep, at least according to UC Berkeley researchers.

Deep sleep, also known as non-REM slow-wave sleep, can act as a “cognitive reserve factor” that may increase resilience against a protein in the brain called beta-amyloid that is linked to memory loss caused by dementia.

In case that wasn’t clear, they provided this not-terribly helpful image:

Beta blockers may not make a difference

After a heart attack, the standard treatment is long-term beta blockers to prevent another. But — Swedish researchers say — that might be unnecessary as long as the patient doesn’t have heart failure.

They looked at the data for almost 44,000 people, 21% of whom weren’t prescribed beta blockers after a heart attack (i.e., the sample size was pretty darned good). Their finding:

The real time data showed that long term treatment with beta blockers wasn’t associated with improved cardiovascular outcomes during an average monitoring period of 4.5 years.

The difference was tiny:

• On beta blockers: 19% had another major heart problem
• Not on beta blockers: 22% had another major heart problem

“And after accounting for potentially influential factors […] there was no discernible difference in the rates of these events between the two groups.”

Link above is to the news story. The editorial in Heart is here (2-page PDF) and the paper itself is here (18-page PDF).

Weight-loss drugs in the news (again)

It’s a small(er) world after all

“Weight-loss drugs. There must be a new negative we can focus on,” said^* the editors of the Atlantic. “We’re supposed to be the World’s Most Depressing Magazine™.”

“I know!” said^* staff writer Sarah Zhang. “How about a story on how Ozempic can ruin a Disney vacation?”

“But Disney vacations are already nightmares if you’re over 12.”

“Yes, but Ozempic can make it worse.”

“You have our attention.”

Presenting: “Can You Have a Fun Vacation on Ozempic?”

^* Not really. Well, probably not. 

Speaking of Ozempic downsides…

Knowing the demand, makers of these drugs have set the price way, way high — and that means higher insurance premiums for employers if their plans cover the drugs.

Semaglutide — sold under the brand names Ozempic, Wegovy and Rybelsus — ranked fourth for total drug expenditures in the U.S. in 2021 at $10.7 billion, up 90% over the year before.

Some insurers have set up “gatekeeping tools” like BMI requirements or step therapy as, unlike bariatric surgery, these drugs aren’t once-and-done — they have to be paid for every month. That’s likely to be even more common as more GLP-1 drugs are approved.

Novo holds back supply

Novo Nordisk, is limiting new doses of Wegovy to existing patients — i.e., it won’t sell starter kits —“to ensure a steady supply for people already on the medication.”

Elsewhere: Drug drones to deliver

The University of Michigan’s Michigan Medicine is going to start (testing) drug delivery by drone next year, at least to patients within a 10-mile radius of one of its facilities.

The drones “will silently hover 300-feet above the ground” and lower their packages “on a tether that precisely delivers to their doorstep or balcony or other place of choice from the patient.”

Packaging mix-up with a 90-day supply

DEA delays telemed rule on controlleds

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

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

Mix it up for hypertension

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

Researchers from India and Australia found that…

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

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

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

Join in on the DPH meeting

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

What’s on the agenda:

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

Have your allergy advice ready

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

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

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

HPV vax: One dose’ll do ya

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

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

Women, stress, and Alzheimer’s

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

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

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

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

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

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

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

Fighting against Parkinson’s

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

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

An Edith Cowan researcher during the study

Short Takes

PBM bill will have to wait

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

First RSV vax approved

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

Diet pill or demon?

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

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

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

One month till convention!

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

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

Register Now!

ADHD kids are still missing out

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

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

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

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

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

Cannabis clears chemo brain fog

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

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

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

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

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

Merck was just collateral damage

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

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

Elsewhere: Aussies ban vaping

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

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

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

^* But not emus. They learned their lesson.

Fentanyl oopsie

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

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

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

Short Takes

The clouds are not our friends

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

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

Elsewhere: It’s 7,000 miles away

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

This glioblastoma treatment sounds both unreal and very satisfying

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

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

Remember the iron filling?

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

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

Poor diet, too much diabetes

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

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

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

In contrast…

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

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

Why don’t people take statins?

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

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

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

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

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

Small study suggests phages work as a last resort

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

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

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

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

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

60-second schizophrenia test

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

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

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

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

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

Short Takes

Electric bedside manner

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

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

Sleep, dementia, and dogs

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

Side note: Play with AI yourself

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

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

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

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

Not as resistant as you think

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

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

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

A carrot for antibiotics

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

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

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

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

New Covid variant causes pink eye

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

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

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

Smoking rates keep dropping

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

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

Diabetes surgery?

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

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

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

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

Coming soon to a TikTok video near you

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

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

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

Short Takes

+13

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

Maybe skip the fries

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

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

Blood thinners sans bleeding

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

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

^* polyphosphate, if you’re interested

A better weapon against pancreatic cancer

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

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

Still, the lead researcher was happy:

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

New pill beats the, um, other way

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

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

It’s expected to be available by June.

Side note

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

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

Tau blocker for Alzheimer’s

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

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

Leqembi follies

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

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

Alzheimer’s patients: That sounds grea—

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

Congress and patients: Wait, what? What registries?

CMS: Privately owned registries.

Congress: But whose — who is setting them up?

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

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

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

Congress and patients: (makes angry blubbering sound)

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

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

CMS: (hums quietly to itself)

^* Actual quote

Prostate cancer is getting worse … or is it?

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

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

Short Takes

Vampires in danger

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

Don’t get bitten by a black widow

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

How to handle a rude patient

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

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

Let me print that vaccine for you

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

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

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

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

The GPhA annual member survey is still waiting for you

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

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

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

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

Anti-PBM alliance solidifies

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

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

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

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

More reasons to take Vitamin D

…if you’re pregnant

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

…if you have allergic asthma

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

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

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

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

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

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

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

Dog eye therapy can help humans

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

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

“Stupid is as stupid does” —F. Gump

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

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

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

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

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

Short Takes

Sometimes drugs aren’t the answer

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

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

Weird science story of the week

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

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

Captain Obvious patiently awaits the McRib

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

That might be more than itchy skin

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

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

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

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

Join AEP at Monday Night Brewing

It’s back and better than ever!

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

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

With pain relief, topical is … topical

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

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

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

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

Naloxone news: Who can pay?

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

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

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

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

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

Glioblastoma breakthrough

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

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

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

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

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

Short takes

That stable mate

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

ADHD can break you

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