Hepatitis cases (sort of) solved

Two separate but equally important teams of researchers in the UK have independently discovered what seems to be the cause of the mysterious hepatitis cases affecting young children around the world.

In short, the kids were infected with a common virus called adeno-associated virus 2 or AAV2. Normally it’s benign — unless it has a helper. And that’s the twist: They were infected with a helper, herpesvirus HHV6.

Normally kids would have immunity to both, but thanks to pandemic precautions, they hadn’t. Bad timing meant they were infected with them concurrently.

They believe that the infection resulting from both AAV2 and the herpesvirus HHV6 offers the best explanation for what caused the unexplained hepatitis.

Our nightmare could be coming to an end

In what could be the biggest health breakthrough of the past 50 years, University of California Riverside researchers have discovered the cause of baldness: A single protein called TGF-beta “is key to controlling when hair follicle cells divide, and when they die.”

Control over this protein and the process could be a cure. (And could also be used with stem cells to promote wound healing.)

Double Duty: Metformin edition

Metformin, it seems, can also help treat bipolar disorder. That’s not too surprising, considering that more than half of people with bipolar disorder also have insulin resistance, and metformin increases the body’s sensitivity to insulin.

In the case of this study out of Canada’s Dalhousie University, bipolar patients taking metformin improved after just 6 weeks and “remained significantly improved or in remission,” for at least 26 weeks.

An eyebrow-raising drug company saga

So biotech company Cas­sa­va Sci­ences has an Alzheimer’s drug candidate (simufilam). It got FDA approval to begin testing based on published research it conducted.

But a couple of doctors outside the company looked at that research and found … issues. They decided the company had manipulated its data, and thus were lying to various federal agencies, and the drug would never work.

They did what any red-blooded Americans would: They figured out how to make money. They shorted Cassava’s stock, then told the Wall Street Journal what they did, which piqued the Security and Exchange Commission’s interest.

Then they lawyered up and filed a petition with the FDA saying simufilam’s clinical trials should be stopped. (The FDA denied it, saying they didn’t have standing to file such a petition.) But word of the petition got out, and Cas­sa­va’s stock crashed.

And now the Justice Department is looking into the whole mess, while Cassava denies wrongdoing and the researchers who started it all say they cashed in (which Cassava, oddly, tried to paint as a “conflict on interest”).

Prophylactic news

A quick course of antivirals helps the coronavirus go down

Even if you aren’t sick, it’s a good idea to take a course of antivirals (Paxlovid or molnupiravir) if you test positive for Covid-19. Mild symptoms can turn worse, and a review out of Canada found that taking the antivirals reduced noticeably the risk of hospitalization.

A morning- (or hour-) after pill

Taking a single dose doxycycline after unprotected sex — a post-prophylactic, if you will — can help prevent common STDs (chlamydia, syphilis, and gonorrhea) that have picked up steam in recent years. The issue, suggests the Emory-led research team, is whether that risks “trigger[ing] antibiotic resistance in the three bacteria that cause these diseases.”

Score one for the old school

What’s the best way to determine someone’s risk of heart disease? It’s 2022, so using a genetic profile is certainly the most accurate way, right? Wrong.

It turns out (say Duke data scientists) that “genetic tests do little to accurately identify cardiovascular risks compared to a simple risk equation that uses basic health measures.”

So forget the new-fangled hocus-pocus, and stick with keeping an eye on blood pressure, cholesterol, and glucose.

“While genetic tests use new technology, they can be high-priced. People should instead visit their doctor and have their actual, clinical factors measured, because this will do a much better job of determining their state of health.

Omicron variant notes

It’s all BA.5 now

The subvariant now controls more than 80% of the U.S. Covid market. So if you read about something that ‘works against Omicron,’ check to see if it mentions BA.5.

For Novavax, the number of the counting shall be three

South African researchers have confirmed that three doses of the new Novavax vaccine provides protection against even the hot new Omicron subvariants.

Covid origin found

Not that it really matters at this point, but it seems the question of Covid-19’s origin has been answered. As much fun as it was to believe it escaped a Chinese lab (intentionally or not), an international team led out of the University of Arizona …

…has confirmed that live animals sold at the Huanan Seafood Wholesale Market in Wuhan, China, were the likely source of the Covid-19 pandemic.

That’s based on examinations and samples from the market as well as tracing genomic sequences of the virus from the first patients infected. The result “virtually eliminate[s] alternative scenarios that have been suggested as origins of the pandemic.”

Someone has some ’splainin’ to do

Facts:

• The past 15 years of Alzheimer’s research has been focused on the build-up of amyloid beta plaque as the cause of the disease.
• This is all based on a single 2006 paper.
• Billions of dollars have been funneled into that approach, and others have been sidelined.
• Not a single treatment targeting those plaques has worked.
• Questions are now arising about the validity of that paper’s data.

A six-month investigation by Charles Piller, an award-winning reporter for Science magazine, finds that key research published in 2006 may have included fabricated data.

Read on.

New vaccine gets the full thumbs-up

The CDC has officially approved Novavax’s Covid-19 vaccine — it’s good enough to be a “primary series option for adults ages 18 years and older.” So if people are afraid of the Pfizer or Moderna vaccines — you know, the ones that alter your DNA to be susceptible to the 5G signals that help target the Jewish Space Lasers and force you to eat processed meat — this is an option.

Actually legit studies (we checked the funding sources)

Cocoa is safe for blood pressure

Cocoa (well, the flavanols in it) can lower blood pressure and reduce arterial stiffness. That’s actually been know for a while. The new news: It only does that when BP is high or arteries are stiff, according to British researchers. That means there’s little risk of patients’ BP going too low after sneaking into the Hershey factory.

Green tea for metabolic syndrome

Taking green tea extract for just four weeks* can not only reduce blood sugar levels, it can also improve reduce GI inflammation and — perhaps most importantly, say the Ohio State nutrition researchers who ran the study — reduce the chance of “leaky gut.”

“What this tells us is that within one month we’re able to lower blood glucose in both people with metabolic syndrome and healthy people, and the lowering of blood glucose appears to be related to decreasing leaky gut and decreasing gut inflammation — regardless of health status.”

* The equivalent of five cups a day.

Pharmacists caught in the crosshairs of poorly written laws

Pro tip: If you’re going to outlaw abortion, don’t write the law in a knee-jerk way. Otherwise you end up putting pharmacists and other providers in a tricky spot, as many medications have multiple uses.

Much of the current focus is on methotrexate, an immunosuppressant used to treat some cancers and inflammatory diseases that also can cause miscarriages and is used to treat ectopic pregnancies.

It’s part of a cohort of drugs that might be classified as “abortion-inducing” by states that have banned abortion, leading to uncertainty about other uses.

And then you get into drugs like isotretinoin (aka Accutane), which “is only prescribed if patients pledge to be on two forms of birth control through a federal database, and patients must present negative pregnancy tests for refills.”

Bros gonna bro

What do you know if you’ve been convicted of fraud and banned from the pharmaceutical industry for life? If you’re Martin Shkreli (former CEO of Turing Pharma), you launch a new company called “Druglike” that “will be used to power early-stage drug discovery projects.”

But don’t worry, he’s not violating his parole. Why, the company even said it’s “not engaged in pharmaceutical research or drug development.” So that settles that.

* It uses “a novel blockchain consensus mechanism“ to “disrupt the current in silico computational chemistry software industry.”

Risky business

Out of bed you daisy head

Frequent napping, say Chinese researchers, could lead to cardiovascular problems. It “was associated with a 12% higher risk of developing high blood pressure and a 24% high risk of having a stroke compared to never napping.”

So, squeeze, Rabban. Squeeze hard.

Having a weak handgrip, Austrian researchers say, is “a powerful predictor of mortality.”

Captain Obvious knows math is hard

“Each Opioid Prescription Refill Increases Risk of Family Members’ Misuse”.

Bonus! Being cut open can apparently be painful: “Patients who undergo surgery are three times more likely to get an opioid prescription than those who do not have surgery.”

The Long Read: Enough Blame to Go Around edition

Blaming the Sackler family and Purdue Pharma for their role in the opioid crisis is a starting point. A history professor — and self-described “historian of addictive pharmaceuticals” explains, though, that it “isn’t enough on its own to fix the pharmaceutical industry’s deeper problems.”

Drugmakers script or influence the professional guidelines that encourage prescribing. They underwrite professional organizations and pay medical experts to spread the word. They fund and channel patient advocacy organizations into supporting the medicines they manufacture.

And then they lobby for legislation, regulations and anything else that can gin up more demand for their drugs.

Ask anyone who’s been on a flight to Orlando

Some headlines stand on their own: “Children really are the best contraception”.

Asthma meds: If at first you don’t succeed …

It’s worth it to try, try again. There are what, six different injectable biologic meds for people with severe cases? And those meds are not (Rutgers researchers stress) the same: “The practical takeaway here is pretty simple: Patients who aren’t getting good relief from a particular biologic should try others.”

Some 324 patients switched medications at least once during the study period — most commonly because their symptoms worsened on the first medication or because initially strong effects waned over time — and their strategy was rewarded, the researchers found. Switching medications was consistently associated with a reduction in exacerbations.

Covid vaccine news

As the fall approaches and with it likely another Covid surge, there’s one question out there: Do you need an Omicron-specific booster?

Probably not, according to a new CDC study — a regular mRNA booster should provide a nice bit of protection, at least against some Omicron subvariants. If the Omicron-specific shots aren’t out, or if a new sub-variant is spreading, it’s a good idea to boost to avoid serious illness.

Can’t trust those CBD labels

Over-the-counter CBD products aren’t exactly labeled accurately. Not only is the actual amount of CBD usually wrong, found Johns Hopkins researchers, many contain THC as well.

The bullet-list of what they found after buying more than 100 products at local stores:

• 15% didn’t bother listing the amount of CBD. Of the rest…
• Only 24% were accurately labeled.
  • 58% contained more CBD than advertised.
  • 18% contained less CBD than advertised.
• 35% of them contained THC (even some labeled “THC-free”), but all within the legal limit of 0.3%.
• 28% unlawfully made therapeutic claims on the label (e.g., ‘helps relieve pain’).

Does your jewelry just sit there?

Joining the mood ring someday could be the glucose necklace. The “smart necklace” developed by engineers at an Ohio State University monitors glucose levels using sweat (i.e., at this point you have to chase someone around the room before getting a reading).

It’s got a bit of a road to travel before it’ll be in stores, but the developers are already considering what other biomarkers it could monitor — or if it could be implanted rather than worn.

More reasons to avoid (long) Covid

You can add hair loss and erectile dysfunction to the list of 61 symptoms that seem to be common across cases of long Covid. British researchers, looking at health records of 2.4 million people also found some are more at risk.

The study suggests that females, younger people; or belonging to a black, mixed or other ethnic group are at greater risk of developing Long Covid. In addition, people from low socioeconomic backgrounds, smokers, people who are overweight or obese, as well as the presence of a wide range of health conditions were associated with reporting persistent symptoms.

If the package don’t fit, you must remit

CMS is getting ready to implement a new law that requires drug companies to refund Medicare for some unused meds.

It’s like this: Some single-use containers have too much medicati in them, meaning Medicare is paying for meds that just get thrown out. (The drug makers cannot possibly have done that deliberately.) So the Infrastructure Investment and Jobs Act has a provision:

Medicare Part B will continue to pay for discarded amounts from single-dose containers, but the manufacturer must pay a rebate (called a “refund”) to Medicare for discarded amounts above a specified threshold.

What’s interesting is that, unlike other rebate/discount programs (e.g., 340B or VA drug discount programs, or the Tricare retail refund program), these rebates are not part of an agreement between the companies and the government — this is a law.

Captain Obvious sits near the violins

Don’t stick your head into the horn of a tuba if the player has Covid-19. You’re likely to catch it, plus you’ll have your head in a tuba.

A study by engineers at Colorado State University found that when you blow into a brass instrument, shockingly, respiratory particles come flying out the business end.

What if we’re completely wrong about SSRIs?

Clinical depression is often caused by a serotonin imbalance, thus the effectiveness of SSRIs to treat it.

Or is it? British researchers, publishing in Nature, say that “Depression is probably not caused by a chemical imbalance in the brain.”

The evidence that SSRIs work (they say) is hit-or-miss, and their review of the studies found that — whether looking at serotonin receptors or transporters — there was little difference among people with depression or without it. (In fact, two studies found that lowering serotonin levels didn’t cause depression among healthy people.)

So what’s going on? They believe it’s simply health professionals repeating a mantra that isn’t supported by strong evidence, but is supported anecdotally enough to keep the practice going. But when it comes down to brass tacks, we just don’t know what’s going on.

It is important that people know that the idea that depression results from a “chemical imbalance” is hypothetical. And we do not understand what temporarily elevating serotonin or other biochemical changes produced by antidepressants do to the brain. We conclude that it is impossible to say that taking SSRI antidepressants is worthwhile, or even completely safe.

You can cross this worry off your list

“Study shows flies, roaches not likely to spread Covid-19” (from Texas A&M).

Polio comes back

What happens if you have a community of anti-vaxxers living in close proximity, and it’s 2022? Why, you get polio: The first case in the U.S. in almost a decade. Remember polio? No, no you don’t — because we eradicated it. With vaccines. So children weren’t killed or crippled.

This case was among Hasidic Jews just north of New York City, and the guy who got it is paralyzed for life. Yeah, this isn’t one of those happy-ending stories — he gets to explain to people that he’s in a wheelchair because he didn’t get a polio vaccine.

Help getting off anticholinergics

Anticholinergics have their uses, obviously, but it’s always good if you can get patients off them and onto something with fewer side effects.

So who among a patient’s healthcare team do you think might have the biggest impact? According to a study out of Purdue and Indiana universities, it’s — wait for it — pharmacists.

“[P]harmacists are well suited for the task. They are knowledgeable about medications, often have a close relationship with the patients and are well trained to communicate with providers.”

They found that, when pharmacists were coordinating the effort to wean patients off anticholinergics, prescriptions dropped 73% and “cumulative use of these drugs by as much as 70 percent.”

Cancer clues in the bloodstream

Cancer isn’t cancer isn’t cancer — they’re all different, even when affecting the same organ. So how do you choose what drug(s) to use? The answer: Trial and error, mostly.

But that’s today. Metastatic cancers shed DNA into the bloodstream — it’s called circulating tumour DNA or ctDNA. And Canadian urologic researchers say they’ve found a way to use a single drop of blood to analyze and sequence that ctDNA, to narrow down details of the cancer and “uncover critical information about a person’s overall disease and how best to manage their cancer.”

“Whereas traditional biopsies only provide a small snapshot of the disease, this new test is able to paint a more complete picture of metastases throughout the body, all from a simple and easy to perform blood test.”

Also cool: The same technique, they say, can be used if treatment stops working, to see what’s changed in the cancer and adapt the treatment.

Is that a banana in your pocket, or are you just increasing your potassium intake?

Sodium is linked to all sorts of heart issues, so it seems smart to see the effect of its arch-enemy — potassium — on a high salt diet. So that’s what Dutch researchers did.

The results have good news and bad news: Yep, “potassium-rich diets were associated with lower blood pressure” … but only in women. It’s a pretty direct correlation, too: “[A]s intake went up, blood pressure went down.”

Two other tidbits: Men can still benefit from higher potassium intake, just not as much as women. And the effect of potassium seemed to be unrelated to sodium consumption, “suggesting that potassium has other ways of protecting the heart on top of increasing sodium excretion.”

Gosh, it’s been months since we’ve seen this headline

“U.S. Drug Prices Sky-High In International Comparison.”

Important caveat: This is referring to brand-name drugs. We’re in the middle of the pack when it comes to generics.

And you can cross this off your worry list, too

Did you wake up at 3:00 am thinking, “Oh, sheesh, what if Lassa fever makes a comeback?” Good news: University of Texas researchers believe they’ve developed a working vaccine against the Lassa virus. It takes a single dose (unlike other vaccine candidates), offers 100% protection against serious disease after three days, and 100% protection from infection after a week.

Have your grain of salt handy

On the one hand, a new study (the “largest-ever study of ketamine therapy”) found that “at-home programs can improve symptoms of depression and anxiety with minimal side effects.”

89% of the participants reported improvement in their depression or anxiety symptoms, and 63% of participants experienced a greater than 50% reduction.

On the other hand, it was conducted by a company that provides … ketamine therapy.

But on the gripping hand, it was published in the respected and peer-reviewed Journal of Affective Disorders, and six of the 10 authors were not company employees.

GPhA’s 2022 Day at the Braves!

Let’s head out to the ball game! It’s Georgia Pharmacy Day at the Braves, when the Atlanta Braves take on the New York Mets, Sunday, October 2 at 1:35 p.m. — the last game of the season!

Go have a blast! Join the fun with your GPhA pharmacy friends — tickets are only $34 (plus Ticketmaster fees, of course). Click here to order yours!

Mets fans are even welcome (as long as they behave themselves).

Covid notes

Ticked off

Having had Lyme disease (or possibly anaplasmosis) increases your risk of contracting severe Covid-19.

Polish researchers found that patients with severe Covid-19 were more likely to have higher levels of antibodies targeting tick-borne bacteria, specifically Borrelia mayonii. “[I]ncreased levels of Borrelia-specific IgGs,” they said, “strongly correlated with Covid-19 severity and with the risk of hospitalization.”

Covid on ice

The Covid-19 virus can live on frozen meat or fish for at least a month. In fact, found the public-health researchers who did the study, “the viruses didn’t fare as well in refrigerated temperatures as in freezer temperatures.”

[T]heir findings are significant because SARS-CoV-2 can reproduce in the gut, not just in the respiratory tract where most people feel its effects.

The Long(ish) Read: CBD and pain

The story is old: Some traditional treatment works well, so scientists delve into TKTK and find the specific cause: Willow bark leads to acetylsalicylic acid; penicillium leads to penicillin.

Now comes CBD, which (if you believe the hype) can treat just about anything in man or beast. But let’s narrow it down to its painkilling properties … or, rather, let’s read about how two Harvard researchers are looking to find CBD’s painkilling mechanism and turn a “highly variable” substance into a useful (and non-addictive) painkiller.

Smile for the day

Sometimes you just want to throw your hands in the air

U.S. kids are getting parechovirus infections

The CDC is warning that reports of human parechovirus (PeV) are spreading in the U.S., “causing fevers, seizures, confusion and other ‘sepsis-like’ issues that can be life-threatening for young infants.” One infant has already died.

Symptoms to watch for: unexplained fever, “sepsis-like syndrome,” seizures, or those of meningitis — irritability, loss of appetite, and sleepiness. If those are present, it says, test for PeV.

Nothing to worry about

The Marburg virus has emerged in Ghana. There is no vaccine and few treatments for the relative of Ebola, which has an 88% fatality rate. Of course, the chances of a deadly virus from halfway around the world affecting the U.S. is obviously slim.

Vaccine, boost thyself

Time-release meds aren’t new, but we (that is, medical engineers) are getting better at controlling them. So what if, rather than thinking in terms of hours, we thought it terms of weeks?

MIT scientists went down that very route, and they’ve created microparticles that can be injected under the skin and act as “self-boosting vaccines.” Their breakthrough is the manufacturing technique, which uses an existing polymer called PLGA.

The particles look like microscopic coffee cups, filled with a drug and sealed with a lid:

[T]he PLGA polymers that make up the particles are gradually cleaved by water, and when enough of these polymers have broken down, the lid becomes very porous. Very soon after these pores appear, the lid breaks apart, spilling out the contents.

By adjusting the specifics of that PLGA polymer, they can change when each “cup” releases its payload.

PoxWatch™

More monkeypox is coming

So warns CDC Director Rochelle Walensky. The virus is spreading, and testing is ramping up — combined, that’s going to show a big uptick in cases.

Georgia is currently aware of 93 cases, all in metro Atlanta.

Close skin-to-skin contact, fact-to-face contact via kissing, and sharing contaminated objects are all likely the main ways the virus is spreading, she said.

Downside: “[T]esting currently requires the presence of lesions on a person.”

The vaccines are rolling out

Technically true, but in reality demand is far outstripping supply. We’ve got 7 million doses on the way … but ”on the way” means it’s still months out.

(Georgia’s DPH reports that it’s received about 3,000 doses — enough for 1,500 individuals because it’s a two-dose series.)

All this has happened before, all this will happen again

Nearly two months after the first case of monkeypox was identified in the United States, the pace of the nation’s response continues to echo mistakes made in the early days of the coronavirus outbreak. Physicians still encounter lengthy delays for test results, meaning some undiagnosed patients are unwittingly exposing others to the virus….

At least there’s treatment

Well, sort of. First, there’s paperwork.

[D]octors simply don’t have enough hours in the day to complete dozens of pages of paperwork every time they need to pry medicine out of the Strategic National Stockpile. And that’s just what has been required for a single patient.

Here’s drug in your eye

If you want to get medication in someone’s eye, you have two choices: drops (which don’t penetrate enough) or a needle (which you have to explain to the patient, wait for the screaming to end, and deal with post-injection pain).

But now a team of U.S. and Korean researchers has a better option: contact lenses with nanoneedles that deliver drugs right into the eye. It’s pain-free like drops, but still gives patients the conversation starter, “Did I tell you that I had meds injected into my eyes?”

So far they’ve only tested them on rabbits, but grad students and further human studies are in the pipeline.

Gee, thanks

The headline: “UnitedHealthcare to eliminate out-of-pocket costs on insulin and other critical drugs.”

Quietly mumbled: “…but only for group fully insured plans,” which is about a quarter of its membership. And other, smaller insurers already do this; so do some Medicare plans.

More importantly, UnitedHealth reported record profits for Q2, up 13.6% from the previous year.

Captain Obvious has it on his business card

“Experts Don’t Always Give Better Advice—They Just Give More”

Suicide hotline goes live

988.

9-8-8.

The new national crisis hotline — call it the suicide-prevention line, the crisis line, whatever you like — goes live today.

No, it’s not at 100% yet as states work out the kinks and staffing issues, but it is working. Let your patients know it’s there if they need it.

Pain killers: Exactly how it was supposed to work

In 2016, the CDC issued new opioid guidelines aimed at reducing the use of the heavy-duty meds while still treating chronic pain. The opioid crisis was in full swing, and those guidelines were supposed to help.

And guess what? They did. After that guidance, non-opioid pain prescriptions increased. And then again the next year. And again. That’s what researchers at the University of Michigan found after checking prescription records.

They found that the odds of prescribing a nonopioid pain medication in 2016 were 3% higher than expected from pre-guideline estimates for the same year. That number increased to 8% in 2017 and 9.7% in 2018.

The big takeaway is good news for chronic-pain sufferers. The numbers say that people were offered different meds, rather than being forced to take fewer meds.

Cancer culprit unmasked

Colorectal cancer numbers are rising, and the reasons aren’t clear ; it’s not just because a celebrity died from it. One reason, found Johns Hopkins researchers, might be the rise of Clostridioides difficile infections.

To oversimplify: “C. difficile brought about a range of changes within colon cells that made them vulnerable to cancer.”

Cells exposed to this bacterium turned on genes that drive cancer and turned off genes that protect against cancer. These cells produced reactive oxygen species, unstable molecules that can damage DNA, and they also prompted immune activity associated with harmful inflammation.

That’s unexpected, to say the least. And it still needs to be confirmed with, as always, further studies. But it seems to be another reason to tackle the rise of C. diff infections, especially as it becomes resistant to antibiotics.

Guys: Do you have pre-diabetes? Are you sure?

If Canadians aren’t getting screened for diabetes enough, you can bet that Americans aren’t either. And Canadians aren’t getting screened enough.

That’s especially true (say Canadian researchers) for men in their 40s — they recommend that everyone over 40 get screened for diabetes at least every three years. It’s men, though, who are more likely to have at least pre-diabetes, but who are less likely to be screened.

Drinking and cognitive decline

It’s been weeks since we’ve had an answer to the question: Is moderate drinking good or bad? Fear not — the good researchers at Oxford University have the latest answer.

[Spin the Wheel of Conflicting Study Results!]

Today it’s … bad for you. That’s right: Even moderate drinking — a glass a day — increases the iron levels in your brain* which “has been linked with Alzheimer’s and Parkinson’s diseases and is a potential mechanism for alcohol-related cognitive decline.”

* Insert “magnetic personality” joke here.

Yes, that’s how math works

If out-of-pocket insulin prices are capped for Americans, and Medicare/Medicaid has to pay whatever drug makers feel like charging, then yes — capping prices will cost taxpayers more, the Congressional Budget Office found. Think of it as government subsides for pharma-company stockholders.

Good news, sad reasons

If you aren’t sure how to feel about this, you aren’t alone: Police deaths in America were down by about 30% in the first half of 2022. Why? Fewer Covid deaths thanks to vaccine mandates. (Covid-19 was the leading cause of line-of-duty police deaths in 2021.)

The Long(ish) Read: Antibiotic Pipeline edition

Infections are growing worse as antibiotics lose their edge against new resistant variants. But pharma companies have little incentive to invest in new ones — they just don’t make enough money. That’s not going to end well.

ICYMI: New Covid vaccine gets the thumbs-up

The FDA has authorized the first new Covid vaccine in a while: Novavax’s non-mRNA shot, which is hopes will be palatable to people who don’t understand the difference between mRNA and DNA and won’t take either the Pfizer or Moderna vaccines.

If the CDC also approves the Novavax shot (after a July 19 meeting), it will be available free to patients; there are 3.2 million doses ready to be shipped. Like the others, it’s a two-dose regimen, but no booster has been tested yet.

2x(40<40)

Congrats to GPhA members AdeSubomi O. Adeyemo of Stone Mountain, now working as an epidemic intelligence service officer for the CDC, and Kevin Florence of Athens, owner of ADD Drug Store — both were named to the UGA Alumni Association’s 2022 Class of 40 Under 40!

Double Duty™

Stop a headache, lose some weight

Triptans — you know, the migraine drugs? — happen to target the serotonin 1B receptor. So what? It turns out that hitting that receptor suppresses appetite. In other word, yes, a migraine drug can help with weight loss, as University of Texas neuroscientists discovered.

After 24 days, mice given a daily dose of the drug frovatriptan lost, on average, 3.6% of their body weight, while mice not given a triptan gained an average of 5.1% of their body weight.

So why don’t people with migraines get skinnier? “Since triptans are generally prescribed for short-term use during migraines, [lead researcher Chen Liu] suspects that patients would not have noticed the longer-term impacts on appetite and weight in the past.”

Did the Aussies cure type 1 diabetes?

Probably not, but they seem excited and their discovery seems fairly important. In short, they’ve found a way to “correct faulty regulatory T-cells to better prevent the immune system from going haywire and causing diabetes.”

Fix the white blood cells and the pancreas is free to keep producing insulin. And their research on the “biological agent” they call “sRAGE” has already been duplicated by Novo Nordisk and published in the journal Diabetes.

“We’ve already started working with companies overseas to explore ways of delivering the treatment in tablet form and we’re optimistic about starting clinical trials within three years.”

The Neverending Story: The Next Chapter

No, this is never going to end, is it? It’ll be a perpetual flu season, but with the spectre of long Covid hanging over it. Ugh.

The latest: While Omicron variant BA.5 is circulating fast and evading vaccines, a new subvariant has emerged. And it’s worse.

Omicron BA.2.75 (nicknamed “Centaurus”) has appeared in at least 10 countries, including the U.S. It seems to spread faster than even BA.5, and its unusual mutations mean it may be able to evade antibodies.

If you must stress eat, eat chocolate (if you’re a rat)

Chocolate (the good, dark stuff) isn’t just good for your brain in general — or for turning that apology up to 11. It turns out that eating it can be good for reducing stress, but a particular kind: “chronic isolation stress.”

That’s because (Iranian researchers discovered) it affects the synapses in the brain’s hippocampal CA1 area. Rats in their study who got the chocolate lost weight and had more plasticity in their neurons (i.e., they were able to respond better to stress).

Will that apply to humans? TBD.

HHS confusion and consternation

Yesterday we told you how HHS had said, essentially, that pharmacists had to be careful about refusing to dispense mifepristone and misoprostol — a patient who had a miscarriage might need it, for example, and refusing it could be a civil rights violation.

But APhA is pushing back for a couple of reasons. First, it can put pharmacists between a rock and … another rock, if state law prohibits them from dispensing those drugs under any circumstance, but federal civil rights law says they can’t discriminate. (And HHS’s guidance was just that, guidance, although it does have that civil right law behind it.)

Second, APhA says, it interferes with pharmacists’ professional judgement:

The guidance also takes away a pharmacists’ professional judgment to make “determinations regarding the suitability of a prescribed medication for a patient; or advising patients about medications and how to take them.”

Of course, that unlocks a different minefield: When should a pharmacist’s judgement override a prescriber’s? (Don’t look at me. I’m just the messenger.)

When to avoid vitamin D

Vitamin D is one of Buzz’s favorite supplements. How can it help you? Let us count the ways. But there appears to be one case where vitamin D can do more harm than good (and we don’t mean overdosing on it).

Taiwanese researchers have found that “Vitamin D supplementation worsens Alzheimer’s progression” — that’s based on both animal testing and human cohorts. It can make Alzheimer’s worse, they say, and “it is likely that it increased the risk of dementia in older people.”

For younger people, though, the benefits of vitamin D are many-fold. But when the ravages of age take hold, it may be time to reconsider.

More hospitalizations, more infections

Covid ripple effect: Thanks to more and longer hospital stays by Covid-19 patients, not only did the number of hospital-acquired infections jump more than 15% from 2019 to 2020, but …

U.S. deaths from bacteria resistant to antibiotics, also known as ‘superbugs’, jumped 15% in 2020 as the drugs were widely dispensed to treat Covid-19 and fight off bacterial infections during long hospitalizations, enabling the bugs to evolve.

Nearly 30,000 Americans died during the pandemic not directly from Covid-19, but from antimicrobial-resistant infections — and “nearly 40% had acquired the infection in hospital.”

Easy pneumonia prevention

One reason for all those hospital-acquired infections? Poor dental care.

Hospital patients not getting their teeth brushed, or not brushing their teeth themselves, is believed to be a leading cause of hundreds of thousands of cases of pneumonia a year.

Part of the problem: “[T]he vast majority of the tens of thousands of nurses in hospitals have no idea that pneumonia comes from germs in the mouth.” The simple solution: Brush patients’ teeth.

Are you ready for yet more immunizations?

With Omicron BA.5 spreading and giving more people a second (or even third) round of Covid, the CDC is urging people to get a second booster if they’re eligible — and soon.

And that’s why this is the time to be sure your immunization skills are honed and ready.

Technicians: GPhA”s Immunization Delivery Training for Pharmacy Technicians (worth 6.0 hours of CE!) is coming up fast — Saturday, August 20 from 9:00 am to noon at GPhA’s World Headquarters in Sandy Springs. Click here for the details.

Pharmacists: APhA’s Pharmacy-Based Immunization Delivery certificate training program — and the 20 hours of CE you get for completing it — starts Sunday, August 21 from 8:00 am – 5:00 pm also at GPhA’s HQ. Click here for the details.

HHS advises pharmacists

Trigger warning: This is a story about abortion. Remain calm because it’s important.

To put this as briefly as possible, so we can move on to the next story: HHS is reminding pharmacies that methotrexate and misoprostol are not always used for voluntary abortions — there are important medical reasons a woman might need one.

Refusing to dispense it, HHS says, or “making determinations regarding the suitability of a prescribed medication for a patient,” might put you on the wrong side of a discrimination claim.

Narrowing down the antidepressants

Got a patient with depression? Antidepressants are hit-and-miss, and after trying half a dozen SSRIs and SNRIs, patients might be a bit … frustrated.

A bit of advice you can give: Genetic testing might make a difference. That’s what a study just published in JAMA found: For a notable number of cases, using genetics to screen out what (probably) won’t work and focus on what (probably) will can cut that frustration down.

“The results were not a slam dunk, and in fact, an important outcome of the study is that only about 15% to 20% of the patients had genes that would significantly interfere with the prescribed medication. But I think the results favoring a positive effect on treatment, although small, will encourage providers to test patients and get this genetic information.”

A new nasal spray

A year ago, the FDA approved Bayer’s Astepro nasal spray antihistamine (basically low-dose azelastine). And now the company says it’s available over the counter.

It works fast like a pill, but it’s as fun to use as a spray. It’s not a steroid, but it can be used along with one like Flonase (aka fluticasone).

Coming to your mailbox soon

12 pages of photos from the convention (and only a few of them are posed)!

Enemy of my enemy

What happens if you get both Covid and the flu? Duke University researchers decided to find out. Although the temptation must have been to use UNC fans, they instead turned to golden hamsters.

Their interesting finding: The influenza A virus “interferes with SARS-CoV-2 replication in the lung, even more than 1 week after IAV clearance.”

So yep, the flu virus prevents the Covid virus from replicating. But the reverse isn’t true — the flu virus “exhibited robust replication” with or without SARS-CoV-2.

Takeaway: There’s something about the flu virus that fights Covid. And thus — wait for it — more research is needed.

So, about BA.5…

The Omicron variant (which oughta get its own Greek letter, if you ask me) now accounts for about 65 percent of U.S. cases, according to CDC Director Rochelle Walensky.

Oooookay, you say, that’s nice.

Here’s the thing: It can “at least partially sidestep some of the immunity people may have from prior infections and vaccinations.”

“Not only is it more infectious, but your prior immunity doesn’t count for as much as it used to. And that means that the old saw that, ‘I just had Covid a month ago, and so I have Covid immunity superpowers, I’m not going to get it again’ — that no longer holds.”

Oh, and possibly the most annoying part: It has a reproduction number of 18.6 (compared to R 3.3 for the original strain), meaning one person infects an average of 18.6 others. That number is higher than measles (18.0) which until now was the world’s most virulent virus. Yay!

ADHD adherence

What are four reasons adult ADHD patients may not take their meds? The long version is published in ADDitude magazine, but here’s the short-and-sweet guide:

1. They don’t understand why they’ve been prescribed it. (Especially true when “the motivation to start medication doesn’t come from the patient, but from another adult like a spouse or employer.”
2. They don’t think it works because the dose is too low. “Ask the patient to rate the medication on a scale from one to ten. […] Anything below a six usually means that it’s time to try a different medication or dose.”
3. They have ADHD — they simply forget to take it!
4. “Unsupportive Clinician Attitudes.” ADHD meds can be maintenance meds, but not every prescriber realizes that.

So put it in while you’re cooking

“Higher frequency of adding salt to foods is associated with a higher hazard of all-cause premature mortality and lower life expectancy.”

Kiss the cook … after he eats

When you put men in the sun, they eat more. No, really.

An international group of researchers “were looking into the ways that sunlight can lead to skin cancer in mice when they noticed that the male mice seemed to grow hungrier when exposed to UV light.”

So naturally they turned to humans — and what d’ya know? They discovered “that exposure to more sunlight over the summer leads to an increase in eating — but only in men, who “consumed approximately 15% more calories during the summer.”

Why? It’s all about the ghrelin, the “hunger hormone,” which they found is produced when guys are exposed to UV radiation. Estrogen, though, interferes with the UV-to-ghrelin reaction, so sunlight doesn’t affect women.

Podcast of the week

The thymus (not the thyroid) doesn’t get a lot of press. But when you hear exactly how it trains the immune system to know “self” from “non-self” — and how close science is to making anti-rejection drugs obsolete in organ transplants — you’ll have newfound respect.

Check out RadioLab’s episode “My Thymus, Myself” from your favorite podcast app.

This is your brain on video games

People who play video games* have more efficient decision-making skills — at least in terms of motor reflexes — than non-players. And it shows in their brains.

That’s what Georgia State researchers found after an (admittedly small) study that used both observation (how fast do they react) and fMRI imaging to see what was up in their brains.

The study also notes there was no trade-off between speed and accuracy of response — the video game players were better on both measures. “This lack of speed-accuracy trade-off would indicate video game playing as a good candidate for cognitive training as it pertains to decision-making,”

* Think Call of Duty, not Minecraft