Danger: mysterious copycat eye drops

The FDA is warning about eye drops that are essentially copies of Bausch + Lomb’s Lumify. The packaging is suspiciously similar, and these drops could be contaminated.

The brands: FivFivGo, Rebright, and South Moon.

The South Moon eye drops were contaminated with Burkholderia cepacia complex, a group of bacteria that could result in an antibiotic-resistant infection. While Rebright testing was negative for contamination, FDA recommends consumers not use this product.

Oh, and at least two of them, despite looking like Lumify, were missing the active ingredient. And to raise your eyebrow a bit more, the agency says, “The origin of these products is currently unclear.”

And when we says they look like Lumify, we don’t mean there’s a passing resemblance:

Much ado about nothing

After all the hullaballoo about Biogen’s Aduhelm med for Alzheimer’s — did it really work? was it worth the $56,000/year price tag? — those worries are gone. Biogen has pulled it from the market.

The biotech company will focus on rolling out Leqembi, a newly approved Alzheimer’s drug it developed with Japanese drugmaker Eisai. It also plans to work on a slate of experimental treatments for the disease.

* * *

To-may-to, to-mah-to

Got a salmonella infection in your GI tract? You could of course take antibiotics, or you can slap yourself on the forehead and say, “I could have had a V8!”

Tomato juice, it seems, can kill salmonella in the gut thanks to a couple of antimicrobial peptides that destroy the bacteria’s membrane.

The researchers said they hope that when the general public, particularly children and teenagers, learns about the outcome of the study, they will want to eat and drink more tomatoes, as well as other fruits and vegetables, because they provide natural antibacterial benefits.

Yep, we’re still paying through the nose for insulin

In what is likely a shock to absolutely no one, a new report found that…

The gross price of insulin in the United States is more than nine times higher than in 33 high-income comparison nations.

What was that the pharma companies said about high prices were to pay for R&D? Insulin is 100 years old.

Ah, but what about the actual price that’s paid after rebates and kickbacks? Yeah, we’re still getting the shaft: “After estimating gross-to-net discounts for insulin, U.S. net prices remained 2.33 times those in comparison countries.”

Diabetic kidney stones: Some meds are better

Here’s an interesting twist about the connection between type-2 diabetes and kidney stones. Diabetics are more likely to get kidney stones (not news), but those who take SGLT2 inhibitors have a much lower risk (news). That’s based on a study out of Mass General of more than 716,000 adults with type-2 diabetes.

Patients who began taking SGLT2 inhibitors had a 30 percent lower risk of developing kidney stones than those taking GLP1 agonists and about a 25 percent lower risk than those taking DPP4 inhibitors. The findings were consistent across sex, race/ethnicity, history of chronic kidney disease and obesity.

So the question of which patients should take which kind of drug … it’s got a bit more nuance.

Painkiller news

The good news for Vertex Pharmaceuticals: Its experimental drug, VX-548, was safe and well-tolerated in late-stage trials for treating acute pain.

The bad news: It was no better than hydrocodone and acetaminophen.

The good news: VX-548 is not an opioid, so there’s little risk of addiction. “If approved, it could achieve annual sales of more than $5 billion, according to analysts.”

(Psst: It’s also good for patients.)

A stopped TikTok…

… is still right twice a day. In this case, the “Sleepy Girl Mocktail” that’s been making the rounds there as a sleep aid actually has some science behind it.

The drink is a combo of tart cherry juice, powdered magnesium supplement, and soda water.

Tart cherry juice contains melatonin, magnesium can help melatonin production, and the soda water makes it easier to actually drink.

You can also try hitting yourself on the head with a hammer, but that was last year’s trend.

Your non-pharma, not-creepy-at-all story

“A team of University of Wisconsin–Madison scientists has developed the first 3D-printed brain tissue that can grow and function like typical brain tissue.”

The UW team at work

Covid options are lacking

So you get Covid. Blech. If you’re not at high risk for hospitalization, you’re (technically) not eligible for Paxlovid; there’s not a lot for you to do even if the symptoms are bad. You can rest, or you can go about your life potentially putting others at risk. There’s no in-between.

Well, not in the US.

In other parts of the world there are anti-virals other than Paxlovid that cut the duration of symptoms (and contagiousness) available to the public.

Simnotrelvir, for example, is used in China and helps people recover faster, but its maker hasn’t applied for FDA approval. Ensitrelvir is available in Japan where it also shortens the duration of some symptoms and also seems to cut the risk of long Covid — that’s according to an Emory researcher, who also says it might lead to fewer “rebounds.”

Ensitrelvir is on the FDA’s fast-track approval pipeline, but there’s no way to know if or when it could be available. Meanwhile the risk of Paxlovid losing its effectiveness hangs over it all.

ICYMI: ADHD med recall

Azurity Pharmaceuticals has recalled one lot of its Zenzedi (dextroamphetamine sulfate) ADHD meds because the bottles contain carbinoxamine. Oops.

The recalled lot has the lot number F230169A and an expiration date of June 2025. Azurity said it has not received any reports of serious injury related to the medication swap.

Shout-out to the Nebraska pharmacist who noticed the problem.

A genetic test for GLP-1 effectiveness

(Ugh. That headline sounds like an academic paper. Sorry.)

Anyway, there are apparently a few reasons someone can eat too much, and according to researchers from the Mayo Clinic, the big ones are…

“Hungry gut” patients, who tend to snack between meals because food moves quickly through their digestive tract, and “hungry brain” patients, who tend to need additional calories to feel full.

(There are also “emotional eaters” and those with a slow metabolism.)

A genetic test those Mayoians developed can tell which category a patient belongs to, and that’s important: GLP-1 drugs work best with “hungry gut” patients, while “hungry brain” patients will probably do better with Qsymia.

“In our studies, if we find someone who is hungry brain-positive and put them on Qsymia, we get better [results]. And while Wegovy is $1,259 a month, you can get with a coupon Qysmia for $100 and it doesn’t have those ugly side effects.”

As one of them points out, although the test costs about $500, it can save a lot more in the long run. “‘We’re not going to solve the obesity crisis by treating 100 million people’ with drugs like Wegovy.”

Alzheimer’s transmitted (sort of) human to human

From the 1960s to the 1980s, some children were given cadaver-derived human growth hormone before it was pulled from the market because of potential contamination that led to Creutzfeldt-Jakob disease.

That contamination? Amyloid-beta protein. The same stuff that’s associated with Alzheimer’s. In fact, that contamination half a century ago didn’t just cause some patients to develop CJD. It also transmitted Alzheimer’s disease.

British researchers found this to be the case in a handful of patients who, decades later, developed Alzheimer’s. It’s disturbing because it …

… provides the first evidence of Alzheimer’s disease in living people that appears to have been medically acquired and due to transmission of the amyloid-beta protein.

To be clear, those people aren’t contagious. Still, it shows that the protein buildup that characterizes Alzheimer’s can be transferred from person to person — even if one of them is dead.

Diseases on the rise

Measles

Measles cases continue to appear in the county, and the CDC “urged vigilance among health providers across the U.S.” to watch for symptoms among their patients.

Officials have tracked seven cases of measles being brought into the country and two U.S. outbreaks with more than five cases each, the CDC said. Most cases were in young children and adolescents who had not received the measles, mumps and rubella (MMR) vaccine even though they were eligible.

As one expert pointed out, “We’re going to see more kids seriously ill, hospitalized and even die. And what’s so tragic about this, these are all preventable.”

Syphilis

Syphilis in the US is at the highest level since 1950. Whoa.

The US saw more than 207,000 cases of syphilis in 2022 — that’s up 17% from the previous year, and the infection rate (i.e., cases per 100k people) jumped 9%. More heterosexual people are getting it, and so are more newborns. Any way you look at it, it’s a problem.

The good news: The rate of new gonorrhea cases fell for the first time in a decade, and chlamydia cases remain relatively flat. Why the discrepancy? They don’t know.

Asthma

There’s more asthma showing up in teenagers in states where marijuana is legal. It’s not that the teens are smoking more (there’s mixed evidence of that) — rather that they’re being exposed to more secondhand smoke, as non-tobacco smokers are indulging a bit of weed.

Captain Obvious does his cardio

“A healthy lifestyle combined with statin use can improve life expectancy.”

Icy water for hot flashes

Women dealing with menopause might consider taking the Polar Bear Challenge. That is, swimming in cold water seems to help with a bunch of typical menopause symptoms. That’s based on a survey of more than 1,100 women by British researchers.

The findings showed that menopausal women experienced a significant improvement in anxiety (as reported by 46.9% of the women), mood swings (34.5%), low mood (31.1%) and hot flushes (30.3%) as a result of cold water swimming.

The big big caveat: The survey was online and by women who already cold-water swim, so they’re a lot more likely to report their symptoms easing. Still, you might still suggest that someone take a jump in a lake. (Perhaps with different wording, though.)

Legislative update

The 2024 Georgia legislative session is moving along, and Melissa Reybold is there. Her latest update covers two bills in particular where GPhA has a horse in the race: One concerns white bagging/brown bagging, while the other covers the idea of selling opioid antagonists via vending machines. Read the details right here.

Ketamine ain’t esketamine

Ketamine’s been in the news a lot as a potential treatment for depression, PTSD, and more. It’s not FDA-approved (yet), but its cousin esketamine is approved for treating some forms of depression.

That gets confusing, especially among lay people who don’t realize how important those extra two letters are. (Consider how you’d feel if you landed in Kansas instead of Arkansas, especially during tornado season.)

Luckily, the good folks at Medscape have a great overview of the differences between ketamine and esketamine, including how they’re delivered, what they’re approved for, and the issues popping up as clinics offer “treatment” that could be ineffective, dangerous, or somewhere in between.

While ketamine and esketamine are chemically related, they are very distinct in terms of their chemical compositions, the FDA-approved indications, dosing, and administration, as well as the level of study and data supporting their safe and effective use.

Death confusion

What’s the leading cause of death in the US? If you said “heart disease,” congrats! You’re correct … and you’re in the minority. More than half of Americans didn’t know that, either assuming it was cancer, saying they didn’t know, or picking something else like terrorism, lung disease, exposure to 5G/microchips, or Jewish Space Lasers.

That’s from a Harris poll commissioned by the American Heart Association, which, as you might imagine, is trying to raise awareness of heart disease.

Prostate cancer updates

Boosting chemo

People with advanced prostate cancer are often given chemotherapy with docetaxel, but after about six months cancer cells can become resistant. What might overcome that resistance? Dicyclomine, the treatment for irritable bowel syndrome.

Researchers at Washington State University found that dicyclomine can block a protein on cancer cells called CHRM1. Without CHRM1’s help the cancer loses its resistance, then docetaxel can get back to work.

“The effect was pretty dramatic in all the experimental models we tested. And because dicyclomine already has a clinical use, this work has immediate translational potential.”

Not only can dicyclomine help docetaxel keep working, it can also allow it to be given in lower dosages, avoiding some of the side effects of chemo.

Go big or go home

When a prostate cancer patient’s PSA suddenly jumps, that usually means it’s time for hormone treatment to lower testosterone. That’s a good idea, found UC San Francisco scientists — but don’t hold back. Hit the patient with multiple testosterone-blockers and you’ll see better results.

Compared to the prostate cancer patients who only received a single drug therapy during their year of treatment, patients who received either one or two additional drugs stayed cancer-free, with low PSA levels, for longer.

Respiratory virus season is easing

Positive tests for flu, Covid-19, and RSV are dropping, but there’s still plenty going around. (Just ask the Georgia General Assembly — if you read Melissa Reybold’s update, you know that Covid is causing legislators to reschedule meetings.)

The latest CDC data shows Georgia is still seeing high rates of respiratory illnesses (10 on a sale of 1-13) but the numbers are down from their end-of-2023 peak.

The X-for-Y Files: Cancer drug for kidney cysts

MIT and Yale researchers have found that drugs called 11beta compounds (which are being tested against cancer) also work against the kidney cysts that develop in certain kidney diseases. That’s because both tumor cells and kidney cysts are particularly susceptible^* to oxidative stress and those 11beta compounds push that stress past the breaking point.

Tumor cells and kidney cyst cells tend to produce increased levels of free radicals because of the oxidative stress they’re under. When these cells are treated with 11beta compounds, the extra oxidative stress […] pushes the cells over the edge.

The treatment actually hits the sweet spot of oxidative stress, adding enough to kill the tumor or cysts but not enough to do damage to healthy cells. “The results also suggest that in patients, treatment with 11beta compounds once every few months, or even once a year, could significantly delay disease progression.”

^* I just wanted to say that I spelled this right on my first try, which surprised me.

A smartphone-based drug patch

Imagine a world where people wore Band-Aid-sized patches on their arms that could deliver whatever meds they needed on demand via microneedles. Then imagine that med delivery could be controlled by a smartphone or computer. Need a painkiller? Boop-beep-boop and you’ve got it. Insulin? Beep-boop-beep, done.

That’s the vision researchers at UNC are working towards, with just such a patch they’ve tested on mice (with melatonin) and think “could be the next frontier in treatment of neurodegenerative disorders and neurological injuries.”

Even better, because drug delivery would be controlled by computer or smartphone, murder-mystery writers would have a field day with the possibilities of hacking someone’s device. Win-win!

Clean house, live longer

Researchers at Cold Spring National Laboratory claim they’ve found the Fountain of Youth — or, rather, that they’ve created it.

What they did was reprogram CAR-T^* cells so they attack the senescent cells in a mouse’s body. Those are the cells that have worn out and no longer replicate, instead building up like grandma’s plastic-tray collection until they interfere with normal functions and start causing inflammation.

The CSNL folks’ treatment is like clearing out grandma’s kitchen cabinets while she’s distracted with “Wheel of Fortune” reruns. But it doesn’t have to be grandma:

“If we give it to aged mice, they rejuvenate. If we give it to young mice, they age slower. No other therapy right now can do this.”

The cool thing about this technique is that T cells have a long memory, so it’s like hiring a permanent cleaning crew rather than doing a one-time scrubbing. “That single treatment can protect against conditions that commonly occur later in life, like obesity and diabetes.”

^* Yep, those are the same CAR-T cells used to fight cancer.

Congrats x 4

Three grads of the UGA College of Pharmacy had their businesses named to the university’s 2024 UGA Bulldog 100 list, “which recognizes the 100 fastest growing, alumni-owned businesses.”

So a big GPhA congrats to…

• Starr Clark ’87 and Ben Ross ’08 — Clark Drug Company, Waynesboro
• Dorris and John Hyer ’12 — King’s Hometown Pharmacy, Blairsville
• Naveed Tharwani ’11 — SynerGrx, Chamblee

And while we’re at it….

A high-five for Jill Augustine, associate professor (and director of assessment) at Mercer’s College of Pharmacy who was named a 2024 APhA – APRS fellow. Nice going!

Covid, women, and the S word

Warning: This story involves sex. If that bothers you, you might want to skip to the next one.

Ladies, here’s another reason you don’t want Covid — or worse, long Covid: It can lead to sexual dysfunction.

A study led by Boston University found that by a host of measures having Covid at any point isn’t good for your sex life. It’s not just a problem while you’re sick (obviously) but even going forward. It’s the viral gift that keeps on giving.

But long Covid is the real problem. Women who have had Covid at least once had lower sexual function than those who never had it, but at least they were still “functional^*”. Women who had long Covid, though, scored much lower on the Female Sexual Function Index.

“Covid-19 infection may be associated with impairment of both cognitive and physiological aspects of sexual function.” Just as the body and mind might take some time to get back to firing on all cylinders when it comes to work, study, and exercise, the same may apply to sex.

^* Based on “levels of desire, arousal, lubrication, and satisfaction.” 

ICYMI

Eight lots of Robitussin have been voluntarily recalled for microbial contamination. If Haleon hasn’t been in touch, the link above has the lot numbers to watch for.

Most people don’t rebound from Ozempic

The anecdotal evidence has hinted that people who take GLP-1 drugs to lose weight will start putting that weight back on as soon as they stop taking the meds. But a new study out of Epic Research found that’s not the case.

Two teams studied more than 20,000 patients who lost at least 5 lbs. (⅓ stone) on semaglutide and then stopped taking it for at least a year. The big news: “a majority (56.2%) of patients either remained around the same weight they were at when stopping the medication or continued to lose additional weight.”

Yep — they lost additional weight. Only about 18% regained the weight they had lost. The chart breaks it down:

Results for liraglutide were almost identical. This means patients might be able to use Ozempic or Wegovy to lose a chunk, then pinkie-promise to eat smart and get some exercise to keep the weight off.

Autism, anxiety and … propranolol?

Good ol’ propranolol, the blood pressure med, can also reduce anxiety for kids on the autism spectrum. Neuroscientists at the University of Missouri found this after following 69 patients over 3 years.

Compared to a placebo group, the participants who received propranolol showed significantly reduced anxiety levels at their 12-week check-up appointments while receiving the medication.

It didn’t change the other effects of autism, such as social communication skills, but reducing anxiety was pretty good on its own. It was admittedly a small study, so the authors admit, “This will need confirmation in a larger multicenter trial.”

ACA signups

Georgia is one of 12 states that saw more than a 45% increase in Obamacare-marketplace enrollments for 2024. In fact, it was the third year in a row of record enrollment thanks to the pandemic and Congress increasing subsidies for low-income patients.

This year’s big jump in particular is due to the number of people kicked off Medicaid last year as part of the post-pandemic ‘winddown’; almost a quarter of enrollees were new to the marketplaces this year.

Elsewhere/ICYMI: Pennsylvania Ave. edition

The Defense Department was a bit unhappy with what it found at the White House pharmacy back in 2018. It just released the report from its inspector general. (Link is to the news story. Click here for the report itself (PDF).)

We found that the White House Medical Unit provided a wide range of health care and pharmaceutical services to ineligible White House staff in violation of Federal law and regulation and DoD policy. Additionally, the White House Medical Unit dispensed prescription medications, including controlled substances, to ineligible White House staff.

Moms and nicotine

This might be surprising or now: Nicotine patches and e-cigarettes are safe for pregnant women. That’s the conclusion from British researchers looking at babies might be affected if mom was using one or the other to quit smoking.

They found that “Regular use of e-cigarettes or nicotine patches by pregnant smokers does not appear to be associated with any adverse outcomes.” The was no notable difference in low birth weight, birth defects, miscarriages, or really any other measure compared to non-vapers. Not surprisingly, both had much better outcomes than smokers.

The class is filling

As of this writing, there are still some seats left for the February 25 session of APhA’s Pharmacy-Based Immunization Delivery: A Certificate Program for Pharmacists at the GPhA World Headquarters in Sandy Springs.

This is the nation’s 800-lb (363 kg) gorilla of immunization training — the best course you can get, and one that gives you 20 hours of CE credit, a spiffy certificate for your wall, and the impressive line on your CV.

The whole shebang is just $349 for GPhA members ($499 for non-members).

Note: This is always a popular course, so the sooner you sign up the lower your risk of being left out and laughed at behind your back.

J&J settles state suits

Some 42 states (plus DC) had sued Johnson & Johnson, claiming the company had misled consumers about the safety of its baby powder. The company has finally reached a (tentative) agreement to settle them all in one fell swoop for about $700 million.

The bad news for J&J is that it had only set aside $400 million for these suits, so it’s going to have to dig a little lot deeper to pay for this. The other bad news is that there are still billions in civil suits pending against the company.

The sort-of good news is that a court has already thrown out one civil verdict against the company because the plaintiffs’ witnesses used “junk science.” Those were popular witnesses for plaintiffs, and they won’t be showing up again.

More multivitamin goodness

Multivitamins are good for the brain.
Multivitamins are good for the brain.
Multivitamins are good for the brain.

That is, a third study has confirmed that multivitamins have “a statistically significant benefit” on older folks’ cognition and memory.

This meta-analysis, done by Mass General Brigham researchers, went a step further than previous ones by including in-person assessments like cognitive tests (“Who was Fred Flintstone’s wife?”). With those previous studies, more than 5,000 participants were included, so it’s pretty conclusive evidence.

[I]nvestigators observed a modest benefit for the multivitamin, compared to placebo, on global cognition over two years. There was a statistically significant benefit of multivitamin supplementation for change in episodic memory, but not in executive function/attention.

What’s still up in the air is exactly how multivitamins have their effect. By definition they include a bunch of minerals, so which of them make a difference — well, that’s for another study to figure out.

The Long Read: Vaccine Quirkiness edition

Here are some odd numbers: Per CDC data, as of January 6….

• 46.7% of Americans aged 18 and older have gotten their flu shot
• 73% of people 65 and older have done

But

• Only 21.5% adults have gotten the latest Covid vaccine, and
• Only 41% of seniors have

What the heck? You would people to either get both or get neither; they’re often given at the same time, after all. So why the weird discrepancy, especially when even mild Covid-19 can cause nasty long-term effects?

It’s actually a bunch of factors. Read on.

The next microbiome

You get a microbiome! You get a microbiome! Everything gets a microbiome! Yes, even you, semen, and yours can affect the quality of the sperm you’re protecting.

UCLA researchers …

…found that one microbe in particular, Lactobacillus iners, may have a direct negative impact on male fertility. Researchers found that men with more of this microbe were more likely to have issues with sperm motility.

What they’re hoping is that this might open an avenue for treating some forms of infertility, but of course more research is needed.

Rent-a-Cancer-Test

Jumping onto the “you don’t own it, you just subscribe to it” culture is DermaSensor, whose eponymous skin cancer detector was just approved by the FDA. The device uses artificial intelligence and a light sensor, and a study showed it was 96% accurate in detecting cancer, and had only a 3% false-positive rate.

But the kicker is that, in a disturbing sign of the time, dermatologists can’t actually buy the device — they can only subscribe to it “at $199 a month for five patients or $399 a month for unlimited use.” Seriously.

A different kind of self-service

We’ll just let this next story speak for itself: “FDA Clears PherDal^* Intravaginal Insemination Kit for At-Home Use.”

Yes, it’s exactly what you think.

^* 100 Internet Points if you realized how it’s pronounced.

Elsewhere: Big Apple, smaller debt

New York City is spending $18 million to work with a non-profit called RIP Medical Debt to wipe out more than $2 billion in unpaid medical bills for the city’s poorer or more debt-saddled residents by buying that debt from hospitals at a deep discount.

“No one in New York City, or in America, in 2024, should have to choose between getting the health care they need and paying their rent or buying food to feed their families.”

Easy diabetes prediction

German researchers have found a quick way to determine whether someone is likely to develop diabetes — whether they’re pre-prediabetic, if you will.

It’s a simple equation based on a blood test and two numbers: the insulin value and the glucose value. The idea is that neither alone gives enough information, but taken together they rate the “control loop for sugar metabolism” to determine a static disposition index, aka the risk of diabetes.

The equation essentially measures the feedback loop between glucose sensitivity and beta-cell function, but the details are beyond us to explain. Good news, though: The full paper is available free for those who want those deets.

Our number two story

Good news if your Imodium sales are lagging: Climate change, and the warmer weather it’s bringing, will also be bringing more campylobacteriosis, aka the disease that causes a lot of diarrhea.

British scientists looked at the data of a million campylobacteriosis cases in England and Wales over 20 years. Then they cross-referenced the weather data and “found a clear link between illness and climate.”

Specifically, when days are longer and temperature or humidity is higher, there’s more of the disease. While day length isn’t going to change (much), the other two … yeah.

Exactly why the disease spreads more under those conditions isn’t clear — it could be that Campylobacter bacteria thrive in warmer and wetter conditions, or it could be due to behavioral changes when it’s hot and humid. Either way, expect to see a bunch more.

The latest legislative update is out

Georgia’s legislative session is going from first gear to second, and Melissa Reybold’s latest legislative update is in. Check it out to keep up with the advocacy team’s season as the preliminary work is being done, especially on a couple of bills we’re watching closely.

Oral insulin is almost here

Needles, schmeedles — an oral form of insulin will begin human trials next year.

A team of Norwegian and Australian biochemists has developed a nanoscale coating^* for insulin that’s got a few tricks up its metaphorical sleeves. First, it keeps the insulin from being digested by stomach acids. Second, it’s broken down by liver enzymes. But the coolest part is that it’s broken down by specific enzymes that are only present when blood glucose is high.

“This means that when blood sugar is high, there is a rapid release of insulin, and even more importantly, when blood sugar is low, no insulin is released.”

It’s been tested successfully on worms, mice, rats, and baboons. Human trials will start next year, and they hope to have a commercial product ready by 2026 or ’27.

But wait, there’s more! It doesn’t need to be refrigerated, and rather than a capsule, it was incorporated into a sugar-free chocolate. (Said the team leader, “This approach was well received.”)

^* As you probably guessed, it’s a chitosan and glucose copolymer that’s applied to insulin bound to silver sulfide (Ag2S) quantum dots. Obviously. 

Mouth breathers, take notice

If you breathe through your mouth, you might not live as long as nose breathers. That’s the conclusion we decided to reach after reading about Florida State researchers’ small study (20 people). That study found breathing through the nose had some cardiovascular benefits, not to mention being less embarrassing.

The research team found that the volunteers’ diastolic blood pressure was lower when they breathed through the nose […] In addition, nasal breathing shifted the nervous system into a more parasympathetic state (“rest and digest” rather than “flight or fight”) during the rest condition.

The differences weren’t huge, and the study didn’t go into why this was the case, but it’s a boon to grad students as the results, the Floridians say, “justify future longer-term studies in other populations.”

A treatment for mild Covid

If you’re a reasonably healthy person who gets Covid-19, you probably don’t need to worry about hospitalization, so you probably don’t need Paxlovid. But you’ll still want to get better faster.

Enter simnotrelvir, an antiviral that Chinese scientists tested on 1,200 “mostly healthy” patients with mild Covid symptoms. They combined it with the protease inhibitor ritonavir for an extra boost, and named the combo Xiannuoxin.

Result: Patients taking Xiannuoxin cut about 36 hours off their Covid symptoms, and had a much lower viral load — so they also reduced the spread.

Blocking metastasis

While you’re trying to kill cancer, it would also be helpful to keep it from spreading. That can be done by compounds called motuporamines. Those were discovered in the ’90s, but they didn’t quite make it as actual treatments.

But now medicinal chemists at the University of Central Florida think they’ve found one (“Motuporamine C”) that — thanks to some tweaks they made to it — will bind to enzymes on cancer cells and keep them from metastasizing.

They tested this on mice with an aggressive form of pancreatic cancer. “The compound worked and blocked the spread of these cells to the liver. Thus,” said the lead researcher, “we really have something special.”

Now they’re looking for funding to begin pre-clinical trials.

Drugs to watch?

Every year the folks at science consultant Clarivate release a list of drugs or almost-drugs to watch, which they named … “Drugs to Watch.” It also includes drug trends to watch, which helps boost it to 96 pages long.

What do they think you should watch in 2024? There are 13 of ’em that the company thinks have the potential to become blockbusters in the next five years:

• High-dose aflibercept
• Budesonide
• Datopotamab deruxtecan
• Efanesoctocog alfa
• Ensifentrine
• Exagamglogene autotemcel and Lovotibeglogene autotemcel
• Mirikizumab
• Niraparib + abiraterone
• RSVpreF and RSVpreF3
• Talquetamab
• Zolbetuxima

If you want the details you’ll need to read the full report, which we’re providing to save you the trouble of filling out the form to get your own copy. Our pleasure.

Pharmacy orgs: Don’t trust Canadian drugs

GPhA is one of dozens of state^* and national pharmacy organizations that signed a letter expressing their concern about Florida’s plan to import some drugs from Canada. The program, they say, “could open the door for harmful and counterfeit drugs to enter our nation’s drug supply, with no evidence that this will result in cost savings for our patients.”

How could Canada’s drug supply be harmful, you ask? Aside from the maple flavoring added by law, the issue is the US’s Drug Supply Chain and Security Act — aka “Track and Trace” — that essentially creates a closed drug-distribution system here. It means a bottle’s pedigree can easily be checked, and counterfeiting is much harder.

“Canada does not have a similar law,” the letter points out, “leaving our drug supply chain at risk under Florida’s program.”

^* 43 states plus DC and Puerto Rico, and including our friends at the Georgia Society of Health-System Pharmacists

Step towards an HIV vaccine

It’s a small advance, but it’s a critical one: Duke researchers working on HIV vaccines have confirmed that their vaccine designed for monkeys can “induce broadly neutralizing antibodies” against HIV.

The “broadly neutralizing” is the important bit; it indicates that the antibodies aren’t necessarily monkey-specific. The “antibodies generated in the animals were structurally and genetically similar to the antibodies needed in humans.”

The next steps will involve developing it into a vaccine candidate for human testing.

Don’t mix ED and chest pain meds

Men taking Cialis, Levitra, or Viagra along with a nitrate “had a higher risk of heart failure, early death, and other negative health outcomes” than those taking just the nitrate, according to a Swedish study of more than 60,000 men with a history of heart issues.

The issue, it seems, is that both meds can cause a drop in blood pressure, although the study didn’t look at the details. The blood-pressure issue was known, but now there’s Swedish confirmation that yes, taking them both can kill you. But perhaps you’d die happy.

They come for the vax and stay for the checkup

There’s a silver lining to the push to vaccinate seniors during respiratory virus season: After they shuffle into the doctor’s office, they tend to stay to get a checkup.

“These are seniors, many of whom have not been to the office for a long time, they’ve come back in, they’ve now got vaccinated, their physicians have picked up other things while they’ve been there.”

This came from a report by UnitedHealth Group that explained in part why health insurers’ stock prices took a hit — they’re having to pay for all that extra health care. (Of course, it’s an ounce of prevention that’s going to save them in the long run, so everybody wins.)

Captain Obvious avoids the left lane

“Seniors Who Smoke Weed & Drive Are Road Hazards: Study”

More measles are coming

Score one for the anti-vax crowd: More measles outbreaks are happening in the US — the latest are in New Jersey, DC, and Philly^* — and experts are expecting more to come as local vaccination rates dip below the level needed for herd immunity.

Currently measles is officially “eliminated” in the US, but if outbreaks continue for more than a year we could lose that designation. Our prediction: Eventual lawsuits against anti-vax organizations.

^* Think that’s up north and Georgia is safe? Think again.

Munchies explained

It’s not news that marijuana can lead to the munchies. (Just ask the Girl Scouts selling cookies.) But until Washington State University researchers took it upon themselves to, you know, research the issue, we didn’t know why. Now we do.

After trying to get mice to smoke tiny joints, the neuroscientists settled for using vaporized cannabis, then scanned their brains. (The mice’s, not their own.) Cannabis, they found, activates certain neurons that are normally dormant.

[T]he cannabinoid-1 receptor, a known cannabis target, controlled the activity of a well-known set of “feeding” cells in the hypothalamus, called Agouti Related Protein neurons. […] When these neurons were turned off, cannabis no longer promoted appetite.

Quick! Justify this research!

It “could pave the way for refined therapeutics to treat appetite disorders faced by cancer patients as well as anorexia and potentially obesity.” But first, more research is needed….

^* Agouti Related Protein neurons, since you asked

The Long Read: How gut bacteria help with weight

A gastroenterologist at the University of Washington explains how the right foods (and the right gut biome) can let your body make its own GLP-1. Free Ozempic!

How to cut opioid prescribing

Here’s one way to nudge doctors to be careful how they prescribe opioids: Send them a letter every time one of their patients dies from an opioid overdose, and — and this is important — include “a plan for what to do during subsequent patient visits.”

USC researchers already knew that a letter informing prescribers about the death of a patient was effective in cutting prescriptions, but now they found it’s even better to give some advice, too. (Kind of like telling a child, “Don’t give the new puppy a chocolate bar. Give him a dog cookie instead.”)

Compared to just a notification…

… physicians who received notifications with additional planning guidance reduced prescriptions of opioids by nearly 13%. They also reduced prescriptions of the anxiety medications benzodiazepines by more than 8%.

(Side note: You know you can trust the research because the lead author is Doctor Doctor.)

Speaking of opioid use…

Medical University of South Carolina medical researchers found that giving spinal surgery patients a dose of N-acetylcysteine (NAC) during surgery reduced their need for post-surgery opioids.

In the 48 hours after surgery, patients who were administered NAC via IV infusion received 19% fewer opioid doses on average than patients who received saline.

They had less pain, too, and waited longer to request pain meds. Side note: Some early studies have shown the NAC can keep heroin addicts from relapsing. “Can we stop giving opiates completely?” asked the lead researcher. “Likely not. Can we decrease the amount patients need? We should try.”

Gabapentinoids and COPD don’t mix

If you have patients with COPD, they shouldn’t be taking gabapentinoids. Drugs like gabapentin and pregabalin already have a warning about the potential for severe breathing difficulties, but there wasn’t a study on the effects on patients with COPD.

Now there is.

Researchers at Canada’s McGill University combed through the patient data of more than 13,500 patients with COPD and found that gabapentinoid use was associated with almost a 40% increase in “severe COPD exacerbation.” Notably, problems surfaced on average about 6 months after beginning gabapentinoid treatment, so the association might not come to mind.

Last chance to submit a nomination!

This coming Friday, January 19, is the deadline for submitting nominations for the 2024 Georgia Pharmacy Association Awards.

You have two days to tell us who’s the best pharmacist, technician, or student you’ve ever met. Nominate someone for one, two, or more awards that’ll be presented at the convention on Amelia Island.

You haven’t waited too long … yet. It takes just a few minutes to describe why someone is deserving, so please take a few minutes and tell us about that awesome pharmacy pro!

Unexpected cancer-drug booster

University of Iowa biomedical engineers found a surprising thing: Smokers did better on autophagy-inhibitor cancer treatment than non-smokers did. Huh.

What was one difference between the two? Carbon monoxide; smokers have a lot more of it in their systems. “[T]his suggested that elevated carbon monoxide might improve the effectiveness of autophagy inhibitors.”

So how can they deliver carbon monoxide to test their idea? Sticking mice into an exhaust pipe from a ’72 VW Beetle is one way, but a cooler idea is to concoct a drinkable, gas-entrapping foam where the trapped gas is carbon monoxide. (They went with plan B.)

When mice with pancreatic and prostate cancers were fed the carbon monoxide foam and simultaneously treated with an autophagy inhibitor, tumor growth and progression was significantly reduced in the animals.

It also worked on human cancer cells in the lab, so maybe “safe, therapeutic levels of CO” can be given to patients taking autophagy inhibitors — via a foam or a few hours on I-85.

Quickie flu update

Flu activity dropped a bit for the first time in a while, according to the CDC. It might be a one-week blip or — hopefully — a sign that the season is finally fading.

Kids are all about weight loss (and that’s bad)

The disturbing news: 13% of kids (especially girls) have tried a nonprescription drug or supplement for weight loss, and the percentage has been going up over the years.

The kids have been using whatever they can — diet pills, laxatives, and diuretics, none of which is good for them (unless, you know, they actually need them). “Not good for them” meaning that using these products actually leads to “low self-esteem, depression, poor nutritional intake, and substance use.”

Do we need to explain why they’re doing this? Fine. It’s a combination, say the Aussie researchers who did the study, of …

”. . . low self-esteem, parental influence to lose weight or parental dissatisfaction with weight, self-body dissatisfaction, peer groups who value thinness, and media or social media influences promoting unrealistic beauty standards.”

Oh, social media, what haven’t you done for us?

Guts, bacteria, fats, and kids

Antibiotics, it seems, can lead to little kids turning into, shall we say, ‘larger kids.’ Actually it’s a combo of antibiotics and a high-fat diet. If young kids are exposed to both, they run a greater risk of obesity, adiposity, and metabolic dysfunction.

The reason, found Vanderbilt University microbiologists, is good ol’ gut bacteria — specifically, the phenyllactic acid that one Lactobacillus bacteria produces. Phenyllactic acid normally tells the epithelial cells of the intestine to ease up on packaging and secreting fat, but when the bacteria aren’t there to produce it, more fat enters circulation.

So could you give kids some phenyllactic acid or Lactobacillus bacteria when they get antibiotics? Maybe. But that, as you can imagine, will require some more research.

Five kinds of Alzheimer’s

This is a Big Deal: It seems that there isn’t a single “Alzheimer’s disease” but rather multiple versions — five of them, to be specific. That’s what an international team found after examining the cerebral-spinal fluid of 600 people (and publishing in Nature Aging.)

Those different subtypes have variations in how they present themselves and — critically — they react differently to treatment, including having different side effects. That might explain why treatment seems to be so hit-and-miss.

This could mean some drugs only work in one Alzheimer’s type. Amyloid focused medication, for instance, may treat a subtype with increased amyloid production but potentially harm a subtype with decreased production.

Obviously more research is needed, but if these findings are accurate it could upend the entire Alzheimer’s-treatment landscape.

The latest legislative update

GPhA’s VP of public policy, Melissa Reybold, has penned the latest of her 2024 legislative updates. The legislative session is just getting started, so she had time to check out the Georgia Board of Pharmacy meeting, too. Read all about it!

Federal scientists: Make marijuana C-III

Scientists from the FDA and the National Institute on Drug Abuse have written a 250-page review and now recommend “that the Drug Enforcement Administration make marijuana a Schedule III drug, alongside the likes of ketamine and testosterone, which are available by prescription.”

The DEA still considers marijuana a schedule-I drug — as dangerous as heroin or LSD and without any medical use; clearly that’s not the case. (GPhA has no official position on the legalization of marijuana, but that doesn’t mean certain facts aren’t obvious.)

The review by federal scientists found that even though marijuana is the most frequently abused illicit drug, “it does not produce serious outcomes compared to drugs in Schedules I or II.”

Marijuana abuse does lead to physical dependence, the analysis noted, and some people develop a psychological dependence. “But the likelihood of serious outcomes is low,” the review concluded.

Still, the DEA’s position makes marijuana illegal to possess on the federal level, even though 24 states have made it legal for recreational use and 38, including Georgia, have legalized it to some extent for medicinal use. Even parts of Georgia have decriminalized it (Atlanta, Clarkston, Forest Park, Savannah, South Fulton, Statesboro, as well as unincorporated Fulton County and Macon–Bibb County), meaning possession of certain amounts is subject to the equivalent of a traffic ticket.

Will this be the impetus for a federal change? We’ll see.

AIP on the road

The folks from GPhA’s Academy of Independent Pharmacy are still on their statewide “DIR Hangover Preparation Tour” — now in North Georgia. That’s where they met with Will Crowley, owner of Crowley Drug Company in Calhoun.

Here we’ve got (l to r) AIP VP Jonathan Marquess; Will Crowley, PharmD; and Member Service Rep Ashton Sullivan

Fun fact: Will started Crowley Drug nine years ago — from scratch!

Stopping flu’s spread

Stopping the flu virus from getting in (or getting hold) protects one person, but why not find a way to stop the virus from getting out, too?

NYU researchers think they’ve found a way to do just that, which could lead to treatments that not only protect the patient, but prevent the virus from spreading.

There’s been plenty of talk about viruses’ spike protein, but this research looked at the other side — the sialic acid (SA) receptors on cells that the spike protein attaches to. They used an enzyme that makes those receptors less receptive, thus keeping the virus from attaching even when it got past the immune system.

[K]eeping virus particles from attaching to SAs limits more than just the entry of influenza A viral infections, but also hinders their exit (shedding) and transmission from mouse to mouse.

This could keep a small outbreak from becoming large, and a large outbreak from spreading further. (Or farther. I always mix those up.)

An epilepsy drug — for arthritis

Finding a totally new use for an existing drug is always good news (because it means a shorter path to approval). One of the latest: epilepsy drugs might slow down the joint degeneration that comes with arthritis.

It seems there’s a sodium channel called Nav1.7 that produces electrical impulses in muscles (and is thus related to epilepsy) but — and here’s the kicker — “the same Nav1.7 channels are also present in non-excitable cells that produce collagen and help maintain the joints in the body.”

So maybe a drug that blocks Nav1.7 to treat epilepsy might also help slow the progression of osteoarthritis. In fact, Yale researchers found, it does just that:

[D]rugs used to block Nav1.7 — including carbamazepine, a sodium channel blocker currently used to treat epilepsy and trigeminal neuralgia — also provided substantial protection from joint damage in the mice.

Omega-3s vs lung fibrosis

Omega 3 fats, like those in fish and nuts (and, you know, supplements) keep turning out to do some serious good for people. The latest: They seem to slow the progression of pulmonary fibrosis.

A study out of UVA looked at the health records of 300 people with interstitial lung disease. The researchers found…

… that higher levels of omega-3 fatty acids in the blood plasma were associated with better ability to exchange carbon dioxide and longer survival without the need for a lung transplant. This did not vary much regardless of smoking history or whether the patients had cardiovascular disease.

Why does it work? Dunno, so you know the mantra: More research is needed.

Frankincense is more than a perfume

If we were a tabloid, the headline would be “Frankincense treats breast cancer!” But we’re not. The actual story is that an extract from the tree that produces frankincense seems to slow the spread of breast cancer cells — in a small study in the lab.

The extract — Boswellia — has some interesting anti-cancer properties, according to researchers at the Medical University of South Carolina. Why it works and how important this discovery is, is still up in the air. But it’s these small breakthroughs that eventually lead to the big ones.

Nifty research tool

Despite it coming for our jobs here at GPhA Buzz, we kinda like playing with AI. A lot of new tools are coming out using the same technology as ChatGPT but with different data sets in their libraries.

One that caught our attention is called Consensus, which lets you ask questions about research on a particular subject to see what conclusions have been reached (and the papers describing them).

Essentially, Consensus has read a gadzillion research papers for you, so rather than just do a keyword search like some kind of ranch hand, you ask your question in plain English.

Just for fun, we used the previous story as a test. “Can Boswellia extract affect breast cancer?” we prompted. Consensus found 10 papers that suggested that yes, it might. The summary:

These studies suggest that Boswellia extracts, containing boswellic acids and their derivatives, can potentially affect breast cancer by reducing inflammation, targeting molecular pathways, and exhibiting cytotoxicity against treatment-resistant and triple-negative breast cancer cells.

It’s free, so perhaps worth a gander….

Shingles vax — timing doesn’t matter

When someone over 50 gets a shingles vaccination, the second shot is supposed to come about 6 months after the first. But a new study out of Kaiser Permanente (based on records of 2 million people) found that it’s okay to wait longer — the effectiveness doesn’t change.

The caveat: The study doesn’t say how much longer you can wait, just “not to panic if your second dose ended up being delayed beyond 6 months.”

That second dose is important.

The study found 2 doses were 76% effective against shingles, while 1 dose was 64% effective. Over the 4-year period, the 2-dose regimen waned little while the single dose waned more, dropping to 52% after the third year.

La France envoie de la pénicilline

With STDs on the rise in the US, it’s a bad time for a penicillin shortage. That’s what we have, though, with Pfizer’s Bicillin hard to find. That’s why the FDA is allowing a French version from Laboratoires Delbert to be imported. While not officially FDA approved, this penicillin G benzathine (called Extencilline) is pretty much the same as Pfizer’s drug, plus it’s French so it’s all fancy.

Laboratoires Delbert noted that it will import 1,200,000 units of its powdered Extencilline and 2,400,000 units of the diluent version for reconstitution for injection. The meds are manufactured in Italy and both lots have an expiration date of 2025.

The super-popular APhA immunization course is back!

Woo-hoo! GPhA is offering “APhA’s Pharmacy-Based Immunization Delivery: A Certificate Program for Pharmacists” for the first time in 2024: Sunday, February 25 from 8:00 am to 5:00 pm at the GPhA World Headquarters in Sandy Springs.

This is the big kahuna of immunization training — it gives you a total of 23 hours of CE.

The live portion (8 hours) is being held in GPhA’s classroom. The rest is self study — easy peasy. At the end you get a spiffy certificate for your wall and the important line on your CV to impress your patients and your boss.

The whole shebang is $349 for GPhA members ($499 for non-members).

Note: This is always a popular course, so the sooner you sign up the less your chance of being left out and being laughed at behind your back.

Get to GPhA.org/immunization for the details and to register. Now!

Your brain can make you live longer

No, not just with mindfulness or by telling you to skip the party-size bag of M&Ms. The hypothalamus, it seems, sends signals to white (adipose) fat tissue: burn, baby, burn^*. When mice get older, though, their hypothalami produce less of a molecule called Ppp1r17†, making the brain-fat signalling loop less effective.

So scientists at Washington University School of Medicine in St. Louis found a way to activate the neurons that cause Ppp1r17 to be produced. When they gave this treatment to mice, those mice lived about 6 to 7% longer than controls — that’s the equivalent of five years longer for humans.

Obviously this is in the early stages, but heck, it can’t hurt to dream about what you might do with five extra years.

^* The details are a lot more complex, but that’s the gist.
† Also the name of Elon Musk’s second child

Calcium vs preeclampsia

Pregnant women only need about 500 mg of calcium a day to reduce their preeclampsia risk. “Only” because that’s a third of what the WHO currently recommends. That’s big news, especially for women in poorer countries; governments there provide supplements to pregnant women but can’t afford to give out that much calcium.

A study out of India, Tanzania, and the US found that 500 mg and 1,500 mg daily were equally good at keeping blood pressure lower (although the higher dose was slightly better at reducing the risk of preterm birth). That means those countries might be able to afford to supplement women after all.

Side note: It’s not clear why calcium has that effect — it might reduces contractions in the uterus to lower blood pressure — but the study included 22,000 women, so it clearly does work.

ICYMI: Blood drive

Give blood. The Red Cross is appealing to everyone to take some time and donate blood — there’s a national shortage at the moment, and it’s going to get worse with so many people getting sick.

The number of people volunteering to donate blood is at the lowest level in 20 years, and over the past two decades, the number who donate through the Red Cross has fallen about 40.

It’s reached the point that some smaller blood centers are working with a supply that might only last a day.

Click here or call 1-800-RED-CROSS to find a donation site and make an appointment.

Can you trust the DSM?

Apparently the “M” in DSM stands for “May not be objective.” It turns out that an eye-bulging 60% of the physicians who helped put together the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders “received payments from industry totalling $14.24 million.”

Because of the enormous influence of diagnostic and treatment guidelines, the researchers say their findings “raise questions about the editorial independence of this diagnostic manual.”

Good news about hot flashes

Bayer says its elinzanetant — a drug candidate designed to reduce hot flashes and improve sleep — has done well in two phase-3 trials “reducing the frequency and severity of vasomotor symptoms, also known as hot flashes, in postmenopausal women.”

The company could be asking for FDA approval soon. It’ll be in the footsteps of Astellas’s fezolinetant (Veoza to its friends), which was approved last year.

Today’s Covid update

For the week ending December 9, 2023, 163 Americans died from the flu. And 1,614 died from Covid-19.

Yes, that’s about 1/7^th the weekly deaths as during the worst of the pandemic, but with fewer than 1 in 5 Americans having received the latest vaccine, a lot of those deaths were preventable.

Perspective: Imagine if five airliners were crashing in the US every week — people would be pretty darned concerned, wouldn’t they?

Captain Obvious … actually, the captain sits this one out

At first the headline seemed rather, well, obvious: “Reduced drug use is a meaningful treatment outcome for people with stimulant use disorders.” Of course reducing drug use by drug over-users is a good thing.

But what the article is actually saying is that if someone is addicted to stimulants, just getting them to cut back is a win — you don’t have to have them quit entirely: “[A]bstinence should be neither the sole aim nor only valid outcome of treatment.”