Georgia takes the lead on affordable insulin

The House of Representatives passed a bill to set insulin price caps — a bill sponsored by Georgia’s U.S. Rep. Lucy McBath of Marietta (and championed in the Senate by Georgia U.S. Sen. Raphael Warnock).

Their bill would require private health insurance companies to set prices for a month’s supply of insulin at no more than $35 or 25% of a plan’s negotiated price, whichever is less, starting in 2023 for some patients and 2024 for all.

(Bonus: An earlier AJC article featured a photo of Senator Warnock with GPhA member Ira Katz at Little Five Points Pharmacy.)

Attention, pregnant women

Two things you may want to avoid while expecting:

Too many disinfectants. A study out of Japan found that babies of mothers who were regularly exposed to them “had a significantly higher risk of asthma in their offspring.”

Marijuana. Babies exposed in the womb — not just to THC, but to CBD as well — might not only have low birth weight and behavioral problems, but are at higher risk of obesity and high blood sugar later in life.

GPhA Buzz debuts on OnlyFans

GPhA Buzz is expanding its social media presence (and income generation) with the debut of GPhA Buzz: OnlyFans. It’s the first part of the upcoming “GPhA Buzz After Hours” program, designed to appeal to new generations of pharmacy professionals.

As GPhA Marketing Director April Sloof put it, “Associations across the country are looking for new an innovative income streams. We think the OnlyFans platform has potential not only to attract new members, but to serve as an additional source of revenue — even if it’s only 10¢ at a time.”

A recipe for humans

Congratulations to the huge international team of scientists who finally — almost 20 years after the Human Genome Project was ‘completed’— sequenced the stubborn last eight percent.

The human genome is, at long last, complete.

The power of oxytocin

“Oxytocin,” the headlines read, “turns fierce lions into kittens.” This does not mean — despite the temptation — that you can spray some in the zoo and climb into the cage with Simba.

What it does mean is that oxytocin makes solitary animals more social — useful for conservation efforts and as a potential therapy for people with anxiety.

After the treatment, the 23 lions given oxytocin became more tolerant of lions in their space. This was measured by seeing how close a lion who has possession of a desired object, in this case a toy, will let others approach it.

I don’t like either of their odds.

Choose your booster

If you got a single J&J Covid vaccine shot, what’s your next move? Another J&J? Or one from Moderna or Pfizer?

A study out of Indiana University’s Regenstrief Institute has the rather clear answer: “We found that any booster strategy is better than a single J&J dose.”

Marco … polio

Polio’s back: After 30 years without it, Africa is seeing polio outbreaks — likely because Covid-19 interfered with normal health services, and a stark reminder that we can’t ever let our guard down.

Irony watch: Two studies have shown that the live-virus oral polio vaccine provides some protection from Covid-19. “[T] these live vaccines […] may be used temporarily to protect people in low-income countries that do not yet have access to COVID vaccines.”

Time to put this to bed

“Ivermectin Does Not Reduce Risk of Covid Hospitalization, Large Study Finds” — and even the guy whose now-retracted study started the craze (virologist Andrew Hill) agrees.

Dr. Hill has run his analysis of ivermectin studies again, this time including the new data from the TOGETHER trial. All told, his analysis included more than 5,000 people. And once more, he saw no benefit from ivermectin.

Money quote: “At some point it will become a waste of resources to continue studying an unpromising approach.”

The Long(ish) Read: Pharmacists Doing More edition

The idea of pharmacists testing, prescribing, and dispensing medication for various conditions — strep, flu, even birth control — is catching on, bit by bit.

“Despite Doctors’ Concerns, Pharmacists Get More Leeway to Offer Treatment With Testing.”

ADHD: Why didn’t someone think of this before?

Using stimulants to treat ADHD (often some form of methylphenidate) is de rigueur, but that begs the question: Has anyone considered using the world’s favorite stimulant: caffeine?

Spanish neuroscientists wondered the same thing, so they, you know, looked. Their review of the research found that — at least in animal model — caffeine consumption did in fact result in “increased attention span, improved concentration, learning benefits, and improvements in some types of memory.”

And that, they say is, good reason to study whether caffeine is a reasonable alternative to Ritalin.

“Our results reinforce the hypothesis that the cognitive effects of caffeine found in animal models can be translated and applied in the treatment of ADHD in people, especially at young ages such as adolescence.”

We still need you to be 1 of the 100

Be one of the 100 people the Georgia Pharmacy Foundation needs to donate $100 in support of the foundation’s great work.

The $100 From 100 Campaign is raising money through this coming Monday, April 4, to fund scholarships for some of Georgia’s deserving student pharmacists.

You should be one of those 100 people.

Help tomorrow’s pharmacists. Invest in the future. Give to the $100 From 100 Campaign!

Covid: Infection plus vaccination

Infection, vaccine, booster — what’s the best way to be protected against Omicron?

Reality: You can go crazy juggling the combinations — “min-maxing” is what gamers call it — to get the absolute best outcome.

But if finding that perfect combo is your thing, here you go: Temple University medical researchers report that people who have been infected with one of the old Covid variants (Alpha, Beta, etc.) seem to only need a single mRNA shot to get their antibodies up to speed. A second dose showed “little or no increase” in antibodies.

In fact, they say, infection+one vaccine seems to produce a longer-lasting antibody response than two mRNA doses, and possibly even two + a booster.

(The usual caveat: Antibodies are just the easiest-to-measure immune response. Those T-cells are still there preventing the worst outcomes.)

GEICO takes 15 minutes; Hutton can do it in 12

Is it time to renew your workers’ compensation or business liability insurance? Talk to Hutton Madden first. Really.

“I need to renew my policy,” you can say, “What can you do for me?”

Hutton Madden, ChFC — Field Representative Pharmacists Mutual Insurance Company

Call him: (404) 375-7209
Email him: hutton.madden@phmic.com
Check him out: phmic.com/agents/hutton-madden

Anthem gets slapped

Georgia hit Anthem with what Georgia Health News called a “whopping fine” — $5 million — for listing providers as in-network when they were not. That hurt patients and, more importantly, it meant that providers weren’t being paid promptly.

The state said it found about 78,000 (!) separate violations; Anthem claimed the state was “focused on a provider database system implemented nearly seven years ago that is no longer in use.”

Keeping drugs close to home

Getting most of our generic drugs and API from China isn’t a bad thing. After all, it’s hard to imagine an unfriendly China or a worldwide pandemic ever happening.

Just in case, though, well, that’s why Congress passed a bill (that President Biden is expected to sign) called the America COMPETES* Act. It would (among other things) “try to crack down on China’s control of certain vital supplies like pharmaceuticals” by bringing in the Department of Justice, FTC and other federal agencies …

… to investigate allegations of market manipulation and other potential violations of US laws by Chinese companies, such as controlling the supply of goods in critical industries of the US.

* America Creating Opportunities for Manufacturing, Pre-Eminence in Technology, and Economic Strength. Ugh.

We’ll believe it when the pharmacist has it

The next candidate for a universal flu vaccine comes from … Singapore and Australia. Researchers there say they’ve cracked the problem of vaccines based on the M2e peptide (which is common to all flu strains) by creating “a novel vaccine platform.” And — thanks for asking — why yes, it might also be used against Covid-19.

We eagerly await their next announcement.

Automatic bandage

You usually don’t need to put antibiotics on a small wound (and there’s an argument that doing so contributes to antibiotic resistance). But if it does need some bacitracin — well, you don’t want to wait until it looks like something that would be featured on “A Very Special Dr. Pimple Popper.”

Swiss researchers are close to a solution: They’ve created a bandage made of heat-sensitive fibers that release antimicrobial drugs when it warms up due to infection. And yes, of course nano-technology is involved.

When inflammation kicks in and the skin heats up above its normal temperature of 32 to 34 degrees*, the polymer changes from its solid to a softer state. In laboratory experiments, the team observed the disinfectant being released from the polymer at 37 degrees — but not at 32 degrees.

And the fibers can be tweaked, so the technology has potential for other kinds of “controlled drug release by an external stimulus.”

* That’s 89.6 to 93.2 in much-more-useful Fahrenheit degrees.

Avocados for life

Wow, all that 1990s avocado toast may pay off: Apparently “Eating two servings of avocados a week [is] linked to lower risk of cardiovascular disease,” according to a study published by the American Heart Association.

Other studies about avocados have been inconclusive, but, say these Harvard researchers:

[T]he current study’s findings provide novel, necessary, and robust evidence that higher intake of avocados is associated with a lower risk of CVD [cardiovascular disease] and CHD [coronary heart disease] in healthy US adults.

And no — it wasn’t funded by Big Avocado. It’s legit.

Use your voice

Many of today’s smartphones support voice calls — not just texting or shooting TikTok videos. But if you’ve been concerned about putting that phone next to your ear, though, fear no more.

British researchers studied more than 380,000 women over an average of 14 years, and they’ve concluded that, “There was also no difference in the risk of developing glioma, acoustic neuroma, meningioma, pituitary tumours, or eye tumours” for anyone who spoke on a mobile phone daily for at least 20 minutes per week over 10 years.

Of course, for serious chatterboxes … “it remains unclear whether the risks associated with mobile phone use are different in those who use mobile phones considerably more than was typical of women in this cohort.”

Scary metformin study (and CNN statistics fail)

This is a bit worrying: Men who are taking metformin before sex are more likely to father a child “with major birth defects, particularly genital birth defects in boys.” That’s what a study of more than 1.1 million of those shifty Danes found, although it didn’t determine the cause.

It’s notable that the genital birth defects occurred only in boys, and these fathers were less likely to have boys than girls compared with the general population.

It’s a risk, but despite what CNN reported it’s not a 40% greater risk. The average odds ratio was 1.4 [CI, 1.08 to 1.82], which makes it statistically significant, though. (I’ll leave it to you to deal with the difference between odds and probability.)

Time to let loose in Atlanta

Take a break and have some fun with your fellow employee pharmacists, courtesy of — who else? — the Academy of Employee Pharmacists!

It’s an afternoon of jocularity, joviality, and (possibly) jollification at the Scofflaw Brewing Company in Atlanta, April 23 from 2:00 to 7:00pm.

The whole time costs a mere $10, and that includes two drink tickets. You won’t find a better time for that price without breaking a few laws. And yes, student pharmacists are invited … as long as they keep their inner ruffians at bay.

All you need to do is register so they know how many to expect — click here to do just that.

Booster 2.0

The FDA says people over 50 can get a second Covid-19 vaccination booster. Do they need it? Depends who you ask. Will it hurt? Nope. Will it help? Yes, it’ll probably boost your antibody count and offer some extra-extra protection. The question is, if you aren’t immunocompromised, will it make much of a difference?

And that’s without going into the issue of T-cell exhaustion…

Speaking of boosters…

The CDC now recommends that people who have received a J&J booster (that is, two shots of the J&J vaccine) now get an mRNA booster — either Moderna’s or Pfizer’s.

Fracture surgery? Hit those amino acids

Got a patient recovering from a major fracture? Get them on some amino acids, specifically supplements of those conditionally essential amino acids*.

A study out of the University of Iowa found that giving a supplement of — arginine, leucine (which is an amino acid, but not a CEAA), and glutamine — after fracture-fixation surgery “reduces complications and prevents skeletal muscle wasting.”

Even better, those patients had “a sharply reduced mortality rate,” which seems like it should have been point #1.

* Arginine, cysteine, glutamine, glycine, ornithine, proline, serine, tyrosine — but you knew that.

The Long Read: Bad Guys edition

“At a Tennessee Crossroads, Two Pharmacies, a Monkey, and Millions of Pills,” from KHN.

“Y’all have got to get your numbers up. Fill fill.”

Simple, synthetic, and deadly

British scientists have created a synthetic antibiotic that they say is “capable of killing ‘superbugs’ including MRSA without detectable resistance.”

The gist: It’s based on the same molecule that bacteria use to kill one another — teixobactin — but simplified, which means they can keep tweaking it. The goal is to have a “library of synthetic teixobactins.”

Oh, and unlike other antibiotics…

The synthetic teixobactins have been found to be robust and stable at room temperature for years thus do not need a cold chain for distribution and storage.

Bonus: Article of course includes the phrase “game-changer.”

Today’s non-pharma “science” story, for your reading pleasure

From the BMJ (yes, that BMJ): “The case of the disappearing teaspoons: longitudinal cohort study of the displacement of teaspoons in an Australian research institute”

56 (80%) of the 70 teaspoons disappeared during the study. The half life of the teaspoons was 81 days.

You need to be one of the 100

The Georgia Pharmacy Foundation needs 100 of you. Step up.

The foundation does some great work, including funding scholarships for some of Georgia’s deserving student pharmacists. This March, the foundation needs 100 GPhA members to each donate $100 — it’s the $100 From 100 Campaign!

Be one of those 100 people.

And no, someone else won’t do it — you need to. Please, help tomorrow’s pharmacists. Give to the $100 From 100 Campaign!

Shrooms: Lots of hype, little data

Magic mushrooms — psilocybin to you and me — are the hot ticket these days for treating depression. But when you’re talking brain chemistry, you need to be careful what substances you’re mixing.

Problem: Oregon Health & Science University researchers found there have only been 40 studies of the effects of psilocybin going back to 1958 (!), not all were scientifically rigorous, and only one involved antidepressants.

“There’s a major incongruence between the public enthusiasm and exuberance with psychedelic substances for mental health issues — and what happens when they combine with the existing mental health treatments.”

Oh, and not only is there a risk of combining shrooms with meds, but the lack of info may force patients to choose between their existing meds and psilocybin — “That’s a very, very tough place to be.”

Carter-sponsored bill would ensure pharmacist reimbursement

Georgia’s own Buddy Carter was one of four members of the House — two Bloods and two Crips — who introduced HR 7213, the Equitable Community Access to Pharmacist Services Act (ECARPS) to …

… ensure patients continue to have access to essential pandemic and pandemic-related health services provided by pharmacists, including services to keep communities safe from COVID-19 and future public health threats.

What does that mean?

In short, it would mean that if physicians could be reimbursed under Medicare Part B for providing testing, initial treatment, or vaccination for “Covid–19, influenza, respiratory syncytial virus, or streptococcal pharyngitis,” well, then pharmacists can, too.

(Subject to limitations, state laws, and so on. You can wait till a legislative expert explains the details, or dive in and read the bill here — the good stuff starts on page 2, line 9.)

It was, of course, immediately praised by just about every pharmacy-related association and company you can name. Haven’t heard much from physicians, though.

* The others were representatives Nanette Diaz Barragán (D-Calif.), Ron Kind (D-Wis.), and David B. McKinley (R-W.Va.).

FDA looking to clean up the supply chain

And by “clean up” we mean it wants to set a federal standard for wholesale distribution and third-party logistics — one that would pre-empt any state laws or regs, even if the state has stricter rules.

It’s designed to affect wholesalers, but it’s got some (proposed) changes that could affect retail pharmacies. Mostly it’s about when a pharmacy crosses the line to being considered a wholesaler — you’d cross it if more than 5 percent of your sales were for office use rather than specific patients.

Oh, and if you’re shipping any meds to another pharmacy or a research institution that are not for a specific patient — yeah, no more of that, if the rule is finalized.

The deadline to provide comments on the proposed rule is June 6, 2022.

Antibiotics and women’s brains

Here’s an unexpected ripple effect: Women who take regular (i.e., chronic) antibiotics in middle age do so much damage to their gut biomes that it affects their cognitive abilities seven years later.

We’re not talking a huge effect — but a noticeable one. While Mass General researchers aren’t sounding any alarms, they do think their study “provide[s] a better understanding of potential complications of antibiotics throughout life, as well as generate hypotheses about the role of the gut microbiome in cognition.”

CBD: Percocet’s little helper

If you believe the hype (and the window posters), there’s little CBD can’t do. There isn’t a lot of actual evidence for its amazing powers, though. That’s changing bit by bit.

For example, a new study out of NYU found that a CBD tablet (Orcosa’s Oravexx) reduced the pain of people who had shoulder surgery “with no safety concerns,” fewer side effects, and — for better or worse — no psychotropic effects.

Test subjects were given Percocet, told “to wean off the narcotic as soon as possible,” and given either a placebo or the CBD to take for 14 days. Result: Those who took the CBD (with the Percocet) had an average of 23 percent less pain than those taking a placebo.

Print me a pill

Someday, probably not too long from now, you’ll* be able to print some medications on the spot, rather than stocking bottles of pills.

That kind of 3-D drug printing already exists in labs: The printer generates a pill layer by layer, using light to solidify it. It takes only a few minutes … per pill.

A new step to that Ctrl-P future: Spanish and British pharmacy researchers have designed a method to print a pill in just seconds by eliminating the layer-by-layer part and printing/solidifying the entire pill at once.

Eventually it will be out of the lab. Till then, if you have the GPhA Buzz Official Bingo Board, you can check off the “game changer” box.

* You being pharmacists and maybe physicians and veterinarians — hopefully not the local ne’er-do-wells.

Is grandma sleeping too much?

As you get older, you nap more (if for no other reason than because you can). Be careful, though: Too much napping can be a sign of Alzheimer’s.

After a 14 year study of older adults, psychiatry researchers at UC San Francisco found that the more people napped, the greater their chance of dementia.

Typical is napping an extra 11 minutes a year. But people who napped 25 extra minutes a year were likely to have mild cognitive impairment, and those whose average nap time went up more than an hour a year — well, they were much more likely to develop Alzheimer’s.

Ultimately, we found that older adults who napped at least once or for more than an hour a day had a 40% higher chance of developing Alzheimer’s than those who did not nap daily or napped less than an hour a day. These findings were unchanged even after we controlled for factors like daily activities, illness and medications.

Not that naps caused Alzheimer’s; more likely the reverse: “[I]t does point to extended naps as a potential signal for accelerated aging.”

Captain Obvious knows basic math

“Covid-19 mixed with flu increases risk of severe illness and death”.

On the other hand, Lieutenant Surprise considers consumption

One way to reduce your risk of Covid-19 is to contract tuberculosis.

Microbiologists at an Ohio State University found …

… that Mtb [Mycobacterium tuberculosis] infected mice […] are resistant to secondary infection with CoV2 and its pathological consequences. [We] believe the inflammatory nature of Mtb infection creates a lung environment that is inhospitable to CoV2 propagation.

Teetotal risk

On Saturday we spun the Wheel of Scientific Studies™ and learned that even moderate alcohol use is bad for your heart.

Today we spin the wheel again and find that … ruh-ro: Never drinking alcohol can increase your chances of multiple sclerosis. Alcohol, you see, suppresses the immune system, while “MS is characterized by an overactive immune system.”

Swedish neuroscientists recognize that alcohol has, well, other issues:

Better understanding of the mechanisms behind our findings may help to define ways to achieve protection against MS by other means than alcohol consumption.

So yes, at the moment you can think of that drink as protection from MS, at least until something better comes along.

A good use for tetanus

Here’s a cool trick: Just about everyone is vaccinated against tetanus, so why not use that against cancer. Inject pancreatic cancer with some benign tetanus proteins* — it’s like putting a giant Kick Me sign on the tumor. In this case, “Kick Me” means “Attack me with your already-primed immune system.”

That’s just what immunologists at Albert Einstein College of Medicine did (with mice) … and it worked. “Following the treatment, both the original tumor and those that had metastasized shrank significantly, and the mice lived longer as a result.”

“Essentially, our new therapy makes immunologically ‘cold’ tumors hot enough for the immune system to attack and destroy them.”

* Using a modified listeria bacteria, which has a fondness for cancer cells.

Beware stroke with anti-nausea drugs

Well this isn’t good. ADAs for nausea (we’re talking domperidone, metoclopramide, and metopimazine) can increase a patient’s risk of stroke especially when first starting on the drug. That’s what French researchers found, although it shouldn’t be a surprise — ADAs are similar to antipsychotics, which have already been shown to do that.

It’s not a small risk, either:

After taking account of potentially influential factors, the researchers found that new users of ADA could be at a 3-fold increased risk of stroke shortly after treatment started.

They caution, though, that this is preliminary and observational, and while “the risk of ischaemic stroke appears to be associated with ADA use,” this study can’t establish cause. But be careful.

Fight insulin resistance with vitamin D

Cutting to the chase: There’s a “significant association” between lower vitamin D levels and insulin resistance. Based on data from almost 50,000 Americans, that’s the conclusion Chinese researchers came to. And it’s especially true for people with a BMI between 24 and 28 (i.e., the higher side of healthy).

This study suggests that keeping vitamin D3 levels as high as possible in the general US population can effectively reduce the incidence of insulin resistance.

Sweet is bad

Sugar is bad for you (and some even suggest it should be considered a poison). High fructose corn syrup is worse. Good thing the whole “artificial sweeteners cause cancer” thing turned out to be wrong, right?

Ha! Trick question. French researchers* now say, after examining the health records of more than 100,000 Frenchies over seven+ years, that “artificial sweeteners (especially aspartame and acesulfame-K) […] were associated with increased cancer risk.”

There had been some smaller studies, but this is (they say) the first one with “robust epidemiological evidence.”

So what’s left? Honey? (tasty, but not good for Diet Coke) Stevia? (blech) Xylitol? (your stomach may disagree) — or are we condemned to a bitter, bitter existence?

* At the Sorbonne — ooh la la

A better probiotic

Probiotics are good for your gut (and therefore good for you, period), but there’s one issue: Whether from supplements or yogurt, most of the microorganisms don’t survive the churning acid bath of your stomach.

So Singaporean engineers came up with a solution: a coating that survives the stomach and only dissolves when it encounters the phosphate ions in the small intestine, where it releases its bacterial payload.

Just like time-release medication, they’re hoping to see this perfected and adopted — and maybe even used for animals as an antibiotic alternative.

Today’s alcohol verdict

Once again we spin the Wheel of Scientific Studies™ — and this time we learn that moderate alcohol consumption is … bad for you. Specifically, it’s bad for your heart.

According to Mass General researchers, the reason some studies say otherwise is that people who drink moderately tend to have healthy lifestyles, which clouds the results. They’re smarter than that — they “leveraged […] new techniques and expansive genetic and phenotypic data from biobank populations.”

The risk curve, they say, is exponential. Going from 0 drinks to one a day has minimal risk, but there’s “much higher risk increases when progressing from seven to 14 drinks per week,” and when you get to 21 or more drinks per week you really need to keep your will updated.

Are Reddit users mentally ill?

Using what people online, AI can identify your mental disorder. So claim Dartmouth researchers who used conversations on Reddit* to do a bit of machine learning and see if they could spot emotional disorders — major depression, anxiety, and bipolar disorder — just based on posts.

What’s new about this model is that it focuses on the emotion expressed, rather than just the topic. That’s because topic-based models might learn to associate “Covid” with anxiety, and thus incorrectly assume that every Covid researcher is suffering from depression or anxiety.

* Hopefully /r/funny and not, say, /r/watchpeopledie**
** Don’t bother, it’s been banned

The Long(ish) Read: Not Too Big edition

Drug Store News explains how — nestled between single indy pharmacies and big nationwide chains, “Patient-centric regional pharmacies play an important role in many small towns and communities throughout the United States.”

Men, women, and diabetes

Could diabetes originate differently in men and women? As usual, we wouldn’t ask if the answer wasn’t at least “Maybe.”

The exact mechanism of diabetes development isn’t known, although there’s a connection to abdominal fat. Fact is, men and women store that differently (men around the organs, women under the skin). With that in mind, Canadian researchers reviewed the studies and concluded that…

[T]here were overall differences observed in the immune cell, hormone, and cell signalling level in men and women that seem to support different origins in diabetes between the sexes.

Or as they titled their paper, “Sex differences in regional adipose tissue depots pose different threats for the development of Type 2 diabetes in males and females.”

Check those new PBM contracts

NCPA is advising pharmacies to check their upcoming Medicare Part D plan year PBM contracts carefully. Not only may some PBMs be offering reduced reimbursement (potentially below cost), but …

… some contracts are opt-out contracts that require a pharmacy to proactively send a specific form of notice to a PBM, sometimes within a short period of time, declining participation in the network if the pharmacy determines that the terms offered are not satisfactory.

Snails vs pain

Those shifty Danes think they’ve found a painkiller in the venom* of sea snails.

Surprisingly, it wouldn’t be the first painkillers to come from sea snails — one from Conus magus already exists, but it’s expensive and needs to be injected via a spinal implant. The new one, though, comes from a different species: Conus rolani. (Chosen because it was the only species they could get enough samples of.)

Resembling a somatostatin, the substance they’ve isolated “can block out pain in mice for an even longer time than morphine.” More importantly, it uses an entirely different mechanism.

“We have discovered a so-called toxin that blocks out pain in a completely different way than well-known drugs like morphine, and hopefully this will enable us to avoid some of the most damaging effects of morphine on humans.”

Plenty more work to be done, but it’s clear we’re finding more and more pathways to block our pain.

* The article calls it “poison,” but it’s actually venom.

Cold comfort coming?

Moderna is working on a bunch of mRNA vaccines including, the company said, “a vaccine against all four of the endemic human coronaviruses.” It doesn’t mean Covid — it’s talking about the common cold.

The vaccine candidate, dubbed mRNA-1287, wouldn’t stop all colds (because there are a lot of ‘cold’ viruses), but it could cut down on a bunch — 10% to 30% of upper respiratory infections every year, according to Moderna.

Dig deeper: Is this feasible? Or even worth it? Endpoints News contemplates those questions.

The latest Covid-19 prevention

Broccoli and Brussels sprouts. Microbiologists at Johns Hopkins found that sulforaphane from cruciferous plants (which is already known to be pretty darned good for you) also seems to inhibit the replication of SARS-CoV-2 and other coronaviruses.

Even cells with low exposure to sulforaphane saw the replication of SARS-CoV-2 get cut in half — and that included the delta and omicron variants. Even cooler, “lower doses of both sulforaphane and remdesivir, when combined, are more effective against the viruses than either applied alone.”

But don’t get too crazy, they say: “While the results are promising, the researchers caution the public against rushing to buy sulforaphane supplements.”

Immunity stays

With Covid vaccines or exposure, the focus has been on antibodies. How are they? How many are they? Are they comfortable? Did they have enough to eat? ARE THEY WANING???

Antibodies get a lot of press because they’re easy to count. But there’s plenty more to the immune system, as you know, and now a new Australian study found that — whether primed via vaccine or exposure — T cells are ready to respond, even after a (relatively) long time.

“Even though some parts of the immune response wane, we can now see that T cells recognising the virus are quite stable over time. After more than a year, they were still roughly 10-fold higher than someone who had never been exposed to the spike protein through infection or vaccination.”

While they may not prevent you from getting Covid, they’ll certainly be ready to drive the invaders out once they cross the border.

Artist’s conception

Captain Obvious clips coupons

“US Drug Prices Distorted to Favor Pharmacy Benefit Managers”

The entire drug distribution system is based on fake prices. List prices are artificial […] So is average wholesale price. The AWP for 20 mg of omeprazole magnesium (Prilosec) in 2021 ranged from $0.30 per unit to nearly $9.

Play it again, Joe

Three studies (to be presented at the American College of Cardiology’s annual meeting) found the same result we’ve heard repeatedly: Drinking two to three cups of coffee a day is good for your heart — and helps you live longer.

In general, having two to three cups of coffee a day was associated with the greatest benefit, translating to a 10%-15% lower risk of developing coronary heart disease, heart failure, a heart rhythm problem, or dying for any reason. The risk of stroke or heart-related death was lowest among people who drank one cup of coffee a day.

Fun facts:

• “Two to three cups” translates to about one or two typical American mugs.
• Instant or the real stuff — it doesn’t matter (other than, you know, the shame of drinking instant coffee).
• Decaf provided almost all the same benefits, except against arrhythmia and heart failure. “[T]he findings suggest caffeinated coffee is preferable across the board, and there are no cardiovascular benefits to choosing decaf over caffeinated coffees.”
• Coffee is safe even for people with heart disease.

Non-pharma, but amazing

(And a little happy, a little sad.)

A fully paralyzed 36-year-old man with ALS was able to communicate using only his brain. With the help of physicians and engineers, he was able to learn to use neurofeedback to control a tone — first using it to indicate “Yes” or “No,” then later to make individual letters.

His first requests: “Goulash soup and sweet pea soup,” “I would like to listen to the album by Tool loud,” and “I love my cool son.”

The Long Read: Do No Harm edition

What’s a physician’s responsibility — or any healthcare provider’s — when it comes to vaccine-hesitant patients? It’s patient autonomy vs. the danger to society.

Physicians respect the patient’s right to refuse treatment for their own illness, but may find it difficult to respect the patient’s right to refuse treatment for a contagious disease that can affect everyone else.

Doc Ock meets “Fantastic Voyage”

If engineers are tasked with creating a drug-delivery system for the lungs — but then stay up late drinking and watching the wrong kind of anime — this is what they come up with: a “magnetic tentacle robot” that can be guided deep into the lungs.

It’s designed to replace the bronchoscope, a large tube inserted through the nose or mouth. Its size makes it unwieldly, though, and hard to ‘steer’ to the right place. The magnetic tentacle robot, though, is small enough to go deep, controlled by external magnets.

As the magnets outside of the patient move, they develop forces on the magnetic particles in the segments of the catheter, causing them to change shape or direction — enabling the robot to be manoeuvred through the lungs and to a site of a suspicious lesion.

Once at the target location, the robot is used to take a tissue sample or deliver treatment.

So far it’s been tested in an artificial lung; the team will next try it on a cadaver before moving on to grad students.

Who’s that calling?

That voice you’re hearing — assuming it’s not the neighbor’s German shepherd — is probably Amelia Island calling!

Will you answer? The Georgia Pharmacy Convention is coming up, and you ought to be there. Amazing courses, great events, that incredible beach, lots for the family to do … it’s always an amazing event. (Yeah, we said “amazing” twice. Can’t be helped.)

Check it all out at GPhAConvention.com, then register, grab your room, and we’ll see you at the beach!

June 9-12, 2022. Room block closes May 18. Be there or be square.

Don’t worry, honey, I’m on the pill

A non-hormonal birth control pill for men is expected to start human trials this year.

Other male Pill candidates target testosterone, but researchers at the University of Minnesota tried a different tack: Their pill interferes with vitamin A, which is necessary for mammal fertility.

The result (they hope) will be “long-lasting but reversible sterility.” And because it doesn’t target testosterone, the so-called GPHR-529 pill shouldn’t cause unwanted side effects like higher cholesterol or lower sex drive.

Captain Obvious will never trust an influencer again

“TikTok videos about high blood pressure often lack scientific basis”

The dark was rising

What kind of person was most likely to have “maladaptive responses” to the pandemic — e.g., refusing to take steps to reduce risk?

In Brazil, which had one of the worst responses (with the government essentially doing nothing) the answer, according to an international group researchers, is “people with ‘dark personality traits’.” These are folks who “prioritize themselves more than the health of others,” exhibit lower levels of empathy, higher levels of deceitfulness, and higher levels of the so-called “Dark Triad.”

The Dark Triad: Machiavellianism/cynicism, psychopathy, and narcissism. To get the full Dark Pentad you can add sadism and spitefulness.

The Dark Pentad was overall negatively correlated with worry about the pandemic. In other words, those with higher Dark Pentad scores were generally less concerned with the pandemic. Higher Dark Pentad scores were also generally associated with less adaptive responses and more maladaptive responses to the pandemic.

HuffPo champions pharmacists

High-five to the Huffington Post (and reader S.S. who pointed it out) for a piece we’d like to see more of: “8 Health Issues You Didn’t Know Your Pharmacist Can Help With.”

Fighting mouse epilepsy

If you have mice — particularly female mice — with epilepsy, there’s good news afoot. A compound called TC-2153 reduces seizures in the hippocampuses* of mice — and that’s where 60 percent or more of them start.

University of Illinois physiology researchers were actually expecting to cause seizures when they tested TC-2153, and were surprised to find the opposite. Back to the lab: “Further studies will explore how TC-2153 works and will test its effects in human neurons.”

Interesting, while it worked on both male- and female-identifying mice, it was more effective on the girls. When they removed those mice’s ovaries, the efficacy dropped — offering a possible avenue for future research.

* It’s from the Greek, so it’s not “hippocampi.” I checked.

Breaking up the stones

Breaking up kidney stones from outside the body isn’t new. Extracorporeal shock wave lithotripsy is popular, using X-rays and shock waves to break up stones.

The downside is that ESWL needs to be done in hospital, can’t be used on pregnant people, and requires patients to be at least sedated, if not anesthetized. Not to mention the whole X-ray thing.

Now University of Washington and Indiana University have a better way: burst wave lithotripsy, which uses a small, handheld device and doesn’t require sedation. Instead of X-rays, it uses focused ultrasound pulses. The only side effect is a bit of “mild and manageable peripheral tissue injury.”

The first study of BWL in human subjects resulted in a median of 90% comminution of the total stone volume into fragments ≤2 mm within 10 minutes of BWL exposure with only mild tissue injury.

More research is coming. In the meantime, there’s always the roller coaster.

About those dietary guidelines

In 2020, HHS and the USDA released the latest version of “Dietary Guidelines for Americans” — recommendations for healthy eating. The question, as always, was how much those recommendations were based on science, and how much they were based on “input” from industry.

So a group of Irish, US, and UK researchers decided to find out. And yep, there was plenty of conflict of interest to be had:

Our analysis found that 95% of the committee members had COI with the food, and/or pharmaceutical industries and that particular actors, including Kellogg, Abbott, Kraft, Mead Johnson, General Mills, Dannon, and the International Life Sciences had connections with multiple members.

So take all these recommendations with a grain of salt. (But not too much.)

While you’re enjoying that grain of salt…

Eating cranberries every day can improve your cardiovascular function … according to a study funded by the Cranberry Institute.

Move over, vapin’

What do we want? Nicotine pouches!
When do we want them? Real soon!

Combining the best* parts of smoking (lots of nicotine) and chewing tobacco (shoving something between your teeth and gums), nicotine pouches are slowly gaining traction.

And by “slowly” we mean “very quickly,” according to a Rutgers study. Since becoming widely available a couple of years ago, sales, they say, are growing exponentially.

Fun facts:

“Smokers ages 18 to 44 were three times more likely to use nicotine pouches than older smokers” and the people most interested were those looking to quit (as opposed to those just looking for a ‘safe’ way to take nicotine).

(Looking for a gift for the new pouch user? May we suggest the lovely Bulk Savor Silver Spitter spittoon, available at Home Depot, or the portable Spit Bud Spittoon from Walmart?)

* This is sarcasm.

Immunization training for techs comes to Douglas

Technicians down south — we haven’t forgotten you! GPhA’s got it’s hot hot hot immunization training session, coming to Douglas, Ga.*, live on Saturday, April 2.

Be ready for Rho, Upsilon, and the eventual Andromeda strain: Get your vaccine training, bragging rights, and a spiffy certificate with GPhA’s Immunization Delivery Training for Pharmacy Technicians. It’s a total of 5½ hours of CE, including home-study and live training.

Space is limited, so don’t wait — click here for all of the details and to register now!

* At the Grace Pointe Church, kitty-corner from Space Cow Creamery

Boosting chemo

Switching to eating high-fat, low-carb, low-protein foods (yes, that’s a keto diet) seems to help kill pancreatic cancer cells — at least, when combined with chemotherapy of cisplatin, gemcitabine, and nab-paclitaxel.

Apparently (a Princeton-led, pre-clinical study found) the diet “changes pancreatic cancer metabolism and its response to chemotherapy” by limiting the availability of glucose.

Hop into the W.A.B.A.C. Machine…

The idea that the right diet can boost cancer drugs … well, that’s not new. Back in the Long Long Ago (2018), an MIT study found that “supplementing mouse chow with the amino acid histidine made a chemotherapy called methotrexate more effective against leukaemia.”

And in 2021, researchers at Memorial Sloan Kettering began testing a failed chemotherapy — phosphatidylinositol 3-kinase — with a keto diet, “hop[ing] the diet will render tumors more vulnerable to the drug.”

Bottom line:

Still, compelling results in patients will be needed to overcome some oncologists’ view of special diets as fringy alternative medicine.

Recall #1: Jergens lotion

Some 3- and 10-oz bottles of Jergens Ultra Healing Moisturizer could be infected with Pluralibacter gergoviae bacteria — a potential danger for someone with a weakened immune system. Check the FDA site for the recalled lot numbers.

Just call it “dihydrogen monoxide therapy”

Ah, homeopathy — the idea that water can cure this, that, or the other thing simply by having a ‘memory’ of an appropriate chemical (even if it’s diluted to the point of non-existence).

And yet there are people who believe in it. In fact, there have been studies that show it works.

A group of Austrian researchers (and one American) was curious about those studies — so they did what scientists do: They conducted a meta-analysis. Turns out, not surprisingly, that there’s a heck of a lot of bias in what’s out there. The biggest issue: Trials that show a homeopathic product don’t work just aren’t published. The rest are a bit iffy, too.

Many clinical trials haven’t been registered, with the main outcome changed in a quarter of those that have been. And many remain unpublished. All this indicates “a concerning lack of scientific and ethical standards in the field of homeopathy and a high risk for reporting bias,” say the researchers.

Or, as the BMJ put it, “Poor research practice suggests true impact of homeopathy may be ‘substantially’ overestimated.”

Recall #2: Accuretic

ICYMI, Pfizer is recalling some lots of blood pressure drug Accuretic (quinapril and hydrochlorothiazide, and including two generics) “due to the presence of elevated levels of nitrosamine, a potential cancer-causing impurity.”

I feel the need, the need for C

Everyone’s favorite acid — ascorbic — seems to play a role in cognitive impairment. Or, rather, the lack of it does. So found Aussie researchers after a small study (160 patients over age 75).

“Our findings showed that cognitive function scores were significantly lower among patients who were vitamin C deficient, with further analysis suggesting vitamin C deficiency was almost 3 times more likely to be associated with cognitive impairment.”

In fact, some of the patients’ vitamin C levels were low enough that they were at risk of scurvy.

Of course, the ol’ cause/effect question is out there: They can’t say that vitamin C deficiency causes impairment, but they can say that “vitamin C deficiency is common and is associated with cognitive impairment in older hospitalised patients.”

By law, any story about vitamin C must include pictures of citrus fruit.

And while we’re on the subject…

A potential treatment for Alzheimer’s (yes, yet another) comes from LSU and researchers in Sweden: a nasal spray that “arrested memory loss and brain degeneration in an experimental model.”

What’s in the spray? If you guessed “specialized pro-resolving lipid mediators,” give yourself 100 Internet Points. These are essentially fatty acids that can reduce inflammation, and what’s notable is that they’re often in short supply in people with Alzheimer’s.

Like most Alzheimer’s breakthroughs, this is still experimental — but, like so many others, it’s another step toward a treatment … and maybe even a cure.

Here comes the pill

Remdesivir — the 800-pound gorilla of Covid-19 treatments — may soon be available in pill form. Scientists at UNC-Chapel Hill are testing it right now, and it’s looking to be as effective as molnupiravir (already a pill) … at least for mice.

New life for old cancer drug

A treatment for canine glioma could be coming to humans as a glioblastoma treatment.

A team of biologists from Virginia-Maryland College of Veterinary Medicine and Wake Forest School of Medicine has been treating dogs with a drug*, a version of which had been unsuccessfully tried in humans.

The problem with the human trial wasn’t that the drug wasn’t effective, but that “It cannot be given orally or injected, which presents a challenge.” (Indeed.) But now, with some dog work under their belts, scientists have an answer: a technique called convection-enhanced delivery where catheters are inserted into the tumor tissue. (They’ve also upgraded the drug to target four receptors instead of two.)

Said team leader John Rossmeisl:

“[T]his is the ultimate embodiment of what I want to do. I put something in dogs that not only helps dogs, but it might help someone’s father, mother, sister, brother, daughter, or son.”

* It has no name, just “IL-13 mutant and ephrin A1 (EFNA1)-based bacterial cytotoxins.”

Today’s odd non-pharma story

Is there a perfect alarm tone? Sleep and sensory researchers at Australia’s RMIT University decided to find out, asking, “what type of alarm provides peak alertness upon waking?”

It needs an energetic melody*, should be between 100 and 120 beats per minute, and it has to be at the right frequency — about 500Hz does the trick.

Of course they made one. You can listen to it on YouTube.

* “People who use alarms that carry a tune they will readily hum along to will experience less grogginess than those with a standard ‘beeping’ alarm.”

How’s your toilet paper supply?

It’s not all that surprising, but it’s worth noting: The new Omicron variant — sorry, subvariant (previously called “stealth Omicron” but now the less-scary “BA.2”) — is chugging along in Georgia.

Nationwide, BA.2 makes up about a quarter of new cases (which, by the way, have started rising again). In Georgia it’s half that at the moment — about 12.4%.

Feds end coverage for Covid vaccines and testing for uninsured

Last week we told you how Congress isn’t providing more funding for the country’s Covid response. Now that’s hitting home.

The federal Health Resources & Services Administration has announced that, after March 22, its Covid-19 Uninsured Program “will stop accepting claims for testing and treatment due to a lack of sufficient funds.” Then, after April 5, it “will also stop accepting vaccination claims due to a lack of sufficient funds.”

Claims that have been submitted by these deadlines will be paid subject to eligibility and availability of funds.

For more information, visit https://www.hrsa.gov/CovidUninsuredClaim.

Bad to the bowels

What makes inflammatory bowel disease worse? If you said “the gut biome,” you’re right — and you might be a regular reader (thank you!).

Specifically, it’s a “high-damaging” strain of the Candida albicans fungus that produces candidalysin — a toxin that damages immune cells.

It’s a vicious cycle. When inflammation is present, C. albicans has a field day in the intestines. There that candidalysin, in damaging the immune cells, increases inflammation — often to the point that standard treatments don’t work. And more inflammation, more C. albicans.

The Cornell researchers who discovered the mechanism now hope they can use it to develop better treatments.

Up your POC testing game

Don’t be surprised if you’re selling a lot more point-of-care testing kits, and not just for you-know-what. Drugs, flu, pregnancy … you name it, there’s probably a test for it.

Help your patients get the most from these tests — and better yet, show them how impressive you are with a nationally recognized point-of-care testing certificate on your wall.

That’s why GPhA is offering you (yes, you!) the NASPA Pharmacy-based Point-of-Care Testing Certificate Program — 20 hours of CE (4 hours live, 16 home study). The live portion is in our Sandy Springs location on Sunday, April 24.

Check out the details, then sign up today before too many other people beat you to it: GPhA.org/pointofcare!

Nasonex goes OTC

The FDA has approved Nasonex — mometasone furoate monohydrate to you science geeks — for over-the-counter use to “treat and prevent hay fever and allergy symptoms” That is all.

Cholesterol news

The good stuff is better: Patients with sepsis have lower levels of HDL cholesterol, and a University of Kentucky study suggest that “HDL treatment could be an effective treatment.” (Specifically, a synthetic HDL treatment called ETC-642.)

The bad stuff may not be so bad: High LDL cholesterol is bad for your heart, right? Maybe not. Irish researchers, looking at the use of statins (which, as you know, lower LDL) found that “lowering LDL-C using statins had an inconsistent and inconclusive impact on CVD outcomes such as myocardial infarction (MI), stoke, and all-cause mortality.”

Is it possible that medical marijuana isn’t all it’s cracked up to be?

Sure, everyone knows cannabis and its derivatives are magical treatments developed by pixies that can treat just about anything: pain, seizures, the mystery of the evil realtor pretending to haunt a house, nausea, depression, and so on*.

Could this possibly be overhype? What if there was a downside?

Turns out there is, according to researchers at Mass General. Not only did they find that medical marijuana simply doesn’t work in a lot of cases, it can increase patients’ chances of abusing it — i.e., “in rapid onset of cannabis use disorder.”

“In this first study of patients randomized to obtain medical marijuana cards, we learned there can be negative consequences to using cannabis for medical purposes. People with pain, anxiety or depression symptoms failed to report any improvements, though those with insomnia experienced improved sleep.”

The big issues: Doses of the “medicine” aren’t monitored or regulated, and prescribers don’t often follow up.

“There needs to be better guidance to patients around a system that currently allows them to choose their own products, decide their own dosing, and often receive no professional follow-up care.”

* Baldness, poor eyesight, war, famine, pestilence ….

Worms detecting cancer

You’ve heard that dogs — and even ants — can detect cancer. And now Korean scientists have added worms to the list.

Today, testing for lung cancer requires an invasive biopsy or often-too-late chest X-ray. Instead, these scientists only needed a bit of lung tissue culture. They put it on one side of a chip, with a sample of normal tissue on the other … and worms (C. elegans) in the middle.

After an hour, if the worms preferred the patient’s lung culture, it could be cancerous. (The prototype was correct about 70 percent of the time.) The worms, apparently, can detect a chemical called 2-ethyl-1-hexanol that’s emitted by the cancer cells.

“We don’t know why C. elegans are attracted to lung cancer tissues or 2-ethyl-1-hexanol, but we guess that the odors are similar to the scents from their favorite foods.”

Weird Science: Boring edition

Do you know someone who’s religious, does data entry for a living, lives in a small town, and likes watching TV?

British psychology researchers into the “the science of boredom” have discovered what makes the world’s most boring person — and that list fits them to a T. (But bonus Boring Points™ if they’re also into bird watching.)

To be clear, this is what people perceive to be boring — “the stereotype that people hold about boring people, not the actual individual characteristics that boring people possess.”

* Why? Because “the stereotypical beliefs about bores—that is, perceptions of people as stereotypically boring—have hardly received empirical attention.” Wonder why.

Lithium vs dementia

A new weapon in the never-ending fight against dementia: lithium. Everyone’s favorite mood stabilizer seems to reduce a person’s chance of a dementia diagnosis — that’s according to British researchers looking at the health records of 30,000 people.

For the group that had received lithium, 53, or 9.7%, were diagnosed with dementia. For the group that had not received lithium, 3,244, or 11.2%, were diagnosed with dementia.

There are limitations, of course (e.g., the small number of patients taking lithium), but the data are encouraging. Not only might lithium might reduce overall dementia risk, but “it’s possible that lithium might reduce the risk of dementia in people with bipolar disorder.”

Unexpected bipolar treatment

Fecal transplants. Aussie researchers have found they can tweak the gut biome (the deep state of the body) using fecal microbiota transplants (FMTs) — and twice now they’ve cured, or at least significantly treated — bipolar disorder.

In the study detailing the most recent case, they found that after the transplant, “there was a distinct improvement in mood oscillations, anxiety, and in putative ADHD symptoms, seemingly independent conditions.”

For a man who had required extensive and extended medications to have his bipolar condition largely remit following FMT with no need for maintenance medication, such a case is quite striking.

Link above is to the paper; click here for the news story.

Put on your dancin’ shoes!

Every convention’s band is better than the last, and this year is no exception. Cranking up the volume and making even the most grumpy old stodge dance dance dance* will be the Blues Factor Band! Blues, rock, Motown, country, funk, R&B … it’s gonna be a-frickin’-mazing.

Check ’em out:

Haven’t registered yet? What’re you waiting for?

June 9-12, 2022 Room block closes on May 18. Sign up today!

* Set your pacemaker to 11.

Does this membrane make me look drug resistant?

You can tell when a bacteria is drug resistant when, well, a drug stops working on it. But there seems to be an easier way: Look at it.

Instead of trying to tease out genetic changes in bacteria, Japanese microbiologists found an easier, 21st century way. Throwing an electron microscope and some machine learning at the problem, they discovered that resistant bacteria look different.

For example:

“We found that the bacteria that were resistant to an antibiotic called enoxacin exhibited differences in cell shape, outer membrane structure, periplasmic space, and granule content and location compared with the drug-sensitive strain.”

Now knowing that resistant bacteria “flaunt their new power” this way, they’re hoping to turn it into a technology that can automatically predict drug resistance with just a peek or two.

You don’t say

WSJ: “Ivermectin Didn’t Reduce Covid-19 Hospitalizations in Largest Trial to Date”

Human batteries and electric clothing

When you’re worried that a mask doesn’t do quite enough to keep viruses away, a group of Korean engineers and virologist have the Next Big Thing in fashion: a virus-blocking textile (VBT) — i.e., clothing that repels viruses.

Good masks use electrostatics, not just tiny holes, to keep viruses away. SARS-CoV-2, for example, has a negative charge, so it’s repelled by another negative charge, like two divas in an opera. The new fabric takes advantage of this, getting power from the person wearing it via the triboelectric effect — i.e., electricity from rubbing two things together, like a balloon on Junior’s hair.

Once they had the fabric and the human batteries working, they tested the result and found…

…that VBT can effectively repulse SARS-CoV-2 aerosols, resulting in 99.95% of SARS-CoV-2 blocked. Finally, high breathability, washability, and durability of VBT were demonstrated, and this suggests that practical application of VBT as an effective face mask or filter is enabled.

Quick drug-cost facts

Specialty drugs account for a huge chunk of drug spending in the U.S., and two categories make up the vast majority (89%) of specialty drugs: Treatment for autoimmune diseases and for asthma/atopic dermatitis, according to data from CVS.

Of note: The high overall cost, the company claims, isn’t from higher prices, but from “increased utilization.”

Opioid-abuse treatment cage match

There are three major drugs used to treat opioid-use disorder*, but which works best? There hasn’t been a study to figure that out … until now.

Analyzing data from 82,000 Medicaid claims in Ohio, researchers from Case Western Reserve, Indiana University, and an Ohio State University found that (spoiler alert!) …

[O]verwhelmingly, methadone was associated with the lowest risk of treatment discontinuation, followed by buprenorphine, then naltrexone.

Oh, and you can step it up a notch, too: “Researchers also found that medication-assisted treatment, coupled with behavioral health therapy such as counseling, increased success in patient retention.”

* Buprenorphine, methadone, and naltrexone

The Long Read: What if She’s Pregnant? edition

There’s precious little data on how prescription meds affect fetuses. Why?

When it comes to medical research, there’s “a sort of no-regrets policy toward pregnant people,” says Ruth Faden, a bioethicist at Johns Hopkins University, “as in, ‘Let’s not do anything, so we won’t have any regrets.’”

Slowly, though, that’s changing.