Combos for Lyme

The standard treatment for Lyme is, of course, good ol’ doxycycline. The downside is that it doesn’t always clear the infection completely (especially if it’s taken late), leading to persistent cases — aka “post-treatment Lyme disease.”

Tulane immunologists found that no single antibiotic could completely wipe out persistent Borrelia burgdorferi bacteria, but several combos did the trick. What combos, you ask?

• doxycycline and ceftriaxone (with or without carbomycin or loratadine)
• doxycycline and cefotaxime
• dapsone with either rifampicin or clofazimine

The more you know. (Bonus: It’s a “game-changer”!)

Take your glass half full and…

You know that relentlessly optimistic person whose sunny disposition eventually drives you nuts? Don’t judge so harshly — it might be because they have lower cognitive ability.

Despite what those self-help books might tell you…

Research from the University of Bath shows that excessive optimism is actually associated with lower cognitive skills such as verbal fluency, fluid reasoning, numerical reasoning, and memory. Whereas those high on cognitive ability tend to be both more realistic and pessimistic in their expectations about the future.

Yeah, you read that right: Smarter people are more realistic and pessimistic.

The brains of the 100-Acre Wood

Respiratory sitrep

The latest CDC data show that flu cases are rising across the country, while RSV — which has pounded Georgia’s emergency rooms — appears to be leveling off. Covid-19, meanwhile, “continues to cause the most hospitalizations and deaths among respiratory illnesses — about 15,000 hospitalizations and about 1,000 deaths every week.”

Syphilis drug shortage

While shortages of ADHD and cancer drugs get most of the coverage, the National Coalition of STD Directors is warning that there’s a shortage of Bicillin L-A (aka benzylpenicillin) — the primary treatment for syphilis and the only one for pregnant women.

The CDC says that yes there’s a shortage, but it doesn’t know of any cases where a pregnant woman couldn’t get it. But according to the NCSDDC, “health departments are hearing different information”: Women are getting it, but only 56% get it within a week.

This, of course, in the midst of a surge in syphilis cases across the country.

In the previous three months…

• 46% of clinics have attempted to order Bicillin L-A, but the drug was not available;
• 55% of clinics that had orders completely unfilled had more than half of their orders unfilled;
• 31% of clinics have received partially filled orders; and
• 40% of clinics have had their Bicillin L-A orders delayed.

Lilly’s weight loss drug hits shelves

Eli Lilly’s ticket onto the GLP-1 bandwagon has been punched, and the company’s Zepbound (tirzepatide) is heading to pharmacy shelves. It’s got a list price of $1,060 ($25 per month out of pocket) and will be available for a mere $550 a month to patients who don’t have health insurance but can afford that price tag.

In trials, Zepbound helped people lose more weight than Novo’s Wegovy — a whopping 20% of their weight compared to a measly 15% for Wegovy.

Quick takes

ICYMI: Cantaloupes of doom

If you don’t know where that cantaloupe came from, don’t eat it. That’s the message from the Georgia Department of Public Health in response to an outbreak of salmonella infections in sliced cantaloupe that has sickened at least five Georgians.

Elsewhere: Rite-Aid edition

Rite-Aid has given its pharmacists in California, Maryland, New Hampshire, Nevada, and Oregon permission to prescribe oral contraceptives (because state law permits it).

When mom should take B12

Vitamin B12 is important for infants; they get it from their mothers either in utero or via breast milk. But if you’re going to supplement it, when’s the best time?

It matters, found George Mason public health researchers. To cut to the chase, you need both but one might be more important. Pre-natal supplements give a short-term B12 boost, but it’s the post-natal vitamin that gives the longer-term benefits.

Weirdly, they tend to interfere with each other to some extent:

[T]he effect of the prenatal vitamin B-12 supplement diminished when used together with the postnatal supplement. Likewise, the effect of the postnatal vitamin B-12 supplement diminished when used together with the prenatal supplement.

The Masonites still recommend using the two together, although their findings mean either A) once deficiency is corrected there aren’t any more benefits, or 2) Mom might need a higher dose to overcome that ‘cancellation’ effect. They aren’t sure … yet.

Congress to FDA: What took you so long?

Why did it take so long for the FDA to pull phenylephrine from the shelves? House Republicans want to know.

The FDA “relied upon outdated and insufficient evidence regarding phenylephrine’s use as a decongestant for so many years, despite numerous appeals by the scientific community.”

We, too, would like to hear the answer.

A new drug for Fido

There could soon be a drug available to help your dog live longer. Yes, that simple — a drug to tackle one of the root causes of premature aging on larger dogs.

Veterinary biotech company Loyal for Dogs got FDA blessing to begin clinical trials of its anti-aging drug LOY-001. Right now it’s a four-times-a-year injection for older (7+ years) and larger (40+ pounds) dogs, but the company is working on versions for smaller dogs as well as a pill form.

All versions of the drug work by limiting the power of a growth-related hormone, called insulin growth factor-1 (IGF-1), which as well as contributing to growth is linked to aging and longevity in animals like roundworms, fruit flies, and mice.

IGF-1 is partly responsible for larger dogs growing larger, but it’s also a culprit in their dying younger. So that third “Clifford the Big Red Dog” book? Probably fantasy.

The Long Read: Pharmacists are revolting

It’s more than just about being overworked. The new corporate reality of American healthcare has pharmacists and physicians rethinking their jobs — and unionizing.

Once accustomed to a status outside the usual management-labor hierarchy, many health professionals now feel as put upon as any clock-punching worker.

More older folks are ‘self medicating’

Picture eight of your older patients. Chances are one of them is using some kind of cannabis product — especially the ones who drink a lot of alcohol.

That’s what a new study out of the University of Michigan found: “with 12% [of patients 50–80] saying they’ve consumed a THC-containing substance in the past year and 4% saying they do so multiple times a week.”

That’s up from less than 10% in 2019, and it’s important for healthcare providers to know.

Older adults represent a vulnerable age group for cannabis use due to interactions with medications, risky driving, cannabis-related mental health impacts and increased possibility of falls and memory issues.

So when you think about medication interaction, it’s important to consider that there’s a decent chance that people over 50 are engaging in a little extracurricular activity.

One of the right gut bugs

Oh, lactobacillus, what can’t you do? It seems everyone’s favorite gut bacteria “helps the body manage stress and may help prevent depression and anxiety,” according to UVa researchers.

This is important because while it’s clear that “healthy gut bacteria” is good for you, what exactly constitutes those healthy bacteria isn’t clear. Of the thousands (millions?) of species floating around inside us, it’s hard to tell the good from the bad, making probiotics are hit or miss.

By using a new technique to create mice with and without lactobacillus in their guts, the Virginians were able to tease out exactly why it’s good for mood:

Lactobacilli in the family Lactobaccillacea maintain the levels of an immune mediator called interferon gamma that regulates the body’s response to stress and helps stave off depression.

This could lead to either a targeted probiotic or even a treatment for mood disorders that takes advantage of the same pathway.

Muppets explain addiction

You know the opioid crisis is really a crisis when the Muppets get into the act. As tempting as it is to think that Elmo has a painkiller problem, in fact he and friend Karli are explaining to kids why Karli’s mother is in a special place. (Not Heaven — rehab.)

Spit, don’t prick

Why stick yourself with a needle when you can just lick something? That’s not just good advice for tailgating at the Grateful Dead reunion tour, it might soon be something for diabetics to consider.

Scientists at Canada’s L’Université de Sherbrooke have made a sensor sensitive enough to detect glucose levels in the saliva — something that hasn’t been possible because the concentration was so low. But by supercharging the engineered DNA (called aptamers) used in biosensors, they made a device that can replace a finger-prick with a sensor-lick for measuring glucose.

Not only was the sensor accurate at measuring glucose concentrations in the liquid — providing readings in just 30 seconds — it also retained its sensitivity for up to one week….

Oh, and their new technology can also work with other biomarkers such as one that indicates gum disease.

The snozzberries test for LSD.

The path towards older worms

If you’re tired of your roundworms dying (and having to explain to your kids that Squiggles has gone to live with a nice family upstate), there’s good news out of the University of Liverpool.

It seems that rilmenidine, the blood pressure drug, “at young and older ages increases lifespan and improves health markers, mimicking the effects of caloric restriction.”

So instead of cutting your worms’ diets to the bare minimum, you might be able to help them live longer by adding an Albarel supplement.

Even if that doesn’t translate to humans, they discovered that rilmenidine affects a cellular receptor^* called nish-1, meaning nish-1 could be a target for other longevity drugs.

^* Techically an I1-imidazoline receptor

Novo targets compounders (again)

Instead of claiming they don’t have the right to compound semaglutide (the company lost that fight already), now those shifty Danes at Novo Nordisk have changed tacks. They’re claiming that the compounded semaglutide they found in a few pharmacies isn’t as strong as the real deal — it’s a lower dose.

So yes, Novo is suing two Florida pharmacies for selling a lower dose of the medication they don’t think those pharmacies should be allowed to sell at all. (How this hurts Novo isn’t clear.)

The company is also claiming some of the compounded versions contain a peptide called BPC-157 that isn’t allowed in compounded meds. (If Novo found a shady compounder playing fast and loose with the law, good for them — but that seems like a criminal issue rather than a civil one.)

Speaking of Novo Nordisk…

The company has showered medical pros with $25.8 million over a decade to get them to recommend its weight loss meds.

Example: Dr. Lee Kaplan, chief of obesity medicine at Dartmouth College’s medical school. He’s been pushing Wegovy on the one hand while receiving $1.4 million from Novo “for consulting work and travel between 2013 and 2022,” in the other hand, according to Reuters.

“To prevent and defeat a serious chronic condition like obesity, we need to do more than supply the right medicine,” Novo said. “This is why we work with medical professionals, institutions and other experts to conduct research and educate and raise awareness about obesity.”

Because apparently Americans aren’t aware of obesity. (Keep that $25.8 million in mind next time a drugmaker says its drugs are so expensive in order to pay for research and development.)

Elsewhere: Where the piece of cloth is tyranny

The anti-vax attorney general of Texas is suing Pfizer over its Covid vaccine. He claims that the vaccine wasn’t actually 95% effective as Pfizer’s tests showed, but only 0.85% effective. And, as Reuters reported, “He also said the pandemic got worse even after people started taking the vaccine.”

Uh-huh. Also: The moon landing was fake and birds aren’t real … but that’s another story. He did give us a lovely hyperbolic use of the word “tyrannical”:

“Pfizer did not tell the truth about their Covid-19 vaccines,” Paxton said in a statement. “We are pursuing justice for the people of Texas, many of whom were coerced by tyrannical vaccine mandates to take a defective product sold by lies.”

Captain Obvious doesn’t mix her vices

“Combined use of alcohol and THC can affect rat brains, study finds” —University of Illinois

In other medical news

Plastic surgeons are contemplating one of life’s great mysteries.

CAR-T dangers?

CAR-T is one of the more new and powerful treatments for cancer, but a potential issue is emerging. The FDA is investigating several cases of patients coming down with different* cancers, including lymphoma, being reported after receiving CAR-T therapy.

Notes:

• The risk applies to all existing CAR-T therapies.
• CAR-T labels already warn of a risk of other cancers, so it isn’t a complete shock.
• The FDA says that, based on current information, the benefits outweigh the risks.

At the moment the FDA is just keeping an eye on things, but that could change if more reports come in.

Good cholesterol’s darker side

There’s good cholesterol (HDL) and there’s bad cholesterol (LDL). But, as with chocolate cake and Marvel movies, it seems there can be too much of a good thing.

A new study out of Australia’s Monash University found that “Abnormally high levels of HDL-C, colloquially known as ‘good cholesterol’, are associated with an increased risk of dementia in older adults.”

When they say “very high,” they mean higher than 80 mg/dL — at that level patients had a 27% higher risk of dementia. And when they hit age 75 it jumped to a 42% increased risk.

Why? They have no idea, so you know the mantra: “More research is needed.”

Part D costs: One step forward, one step back

Good news for seniors: Starting in 2025, your Medicare prescription costs are capped at $2,000 for the year. (Currently it’s capped at $7,000.)

The bad news: To help balance the books, private Medicare Part D premiums are going up big time — as much as 57% next year in the states with the highest Medicare populations, which comes to about $25 to $30 more per month. (That doesn’t include Georgia, but you can expect Georgians’ premiums to rise as well.)

And, of course, it means Medicare Advantage plans, which include prescription coverage, will also see premiums rise to offset the cap.

A fix for post-diuretic glucose

Thiazide diuretics have a downside: high blood sugar thanks to lower blood potassium. And to keep things interesting, potassium supplements don’t help.

What’s a patient to do? Maybe take a supplement developed at the University of Texas that’s a combination of potassium, magnesium, and citrate that they gave the memorable name “KMgCit.”

A study of 60 people found that, while taking either KMgCit or plain ol’ potassium chloride raised potassium levels, only the KMgCit also lowered blood glucose.

Although it’s unclear which component in the combination supplement lowered glucose, previous studies have shown that deficiencies in magnesium can have wide-ranging negative metabolic effects. Future studies will examine the effects of magnesium and citrate separately.

Shocking smoking discovery

If you smoke tobacco and smoke marijuana, your chances of getting emphysema are much higher.

Less shocking (and more interesting) is that the risk when you smoke both is higher than if you smoke only one.

This could mean that weed and cigarette smoke might somehow interact with each other to have even worse effects on the lungs and airways, the researchers said.

ICYMI: US life expectancy finally rises

The other day we told you how the life-expectancy gap is widening in the US between men and women. Now there’s new data that’s a bit better: After two years’ of dropping thanks to the pandemic, US life expectancy has ticked up based on 2022 data from the CDC.

We still lag the rest of the highly developed world (and we’re still below our pre-Covid high), but it’s good to see the numbers moving up again.

ADHD treatment: You gotta believe

There have been a bunch of studies on the effectiveness of transcranial magnetic stimulation for ADHD, but there might be a huge twist to all of them. It seems that a lot of the effect of the brain zapping might depend on the patients’ belief in them.

British psychology researchers found that in four out of five studies…

…patients’ beliefs about whether they were receiving real or placebo treatments explained the treatment […] On some occasions, the subjects’ beliefs explained the treatment’s results better than the actual treatment itself.

Captain Obvious loves the Snooze button

“Sleep Loss Impairs Decision-Making”

Cigna, Humana in merger talks

The Wall Street Journal is reporting that the two insurance giants are talking about hooking up. There isn’t any official word yet, as they’re probably trying to write the press releases that will explain how this will somehow be good for patients.

Cigna and Humana have distinct focuses, which could help appease antitrust concerns. Humana sells mostly Medicare Advantage plans to seniors and has said it is going to stop selling employer coverage, where Cigna is strongest. Cigna’s Medicare business is small by comparison.

Shredding cancer with CRISPR

CRISPR gene editing works by seeking out a particular DNA sequence and then replacing it with something else. It’s a great tool for fixing errant genes, but it can also bring death … to cancer.

It’s pretty straightforward, at least to explain.

Instead of fixing ‘broken’ cells, scientists at Gladstone Institutes — including Jennifer Doudna, who shared the Nobel Prize for discovering CRISPR — used CRISPR to screw with the genes of tumors.

Using a novel technique they’ve dubbed “cancer shredding,” the researchers programmed CRISPR to zero-in on repeating DNA sequences present only in recurrent tumor cells — and then obliterate those cells by snipping away at them.

The goal would be to use CRISPR in conjunction with traditional glioblastoma therapy, where some cells could escape treatment. Those escaped cells have genetic markers that look like a big ol’ target to CRISPR — they can run, but they can’t hide.

Don’t forget to think of a great pharmacy pro

Take a few minutes to tell us about a great pharmacist, technician, or student who deserves some big-time recognition at the 2024 Georgia Pharmacy Convention.

Head over to GPhA.org/awards to see the list of awards, the criteria, and how to nominate someone. The deadline for nominations is January 19, 2024, so don’t wait too long!

Chickenpox danger zone

Babies get chickenpox immunity from their moms — at least long enough until they’re eligible for the varicella vaccine, which is usually given when they’re about 12 months old.

Except that it seems that mom’s immunity doesn’t actually last that long, researchers at the University of Toronto discovered.

They found that antibodies protecting against varicella wore off quickly, and that almost 80 per cent of infants were susceptible to infection by the time they were three months old. At six months, all the infants studied were susceptible to chickenpox infection.

While chickenpox is usually (but not always) mild in children, infants are at higher risk of serious complications. The takeaways, per the Canadians, are to keep infants away from anyone who might be infected, and to have any rashes that appear checked quickly.

Semaglutide vs. alcoholism?

GLP-1 inhibitors work (mostly) by slowing down your digestive system so you feel full longer. But they’ve also been shown to have other effects on addictive behavior. In this case, researchers at the University of Oklahoma and Oklahoma State found that semaglutide specifically reduces the symptoms of alcohol use disorder.

This is just preliminary research (and only only six subjects), but the Okies are hoping it can “set the stage is set for future clinical trials [… that] can definitively tell us whether semaglutide is safe and effective for treatment of alcohol use disorder.”

The latest “Alcohol: Good or bad?” has a twist

Is moderate alcohol consumption good or bad for you? Normally the answer comes from the nearest Magic 8-Ball, but now Boston and Tufts university researchers have come to a shocking conclusion: It depends.

What it depends on are the particular metabolites circulating in a person’s blood. There are about 60 of them that are related to alcohol consumption. The researchers found that seven will increase the risk of cardiovascular disease and three will decrease the risk — this among moderate drinkers.

It gets even more complicated. Gender plays a role (“perhaps due to women’s generally smaller body size”) as does whether the drink is beer, wine, or liquor. So next up, of course, are bigger, broader studies.

GLP-1 cage match winner

“Mounjaro is more effective than Ozempic for weight loss” —in other words, tirzepatide is better than semaglutide.

Patients taking Eli Lilly’s Mounjaro were significantly more likely to lose 5%, 10% and 15% of their body weight overall and saw larger reductions in body weight after three months, six months and a year compared with those on Novo Nordisk’s Ozempic.

What makes this story different is that it’s based on a large, real-world study, and that it found a significant difference between the two; previous (small) studies found just a slight difference.

Gov’t declares shortages to be a national security issue, invokes Cold War law

We’ve said before that the federal government can’t force companies to make drugs, but it can encourage them with taxpayer dollars — as it’s taxpayers who are dealing with drug shortages.

Invoking a 1950s law — the Defense Production Act — the Biden administration is essentially declaring those shortages to be a national security issue.

Doing so means the government will be able to invest money “in domestic manufacturing of essential medicines, medical countermeasures, and critical inputs that have been deemed by the president as essential to the national defense.” It’s not waiting, either; HHS has already identified $35 million worth of investments “in domestic production of key starting materials for sterile injectable medicines.”

Other plans announced:

• A new HHS supply chain resilience and shortage coordinator “to strengthen the resilience of medical product and critical food supply chains, and to address related shortages.”
• The Defense Department will also be looking at ways of “reducing reliance on high-risk foreign suppliers.”
• Better monitoring of all aspects of the supply chain, including “supply chain risk assessment tools” out of the Commerce Department that will hopefully “address foreign dependency vulnerabilities and points of failure.”
• A public-private partnership headed by the Department of Transportation to monitor logistics so companies can “avoid bottlenecks, shorten lead times for customers, and enable a more resilient and globally competitive freight network.”

In short, the government will be able to pay to increase production, and to use its gigantic resources to provide information to help reduce disruptions. But there’s only so much it can do in a market-driven economy — at the moment, American companies can simply reap more profits by having foreign manufacturers make their drugs on the cheap.

Trigger warning: The link goes to the White House website, which is a bit … let’s call it rah-rah. It has more detail than a lot of the news stories, though.

A recall you can snicker about

Miami-based Noah Wholesale has recalled its sexual enhancement pill, “The Rock,” because 1) it turns out not to be FDA-approved and 2) it may or may not work. It contains good ol’ sildenafil, but that’s not listed on the package.

Each red 1200 mg capsule was sold solo in a blister pack with red and black lettering on a white piece of cardboard. The recalled lot is No. 03032021, expiration 12/2007 with UPC No. 6 61799 95052 7.

And in the final bad pun, it was distributed by a company called Steele Products.

Long-term use issues

Of ADHD meds

Taking methylphenidate or lisdexamfetamine for three years or more raises a patient’s risk of cardiovascular issues. That’s according to a meta-analysis by Swedish researchers, who found that “each 1-year increase in use of ADHD drugs was tied to a 4% increased risk of CVD,” and this applied to both children and adults.

In particular, hypertension and arterial disease were the big issues. The good news was that they didn’t find a connection to arrhythmias, cerebrovascular disease, heart failure, ischemic heart disease, or thromboembolic disease. So there’s that.

Marketing opportunity: Recommend sphygmomanometers to your patients taking ADHD meds.

Of aspirin

Taking low-dose aspirin used to be a gimme for older people to cut the risk of heart issues. Then it got dialed back because of GI problems. Now there’s a new twist: cancer.

Based on 20 years’ of data, a group of those shifty Danes found that continuous use of low-dose aspirin was associated with…

• Increased risk of lung, bladder, brain, and renal pelvis or ureter cancers

BUT

• Decreased risk of melanoma, as well as non-Hodgkin lymphoma and cancers of the small intestine and liver

And then, to add yet another twist, “The researchers also looked at high-dose aspirin (500 mg) use and found that consistent use was associated with a lower risk of cancer overall.”

The takeaway? “It’s complicated.”

Are you coming to Asheville?

The early-bird deadline for the 2024 Southeastern Pharmacy Leadership Weekend is fast approaching — you only have until this Friday, December 1 if you want the discounted rate for the conference and the hotel.

The former “Women of Pharmacy Leadership Weekend” is now open to everyone — it’s January 12-14 at the Omni Grove Park Inn in Asheville, North Carolina.

Great speakers, tons of CE, and “plenty of time for spa appointments.”

GPhA members get a $100 discount: The early-bird rate till December 1 is just $379 for the weekend; after that it jumps to $479. Use discount code GAMEMBER24.

Full registration includes participation in all events, event materials, Friday night networking reception, and dinner and two breakfasts. It does not include the hotel, which is $259 per night, which includes the resort fee.

Click here for all the details.

Bird flu comes to Georgia

The bird flu (H5N1) has hit a Georgia duck-breeder in Sumter, affecting 30,000 birds. This is the first time avian influenza has hit Georgia.

Used coffee grounds can help treat neurodegenerative diseases

That’s not exactly true, but it makes for a good headline.

What University of Texas chemists found was that chemicals called “caffeic-acid based carbon quantum dots” (CACQDs) can protect brain cells from damage by Alzheimer’s, Parkinson’s, and other neurodegenerative diseases. That’s because caffeic acid has an important property: It can penetrate the blood-brain barrier. Once there, it goes to work.

The CACQDs, the team observed, were able to remove free radicals or prevent them from causing damage and inhibited the aggregation of amyloid protein fragments without causing any significant side effects.

And then there’s the headline. The CACQDs can be easily cooked from used coffee grounds, which are obviously pretty common. So the process is simple, cheap, and green.

The downside: This was only done in the lab, so a lot of further testing is needed.

Meanwhile, in caffeine news…

People who consume caffeine regularly might be giving up brain plasticity in the bargain. Specifically, researchers found, because caffeine is an adenosine receptor antagonist, it can interfere with neurons’ long-term potentiation. That’s kind of important, because long-term potentiation means ‘forming long-lasting connections’ — something you need for learning and memory.

(Note: This is yet another story that confuses coffee and caffeine. The story is about caffeine, although the article’s headline speaks of coffee.)

The bad amino acid

You’re used to hearing about how amino acids can do a body good, but there’s at least one case where cutting down on one helps mice live longer and happier.

The acid is isoleucine, and University of Wisconsin researchers found that cutting it out of mice’s diets helped them live longer and better, even when they ate more.

Mice on the low-isoleucine diet lived longer — on average 33% longer for males and 7% longer for females. And, based on 26 measures of health, including assessments ranging from muscle strength and endurance to tail use and even hair loss, the low-isoleucine mice were in much better shape during their extended lives.

Good luck cutting isoleucine from your diet, though. First of all, you need some of it to live. Secondly, it’s in a lot of foods — you can’t switch to a diet of isoleucine-free mouse chow. But learning the effect of this one amino acid “gets us closer to understanding the biological processes and maybe potential interventions for humans, like an isoleucine-blocking drug.”

Cancer hates lidocaine

Lidocaine, besides numbing skin, activates a person’s bitter-taste receptors. So what? I hear you ask. It turns out that the receptor, called T2R14, is pretty popular with cancer cells, especially oral and throat cancers.

The fun part: When lidocaine hits those cancer cells, it kills them. That’s what UPenn researchers found, and it surprised them: “Lidocaine targets the one receptor that happened to be most highly expressed across cancers.”

“While we’re not suggesting the lidocaine could cure cancer, we’re galvanized by the possibility that it could get an edge on head and neck cancer treatment and move the dial forward.

Simpler, cheaper chemo ingredients

Making cancer drugs is expensive — we’re talking more than the price of gold for just one component. (That’s partly because the manufacturing process requires platinum and gold.)

But now UCLA chemists have made a breakthrough that uses oxygen and copper instead of that platinum or gold to create amines, a building block of a lot of pharmaceuticals. Their process, called aminodealkenylation^*, not only uses cheaper materials, it takes fewer steps — three instead of more than a dozen.

And the final bit of good news is that the technique works for more than just cancer drugs:

“We have used this unconventional transformation for late-stage modification of hormones, pharmaceutical reagents, peptides, and nucleosides.”

That means once it’s out of the lab it could knock down a lot of drug prices.

^* Coincidentally, that’s also the name of one of UCLA’s backup linebackers.

The Long(ish) Read: Stopping Ozempic edition

Can people stop taking GLP-1 inhibitors? Well, they do stop — many people give up after a year or two for various reasons (side effects, insurance coverage). The question is whether people can stop taking them and keep off the weight, and how to help them do that.

Still nothing to see here

While there is absolutely nothing to worry about with the new respiratory illness spreading in China, the Chinese ministry of health has “urged local authorities to increase the number of fever clinics.”

“Efforts should be made to increase the number of relevant clinics and treatment areas, appropriately extend service hours and strengthen guarantees of drug supplies.”

(For its part, the WHO says that this spike in illnesses ‘isn’t as high as it was before the pandemic.’ This makes no sense at all — at some point there were only a handful of Covid cases, just like with the current outbreak.)

The cause of itching

Harvard researchers might have figured out what causes itching — at least some of it. The answer: Staphylococcus aureus, or rather an enzyme it generates (protease V8, if you’re interested). They knew that people with eczema often had more S. aureus on their skin, but didn’t know what the connection was. Now they do.

Normally conditions like eczema and atopic dermatitis are treated by treating the inflammation — the result. But this new research means they might be able to tackle the cause instead using an FDA-approved PAR1 blocker.

Of course, the researchers have already filed for a patent based on this.

Turkey vs. ulcerative colitis

If you have turkey leftovers, good for you — they might help relieve the symptoms of ulcerative colitis.

You might think of tryptophans as what people argue about every Thanksgiving. Do they make you sleepy, or is that a myth?

Who cares? The news out of Jefferson University is that — now follow along — tryptophan can make T-reg immune cells produce more of a receptor called GPR15. The more GPR15 receptors they have, the more strongly they’re attracted to the colon. And when they get to the colon, those T-reg cells reduce inflammation.

They tested this on mice and …

They saw a doubling in the amount of inflammation-suppressing T-reg cells in the colon tissue compared to mice that weren’t fed extra tryptophan [… as well as] a reduction in colitis symptoms. What’s more, the effects seemed to last for at least a week after tryptophan was removed from the diet.

The only downside is that it seems to prevent colitis flare-ups, but do little to treat them when they occur. Still, it’s a new twist on the annual tryptophan story.

Lower cholesterol, better breast cancer outcome

Statins, it seems, might help women with breast cancer stay alive. Well, it’s more accurate to say that lowering cholesterol was good for women with breast cancer.

Finnish researchers looked at the data for more than 13,000 women with breast cancer. They found that women had a lower risk of death from that cancer if, after diagnosis, they lowered their cholesterol level.

Read that carefully. It wasn’t just that lower cholesterol was good. It was that they lowered their cholesterol after they were diagnosed. I.e., they were looking at the change in levels, not the absolute levels.

Covid’s holiday rebound

Covid cases are on the rise again, and hospitalizations jumped 8.6% in mid-November, according to CDC data.

The good news is that it’s easy to get a high percentage jump when numbers are low, which is the case. The news to watch is that cases and hospitalizations are going up.

The bad news lurking in the background is that the CDC figures are probably low; there’s no longer any kind of national tracking in place. It’s not time to buy toilet paper, or probably even to mask up … but it might be time to think about avoiding crowded indoor spaces with strangers.

Nothing to see here

There’s a Mysterious Respiratory illness spreading in China, but don’t you worry says the WHO. It’s probably nothing to worry about.

This report brought to you by Charmin bathroom tissue. Do you have enough?

New med to keep Mr. Fluffikins chill

The FDA has just approved a new drug designed to relax your feline friend so you can safely take Mittens to the vet.

Best of all is the name: Bonqat — pronounced “bonk-cat.”

The drug is administered orally approximately 1.5 hours before the start of the transportation or veterinary visit and can be given on two consecutive days.

Good news for both Snuggles and her owner.

Our number two story

Probiotics are hit-and-miss — we know they can do good stuff in general, but teasing out which bacteria have the effect we want is a lot tougher. You can’t just load up on your favorite yogurt.

But now Chinese researchers think they’ve found one cause and effect: Strains of the gut bacteria Bifidobacteria longum can “kickstart gut motility.” That is, B. longum can relieve constipation.

The catch is that it has to be a strain that contains the abfA gene cluster, which helps gut bacteria process some plant-based nutrients. So now they know not only which bacteria can help, but also why — and that can lead to finding other probiotics that do the same thing.

You know the headline writer was giggling

“Nuts may enhance fertility for men: study” The gist is — per Aussie researchers — that eating about two handfuls^* of nuts per day improved the quality, although not quantity, of sperm.

That’s based on a review of four published studied that looked at walnuts, hazelnuts, and almonds, raw and roasted, although they think any nut combo would have the same effects.

Hypothesis: “[T]he high concentration of omega-3 polyunsaturated fats, dietary fibres, vitamins, minerals and polyphenols found in nuts could improve reproductive health.”

Bonus: No, it was not funded by Big Nut. This was legit.

^* (snicker)

Things that make you go “Hmmm”

What is a drug?

↑ That’s the question an Australian medical philosopher asks. And he couldn’t find a good answer, only lists of what’s officially considered a drug.

Despite their centrality to medicine, we have no idea what medical drugs are. We can’t even tell the difference between drugs and food, let alone drugs and so-called “natural” alternatives.

That makes it hard to write regulation or even decide what can be prescribed. It’s not about chemistry, or origin, or function, or outcome. In fact, he says, “there is nothing, chemically speaking, all drugs have in common.”

Why not 12 months?

How can you reduce pharmacist workload and maybe even increase adherence? Why not stop making patients pick up their meds every month? So argues one drug supply chain expert.

[I]nstead of dispensing 30- or 90-day prescriptions, convert patients to receive six or twelve months of medication in a single prescription pick-up. I’m not talking about new prescriptions a patient is trying for the first time, where titration is still occurring, or controlled substances. I’m talking about the long-term chronic medications on which a patient is stable on therapy.

Teamwork makes the dream work (if the dream is lower blood pressure)

Researchers at Tulane University have found a new way to tackle high blood pressure, especially in low-income folks: Have a small team spend a little more time with them.

They ran a trial^* of a new hands-on approach, where nurses, pharmacists, and medical assistants got down to business, coaching patients on lifestyle changes and sticking to their meds. Plus, patients learned to check their blood pressure at home.

The results? Those in this more involved group saw their systolic blood pressure drop by a solid 16 mmHg, compared to a 9 mmHg drop in the usual-care group. That ‘involved’ group was also better at taking care of themselves at home over the long term.

^* 18 months long, with more than 1,200 low-income patients in Louisiana and Mississippi 

Legal, schmegal — what’s the fam doing?

The latest twist to the effects of marijuana legalization comes out of the University of Massachusetts. Researchers’ finding: High school students are more likely to try pot if their family or friends use it, but — and this is the news part — legalization had no effect on that.

When comparing data from 2016, before legalization [in Massachusetts], and 2018, after legalization but before retail cannabis stores had opened, the researchers found no statistically significant differences in the prevalence of past 30-day marijuana use.

FDA’s big new rules for pharma TV ads

The FDA has released new rules for prescription-drug ads that run on television and other video streaming media — collectively called “TV format^*.”

The gist is that companies can no longer play fast and loose with the side effects they list.

Like six-year-olds saying “I’m not touching!” in the back seat, pharma has gotten around the rules about listing side effects by using tricks like rattling them off at 20x normal speed while music plays in the background.

The FDA has had enough. Now those side effects have to be understandable. And just like six-year-olds who need the nuance explained, the agency took 87 pages to do just that.

There are five new standards that “help ensure that the major statement is presented in a clear, conspicuous, and neutral manner.”

1. No jargon: [T]he information must be presented in consumer-friendly language and terminology that is readily understandable.
2. No mumbling or speed talking: The audio information in the major statement must be at least as understandable as the audio information presented in the rest of the ad.
3. Put it in writing: The information presented in the audio portion of the major statement must also be presented concurrently in text for a sufficient duration to allow it to be read easily.
4. No tiny text: The information in text must be formatted such that the information can be read easily.
5. No distractions: The ad must not include audio or visual elements during the presentation of the major statement that are likely to interfere with comprehension of the major statement.

^* “TV format,” because you know companies would try to skirt the rules if the FDA got too specific — although advertisers on TikTok will probably claim that vertical ads aren’t “TV format.”

How dare you call yourself “Doctor”

Physicians are getting their stethoscopes in a wad because nurse practitioners can earn doctorates and thus be entitled to be called “Dr.” Oh no no no, say the physicians, only medical doctors should be able to use the term “Doctor” in the healthcare world.

Florida, in fact, was considering barring non-physicians from using “Doctor” in clinical practice. Similar “not-a-doctor” bills are under consideration in California, Connecticut, Florida, Massachusetts, North Carolina, Texas, and Wisconsin.

Nurse practitioners and physician assistants^* argue they deserve to be able to practice to the fullest extent allowed by their education and credentials, and that — like anyone who’s earned a doctorate — they should be able to use the title conferred on them.

“It has nothing to do with ego or wanting to be something I’m not,” [one doctor of nursing practice] said. “If I worked hard and earned a doctorate, I can use the title of ‘Dr.’”

If only there was some other designation an MD could use to indicate that he or she was an MD. Perhaps MDs could use some other letters to indicate that they’re MDs. Surely MDs can come up with something to differentiate themselves from people who aren’t MDs. Maybe they can ask the DDSs.

^* Yes, we’re aware the article left off a rather significant group of doctorate holders.

Flu ‘soars’ in Georgia

Georgia is one of seven states where the latest CDC data shows flu cases are at the highest. (The others are Alabama, Florida, Louisiana, Mississippi, New Mexico, and South Carolina as well as Puerto Rico.)

The flu season is a little early this year — typically it starts big-time in December, but last year October was kickoff, so November isn’t too unusual.

The good news is that “the version that’s been spreading the most so far this year usually leads to a lesser amount of hospitalizations and deaths in the elderly.”

Another benefit of the flu vax

It can reduce your risk of heart attack. Mm hmm. That’s what an analysis of five studies and more than 9,000 patients by Iranian researchers found; it was published in Nature’s Scientific Reports.

Participants who received the flu vaccine saw a notable reduction in the occurrence of major cardiovascular events, with 517 cases compared to 621 cases in the placebo group.

There was a decreased risk of heart attacks in vaccinated patients and a significant reduction in cardiovascular death events.

Why? Their hypothesis is that vaccination might reduce inflammation, or possibly “ensuring the stability of atherosclerotic plaque, which can become destabilized during the flu.”

Health-system pharmacists, take note

The FDA is reminding/warning you not to use Cardinal’s new (since June) Monoject syringes with patient-controlled pumps. Cardinal recalled those “due to incompatibility concerns with syringe pumps.”

The older version — called Covidien — are still okay to use. The problem is with the new Monoject syringes.

Red wine headaches explained

As Thanksgiving approaches, we see the usual lineup of food-related news stories. Here’s a different one, though: an answer to the question, “Why do some people get headaches from red wine?”

The answer (per UC Davis researchers) is that red wine contains quercetin, a flavanol in grapes that’s even available as a supplement. But when quercetin mixes with alcohol it becomes quercetin glucuronide, which happens to block alcohol metabolism.

As a result, people can end up accumulating the toxin acetaldehyde […] a well-known toxin, irritant and inflammatory substance.”

And there you have it.