Protecting the pancreas (and stopping diabetes)

A new drug being developed seems to prevent and even reverse type 1 diabetes.

Created at Johns Hopkins, “mAb43” uses a different mechanism than other treatments; it works by creating a shield around the insulin-making beta cells in the pancreas, preventing the body’s immune system from attacking them. And when we say “shield,” that’s a literal shield. Check it out — mAb43 is in yellow:

Quoth the lead researcher:

“mAb43 in combination with insulin therapy may have the potential to gradually reduce insulin use while beta cells regenerate, ultimately eliminating the need to use insulin supplementation for glycemic control.”

The good news is that it worked in preliminary studies.

The bad news is that it’s only been tested in mice, using mouse-derived monoclonal antibodies. And if it works in humans it’ll be a long-term maintenance drug once it passes years of trials. Then it might be more convenient than insulin (the mice were given weekly shots), but you can bet the price tag won’t be small.

One week left…

… to register online for the 2024 Georgia Pharmacy Convention!

May 22 is the last day to pre-register online for the convention. After that registration will only be available on site, and the price will go up by $120. There’s a lot better stuff you can buy for $120^*!

Don’t miss out on the exciting events, more than 30 hours of CPE, the Saturday night President’s Bash, and of course all Amelia Island has to offer.

Register now, and we can’t wait to see you on Amelia Island June 13-16!

^* 2,000 glass marbles, for example

A little dab’ll do ya

An over-the-counter gel looks like it’ll be competing with Viagra in 2025. It’s called Eroxon (yes, seriously — it was originally “MED3000,” which sounds like something Wile E Coyote would use in “Looney Tunes After Dark”), and it works about 10 minutes after topical application … for at least 60% of men who tried it for erectile dysfunction.

It’s already got FDA approval because somehow it’s considered a device, and maker Futura says it’ll be on these shores next year. (It’s already for sale in the UK for $31 for four single-use tubes.)

The best part? It’s “slightly more effective if applied by a partner.” Indeed.

They doth protest too much

There are eight companies whose drugs are subject to Medicare price negotiations. All of them have claimed that cutting their profits will hurt their research and development efforts.

And yet another report proves that’s just not true. With one exception — Merck — they all spend more on either shareholder payments or admin and marketing than they do on research and development.

The folks at PhRMA, the industry’s lobbying group, did a nifty job of avoiding the question. Their statement simply answered a different question:

“The truth is the biopharmaceutical industry is one of the most research-intensive industries in America. Companies invested $122 billion in R&D in 2020, and we invest six times more on average in R&D as a share of sales than all other manufacturing industries.”

“Johnny, did you spend most of your allowance on junk food again?”

“The truth, Mom, is that I spend less on baseball cards than any other kid!”

Covid still lurks

There’s a new Covid-19 variant appearing in wastewater sampling, and to be sure to keep the naming conventions confusing, this one is called “FLiRT^*.”

It’s technically “KP.2,” and it’s related to the recent JN.1 variant but different enough to raise some scientific eyebrows, especially as it’s making up more than 35% of the strains currently active.

Should you worry? Probably not — we have a good track record of updating vaccines if necessary, and this doesn’t look any worse than what’s been out there.

^* Named for changes in some amino acids: F456L and R346T. Virologist humor is unique. 

Bird flu: What you need to know

If and when the H5N1 bird flu makes the jump from human to human, we’ll be a lot better off than when we were blindsided by the “mysterious Chinese illness” in 2019. If nothing else, we know how to make flu shots, even if it can take several months to grow a batch.

Then again, dealing with H5N1 isn’t quite as simple as cranking out the annual flu vaccines — this strain is a bit different. Read the details in one of the better “preparing for the bird flu” articles, from the Guardian.

The silly reason we don’t get the good sunscreen

Here’s an oversimplification of a story: There are better sunscreens available than what you sell — ones that block a lot more UVA (which causes cancer, as opposed to UVB, which causes sunburn). People in Europe use ’em all the time.

Why aren’t they available here? Because, in part, the FDA requires them to be tested on animals, while in Europe animal testing is banned. The result is that cosmetics companies don’t want to ruin their reputations overseas by doing animal testing here, so the US gets the second-rate sunscreen.

There’s also the issue of social media infomercials “influencers” convincing people that sunscreens in general are bad. (The exceptions are those using zinc-oxide because, they say, zinc oxide isn’t a chemical, it’s a physical barrier. News flash: Zinc-oxide is a chemical).

Bullying means bad teeth

If you’re thinking of bullying someone, consider an unexpected consequence: You might be hurting their dental health. No, not by knocking their teeth out^* — Norwegian researchers found “that bad childhood experiences, including bullying, are associated with bad teeth cleaning habits.”

Why? No clue. Heck, it’s just an association (so it could be the opposite — that kids who don’t brush get bullied), but they suggest that it’s something to be aware of. If a kid has bad teeth, it might be worth a conversation.

^* That’s assault, not bullying.

Probiotics vs IBD

After a bout of gastroenteritis, many people end up with some form of irritable bowel syndrome. Treatment is usually about managing the symptoms.

Italian microbiologists tried something different. Assuming that gut bacteria (or the lack thereof) might be part of the problem, they developed a personalized regimen for each patient in a study. They analyzed each person’s gut biota to see what bacteria they might be missing and what they had too much of. “Then, a personalized therapy was designed for each patient, based on their results, with the goal of rebalancing their gut microbiota.”

That therapy was a combination of an antibiotic to kill the unwanted gut bugs, followed by “prebiotics and/or postbiotics to enhance the numbers of protective bacteria.”

Twelve weeks after the start of treatment, 93% (12/13) of patients experienced an improvement in symptoms and 38.5% (5/13) achieved total remission.

This trial was more proof-of-concept, so next up will have to be bigger, broader studies.

Omalizumab and peanut allergies

For kids with peanut allergies, omalizumab — aka Xolair — can be a lifesaver, literally.

By taking omalizumab every two or four weeks, many patients had significant protection against allergic reactions from food allergen contamination, particularly life-threatening conditions like anaphylactic shock.

Still, it’s not a miracle drug; it has some significant limitations. Eat a peanut-butter sandwich? No. Ride on a bus with someone eating peanuts? Probably. The folks at the University of Rochester explain it all.

J&J settles ovarian cancer suits

The company will pay $6.5 billion (over the next 25 years) to settle nearly all the lawsuits that claimed its talcum powder caused ovarian cancer. Still outstanding are a different set of suits (but not nearly as many) claiming it caused mesothelioma.

The deal still needs buy-in from at least 75% of the claimants.

Reversible heparin replacement

How’s this for an anticoagulant trick: It’s instantly reversible. That means if something goes wrong and a patient starts to bleed, you just slip ’em the antidote and the bleeding stops (in theory).

How’s it work? The drug consists of two molecules that bond to each other and to thrombin, preventing the thrombin from helping blood coagulate. The antidote breaks the connection between the drug molecules — like breaking the bond between the Wonder Twins — and that releases the thrombin. Simple!

A group of Swiss and Australian researchers came up with the new drug. They say that there are 235,000 emergency visits for anticoagulant treatment in the US every year, so that’s a lot of people who’ll be happy to see it hit the market.

The X for Y Files: BP drug twist

If you have a roundworm you want to live longer, you might consider getting it a prescription for rilmenidine. It seems (found British researchers) that the hypertension drug might have the same effect as a calorie-restrictive diet, which is considered one of the best ways to increase lifespan.

And even if it doesn’t pan out in humans, the research identified the receptor that rilmenidine binds to, meaning it’s at least a big step towards an eventual pharmacological treatment.

AI’s latest trick

Protein molecules each have a unique 3-D structure, and that’s the target of drugs. The trick is finding what chemicals might interact with what proteins, and that can take a lot of work. Well, unless you turn AI onto the problem.

Swiss researchers did just that, and they say the result was “a real breakthrough for drug discovery.” Rather than spending weeks of computer and meat-brain time trying to fit a potential drug molecule into the protein, the AI speeds through it. But the biggest benefit is that the AI knows what can actually be synthesized, so it doesn’t bother suggesting impossible chemicals.

For any protein with a known three-dimensional shape, the algorithm generates the blueprints for potential drug molecules that increase or inhibit the activity of the protein. Chemists can then synthesise and test these molecules in the laboratory.

Quit vaping to get pregnant

Ladies, give up vaping if you want to get pregnant. With what they say is “the first piece of evidence to show a link between fertility and vaping across a large population,” British molecular geneticists found…

…that people who vape or smoke tobacco had lower levels of anti-Müllerian hormone (AMH), which indicates how many eggs women have left in their ovaries.

Women trying to get pregnant should be told “no drinking, no vaping, no smoking, no drugs,” they say. Plus there’s the whole nicotine-addiction, chemicals-in-your-lungs angle as well, but one battle at a time.

Side note: Vaping has gotten so bad over there that Welsh health authorities are talking about offering nicotine patches or gum to help kids break their nicotine habits.

PBMs vs grandma

It seems PBMs have found a new way to stick it to Medicare recipients: Moving their old generic drugs to higher formulary tiers — the ones that require a larger co-pay.

Seniors are finding that the meds they’ve been taking for years suddenly cost more out of pocket for no reason other than someone at a PBM threw a dart and decided to move it up a tier.

In 2011, 73% of generic drugs analyzed by Avalere were placed on Tier 1, which has a zero-dollar copay on average. Ten years later, only 15% of those drugs were still on Tier 1, despite the average price of those medicines falling by 38%.

Why would a PBM make cheaper drugs more expensive? The idea is to drive patients not to the best medications or the least expensive, but to the drugs that give the PBMs the highest kickback. That’s one reason biosimilars haven’t taken off, and why patients can be pushed to brand-name medication.

The Long Read: Prior Denial edition

Some investigative reporting, plus a former insurance company doctor, reveals the culture of “deny deny deny” inside health insurance companies.

All a Cigna doctor had to do was cut and paste the denial language that the nurse had prepared and quickly move on to the next case.

Feeling lighter in the wallet?

Pharmacists’ wages are going down, it seems, although it’s worse for retail positions than for folks in hospitals. And technicians and aides? Their wages are going up.

All this comes from a new study published by APhA (by a pharmacoeconomicist out of UC San Diego) that looked at how wages were being affected by market consolidation, where fewer employers mean each has more control over wages: “In other words, the employers become the wage setters, and the employees become the wage takers.”

From 2012 to 2022…

• Retail pharmacists saw their annual wages decrease by 16.6%.
• Hospital pharmacists saw a 2.5% decrease.
• Retail technicians had their salaries increase by 3.4%.
• Hospital technicians saw a 7% increase.

ICYMI: DEA looks to make pot C-III

The DEA has started the process of moving marijuana from schedule I (with heroin and LSD) to schedule III (with codeine). No, it wouldn’t legalize pot, it would just “acknowledge it has less potential for abuse than some of the nation’s most dangerous drugs.”

But first the new rule has to be officially proposed and reviewed by the Office of Management and Budget. If it passes OMB, it’ll be open for public comment before being dropped or finalized.

In the name of all that’s holy, don’t drink raw milk

Raw milk isn’t better, it never has been better, and these days it’s even more dangerous. Sure, pasteurization is still a new technology (it’s only been around since the 19th century), but they stopped adding the microchips back in the 1980s.

Jokes aside, the CDC says that “improperly handled raw milk is responsible for nearly three times more hospitalizations than any other food-borne disease source, making it one of the world’s most dangerous food products.”

And with bird flu in the mix? Just don’t.

“Bird Flu in Raw Cow Milk Has Killed Farm Cats in a Concerning First”

FTC challenges a whole lotta drug patents

The Federal Trade Commission has had enough of what it calls “junk patents” filed by pharma companies, and it’s challenging them — starting with a warning letter to 10 companies about 20 brand-name drugs and more than 300 patent filings.

What’s a junk patent? According to the agency, it’s a patent that really doesn’t affect the drug, but is included with the FDA filing anyway. Why? Because patents can block generic competition for up to 30 months — more patents means longer exclusivity.

These companies include Novo Nordisk, AstraZeneca, Boehringer Ingelheim, Covis Pharma, GlaxoSmithKline, Novartis, and Teva Pharmaceuticals and Amphastar Pharmaceuticals, as well as some of their subsidiaries.

The companies will hear from the FDA next, and will have 30 days to withdraw or edit their drug’s listing or pinkie promise certify under penalty of perjury that the patents are legit.

PharmPAC at work

Check it out: GPhA/AIP member Tommy Bryan, owner of St. Simon’s Drug Company, presents a PharmPAC donation to Senator Mike Hodges (left). Senator Hodges sits on the Senate Health and Human Services Committee and was a huge help getting our SB 198 to the Senate floor for a final vote. Thank you, Senator Hodges, and thank you, Tommy Bryan, for supporting PharmPAC!

You can help PharmPAC, too — invest in your practice and protect the future of pharmacy in Georgia at GPhA.org/pharmpac.

FDA expands test regulation

The FDA said it’s going to start regulating the diagnostic tests that testing companies like Labcorp and Quest have developed and are marketing to patients. These are the “lab developed tests” that claim to detect this or that, but that haven’t been formally reviewed to ensure they do what they say.

Under the new rules, these tests would be required to meet the same requirements as other diagnostic tests from medical device makers, including the FDA’s review of their applications and the reporting of adverse events.

Which brings up the obvious question: Weren’t they regulating these tests in the first place?

Medicare wins again

Pharma companies have lost yet another court challenge to drug price negotiations — that’s four losses, if you’re keeping score. This time it was Bristol Myers Squibb and Johnson & Johnson, and it was a U.S. district court in New Jersey.

The rulings are consistent: No one is forcing them to participate in Medicare, so they have no right to complain about capitalism at work.

The drug makers say they plan to appeal the ruling. Their argument, apparently, is that Medicare is such a large customer they are effectively forced to participate or they’ll make less of a profit. (Profit, apparently, is now a legal right.) And, of course, Medicare should be forced to accept whatever prices the companies wish to charge.

Perspective: Can you imagine if Walmart’s suppliers said the retailer was so big, it should be required to buy their products at any price they chose?

Side note: Remember, these are the companies that don’t pay taxes because they claim to be losing money.

Sleep and diabetes

“Go to sleep or you might end up with diabetes like that man on TV.”

Eat as healthily as you like, if you don’t get enough sleep you’re increasing your risk of type 2 diabetes.

Using data of 250,000 people over 12 ½ years, Swedish and Chinese researchers found that people sleeping for fewer than 6 hours a night “had a notably higher risk of developing T2D compared with those with 7 to 8 hours of sleep.” And the less sleep they got, the higher the risk — even among adults with healthy eating habits.

If they’re women, though…

They can chow down on avocados. A study by Mexican researchers found that “Females who ate 30-38 grams of avocado had significantly lower odds of diabetes than those who did not consume avocados.” But don’t hit the guac just yet (except with a few grains of salt) — the research was out of California’s Avocado Nutrition Center.

Bird flu news

It’s now been found in a dolphin. That is all.

But there’s good flu news, too

The US had a long flu season this year, but thankfully it wasn’t a severe one and it’s just about over. That’s cold comfort to the friends and families of the 24,000 people (including 148 children) who died from the flu, but it’s a lot lower number than it could have been.

Even at the peak, “we felt strained but never over-capacitated” said Dr. Jay Varkey, infectious disease physician at Atlanta’s Emory University Hospital. “It felt more like a traditional respiratory virus season than when we had massive upswings of COVID confounding it.”

US birth rate keeps dropping

The birth rate in the US has been going down for decades, and after a brief pandemic “baby bump,” it’s dropped again — to the point where it’s well below the “replacement rate.” In other words, the population will begin shrinking.

[T]his continued decline comes at a time of growing concern over access to reproductive healthcare and intensely politicized debate over abortion access, as well as concerns over the economy, a lack of rights for working parents and growing fears over the future of the planet.

It’ll be interesting to see how debates about reproductive and immigration issues are affected. After all, if we aren’t making enough Americans, that “portends sluggish growth, an aging population and an economy that one day may struggle to find enough workers to fill jobs and pay the taxes required to maintain the state and care for a large elderly population.”

A “new” med for UTIs

The FDA has approved Utility Therapeutics’ Pivya — aka pivmecillinam — to treat uncomplicated urinary tract infections. This is the first “new” antibiotic approved for UTIs in something like 20 years. (New in quotes because Pivya is an old drug that’s been used in Canada and Europe for 40 years.)

Pivya is a narrow-spectrum antibiotic […] For this reason, Pivya is only approved for use in UTIs caused by Escherichia coli, Proteus mirabilis, and Staphylococcus saprophyticus.

11 new drugs in shortage

(Links go to more details from the American Society of Health-System Pharmacists or the FDA.)

• Cisatracurium besylate injection
• Clobetasol propionate cream
• Difluprednate ophthalmic emulsion
• Evolocumab injection
• Granisetron hydrochloride injection
• Hydroxocobalamin injection
• Isosorbide mononitrate immediate-release tablet
• Lacosamide tablet
• Rifaximin tablet
• Valproate sodium injection

Answering the hard questions

A British biochemist tackles the issue: “Does ejaculating often reduce your risk of prostate cancer?”

(Oh come now, we’re not going to spoil it by giving you the answer.)

Chances are your data was exposed

In case you thought the fallout from the Change Healthcare attack was ending, think again.

“[T]he personal health information and personally identifiable information found in the files ‘could cover a substantial proportion of people in America’,” according to UnitedHealth. But don’t worry, it may not have included full medical histories.

The company is offering two years of credit monitoring and identity theft protection to anyone who has been affected by the breach. (How to apply for that isn’t clear.)

Fun fact: UnitedHealth seems to have paid the hackers a ransom of $22 million.

The liver means timing matters

There are good reasons to consider what time of day to take a drug — sleep issues probably top the list. But now MIT researchers have found that it’s a lot more complicated thanks to enzymes in the liver. Drug metabolism, it seems, is affected by the body’s circadian rhythm.

These circadian variations affect how much of a drug is available and how effectively the body can break it down. For example, they found that enzymes that break down Tylenol and other drugs are more abundant at certain times of day.

What that means is it might be possible to fine-tune the use of drugs to take advantage of this fact, setting dosing times to get the most out of a medication.

Two unexpected vaccines

First: against antibiotic resistance

We hear a lot about antibiotics to treat infections, but not so much about vaccines. That might change. Michigan State chemists have developed a carbohydrate-based vaccine (rather than a typical protein-based one) that targets Staphylococcus aureus — specifically the methicillin-resistant kind, aka MRSA.

So far they’ve tested it in the lab and in animals, and obviously it works or we wouldn’t be writing about it.

Second: against melanoma

British researchers have just begun phase-3 trials of “the world’s first personalised mRNA cancer vaccine for melanoma,” which they are, of course, calling a “game changer.”

The personalized part is what’s important, as each vaccine has to be tailored to the individual.“[A] sample of tumour is removed during the patient’s surgery, followed by DNA sequencing and the use of artificial intelligence. The result is a custom-built anti-cancer jab that is specific to the patient’s tumour.”

I’m not sure what the lead investigator means by this, but it sounds good:

“To be able to sit there and say to your patients that you’re offering them something that’s effectively like the Fat Duck at Bray versus McDonald’s — it’s that level of cordon bleu that’s coming to them … The patients are really excited about them.”

Science at work

After their work on the groundbreaking 2022 paper “Fire is Hot,” researchers at the University of Chicago have a new study — in the journal Otolaryngology-Head and Neck Surgery — with a shocking conclusion: “TikTok Riddled With Misleading Info on Health.”

The team’s next paper: “What Color Is the Sky? A Multi-Modal Investigation of Lower-Atmosphere Chromatic Conditions”.

From stomachache to headache

People who take acid-reflux drugs — proton-pump inhibitors, H2 blockers, or even antacids — apparently have a greater risk of migraines. And if they also take magnesium, the risk is even higher.

That’s what University of Maryland nutritionists discovered after parsing the health data of almost 12,000 people who used some kind of acid reducer.

[T]hey found that people taking proton pump inhibitors were 70% more likely to have migraines than people not taking acid-reducing drugs. Those taking H2 blockers were 40% more likely and those taking antacid supplements were 30% more likely.

They can’t prove cause and effect yet, but the relationship, they say, is definitely clear.

Sour sweetener

One of the newest crop of artificial sweeteners, neotame, just went from “Well, it’s better than aspartame” to “Oh, geez, another one that’s unhealthy.” In the case of neotame, it…

…can cause previously healthy gut bacteria to become diseased and invade the gut wall – potentially leading to health issues including irritable bowel syndrome and sepsis.

Drug spending jumps

Americans — people, insurers, and the government — spent $772.5 billion on drugs in 2023, up a whopping 13.5% from the year before. What changed? GLP-1 agonist weight loss drugs, that’s what.

Spending for semaglutide doubled in 2023, making it the top-selling drug in the nation, replacing autoimmune disease drug adalimumab.

Interesting side note: “Hospitals’ drug spending fell by 1.1%, continuing a steady period of falling expenditures.”

Curious what the 25 most popular drugs are? Becker’s Hospital Review has you covered.

Pharmacy techs: You could win a 15-hour course

The good folks at the Alliance for Pharmacy Compounding Foundation are offering $495 grants for 10 pharmacy technicians to attend a 15-hour on-demand online course, “The Ethical, Legal, and Regulatory Foundations of Pharmacy Compounding” out of Virginia Commonwealth University.

If you’re interested in getting into compounding pharmacy, this is a great idea — it gives 15 hours of CE credit, not to mention a great line on your résumé.

The deadline to apply is June 30, 2024 at 11:59pm EST. Here’s the link to do just that. (Got questions, contact the Pharmacy Compounding Foundation at foundation@a4pc.org.

Not getting the message

We’re taking some steps backward when it comes to antibiotic use. Based on the latest data^*, more than a quarter of all antibiotic prescriptions are inappropriate: “[T]he percentage of all antibiotic prescriptions given to treat conditions they’re useless against was even higher in December 2021 than it was before the pandemic began.” (It didn’t help that a bunch of those scripts were supposed to treat Covid-19.)

Some groups of people were more likely to receive inappropriate antibiotics. At the end of 2021, 30% of antibiotics for older adults with Medicare Advantage coverage were inappropriate, compared with 26% of antibiotics for adults with private health insurance and 17% of antibiotics for children with private insurance.

^* “from more than 37.5 million children and adults”

Why to put Neosporin in your nose

Here’s a twist: Putting Neosporin (well, neomycin) in your nose might get your body to fight off respiratory viruses.

Not that the ointment itself does the job — rather, Yale researchers found, it “triggered a swift immune response from genes in the human nose that serve as a first line of defense against invading viruses.”

[T]he researchers found that mice treated intranasally with neomycin showed a robust [interferon-stimulated genes] line of defense against both SARS-CoV- 2 and a highly virulent strain of influenza A virus.

Oh, and they tested it on humans, too, and found the same response. The question is how long the response lasts. Would you need to rub it in your nose every day, or just once? Stay tuned.

Ozempic quickies

Do GLP-1 drugs change your personality?

Maybe if you believe social media (or the quality journalism in the NY Post or Daily Mail).

But seriously, folks

They also help with knee osteoarthritis. It’s not surprising, really, but the question is whether that will ever be an approved use.

Rules are apparently made to be ignored

During the pandemic, obviously states with more rules for nursing homes had fewer cases and deaths (thanks to slowing the virus’s spread).

Wrong!

A team led by folks at Columbia University compared the number of Covid-19 policies in a state to the number of cases and deaths in nursing homes and home healthcare agencies. Turns out that having more anti-Covid policies in place “wasn’t consistently tied to lower community- or [nursing home]-level disease burden.”

“For example, on May 24, 2020, Montana, Hawaii, and Alaska had no Covid-19 deaths or policies, in contrast with North Carolina’s moderate burden and several policies.”

[…]

“By January 12, 2021, New York had a severe Covid-19 burden and the greatest number of policies, while Pennsylvania, Montana, and Florida had a similar Covid-19 burden but fewer policies.”

So why was it such a crapshoot? Implementation and compliance. Just having policies on paper — and not actually enforcing them (or facilities being unable to implement them) — means that the data won’t line up.

HGH trouble

How do you make a shortage of growth hormone for kids even worse? By throwing insurance companies and prior authorization into the mix.

[P]atients and doctors are chasing whatever size injection pen and whatever brand is available. That triggers insurance companies to ask for a new prescription and new prior authorization every time patients need to switch gears and ask for a different pen size because their normal one is out of stock.

The Long Read: Bird Flu edition

So is H5N1 bird flu something we really should worry about, or just another case of ‘much ado about nothing’? It’s looking like a bit of both:

Avian flu viruses tend to be picky about their hosts, typically sticking to one kind of wild bird. But this one has rapidly infiltrated an astonishingly wide array of birds and animals, from squirrels and skunks to bottlenose dolphins, polar bears and, most recently, dairy cows.

In fact, viral particles are showing up in grocery milk. But there’s no need to be concerned, citizen. The good thing is we’ve got plenty of warning in case it does become more virulent, plus there’s already a vaccine.

Urine at the U of M

The folks at the University of Michigan’s Rogel Cancer Center have been busy studying, well, pee.

First, a group of researchers found a way to use a urine sample to not only detect prostate cancer, but to differentiate the two major kinds — the slow-moving type that’s usually ‘keep an eye on’, and the dangerous aggressive type that needs immediate attention.

Second, a different group “have created a urine-based test that detects pieces of DNA fragments released by head and neck tumors.” That’s important because there isn’t any kind of test available at all, other than a biopsy, for those cancers.

Antipsychotics and dementia don’t mix

Giving dementia patients anti-psychotic meds might be a very bad idea, according to a new, big British study: It used data from 174,000 patients with dementia, more than 35,000 of whom were prescribed antipsychotics for the first time.

To cut to the chase:

Antipsychotic use compared with non-use in adults with dementia was associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, but not ventricular arrhythmia. (Emphasis ours.)

The risks of drugs like haloperidol, quetiapine, and risperidone weren’t a secret, but this is one of the larger studies to suss out the details, and it “found a considerably wider range of harms associated with antipsychotic use in people with dementia, and the risks of harm were highest soon after initiation.”

Their recommendation is no surprise: The risks are serious, so “Any potential benefits of antipsychotic treatment therefore need to be weighed against the risk of serious harm across multiple outcomes.”

Juice of the cabbage (and IBD)

Mmm, nothing like a glass of cabbage juice to treat what ails ya. Well, if what ails ya is inflammatory bowel disease and you’re a mouse.

We all know by now how important gut bacteria are, and University of Missouri veterinary researchers found that red cabbage juice helped some good bacteria flourish in mouse guts. “Good” because they happen to produce some short-chain fatty acids that can reduce inflammation associated with IBD. Specifically…

“These changes in the gut microbiota are associated with improved gut barrier function, enhanced colon repair and anti-oxidative effects, ultimately mitigating intestinal damage and colonic inflammation.”

Drink up!

Diet vs drugs against IBS

We won’t tell if you won’t: Changing a patient’s diet might treat the symptoms of irritable bowel syndrome better than drugs do.

Swedish researchers tested two diets against standard IBS meds.

The first diet included smaller and more-frequent meals and fewer foods with lactose, as well as cutting back on legumes, onions, and grains “which ferment in the colon and can cause pain in IBS.” The second group went with low carbs and higher protein and fat. The third group took whichever drugs were recommended based on their individual symptoms.

In the end, 76% of the first diet group saw reduce symptoms, 71% of the second diet group did, while only 58% of the medication group got relief. (For what it’s worth, all the subjects “reported significantly better quality of life, [fewer] physical symptoms and [fewer] symptoms of anxiety and depression.”)

Want to live forever?

Choose a female GP, especially if you’re a woman. A new study out of Japan — based on US Medicare data — found that “Being treated by a female physician can reduce the risk of death and hospital readmission.”

Based on data of almost 800,000 male and female patients over three years, it found a “large and clinically meaningful” difference for women seeing female docs, and a small difference for male patients.

To be fair, their definition of “large and clinically meaningful” doesn’t seem large: There was an 8.15% mortality rate when seeing a female physician, vs. 8.38% when the physician was a man. Still, if you’re rolling the dice you want the best odds you can get. (And you can bet that little detail won’t appear in a lot of news stories.)

Oh, and “Both women and men had a lower adjusted readmission rate when treated by a female physician.”

With meds, what’s old is sometimes just … old

Hospitals, it seems, are still using older, generic antibiotics even when patients have resistant infections, and even when there are newer, better drugs available.

A study from the NIH (with Emory and George Washington universities) found that not only were hospitals behind the times, “nearly 80% of the time these older agents are already known to be highly toxic or sub-optimally effective.”

Why? A few reasons. In some cases, physicians preferred to use the newer drugs only on “difficult-to-treat bloodstream infections and those with a high comorbidity burden.”

Some hospitals — such as smaller facilities and those in rural areas — tended not to have those drugs available, likely because of the low prevalence of resistant infections. And then there’s the cost, as hospital reimbursement can be lower for newer, higher-priced medication. (“Sorry, we’re not giving you the best drugs because that’s less profitable for us”?)

^* “Meropenem–vaborbactam, eravacycline, imipenem–cilastatin–relebactam, and cefiderocol,” in case you’re interested 

Ozempic answers

Why doesn’t it work for everyone?

Semaglutide helps something like 86% of patients lose weight. But what about that other 14%? Failing to lose weight could be due to a number of factors, so Healthline offers “5 reasons you may not lose weight on drugs like Ozempic or Wegovy.” (Really it’s just four reasons, because one is ‘Not taking the medication’ — that doesn’t count.)

What happens when you stop?

Most people know that a downside to GLP-1 agonists for weight loss is that once you stop taking them, you’ll probably gain back the weight you lost. But why? Can’t you lose the weight, then change your lifestyle to keep it off?

An Aussie GP explains why, while that might be possible, it’s not simply a matter of willpower.

Trust issues

The latest poll about healthcare trust has some bad news for pharmacists: Trust in them (that is, you) dropped 3 percent from 2023 to 2024. That was only half the drop that trust in “friends and family” saw; maybe they got tired of being told, “No, dear, watermelon won’t cure your ingrown toenail no matter what you saw on TikTok.”

Trust also dropped in pharma companies, government leaders, and journalists — all likely because people think they can find better information on their own.

“The rise of empowerment is potentially something great,” said the CEO of Edelman Trust, which conducted the survey. “But without it being balanced with some form of trust in institutions, trust in expertise — if it’s all self-reliance, it’s like giving a kid the keys to a car and saying, ‘Go drive!’”

The problem, of course, is that “empowerment” for many people means “believing whatever nonsense is being spouted on social media,” leading to people thinking mRNA vaccines contain nanobots, or that drinking bleach can treat Covid.

CGM info and a free dinner, on Abbott

Hey, pharmacists and pharmacy techs — want to learn about Abbott’s new FreeStyle Libre 3 continuous glucose monitor? How about if Abbott threw in a free dinner to go along with it?

If you’re in the Columbus area this coming Tuesday, April 23, register for the aptly named “An Overview of the FreeStyle Libre 3 system.” The program is at Mabella Italian Steakhouse^* at 6:30 p.m. and includes dinner while you listen to Bantwal Baliga, the director at East Alabama Endocrinology.

Like we said, the program and food are free — but you do have to register. Click here to do that, then enter meeting ID 11165.

^* 6835 Midland Commons Blvd in Columbus (map)

Ups and downs for Lilly

The good news for Eli Lilly is that Zepbound (tirzepatide) was shown in phase-3 trials to work against obstructive sleep apnea.

It makes sense, of course. As GLP-1 drugs help treat obesity, they also help with the side effects, from heart issues to sleep apnea. The important part is getting FDA approval to treat those on-label, which would mean more insurance coverage for the drugs.

But the bad news….

…is that supply problems continue for Zepbound and other GLP-1 agonists. The drug isn’t expected to be out of shortage until June. The reason is simple: “insatiable demand.”

On the subject of GLP-1 agonists

Diabetes, obesity, heart issues, sleep apnea … what else might Mounjaro, Ozempic, and Zepbound be able to treat? How about fatty liver disease, kidney disease, brain disorders, Parkinson’s, Alzheimers, depression, bipolar disorder, anxiety … heck, just throw a dart at an ICD-10 chart.

Forbes has the full rundown of what scientists are looking at.

Please, sir, can we have our asthma meds?

After pledging to lower the costs of its Flovent asthma med, GSK went and pulled it from the market, leaving generic fluticasone in its place — without that $35/month guarantee. Oh, well.

Worse, the generic version still isn’t covered by many insurers, so American kids can’t get their daily-use inhalers unless their parents shell out the big bucks — or convince the insurers to pay for it.

You would think insurance companies would be happy to cover cheaper generics, but you’re forgetting one thing: kickbacks. Insurers and PBMs don’t get kickbacks from drug makers on generic products, only on branded ones, so why bother covering the generics? That wouldn’t be good for shareholders, would it?

Short takes

New antibiotic for gonorrhea

GSK says its new, first-in-class gonorrhea treatment, gepotidacin, has passed its phase-3 trials with a 90+ percent success rate. That’s good news, what with STDs running rampant these days.

Elsewhere: Could Be Worse edition

Drug shortages here are a problem, but they’re worse overseas — specifically, in Britain, where they’re dealing with not only the general Europe-wide issues, but the continued fallout from Brexit. “Drug shortages in the UK more than doubled between 2020 and 2023 with Brexit likely to ‘significantly weaken’ the country’s ability to tackle supply chain snags.”

The Long Read: menopause, estrogen, and women’s unused options

Women have been dealing with menopause for a couple of hundred thousand years, and yet there’s still a bit of a stigma talking about it, the effects it can have on a woman’s body, and ways to help alleviate some of those negative issues.

Worse, as this article in the Atlantic explains, many gynecologists will try to solve everything with estrogen (or, if they’re British, oestrogen). Since the 1960s it’s been the go-to magic bullet for women in and after menopause.

Reality, though, is more complex — and we’ve learned a lot since the ’60s. Still, though, the lack of a “frank approach to sexuality” for both people born female and those who have transitioned there has kept many from realizing the benefits of other hormones. (Ironically, trans women often get better care when it comes to hormones.)

The point of all this, and of the Atlantic article, is that it’s important for women to think beyond estrogen.