“Computer, identify some new treatments”

Can existing drugs be used off-label for other conditions? Of course. But it’s not always easy (or obvious) to figure out which drugs might yield surprises.

Unless, that is, you’ve got millions of medical and insurance records and a high-powered computer at your disposal. In that case, let artificial intelligence (aka “deep learning”) take a whack at it. That’s what OSU scientists are working on:

“…a framework that combines enormous patient care-related datasets with high-powered computation to arrive at repurposed drug candidates and the estimated effects of those existing medications on a defined set of outcomes.

In other words, the computer can find correlations that mere humans might not realize. Maybe “A lot of Hispanic men between 25 and 45 taking azithromycin also saw their risk of prostate cancer go down” or whatever. By teasing out potential connections, the system might speed the discovery of new uses for existing drugs.

When it’s time to go

Japanese researchers checked out the anecdotal evidence for both senna and magnesium oxide as laxatives. Either, they found, “improves bowel movements in patients with constipation.”

The response rate for overall improvement in the placebo was 11.7% compared with 69.2% in the senna group and 68.3% in the magnesium oxide group.

Five vaccine tidbits

President-elect Joe Biden will release all available vaccine stockpiles, rather than hold some back for second doses.

[T]he Biden team believes that vaccine manufacturers will be able to produce enough second doses in a timely fashion while administering first doses to more Americans.

He also said he’ll use the Defense Production Act “to produce vaccine materials and other supplies in order to ensure there’s enough vaccine for both doses.”

Know this: The five things the CDC wants clinicians to know about the vaccine.

The Pfizer vaccine seems to work against not only the U.K. strain, but the South African one as well.

We’re learning a lot from this practice pandemic. Like, “Unexpected weak link in supply chains: A shortage of workers“.

Here come the side effects — a “tidal wave” of reports of adverse reactions, especially because vulnerable people on multiple meds are top of the list to get the vaccines.

30 minutes to vaccination compliance

On Thursday, GPhA hosted a webinar, “COVID-19 Vaccine: Ensuring Pharmacy Compliance in Just 30 Minutes!” We knew it would be popular, but it got a little crazy — we even ran out of time for Q&A.

So…

If you missed the presentation, you can view a recording of this program HERE. (Sorry, there’s no CE involved.)

Even better, we’ve scheduled a follow-up Q&A session for next week with GPhA and a panel of professionals from the Georgia DPH.

Tuesday, January 12, 2021; 8:00 – 8:30am. (Save your spot; space is limited. CLICK HERE to register for the special Q&A session.)

Slow talkers had better practice, because this is going to be fast-paced to get as many answers as possible. Pro tip: CLICK HERE to send your questions in advance to GPhA’s Teresa “Mach 5” Tatum.

A million years of plaque

Wondering about the drug habits of ancient people? (Who isn’t?) Here’s a fun place to look: The tartar on their teeth. Washington State University archaeologists — with some help from those shifty Danes (at Aarhus University) are using mass spectrometry on the tartar of skeletons to learn how Dutch farmers may have self-medicated.

Fun fact: “Tartar traps bits of food, drink, and other substances while a person is living, and it can survive more than 1 million years on fossils.”

And there are some modern uses, too:

Because tartar seems to keep a long-term record of drug intake, it could be used in place of hair samples when criminal investigators need to test for substance use after drugs leave the bloodstream.

So many police procedural episodes just got ruined

Identical twins, it seems, aren’t identical — at least not more than briefly. Enough mutations occur in the embryonic stage that those ‘nature-vs.-nurture’ studies might need to be thrown out.

They measured mutations that occurred during embryonic growth and found that identical twins differed by an average of 5.2 early developmental mutations. In 15% of twins, the number of diverging mutations was higher.

As one of the Icelandic researchers put it:

“So if you take identical twins raised apart and one of them developed autism, the classic interpretation has been that that is caused by the environment. But that is an extraordinarily dangerous conclusion.”

Why did the pharmacist cross the road?

“New Study Finds that Delivering the News with Humor Makes Young Adults More Likely to Remember and Share”

Captain Obvious surrenders

“Covid-19 spiked in US counties where universities held in-person classes”

Covid-19 incidence increased by 56.2% in counties with in-person instruction, compared with a decrease of 17.9% in counties with remote learning.

Allow me to mess with your world today

3D science artist Joanna Kobierska created this image of what a velociraptor might actually have looked like:

Click to see the full image she posted on Twitter.

Ramping up vaccinations

With the Covid-19 vaccine rollout still slow in many places, the federal government — although it’s not directly involved with the distribution — is doing what it can to help states get more people vaccinated.

• It’s decided on an “early launch” of its planned partnership with pharmacy chains — starting immediately, rather than having a gradual rollout.
• It’s urging states not to allow vaccines to sit unused. “[S]tates do not have to complete vaccination of all health care providers before moving on to other prioritized populations.”

Yet another metformin recall

Nostrum Labs is recalling its 750 mg metformin HCl extended release tablets: NDC 29033-056-01, lot number MET200501. That is all.

Smell ya later

Losing sense of smell post-Covid isn’t a rare thing, it seems. In fact, it affects a whopping 85.9 percent of people with mild cases (according to Belgian researchers).

The good news: 75 to 85 percent of them recover their senses after two months.

Goodbye, “institutional green”

Medications and therapies can to a lot to help with mental health, but for people who are in a facility, architecture matters. Getting rid of the feeling of a hospital (or worse) is crucial.

Nature plays a big role: Windows provide views of greenery, landscapes decorate walls, and outdoor areas give patients and staff access to fresh air and sunlight.

The new approach, promoted as healing and therapeutic, has produced environments that are more calming and supportive. And it feels particularly timely, given the surge in mental health issues created by the pandemic.

The early bird gets the plasma

First blood plasma transfusions from recovered patients were thought to be a great treatment for Covid-19. Then it seemed it didn’t help much. Now Argentinian researchers think they’ve found the sweet spot: Convalescent plasma works, but only if given early — “within days of the onset of the illness.”

Administering the therapy too late in the course of disease […] is akin to allowing a burglar to ransack a home for hours before deciding to call the police.

The human way

So you know that one treatment for osteoporosis is the hormone calcitonin. But the kind that’s given to people is salmon calcitonin, because the human version essentially breaks down in solution and isn’t very effective. Unfortunately, the salmon version isn’t very potent and can have some nasty side effects.

Enter Purdue researchers, who have found a way to make a stable, prodrug form of human calcitonin, which they say is more effective than the salmon variety with fewer side effects.

“Our approach will increase the therapeutic potential of human calcitonin, promising a more effective option to replace salmon calcitonin for osteoporosis and related disorders.”

Pollen and urinary pain

Pollen doesn’t just trigger allergies. Apparently, Washington University researchers found, high pollen counts can trigger flare-ups of urologic pain in people with Urological Chronic Pelvic Pain Syndrome.

Of note: The cause of UCPPS isn’t known, so this allergen connection might provide clues to the condition. (It’s already known that allergy and asthma medications relieve UCPPS symptoms.)

The Long Read: What-Could-Happen edition

What might Joe Biden and the Democrats do for healthcare? Short version: Try to expand access and coverage, and reduce prices. Long version: a bit more complicated.

Local Covid news

The first case of the more-virulent U.K. strain of the virus has been reported in Georgia.

The South, including (obviously) Georgia, is now the nation’s hotspot for the coronavirus.

South Dakota, West Virginia, and the Northeast are currently the farthest along distributing the vaccines.

Shout out to Cobb County pharmacy

Innovation Compounding in Kennesaw is doing what it can to help get the Covid-19 vaccine to as many Georgians as possible. It’s giving drive-through vaccinations and set up a website — vaxgeorgia.com — to take appointments from healthcare workers who are eligible for the vaccine. It’s also getting help from volunteers from Mercer University College of Pharmacy.

“We are honored to help administer vaccines to Georgia’s heroes in health care,” said the pharmacy’s president and CEO — and GPhA member — Shawn Hodges. “The more health care workers we can vaccinate, the faster they can safely return to work and vaccinate our communities.”

Speaking of independent pharmacies….

Across the country other small pharmacies are rising to the challenge of vaccination. As one independent pharmacy owner put it, his whole career has, in a way, led to this point.

“It’s like the Super Bowl, man,” said pharmacist Steven Hoffart. “It was talked up, talked up, talked up. That day is here.”

This is why we can’t have nice things

They said that contact-tracing apps could be used to stop the spread of Covid-19. Privacy concerns? Don’t worry — this is just about the virus, nothing else.

Oopsie: “Singapore’s police now have access to contact tracing data“. Well, so much for getting people to use an app the next time around.

Hot chemo news

Here’s a neat finding out of University College London: If chemotherapy drugs can also heat cancer cells (using magnetic iron oxide nanoparticles and a magnetic field, of course), those drugs are more effective — up to 34 percent more effective, in fact.

[O]nce the nanoparticles have accumulated in the tumour area, an alternating magnetic field can be applied from outside the body, allowing heat and chemotherapy to be delivered simultaneously. The effects of the two treatments were synergistic — that is, each treatment enhanced the effectiveness of the other, meaning they were more potent when combined than when separate.

Brown fat, brown fat, what do you do?

Apparently it can protect people from a variety of cardiac and metabolic disorders, including type 2 diabetes and coronary artery disease. The downside: Most people don’t have much, and it’s not clear anyone can actually get it.

They found that several common and chronic diseases were less prevalent among people with detectable brown fat. For example, only 4.6% had type 2 diabetes, compared with 9.5% of people who did not have detectable brown fat. Similarly, 18.9% of individuals who carried brown fat had abnormal cholesterol, compared with 22.2% of those without brown fat.

The gut biome is at it again

This time it seems that “a few organisms in the gut microbiome play a key role in type 2 diabetes,” according to Oregon State University researchers.

It’s all about glucose metabolism, and there are four type of bacteria that apparently affect it — two for the better (Lactobacillus johnsonii and Lactobacillus gasseri), two for the worse (Romboutsia ilealis and Ruminococcus gnavus).

“Our study reveals potential probiotic strains for treatment of type 2 diabetes and obesity as well as insights into the mechanisms of their action. That means an opportunity to develop targeted therapies rather than attempting to restore ‘healthy’ microbiota in general.”

Don’t worry about your cats

A Covid-19 vaccine for them is on the way, and is expected to be approved later this year. Downside:

[B]ecause the vaccine requires a complex delivery method called electroporation — using a brief pulse of electricity to allow the vaccine to enter cells more easily — it’s likely it will initially only be available at larger clinics with the right tools to administer it.

But do worry* about what’s coming

“U.S. Is Blind to Contagious New Virus Variant, Scientists Warn” — specifically, they’re saying we’re not (yet) equipped to do enough genetic sequencing: “The United States has no large-scale, nationwide system for checking coronavirus genomes for new mutations.”

*But don’t panic

Don’t mess with the vaccine: FDA

As America’s sputtering Covid vaccine rollout* continues, questions are coming up about changing the schedule of doses, or even cutting them in half.

Don’t do this, says the FDA. Those changes “are premature and not rooted solidly in the available evidence.”

“If people do not truly know how protective a vaccine is, there is the potential for harm because they may assume that they are fully protected when they are not, and accordingly, alter their behavior to take unnecessary risks.”

* Actually 50+ separate rollouts

Floyd County: Wear your masks and wash your hands

The latest numbers show a frightening 20 percent positivity rate in Covid-19 tests.

Reminder: Nominate Someone for a 2021 GPhA Award

The submission deadline is February 1, 2021!

Do you know a Georgia pharmacist who deserves recognition for his or her work?

Perhaps an amazing young pharmacist, an outstanding innovator, or someone who has worked hard to fight drug abuse? Or maybe it’s someone who has spent a lifetime in service of others and the profession of pharmacy.

It’s that time of year — time to start choosing the best of the best in Georgia pharmacy, and that means we need your nominations for the 2021 awards.

They’ll be presented at the 2021 Georgia Pharmacy Convention in Amelia Island, Florida.

Who are we looking for? Check out the details on that awards page, including criteria and a link to nominate.

• Distinguished Young Pharmacist Award
• The Excellence in Innovation Award for Pharmacy Practice
• The Larry L. Braden Meritorious Service Award
• The Bowl of Hygeia

These are GPhA awards, but the nominations come from you — and that’s what gives them meaning!

Remember: The deadline for submissions is February 1, 2021.

No good deed…

Like a neighbor borrowing your chainsaw to cut down your favorite tree, it seems that P. gingivalis bacteria likes to borrow growth molecules from V. parvula, a “common yet harmless bacteria in the mouth” and then destroy your gums. The stronger the friendly(ish) V. parvula gets, the more power it gives to the nasty gingivitis-causing bacteria.

It’s a totally one-sided relationship, too, as “V. parvula received no obvious benefit from sharing its growth molecules,” according to University at Buffalo researchers.

Be very afraid

So the U.K. variant of Covid-19 spreads faster than its more-common cousin, but the current vaccines should prevent it. But then there’s the South African version, which, it seems, may not be as vulnerable to the vaccine.

Specifically, the variant found in South Africa has more mutations in its spike protein. […] If the spike protein accumulates too many mutations, it may become unrecognizable to the immune system, allowing the virus to avoid detection in the body; this is the potential concern with the new variant.

Set your Google Alert to keep an eye on “501.V2”.

The rising

Were you worried about drug companies’ not making enough money? After all, demand has dropped during the pandemic (and there are those pesky drug-pricing rules from HHS). Fear not! They’ve already begun raising prices for 2021 — on average at more than twice the rate of inflation.

A different vaccine question

Why isn’t there a vaccine for fentanyl? Yes, it’s possible, and yes, it’s being researched.

The prototypes for these vaccines were established 50 years ago by chemically coupling heroin or fentanyl derivatives that are too small to induce antibodies to antigenic carriers —such as tetanus or diphtheria toxoids. Injecting this combination can produce antibodies against fentanyl within 6 weeks.

And yes, they work: “proven to reduce brain fentanyl levels by 50% to 80% depending on the dose of fentanyl taken”.

But right now, only the government is researching the potential of an opioid vaccine to help rein in the epidemic — why not private industry? (Hint: Could it be the profit potential?)

Free PrEP has started

The U.S. Preventive Services Task Force gave a grade-A rating to preexposure prophylaxis for HIV. That means that, starting this year, the Affordable Care Act requires all private insurers to cover PrEP treatment (e.g., with Descovy or Truvada) with no out-of-pocket costs to patients.

Note: Those drugs can also be used to treat HIV, but the law only requires them to be free for prevention.

Don’t end up like this guy

Please, folks, take care of your mental health. We’re all a bit stressed these days, but the end is in sight (in a good way).

Nobody puts pharmacists in the corner

Not even Walmart. Facing a lawsuit from the U.S. government for its role in the opioid crisis, now former Walmart pharmacists say they were raising red flags for years.

“They told me, ‘Do not reach out to the DEA, do not call the police. If you do so, your employment is going to be terminated immediately,’ ” [pharmacist Ashwani] Sheoran said, describing a warning he said was issued by his supervisor.

ICYMI

Haven, the healthcare “venture” from Amazon, Berkshire Hathaway, and JPMorgan, is shutting down. It lasted three years.

Let’s do the Covid-19 bullet points

So many numbers — deaths, hospitalizations, positive tests — which one will tell you whether the pandemic is getting better or worse? Hospitalization counts, says the Covid Tracking Project, because it’s the one metric not affected by testing slowdowns or reporting delays.

* * *

In Georgia: As of January 3 there were 4,921 hospitalized with Covid-19 — that’s about 30.5 percent of all hospitalized patients … and 20 percent higher than the previous week.

Scary:

Today, 89.8% of the state’s ICU beds are full. As of yesterday’s HHS Community Profile Report, 41% of those beds are held by a COVID-19 patient, nearing half of all ICU beds in use.

* * *

Georgia adds more people to “you can get the vaccine” list: people aged 65 and older, law enforcement officers, firefighters, and first responders are now on the list. (It previously only included healthcare workers and staff and residents of long-term care facilities.)

Here’s GPhA’s Jeff Lurey getting his from pharmacist (and GPhA past president) Pamela Marquess:

That in mind, county health departments in North Georgia are switching their focus from testing to vaccinations.

Beginning January 11, testing will be offered at health departments in Fannin, Gilmer, Murray and Pickens counties Monday through Friday between 8:00 AM to 9:00 AM for symptomatic first responders, school employees and court staff.

In Cherokee and Whitfield counties, COVID-19 testing will continue to be provided to anyone who needs it Monday through Friday from 8 AM to 11 AM, but by appointment only. To make an appointment for testing in Cherokee and Whitfield counties, call 1-888-881-1474.

* * *

Outpatient antibody treatments, which can work well for Covid patients, have been sitting unused — they’re not FDA-approved for Covid-19, and they take time and effort to administer (not good for overwhelmed hospitals).

But now dialysis centers are stepping up to give them — which makes sense, because their patients are among the highest risk (and dialysis centers are also perfectly equipped for that kind of outpatient procedure.

* * *

Hesitancy: A lot of frontline healthcare workers — we’re talking 29 percent — are hesitant about or outright refusing the vaccines. Why? Fears of it having been rushed, lack of testing on Black and Hispanic people, and distrust of the government.

Ironically, those frontline workers are disproportionately people of color — a group most at risk from the virus, but also one with memories of “past atrocities, such as the unethical surgeries performed by J. Marion Sims and the Tuskegee Syphilis Study.”

* * *

Trust the long-haulers: A lot of people who recover from the coronavirus find themselves experiencing a host of nasty symptoms, from breathing trouble to “brain fog.” No one is quite sure what’s up with these “long haulers,” but healthcare pros are being told clearly not to dismiss these complaints. Clearly something is going on.

How the problems play out in different people is unpredictable, doctors say, with some gradually getting better and others not. Multiple organs are involved, so multiple biological mechanisms might be at play.

The latest way to live forever

If you’re already taking vitamin D and drinking three to four cups of coffee a day, you might want to add glucosamine/chondroitin to your daily regimen.

West Virginia University researchers found that …

…individuals who took glucosamine/chondroitin […] on a daily basis for at least 1 year saw a 39% reduction in mortality from all causes of death and a 65% reduction in the likelihood of death from cardiovascular disease.

This was an epidemiological study, not a clinical trial, so don’t read too much into it yet. But still, worth a mental note.

Medicare pricing change won’t be coming anytime soon

Remember the administration’s plan to tie Medicare reimbursements to certain drugs to what other countries are paying? It’s hit a speed bump, with the U.S. District Court of Maryland issuing a 14-day injunction.

Why? “The rule was promulgated based on an executive order, not a congressional act, and standard notice and comment procedures were not followed.”

There are no words

1. Obtain poison from the poisonous giant monkey frog, native to Brazil.
2. Burn several dots into patient’s skin with hot embers.
3. Scratch the burns and put the poison on it, for rapid absorption.
4. Watch as patient immediately begins to experience “nausea, vomiting, diarrhea, sweating, and fevers” along with “dehydration, seizures, and delirium.”
5. Profit.

It’s called kambo, and it’s the newest craze in — you guessed it — California (and elsewhere).

It’s been touted to help ailments such as depression, chronic pain, hypertension, migraine headaches, thyroid disorders, diabetes, and alcohol addiction.

But…

Those who’ve experienced it describe it as one of the worst experiences of their lives, while, at the same time, they also voice plans to undertake the experience again.

A step toward a deafness cure*

Israeli scientists have cured a type of deafness using a virus to deliver a genetic treatment.

The bad news: It’s only one particular type of deafness (and a rare type at that); it’s also only been done in mice

The good news: “[T]his novel therapy could lead to a breakthrough in treating children born with various mutations that eventually cause deafness.”

* I refuse to use headlines like “Can you hear me now?” or “Now hear this” — too easy

Get ready to vaccinate

In case you haven’t noticed, there’s been a bit of news about vaccines these days. Soon enough you’re going to have a lot more people getting one in particular.

You know there’s paperwork, but are you sure you know the latest rules and regs?

Yes, this is a promo for a GPhA CPE class — and an important one: The Vaccine Protocol Update presented by the terrific Johnathan Hamrick, PharmD.

Get this: It’s now available for home-study CPE. Yep, you don’t need to step out of your home, and you can still get the same great education (minus the Q&A, to be fair).

Learn the protocols, what you can deliver, how things have changed, even storage, handling, and disposal. It’s a mere $20 for GPhA members.

Click here for info and to register today!

Face the face

You know how newspapers black out someone’s eyes to hide their identity? What happens when you can’t see someone’s nose or mouth because they’re wearing a mask?

York University researchers wondered that — how hard is it to recognize someone when you can only see their eyes. Turns out, it’s about 15 percent harder.

“[F]ace perception typically relies on holistic processing, that is the processing of the face as whole. However, for masked faces, this form of perception is not as efficient, and observers process different face features separately,”

And if you’re wondering what it means to process faces holistically, may we introduce you to the “Thatcher Effect“?

It’s the time of year for top-10 lists

Andy Miller of Georgia Health News has a list of “The Top 10 Georgia health care stories in 2020,” and no, they aren’t all about Covid.

Can’t possibly be true

“Clowns Make Hospitals Less Scary For Young Patients.” (Says Son of Buzz: “Maybe little kids who don’t know any better.”)

Timmy went to sleep real fast!

Don’t (necessarily) stop those CV meds

If you have patients with chronic kidney disease who are taking RAS inhibitors, there’s a chance their prescribers will want to stop those meds. Some small-scale studies found that cutting out RAS inhibitors can improve kidney function.

What you might need to know: It ain’t that simple. Especially when the kidney disease is advanced, the dangers of stopping might outweigh the benefits. Swedish researchers looking at the issue found there isn’t enough information to support discontinuing the meds:

“Rather than routinely discontinuing treatment, our results show that the issue is a complex one and that doctors must carefully weigh the protective effects of RAS inhibitors on the cardiovascular system against the potential harms on the kidneys.”

Captain Obvious…

…does a facepalm: “Privileged White U.S. Citizens Have Better Health Outcomes”

…and then a double-take: “White US citizens in the 1% and 5% highest-income counties […] had worse outcomes for infant and maternal mortality, colon cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction compared with average citizens of other developed countries.”

ICYMI

The coronavirus relief bill that Congress passed (and that was signed into law) includes lifetime coverage of kidney transplant drugs for people on Medicare. It’s expected to save about 375 lives — and $40 million — per year.

Covid-19 just keeps on giving

Overuse of azithromycin to treat Covid-19 (hint: it doesn’t work) — as well as a slowdown in STD testing — has helped lead to the spread of “super gonorrhea” that’s just about untreatable.

=AND=

To be filed under the ever-growing list of post-Covid issues is now psychosis: “Most had no history of mental illness and became psychotic weeks after contracting the virus. ”

Diabetes and your dog

Here’s an interesting tidbit: “The owners of dogs with diabetes are more likely to acquire type 2 diabetes themselves.”

Or, more accurately, it’s the other way around:

The link is not a total surprise, as previous research has found that people with overweight who own dogs tend to have overweight canines as well, perhaps due to a shared sedentary lifestyle. Having overweight increases a person’s risk of developing type 2 diabetes.

Think mink

It’s hard not to make jokes about minks and Covid — “Zombie Danish Minks” is both a perfect headline and a great name for a rock band — but the Atlantic* would like to tell you that “The Mink Pandemic Is No Joke.”

If the virus keeps spilling over into wild animals, it could circulate in parallel and keep reseeding outbreaks among humans.

* “World’s Most Depressing Magazine”

Ketamine loosens your brain

We know ketamine works as a virtually instant treatment for major depression, but it’s not entirely clear why. Kiwi researchers think they have an idea, though.

In short, ketamine seems to help reprogram the brain to be, in a sense, more willing to accept new ideas — specifically, new ideas about yourself. So if the idea that you’re a failure is too deeply ingrained, ketamine can help your brain get out of the rut.

Securing those vaccines

For all the stories about how people are hesitant to get a Covid-19 vaccination, that doesn’t mean they’re above stealing it. And that means pharmacies have to install all sorts of security measures.

[H]ealthcare systems have learned from the opioid epidemic, where threats of theft can come from both outside the hospital — and from the people working there.

You might be eligible for a PPP loan now

The new stimulus bill just passed by Congress includes a continuation and expansion of Paycheck Protection Program loans. Could your pharmacy be eligible? Maybe — small businesses are included this time. It might be worth talking to your financial advisor or the Small Business Administration.

An eight-month window

One of the biggest questions about the Covid-19 vaccine is how long immunity lasts. Would it be permanent, like the measles vaccine, or would it require annual shots like the flu?

The latest: An Aussie study finds that it seems to last at least eight months.

What that means: Assuming it’s true, we have at least an eight-month window to achieve herd immunity.

For the pandemic to be brought well under control, if not eradicated altogether, we’ll need at least 70 percent of a population to be immune within the same window of time. Only then can we be sure the virus will have so few places to hide, it just might vanish.

Winning the war on two fronts

You can attack pathogens with a chemical, and the body can attack as well. Scientists at the Wistar Institute says they’ve got a way to use both at once. This “creative, double-pronged strategy” not only kills the bacteria directly, but summons a rapid immune response. Together, they figure, it can overcome antimicrobial resistance.

“We believe this innovative [dual-acting immuno-antibiotics] strategy may represent a potential landmark in the world’s fight against [anti-microbial resistance], creating a synergy between the direct killing ability of antibiotics and the natural power of the immune system.”

More vaccines a-comin’

Pfizer has reached a deal with the U.S. government to supply an additional 100 million doses (i.e., enough for 50 million people).

BUT check it out: Here’s GPhA member Ben Ross, owner of Forest Heights Pharmacy in Statesboro, getting vaccinated by his business partner, pharmacist Pete Nagel. (And yes, you can and should admire their coordinated masks and shirts.)

And here’s Ben holding a box that can potentially save a lot of lives:

U.S. sues Walmart for understaffing pharmacies

What, you thought the opioid crisis lawsuits were all over? Nope. The feds’ suit against Walmart is a little different, than the other ones, though:

The Justice Department’s lawsuit claims that Walmart sought to boost profits by understaffing its pharmacies and pressuring employees to fill prescriptions quickly. That made it difficult for pharmacists to reject invalid prescriptions, enabling widespread drug abuse nationwide, the suit alleges.

Deadliest year in history

Yeah, U.S. life expectancy had gone up in 2019, but that’s behind us now. No hyperbole; 2020 is the deadliest year in American history. (And with one American dying from Covid every 30 seconds, the few days left in the year are just awful icing on the cake.)

You can’t always trust pulse oximeters

If you have Black or dark-skinned patients, here’s an important piece of info: Fingertip blood oximeters are less reliable when used with dark skin. We’re talking three times more errors.

With blood oxygenation being used to determine how severe a case of Covid-19 someone has, this is a scary bit of news.

“I think most of the medical community has been operating on the assumption that pulse oximetry is quite accurate,” said Dr. Michael W. Sjoding […] “I’m a trained pulmonologist and critical care physician, and I had no understanding that the pulse ox was potentially inaccurate — and that I was missing hypoxemia in a certain minority of patients.”

Green means go

A pair of researchers have found a way to alter the genes of gut bacteria so they respond to light. Why would you want to do this? Because if you alter the right genes, you can use light to make the bacteria to behave the way you want it to.

For example, you could engineer a bacteria to produce more colanic acid, which seems to improve lifespan (at least in nematode worms). But you only want the acid in the small intestine, and you don’t want to overdo it.

Make that bacteria respond to green light, though, and you can control when and where it happens. Presto: Immortality! (Well, possibly better health at least.)

British invasion in five sentences

The new Covid-19 strain from Britain is probably already here.

It’s more virulent, but not (it seems) more deadly … although a different variant (in South Africa) does seem more dangerous.

The vaccines we have should work against it.

Most of Europe has closed their borders with the U.K.

The U.S. is still taking travellers from there, but the CDC is at least a little worried.

Ferrets get protection

Black-footed ferrets are cute, endangered, capable of getting Covid-19 … and potentially spreading it to humans (possibly after helping it mutate). So scientists in Colorado aren’t waiting for a commercial vaccine — they’re acting now.

As one put it:

“If the virus returns to the animal host and mutates, or changes, in such a way that it could be reintroduced to humans, then the humans would no longer have that immunity. That makes me very concerned.”

Come out, come out, wherever you are

No more hiding in the back, pharmacists. Rite Aid’s new “RxEvolution” strategy will take pharmacists from the back of the store and put ’em right out front.

The Store of the Future is designed so that pharmacists sit behind the registers, so that they can easily come out to the customers and can bring them over to their consultation area, streamlining the entire experience.

This is clearly great news for pharmacists, who will now be able to “address mind, body and spirit of each of [Rite Aid’s] customers.”

Land of confusion (but getting better)

In the movies, the moment a cure is discovered it’s quick and easy to get it to everyone. Despite the evidence, this isn’t actually a movie, and vaccine distribution is tricky. Chaotic, you might say. In rural areas (and yes, the article specifically mentions Georgia) it’s even trickier.

Storage requirements, federal hiccups, questions of who gets it, weather issues — it all adds up to a bumpy road, but one that’s at least going in the right direction.

“It’s day to day and even then hour by hour or minute by minute — what we know and how we plan for it. We’re building the plane while flying it.”

It may not last

In all the excitement of having one, two, three vaccines that seem to work against Covid-19, there’s one huge question: How long will it last? The answer could very well be “Not as long as we hope.”

Last year had some problems too

From ” Labeling, Packaging, and Nomenclature” to “Order Communication and Documentation” to mixups, bad labels, and more, check out the Pharmacy Practice News list of 2019’s* medication errors.

* The Institute for Safe Medication Practices takes some time to compiles them, obviously.

A diarrhea drug fights cancer…

If you woke up thinking “Degrading the endoplasmic reticulum of cancer cells is one way to fight them!”, German researchers are right there with you. They found that loperamide — yes, the anti-diarrhea drug — seems to cause the cells in glioblastoma brain tumors to self-destruct.

It’s only in the lab at the moment, but they’re optimistic, as only Germans can be.

The loperamide-induced death of glioblastoma cells could help in the development of new therapeutic approaches for the treatment of this severe form of cancer.

…and a cancer drug fights diabetes

Let’s say you have diabetic mice. And let’s say you’re treating them with GLP-1 agonists. So far, so good, but get this: Indian researchers found that combining the anti-cancer drug entinostat (aka MS-275) with a GLP-1 agonist like Trulicity, [does an even better job with diabetes and glucose control](

https://elifesciences.org/for-the-press/15fd465f/new-drug-combination-could-improve-glucose-and-weight-control-in-diabetes ).

[M]ice treated with the combination of GLP-1 agonist and MS-275 had a much lower fasting glucose level than control mice that were sustained with repeat dosing. Where a high-fat diet increased fasting blood sugar in the untreated mice, the mice on the combination treatment remained in control.

Biologists at work

University of Bristol researchers are thrilled to announce that, after detailed study of more than 1,400 genes and the use of sophisticated computer algorithms, they have determined where fleas fit on the tree of life.

Harvard biologists have made a detailed genetic and bioinformatic study of the bacteria living in the human mouth and have concluded ‘there are a lot of different kinds.’

The Long Read: Sleeping through Covid

“The Mysterious Link Between COVID-19 and Sleep,” from the Atlantic.

There’s definitely some connection between Covid-19 and sleep, and researchers are working to figure it out. Some data points:

• People taking melatonin “had significantly lower odds of developing COVID-19, much less dying of it,” it was even given to Donald Trump during his treatment.
• After recovering from the virus, many people report neurological symptoms — most commonly insomnia.
• One effect of the virus seems to mimic that of myalgic encephalomyelitis — aka chronic fatigue syndrome.

Roughly three-quarters of people in the United Kingdom have had a change in their sleep during the pandemic, according to the British Sleep Society, and less than half are getting refreshing sleep. “In the summer, we were calling it ‘COVID-somnia’.”

Georgia’s getting clobbered

Covid-19 cases were up 14.5 percent in Georgia last week, as the post-Thanksgiving virus surge continued with more than 44,000 people testing positive. And no, it’s not about the number of tests — the percentage of positive results is going up.

Pfizer/Moderna cage match

Wondering how the two current Covid-19 vaccines stack up, side by side? Stat has the overview, from storage requirements to side effects to dosage.

CDC issues opioid-overdose health advisory

Opioid overdoses are on the rise again. Remember: Pharmacists have a role to play.

Stock and dispense naloxone to save lives. It can be that simple.

The CDC Official Health Advisory issued a warning about the increase in fatal drug overdoses across the United States driven by synthetic opioids before and during the COVID-19 pandemic.

What’s in the advisory?

The issue: Rapid increases in overdose deaths involving synthetic opioids excluding methadone — especially illicitly manufactured fentanyl.

Why the advisory: “A concerning acceleration of the increase in drug overdose deaths,” especially from March to May 2020. Yes, that coincides with the first wave of the pandemic.

What’s changed:

• Geographic distribution of overdose deaths “with the largest percentage increases occurring in the western United States”
• Significant increases in overdose deaths involving psychostimulants with abuse potential, e.g., methamphetamine

Recommendations for communities, including pharmacists and other healthcare providers.

Oh no, it’s mutating! (Don’t panic)

The big news out of Europe is the emergence of a new strain of Covid-19 in Britain. It (seems to) spreads faster, but the vaccine (seems to) still work on it. Why the “seems to”? Because all the testing so far has been in a lab.

Short version: This isn’t unexpected, isn’t a huge deal, but it bears watching.

You want it perfectly balanced, as all things should be

It’s not just your blood pressure that can foretell a risk of heart attack or stroke — it’s the difference in blood pressure between your two arms. So found a global study out of the University of Exeter, using the records of almost 54,000 people.

“[T]he higher the difference in blood pressure between arms, the greater the cardiovascular risk, so it really is critical to measure both arms to establish which patients may be at significantly increased risk. Patients who require a blood pressure check should now expect that it’s checked in both arms, at least once.”

GoodRx expands

The company is making the leap from pharmacy discounts to … telemedicine? Yep.

As a means to augment its existing prescription medication savings offerings, the new Gold plan will provide members with the ability to: “See a doctor or healthcare provider online for as little as $10 per visit; Get treatments and prescriptions for conditions ranging from acne to high cholesterol;”

And, of course, the usual pharmacy savings stuff.

Saving you a click

“Sleep, Diet or Exercise? Here’s The Factor Most Linked to Better Mental Health“. It’s sleep.

[W]hile physical activity was the second clearest indicator of wellbeing, it was sleep quality that outranked them all as the strongest predictor of good mental health.

Building a better antibiotic

Aminoglycosides: powerful and common … but with a potential side effect of deafness. Now Stanford scientists have developed a new type, based on sisomicin, that works as well, but without the side effects.

The trick was to take into account how the ear’s sensory cells work: They open ion channels to get signals to the brain. Aminoglycosides can get into those channels and kill the cells, causing hearing loss. By tweaking the non-clinical side of the antibiotic’s molecule, they were able to make a version that didn’t enter those ion channels.

Bonus: The same tweaking also prevents aminoglycosides from affecting the kidneys — another common side effect.

Nobody expects a pandemic-nixed inspection

Novartis expected its new inclisiran cholesterol drug to be a blockbuster. But it didn’t expect a worldwide pandemic that would keep its factories from being inspected by the FDA. But that’s what happened.

The agency rejected approval for inclisiran not because there was anything wrong with the European factory, but because it couldn’t get to the plant because of Covid travel restrictions.

You’ll put your eye out!

At least one ophthalmologist is sounding the warning: Don’t get over-eager on New Year’s Eve and pop a champagne cork into someone’s eye.

“We want people to find some joy in these difficult times, but if you’re going to introduce a pressurized bottle with a potential flying projectile, an unguided little missile, do it with caution and be aware that there is a risk.”