Six Ways Amazon Could Up-End the Pharmacy Business


In June, the online retail giant moved into the roughly $800 billion U.S. grocery space by buying Whole Foods Market Inc. Drugs, a $450 billion industry in the U.S., are likewise most often sold from brick-and-mortar stores. Shoppers filling prescriptions frequently pick up toiletries, beauty supplies and dish soap — all retail items Amazon already sells. And the distribution chain for drugs has lots of middlemen whose markups Amazon can seek to undercut.

No wonder shares of drugstore chains CVS Health Corp. and Walgreens Boots Alliance Inc. have dropped sharply since analyst speculation about Amazon entering the pharmacy business intensified last month. On Monday, CVS Health said it would begin same-day delivery in several cities in early 2018, an apparent defensive move. Amazon has never commented on its pharmacy ambitions.

Drugs, which are light and don’t require in-person selection, “are a perfect match” for Amazon, said SSR Health analyst Richard Evans in a recent report.

Here are six ways the retailer could overturn the American pharmacy market:

1. Use its shipping power to destroy rivals
2. Become the ultimate buyer of cheap generics
3. Turn Whole Foods into Whole Drugs
4. Or buy into the pharmacy business
5. Or launch a startup of its own
6. “Alexa, refill my Lipitor”

Allergy Experts: Single Drug Best for Allergic Rhinitis

When it comes to treating seasonal allergies, one drug is often better than two: updated guidelines for the treatment of teen and adult patients with allergic rhinitis recommend initial treatment with an intranasal corticosteroid alone without an oral antihistamine.

The guidelines, appearing in the Annals of Allergy, Asthma and Immunology, follow a comprehensive review by a joint task force of the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology 

341 Days Without a C. difficile Infection: How Mercy Health – St. Anne Hospital Reduced C. difficile Infection Rates to Zero

It can be done.....

C. difficile (C. diff) is the most common cause of healthcare–associated diarrhea in U.S. hospitals. Reducing healthcare-acquired Clostridium difficile infections (CDIs) is a complex and evolving battle. But it’s a battle that can be won. At Mercy Health — St. Anne Hospital, a 100-bed community hospital in Toledo, Ohio, my team and I used a multi-component strategy to reduce CDI rates and from July 2016 to July 2017 successfully eliminated all healthcare-associated CDI cases.

Prior to 2015, St. Anne Hospital had 40% more infections than predicted from baseline. Aiming to improve, my team and I worked with administration at both the hospital and system level to reduce the hospital’s rate of CDI. We began by initiating a “days since last” approach on the hospital’s daily safety call. Each unit shared their daily CDI-related information including number of patients on the unit with known or suspected CDI, number awaiting specimen collection or results, and what day of hospitalization CDI was confirmed. While this call was effective in bringing CDI to the forefront of attention, more needed to be done.

In 2015, we started tracking CDI cases by their location in the hospital. This showed nearly all cases of CDI patients spent time in the ICU, so my team and I ensured each ICU room underwent additional steps in terminal cleaning using bleach and UV light. In addition, we implemented a policy that required the cleaning of suspected and confirmed CDI patient rooms with bleach, exchanging privacy curtains, and cleaning with UV light at every transfer or discharge, regardless of location. This policy also emphasized routine bleach cleaning of areas within the ICU that were prone to frequent touch such as the nurses’ station, hallway handrails, and door handles.

We educated healthcare personnel on appropriate testing, the accuracy of PCR testing, and proper specimen collection. We then implemented policies to assess for diarrhea and C. difficile risk factors at the time of admission. Patients were asked about recent antibiotic use, healthcare visits, and diarrhea. Finding patients with diarrhea and at least one other risk factor would prompt the nurse to immediately isolate the patient and obtain an order for a stool specimen. Isolation was discontinued only if C. difficile was not detected by PCR in the ordered stool specimen, or if the patient did not have watery stool in a 24-hour period. The pediatric Bristol scale helped standardize the description of stool consistency by both staff and patients.

Simultaneously, the hospital’s Infection Prevention and Pharmacy departments implemented an antimicrobial stewardship program (ASP). This program engaged both clinicians and hospital leadership such as the CEO, CMO, infectious disease physicians, and managers from departments of quality, lab, nursing, and education. The ASP staff reviewed charts for duplication of antimicrobials and de-escalation when appropriate. The use of order sets with appropriate antibiotics for diagnoses such as sepsis, community-acquired pneumonia, and UTI was encouraged for emergency department use as well as for admission orders.

The final component of the intervention involved changing contact precaution signs placed outside of CDI rooms and adding a weekly glove and gown compliance report to the safety calls. The new contact precaution signs emphasized strict adherence to the use of gowns and gloves, hand hygiene, and bleach disinfection of shared patient care items before use by another patient.

Through these efforts, my team and I were able to reduce our hospital’s expected number of CDIs to 55% less than predicted in 2016. We are delighted to report that for the first half of 2017, we had no cases of CDI at all.

U-M leading drive to cut opioids given after surgery

"Epidemic" is a tough word, and one often overused.

But it's now clear that we are now facing an enormous and relatively new public health epidemic from the overuse of and our growing addiction to opioid drugs.

And they aren’t all coming from back-alley pushers. Though the exact proportions are not clear, a significant percentage of opioids that enter the supply chain are prescribed by physicians, either to reduce postoperative pain or to help patients with mood disorders.

Research conducted by the University of Michigan further shows that about one-in-10 people who were not on opioid drugs before surgery became dependent on them.

Naturally, a lot of the stuff that does get into the black market comes from pharmacy “pill mills,” corrupt doctors and faked prescriptions and drug dealers. Maybe 35 percent of all prescriptions written are for "acute care" and involve postoperative pain relief, dentistry and emergency medicine ‒ long-accepted medical practice.

My feeling of guilt for being disabled

Whilst I struggle to cope with constant pain, fatigue and disability, the worst thing is My feeling of guilt for being disabled.

I am very fortunate to have found true love, even now I still have the feelings for my wife as I did when we were first dating, I love her but I am also in love with her and I can’t help but smile when I see her.

We struggle financially, we don’t have a social life and we don’t go on holiday and for that I feel like I have let my wife down. I love her and I want her to have an amazing life, I want her to have nice things and I want her to see this world. However because I am basically housebound, we don’t see very much.

Yes being disabled has robbed me of the ability to walk, it has turned me into quite a grumpy old git and it has meant that I have lost many things. However the effect it has had on my wife is the hardest thing to cope with.

This week we discussed about maybe having to swallow our pride and seek the help of a food bank, my wife is a proud woman and her thoughts on that was evident on her face.

We live in a 3 bed bungalow, it took my wife a long time to find somewhere for us to live after our previous landlord announced he was selling up. Many people turn their noses up at those of us that are reliant on welfare, this is partly due to the stigma of being on welfare and also down to the fact that councils now advise tenants to refuse to move out when a landlord asks, they say to take it right up to getting an eviction notice. This of course helps those facing losing a property, giving them more time, but it causes landlords to resent these tenants.

Rent in this part of the country is quite high, our property is £900 pcm and believe me when I say that is cheap, the property is fairly run down, we get damp, the front door has a half-inch gap top and bottom allowing a draft in and the bottom of the door is so rotten you can poke a hole in it. However it is a roof over our heads.

We get as allowed by the Local Housing Allowance rates £606 every 4 weeks which is £7878 a year, we have to pay £10,800 and of course now you don’t get the full council tax amount and that has to be topped up!

Gut bacteria 'boost' cancer therapy

Both studies were on patients receiving immunotherapy, which boosts the body's own defences to fight tumours.

It does not work in every patient, but in some cases it can clear even terminal cancer.

One study, at the Gustave Roussy Cancer Campus in Paris, looked at 249 patients with lung or kidney cancer.

They showed those who had taken antibiotics, such as for dental infection, damaged their microbiome and were more likely to see tumours grow while on immunotherapy.

One species of bacteria in particular, Akkermansia muciniphila, was in 69% of patients that did respond compared with just a third of those who did not.

Boosting levels of A. muciniphila in mice seemed to also boost their response to immunotherapy.

Meanwhile, at the University of Texas MD Anderson Cancer Center, 112 patients with advanced melanoma had their microbiome analysed.

Those that responded to therapy tended to have a richer, more diverse microbiome than those that did not.

And they had different bacteria too. High levels of Faecalibacterium and Clostridiales appeared to be beneficial, while Bacteroidales species were bad news in the study.

Tissues samples showed there were more cancer-killing immune cells in the tumour of people with the beneficial bacteria.

The team then performed a trans-poo-sion, a transplant of faecal matter, from people to mice with melanoma.

Mice given bacteria from patients with the "good" mix of bacteria had slower-growing tumours than mice given "bad" bacteria.

Dr Jennifer Wargo, from Texas, told the BBC: "If you disrupt a patient's microbiome you may impair their ability to respond to cancer treatment."

She is planning clinical trials aimed at altering the microbiome in tandem with cancer treatment.

She said: "Our hypothesis is if we change to a more favourable microbiome, you just may be able to make patients respond better.

"The microbiome is game-changing, not just cancer but for overall health, it's definitely going to be a major player."

FDA Widens Scope of Navigator – Information Tool for Expanded Access

FDA is committed to expanding access to safe and effective treatment options for patients with rare, debilitating, and sometimes fatal diseases. These patients face unique medical challenges. Sometimes there isn’t an FDA-approved drug to adequately address the needs of a patient with a rare disease. Therefore, the agency needs to take new steps to enable more patients with unmet needs to get access to promising treatments prior to full FDA approval.

Two examples of the recent steps FDA has taken in pursuit of these goals are improvements we made to our Expanded Access Program and our Orphan Drug Program. These programs are high priorities of mine. They address the needs of patients with some of the most challenging conditions. Making sure there’s a close relationship with the efforts we take to expand pre-approval access to promising treatments, and the work of our orphan drugs program, is a key step toward maximizing opportunities for patients. To further achieve these goals, we’re announcing that FDA is widening the scope of the new Expanded Access Navigator tool, a comprehensive online information resource maintained by the nonprofit Reagan-Udall Foundation to facilitate pre-approval access to drugs. Previously this tool was rolled out for drugs that treat cancer. It will now apply to drugs that treat orphan diseases.

About Chronic Pain

Chronic pain is a debilitating disease which affects over 100 million Americans. It costs the United States in excess of half a trillion dollars each year and is the leading cause for why people are out of work.

The International Association for the Study of Pain (IASP) defines pain as, “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain is a subjective experience in which there is no method for determining if an individual is in pain. Every person experiences chronic pain in a different way which makes it difficult to treat.  One of our primary goals is to understand the individual differences in each person’s pain so that we can ultimately tailor therapies to that person.

Learn more about the conditions below. You can also find more information on the American Chronic Pain Association’s Website.

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Lessons on Universal Coverage from an Unexpected Advocate: Richard Nixon

Starting from the time of President Harry Truman in 1945, policymakers from both parties have introduced dozens of plans to protect all or most Americans against the high costs of getting sick. Truman wanted to create a national health insurance fund run by the federal government (a pre-Medicare single-payer system). Over decades, Senator Edward Kennedy proposed multiple plans with varying designs. President Bill Clinton in 1993 advocated for government-regulated managed competition as a means to cover all Americans. But in 1974, President Richard Nixon advanced one of the most interesting proposals —introducing a number of novel ideas that have since been incorporated into many reform efforts.

Perhaps because of a childhood plagued by health problems (two of Nixon’s brothers died of tuberculosis, and he likely had a mild case himself), Nixon was deeply sympathetic to the health challenges facing Americans, and he came to believe in the necessity to cover everyone. As a Republican and advocate of limited government, however, Nixon sought narrow, targeted solutions to improve access to health care, relying as much as possible on private markets. The two main pillars of Nixon’s plan were an employer mandate and expanded coverage for the poor to “assure every American financial access to high quality health care.”

Nixon proposed that all employers be required to offer insurance to full-time employees. Employers and employees would share the premium “on a basis which would prevent excessive burdens on either,” a novel idea that would have extended coverage to a large proportion of working Americans. There would be a limit on total medical expenses per covered family, and the federal government would provide temporary subsidies to small and low-wage employers to offer employees affordable insurance.

For low-income people, the unemployed, the disabled, and other vulnerable groups, Nixon proposed a federal program with uniform benefits that would replace Medicaid. He wanted to peg premiums and out-of-pocket expenses to the income of the individual or family, so that a working family earning up to $5,000 (around $26,000 today) would pay no premiums at all. People with higher incomes could buy into this plan if they could not otherwise get coverage. In effect, Nixon proposed a buy-in to a federal, Medicaid-like program, rather than to Medicare, as Hillary Clinton proposed during her 2016 presidential campaign.

Black Licorice: Trick or Treat?

As it turns out, you really can overdose on candy—or, more precisely, black licorice.

Days before the biggest candy eating holiday of the year, the Food and Drug Administration (FDA) encourages moderation if you enjoy snacking on the old fashioned favorite.

So, if you’re getting your stash ready for Halloween, here’s some advice from FDA:

If you’re 40 or older, eating 2 ounces of black licorice a day for at least two weeks could land you in the hospital with an irregular heart rhythm or arrhythmia.

FDA experts say black licorice contains the compound glycyrrhizin, which is the sweetening compound derived from licorice root. Glycyrrhizin can cause potassium levels in the body to fall. When that happens, some people experience abnormal heart rhythms, as well as high blood pressure, edema (swelling), lethargy, and congestive heart failure.

FDA’s Linda Katz, M.D., says last year the agency received a report of a black licorice aficionado who had a problem after eating the candy. And several medical journals have linked black licorice to health problems in people over 40, some of whom had a history of heart disease and/or high blood pressure.

Katz says potassium levels are usually restored with no permanent health problems when consumption of black licorice stops.