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HEALTH

Can Covid research help solve the mysteries of other viruses?

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Barie Carmichael lost her sense of taste and smell while traveling in Europe. She remembers keeping a dinner date at a Michelin-starred restaurant but tasting nothing.

It may sound like a case of COVID-19. But Carmichael, 72, a fellow at the University of Virginia’s business school, lost her ability to taste and smell for three years in the 1990s. The only respiratory infection she’d had was bronchitis.

Scientists say that although the complications of COVID have riveted peoples’ attention, many symptoms — like a loss of smell — are not unique to COVID. Heart inflammation, lung and nerve damage and small blood clots in the lining of lungs occur in a small but noticeable percentage of patients who have had other respiratory and viral infections.

No one is saying COVID is the equivalent of, say, the flu. But COVID-19 is providing a new opportunity to understand the complications of many common viral infections.

Before the pandemic, research grants to study a loss of smell were hard to come by, said Danielle Reed, associate director of the Monell Chemical Senses Center, a nonprofit research group in Philadelphia.

But now, she said, “there is an explosive growth of interest among funders.” (She added that most who say they have lost a sense of taste have really lost a sense of smell.)

Monell researchers want to compare how often people lose their sense of smell after a bout with the flu versus a bout with COVID-19 — and how long the loss lasts. Is there a genetic predisposition to this complication?

Researchers at other institutions want to know who is susceptible to heart infections, blood clots or lung damage after having a respiratory virus like the flu.

Heart problems following a viral infection are among the best studied. Every year, myocarditis — an inflammation of the heart muscle — affects as many as 1.5 million people worldwide, most of whom had a prior respiratory virus infection. Most recover fully.

But symptoms like fatigue are often not recognized as being related to myocarditis. And Dr. Bruce McManus, an emeritus pathology professor at the University of British Columbia, suspects that the fatigue that sometimes follows a bout with COVID-19 might be caused by this heart problem.

“We think of COVID-19 and influenza as respiratory diseases, and in fact they are,” McManus said. “But the reason many patients reach their demise in many instances is myocardial.”

Originally Appeared On: https://www.wionews.com/science/can-covid-research-help-solve-the-mysteries-of-other-viruses-378386

Medications have large impact on increasing health care costs

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Half of Americans take no prescription drugs. At the other end of the spectrum are people like Karen Milligan. She needs several drugs and pays a lot for them.

She has dealt with multiple sclerosis for three decades. It’s a disease of the central nervous system with no cure.

At 65, Milligan is seeing her drug costs continue to increase, even for the same drug she has been taking for years. Her total out-of-pocket spending for medications is running about $9,000 a year, though she’s covered by Medicare. Her husband, Greg, says the MS drug Aubagio has gotten significantly more expensive for her.

The Acworth couple are able to manage the out-of-pocket costs, though it is not easy.

“We’re burning through our retirement savings faster,” Greg says, “but you do what you have to do.’’

Out-of-pocket costs can severely affect people with no health insurance – and even many who have drug coverage.

For people who take prescription drugs, the financial impact largely depends on their health insurance coverage, Matthew Perri, a pharmacist and professor emeritus at the University of Georgia College of Pharmacy, said.

Recently released data from NiceRx, a medication access company, shows that the 10 states with the highest average out-of-pocket costs for prescription drugs are in the South or on its periphery.

Georgia is No. 4, with an average annual expense per capita of $195. Perri says the average amount doesn’t really mean that much because of the many people in the state who have no prescription medication costs.

The highest out–of–pocket costs come in Louisiana, followed by Kentucky, Tennessee, Georgia, Arkansas, Mississippi, Alabama, West Virginia, South Carolina and Oklahoma, the new report, using data from a Health Care Cost Institute 2018 report, says.

The drug cost analysis takes into account spending through government insurance programs as well as medications bought through private coverage.

One factor in consumer drug costs in Southern states, Perri said, may be the region’s higher rate of people without health coverage. Georgia has the third–highest uninsured rate, trailing only Texas and Oklahoma.

The South also has more people with problems getting access to care, plus a high level of people with chronic disease.

Perri notes that the region is known as the Stroke Belt, with the general population having a 34 percent higher stroke rate than people in other areas of the country.

The most prescribed drug in Georgia is amoxicillin, an antibiotic used to treat various kinds of infections. It is also No. 1 in Louisiana and Florida, according to the NiceRx data.

Prescription drug spending is climbing, and represents roughly 10 percent of overall health care spending. The spending increase is linked to prices, utilization and new drugs. The new drugs include biologics, which are derived from living cells and typically cost more because of a complex manufacturing process.

These drugs “are what you see advertised on TV,” Perri says, and include medications for rheumatoid arthritis, cancer and Crohn’s disease.

Dorothy Leone-Glasser of the Rx in Reach GA Coalition, a collaboration of consumer advocacy and medical groups, is among the people with a high monthly drug tab.

“One of my drugs is more than $700 a month,” says Leone–Glasser. “Even with prescription drug coverage, if you have a chronic illness, it’s not going to cover all the drugs for your illness.’’

The new, expensive drugs “have made a difference in people’s lives,’’ she says, but she adds, “when you go to get your prescription drugs, particularly drugs that are cutting-edge, the sticker shock is enormous.’’

Leone-Glasser supported a bill introduced in the Georgia General Assembly this year that would have given consumers with individual insurance policies at least 80 percent of the rebate that the drug companies pay insurers or PBMs (pharmacy benefit managers).

The proposed law would have applied to the more than 670,000 members of the State Health Benefit Plan, which covers state employees, teachers, other school personnel, retirees and dependents.

The Georgia Association of Health Plans, as well as a group representing pharmacy benefit managers, spoke in opposition to the rebate bill, and it failed to win passage.

Perri of UGA advises consumers to choose a generic drug when possible and ‘‘always look for lower-cost alternatives.’’

“Find a pharmacist you trust, and get them involved to help you find the most cost-effective therapy,’’ he said.

Still, those with chronic illnesses “bear the brunt’’ of out-of-pocket spending on drugs, Perri says.

The cost of essential medications for multiple sclerosis has nearly tripled this decade, despite the release of the first generic MS drug, a recent study showed.

Karen Milligan is stable on her MS medications.

“The drugs are doing what they’re supposed to do,’’ her husband, Greg, said.

A new Kaiser Family Foundation analysis shows that price increases for many prescription drugs have exceeded the rate of inflation.

Greg Milligan wonders how that’s possible.

“We need a whole lot more transparency’’ on drug pricing, he said.

Originally Appeared On: https://www.albanyherald.com/news/medications-have-large-impact-on-increasing-health-care-costs/article_4244dd36-a514-11eb-8d4e-47eab01cf08c.html

FDA Approves Immunotherapy for dMMR Endometrial Cancer

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The anti-programmed death receptor 1 (PD-1) monotherapy Jemperli (dostarlimab) received approval for treatment of mismatch repair-deficient (dMMR) recurrent or advanced endometrial cancer that has progressed after treatment with a platinum-containing chemotherapy, the U.S. Food and Drug Administration announced Thursday.

The approval was based on data from the ongoing phase I GARNET trial. In a single arm of patients with dMMR recurrent or advanced endometrial cancer, patients received 500 mg Jemperli through intravenous infusion every three weeks for four doses, followed by 1,000 mg once every six weeks until disease progression or toxicity. Of the 71 patients who received Jemperli, 42.3 percent had a complete or partial response, and the response lasted for six months or longer in 93 percent of responders.

The most commonly reported side effects were fatigue, nausea, diarrhea, anemia, and constipation. Jemperli can also cause immune-mediated side effects, including pneumonitis, colitis, hepatitis, endocrinopathies, and nephritis. Five patients permanently discontinued Jemperli due to adverse reactions.

Approval was granted to GlaxoSmithKline. The company is studying Jemperli for use in endometrial cancer in earlier treatment lines and in combination with other therapeutic agents for patients with advanced solid tumors or metastatic cancer.

Originally Appeared On: https://consumer.healthday.com/fda-approves-immunotherapy-for-dmmr-endometrial-cancer-2652757953.html

The Race Is On For Recreational Cannabis In Pennsylvania

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In the past two months, both New York and New Jersey have officially legalized recreational cannabis for adult use — which means the heat is on for Pennsylvania to follow suit.

Medical cannabis has grown in Pennsylvania to a much larger industry than in either of its neighbors to the north and east, but the decision to legalize it for recreational use could be the difference between a significant acceleration and a massive missed opportunity.

“It could significantly impede both short- and long-term revenue if we wait too long [to legalize recreational cannabis],” state Sen. Sharif Street told Bisnow. “It also makes [keeping cannabis illegal] a little pointless if people cross state lines to get it, so we’re not accomplishing anything to prevent people from using it. We’ll probably also have an uptick in arrests as people bring it across state lines.”

Street, who represents a large swath of North Philly, has co-sponsored legislation in the Pennsylvania state Senate with Republican Sen. Dan Laughlin of the Erie area to legalize adult-use cannabis with some of the same social justice-focused components as those passed in New Jersey and New York, including a provision to expunge all nonviolent, marijuana-related convictions. The bill will enter committee hearings once a suitable number of further co-sponsors join, Street said.

Though Street stressed the importance of Pennsylvania citizens making their voices heard in getting the legislation passed — “The energy outside the building is going to drive the progress inside the building,” he said — those in the industry have expressed confidence that recreational cannabis in the commonwealth is a matter of when, not if.

“I think that it will happen within the next two to three years,” said Stephanie Thomas, who consults for cannabis business development through her company Fifth and Olney and for cannabis-related site selection under the banner of Arrow Real Estate Services. “The whole East Coast is falling in line and Pennsylvania is right there in the middle. But it takes time to get things done here, because it has to go through the legislature.”

New Jersey’s adult-use law passed through a ballot measure in November, and the most recent states to pass similar bills through their legislatures, New York and Virginia, have Democrat control in both their state houses and governors’ mansions. Gov. Tom Wolf and Lt. Gov. John Fetterman are both publicly in favor of adult-use legalization, but Republicans control both state houses in Pennsylvania and as a party have historically been opposed to the concept. The electorate in the commonwealth, just as it is nationally, is heavily in favor of recreational cannabis being legalized, but opposition remains stiff in the state’s GOP, despite Laughlin’s co-sponsorship of the bill.

Building cultivation facilities or dispensaries without a medical license in hand is illegal, so construction solely in anticipation of adult-use legalization is a nonstarter, but the industry is growing and drawing new investors from out of state just the same.

“You have a lot of the major national operators securing licenses and recognizing that Pennsylvania is going to be a very valuable state over the next five to 10 years in the cannabis industry,” NewLake Chief Investment Officer Anthony Coniglio said. “We see a significant amount of proposals for canopy build-out [infrastructure needed to grow cannabis], and we think that’s people wanting to be in position to move quickly once there’s clarity on legalization.”

National cannabis heavyweight Trulieve Cannabis Corp. has operated a combined cultivation and retail facility in the South Jersey suburb of Bellmawr for over five years, and it is well set up to apply for a recreational permit when they become available, Wolf Commercial Real Estate Director of Community Relations David Spector said. Meanwhile, without any dispensaries in Camden, Bellmawr is the likeliest threat of cannabis dollars crossing the Ben Franklin Bridge.

Pennsylvania is at a rare moment of opportunity, considering how advanced its medical program — legalized in 2016 — is compared to New Jersey and New York, which have only 16 and 40 medical dispensaries up and running, respectively. Pennsylvania has over 100 in operation and could approach 200 by the end of the year, Jushi founder and President Erich Mauff said.

The commonwealth has more than twice as much square footage devoted to cultivation and processing of cannabis as New York and New Jersey combined, he said.

“Of all the states on the East Coast, PA is the best poised to introduce adult use and still serve medical patients,” Mauff said. “Plus, it has the infrastructure for additional expansion to be able to service the adult-use population easily.”

Neither New Jersey nor New York has a timeline for when the first cannabis will be sold to someone without a medical card, but until that happens, Pennsylvania has the opportunity to catch up in a meaningful way.

“If there were to be a green light by the end of this year, then by Jan. 1, 2023, I think PA would be very ready for adult use,” Mauff said. “It will literally be light years ahead of New York and New Jersey.”

Jushi’s production facility for the state is in Scranton, where its canopy is 33K SF and services its 11 Beyond/Hello dispensaries in the state, two of which are in Center City, with a third under construction on Lancaster Avenue just north of University City. Jushi is already working on tripling its canopy to 100K SF in Scranton, which Mauff said is purely in response to the amount of demand for medical products.

“If we were to know adult-use [legalization] was coming, we may be more aggressive in our expansion,” Mauff said.

For real estate purposes, two impediments to cannabis business stand out: how to finance it and where to put it. The abundance of land outside of major metros in the state means finding cultivation sites isn’t an issue, keeping at least one element of cost down.

“Generally, the grow process tends to be somewhere in the middle of nowhere, where you don’t have to do as much odor mitigation,” Thomas said. “You can get anywhere in the state and back in one day. It may be a long drive to get from Philly to Pittsburgh and back in one day, but you can do it. Being centrally located would be good, but it doesn’t have to be in Carlisle.”

For dispensaries, the issue is much more complex, as the desire to be close to a dense customer population runs up against use restrictions preventing locations within a certain proximity of schools, religious centers and daycare centers, among others.

The suburbs of Philadelphia are more spread out, but not to the degree that a dispensary can easily avoid any local use restrictions, Thomas said. Then there is the NIMBY factor, which can be more intense in the suburbs.

“Smaller towns, if you go to a community meeting and announce your intent to place a cannabis shop, all the torches and pitchforks come out,” Thomas said.

Still, Jushi has seemingly cracked the code of how to find space in Philadelphia’s most potentially lucrative areas.

“We have not found it difficult to find stores,” Mauff said. “If you put your shoulder to the wheel, you can have a store. Maybe people are upset they can’t be in the perfect location, but I don’t think site selection in PA has been prohibitively difficult.”

As for financing, encouraging signs have emerged in that regard as well. The SAFE Banking Act, which would strike down the ban on lending to cannabis-related businesses for any bank or financial institution receiving federal insurance, passed the House of Representatives on Monday. If it passes the Senate, it would break down a massive barrier to entry for the communities that have been disproportionately harmed by the war on drugs, which could in turn make those communities more amenable to dispensaries that are run by one of their own, Coniglio said.

Adult-use legalization would also allow for more types of business, like pure retail that would have a much easier time buying wholesale from cultivators and distributors if the supply chain becomes regulated more like the alcohol industry than like a prescription drug, Mauff and Street agreed. A possibility even exists for use restrictions to be eased in some circumstances.

“I think that use restrictions [for adult use] could be somewhat similar [to medical cannabis], though there may be an opportunity to revisit some of them,” Street said. “Obviously there would be more establishments, so how many feet they can be away from each other and things like that may change somewhat.”

All specifics of implementation will have to be sorted out if and when the legislation itself passes, which Coniglio and Mauff agree would likely take from nine months at the absolute quickest to a year — time that has to be factored in when considering Pennsylvania’s position relative to its neighbors.

Local players waiting on adult-use legalization to start their businesses would benefit the most from a speedy process. The continued growth of cannabis all over the country has given operators like Trulieve the capital required to make investments ahead of time to a much greater degree than even 18 months ago, Coniglio said.

“The companies that get to market early will have pricing power,” Coniglio said. “For companies that aren’t in the state, now is the time … Pennsylvania absolutely will legalize it; it’s just a matter of when. So they’re willing to commit the capital for when it does happen.”

Originally Appeared On: https://www.bisnow.com/philadelphia/news/economy/pennsylvania-recreational-cannabis-not-if-but-when-race-against-time-108615