December 11, 2024 • 39 mins
With our hosts in a holiday mood and 2024 hurtling to a close, Chris reflects on the clinical, professional, and regulatory wants and wishes he'd like to see come true in 2025. We cover:
- Potential drug approvals
- Provider status for pharmacists
- Biosimilar substitution
- Relieving drug shortages
- A brief digression on Wegovy vs. Zepbound
Before that, Chris highlights the expanded approval of Bimzelx for hideranitis supportiva and breaks down updated guidelines related to COPD and Restless Leg Syndrome.
And for the ending Trivia Capsule segment, Chris makes a light-hearted (if tenuous) connection between the "Rudolph the Red-Nosed Reindeer" and the medicinal benefits of the two most precious metals (medals?).
See you in 2025!
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See the expanded show notes here.
Sponsor Links:
SapphireHealth- https://www.sapphire-health.com/
OPTICS- www.diamondpharmacy.com/clincal-services
Music Heard in Today's Episode:
The Retro Synth by Art Haiz
Medical Logo (5 Versions) by SoulProdMusic
Medical by PaulYudin
Ambient Relax Background by PaulYudin
Christmas Holidays by Angelika728
Fun & Quirky Upbeat Retro by yourtunes
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
From Diamond Pharmacy and Optics, this is Podcast RX with Chris Bender.
(00:11):
When he's not on the mic, Chris is a clinical pharmacist with the Office of Pharmacy Therapeutics
and Integrated Clinical Services, or OPTICS.
He routinely helps providers in correctional and long-term care facilities make better
medication decisions to improve patient care.
And we're so happy that he's sharing his expertise with you.
Hoping that today can be a real knowledge booster.
A classic Batman and Robin or Jordanian type scenario.
(00:35):
A full armamentarium of options that clinicians can choose from.
With the holiday season upon us and 2024 hurtling to a close, I talked with Chris about some
of the clinical, professional, and regulatory changes on his wish list for the new year.
Our conversation covers new drug approvals, provider status for pharmacists, and relieving
drug shortages among other areas.
(00:55):
Chris also details a few updated drug guidelines and approvals.
And we close out the episode with a holiday inspired look at some precious metals and
their uses in medicine.
I'm Adam Campbell, and on behalf of Chris and everyone at Diamond Pharmacy, I'd like
to wish everyone a happy and healthy holiday season.
Thanks for listening.
(01:20):
All right Chris, happy holidays to you.
You have all your shopping done, travel plans ironed out.
How's the holiday season treating you so far?
Well, it's busy as ever.
Happy holidays to you as well.
Oh, thank you.
Yeah, just finished up the Thanksgiving season and now it just feels like we jumped straight
into the next.
So as planned as it possibly can be, but there's always more shopping to be done.
(01:44):
You know how it is.
Always more shopping to be done.
Yes, yes.
And you know, with all the craziness going on this month between shopping and visiting
people and leaving the country or whatever you, you know, whatever you got going on,
you know, it's just a chaotic time.
So we thought for this episode, for the end of 2024, the December episode here, podcast
directs with Chris Bender.
(02:05):
We thought it'd be a good idea to keep December show fairly light affair and take a look at
some pharmacy and healthcare wishes for the new year.
And so Chris, you know, I'm always intrigued by the kinds of trends and developments you
see each day consulting with Optics.
And I look forward to hearing later in the show what you hope the new year will bring
regarding medications, the field of pharmacy and the like.
(02:25):
And after that, I understand you've prepped some pharmacy nerdery that ties into a beloved
holiday season TV special.
Oh, you know, I have, you know, there's nothing I like more than to sprinkle a little bit
of pharmacy info into the holidays.
Well, you are, you are very adept at it.
And I really look forward to hearing what you're going to tell us about.
So speaking of like, if you enjoy this show, please give us a rating review where possible.
(02:49):
We're still a fairly small show and Chris's pharmacy nerdery like that.
It deserves a wider audience.
It really does.
I mean, that's sincerely so please help us out if you can.
And absolutely.
Don't forget to don't forget to tell your friends because I know personally with my
podcast and my podcast listening word of mouth usually goes a very long way.
Absolutely tell your friends, tell the mailman, tell the FedEx guy, UPS, they're going to
(03:14):
be around a lot this time of year.
So you can do let us do let them know, help us get the word out there.
So all right.
Well, Chris, I have to ask first, do you have any medication news that our friends who spend
a lot of time in the clinic should know about?
(03:34):
Absolutely.
So, you know, I feel like the end of the year, things kind of slow down a little bit, not
just with us, but you know, everyone, but especially from like a medical news perspective.
But that being said, I still feel like there was a few things that did catch my eye in
(03:56):
this past month.
Now, there weren't many.
I know I talk a lot about like new drug approvals and stuff, and there weren't really many noteworthy
new drug approvals this past month.
But one drug did get an expanded approval, and that's Benzelix.
I learned that from one of their television commercials, even though it's BIMZELX.
(04:16):
I was always calling it Benzelx, but apparently it's Benzelix, which is a biologic medication
that I've been particularly excited about.
So Benzelix has only been on the market since late 2023.
So not that long of a time, but it's already been approved for five indications, which
is actually pretty impressive in that short amount of time.
(04:38):
Now, those are ankylosing spondylitis, non-radiographic axial spondyloarthritis, plaques psoriasis,
psoriatic arthritis, and now with this new approval, hydradenitis superitiva.
So basically, it works by blocking the IL-17 pathway, which is a key inflammatory pathway
that underlies all of these diseases.
(04:59):
It's one of the things they have in common.
Now, the reason I like this medication is because traditional IL-17 inhibitors have
only blocked one type of IL-17, and that is IL-17A, whereas Benzelix blocks IL-17A, 17F,
and 17AF, which ultimately leads to potentially higher efficacy and potency of this medication.
(05:22):
Now, the approval for hydradenitis came from the B-HERD1 and B-HERD2 trials, which showed
that around 50% of individuals experience at least a 50% reduction in symptoms.
Now, a 50% reduction in symptoms may not sound like it's a lot to our listeners, especially
in this era of biologics where we're seeing nearly like a 100% symptom resolution in other
(05:47):
diseases like psoriasis, for example.
But it's important to keep in mind that HS is particularly debilitating.
It's marked by painful abscesses, nodules, and even tunnels under the skin, which in
many cases can start to leak or drain.
So with that in mind, I think a 50% reduction in these symptoms can be a pretty big impact
(06:10):
for patients.
Now, it's also important to note that currently there are only two other biologics that have
been approved for HS, those being Humira and Cosentix.
So as I kind of always say, it's really great to have another option, particularly in a
different treatment, in a different medication class for those who may find these previous
(06:31):
options to have been ineffective.
Now, in other news, we had a few guideline updates.
Now, the two that I'd like to highlight are the gold COPD guidelines and the AASM restless
leg syndrome guidelines.
So the gold guidelines remain largely the same from the previous year, at least with
regard to the initial management of the disease.
(06:54):
Most individuals are recommended to receive at a minimum dual long-acting bronchodilators,
while those with exacerbation history and evidence of blood eosinophils, which are a
marker of inflammation, should receive triple therapy with dual long-acting bronchodilators
plus an inhaled corticosteroid.
What's new, however, is the inclusion of O2-Vehr and Dupixant, which listeners may recall
(07:17):
us reviewing both of these agents on previous episodes.
The O2-Vehr is now recommended as an add-on option to consider for individuals who continue
to experience dyspnea or shortness of breath, despite them already being on an optimized
dual long-acting bronchodilator therapy.
And Dupixant is now recommended as an add-on option for individuals with blood eosinophils
(07:41):
greater than or equal to 300, who continue to experience exacerbations despite being
on optimized triple therapy.
Now the other major guideline update, as I previously mentioned, is for restless leg
syndrome.
Now the most notable change is that dopamine agonists, so examples of those are perimepexol
(08:02):
and ropinol.
These are drugs that have long been a go-to option.
They're no longer recommended because, as it actually turns out, these drugs can actually
worsen the condition in the long run.
So that's actually a pretty big flip in the guidelines.
So now it's actually recommended to use gabapentin or pergabalin, more commonly known as lyrica.
(08:24):
So this is going to be a pretty big shift for our correctional partners, since gabapentin
and pergabalin are often avoided in the correctional environment, just given their potential for
abuse.
Additionally, the guidelines now recommend screening patients for iron deficiency and
providing iron supplementation if it's needed.
(08:45):
It's long been known that iron deficiency can cause and exacerbate RLS, so it's nice to
see this inclusion in the guideline.
Chris, on a real quick note, did you see the Wall Street Journal article about ZetBound
outperforming Wigovie in the first clinical trial between those two drugs?
I know that was something, obviously listeners know this is one of our favorite topics on
(09:09):
here, the GLP-1 agonists, and this is some big news.
Yeah, absolutely.
So just, you know, just breaking news yesterday before we started recording this was basically
ZetBound went head to head with Wigovie in a head to head trial and basically outperformed
ZetBound, outperformed Wigovie with an average weight loss of 20% compared to about 13%.
(09:35):
I mean, that's a considerable difference and that's not all too surprising because I think
you and I were even talking before the show.
This is something that I pretty much mentioned at least indirectly in previous podcasts.
Like I always said, you know, there's not been head to head, you know, studied head
to head, but it appears that ZetBound is, is better or more effective from Wigovie and
(09:57):
here we have it.
So it's really good to see.
It's just nice to have more.
I'm a fan of head to head trials because then you can kind of get a hierarchy and understand
where things lay in the whole treatment landscape.
But unfortunately you don't often get a lot of head to head trials.
So whenever you do get one in pharma, it's really, really cool to see.
For sure.
And maybe we could develop a podcast on the upcoming GLP wars, perhaps.
(10:20):
Oh, that'd be really good.
There's a lot, there's a lot, there's a lot in the pipeline.
In fact, one of them, one of them, one of them we'll be talking about a little bit later
here.
But yeah, it's, it's exciting times for that whole, that whole group of drugs.
Absolutely.
It is.
Let's take a quick break.
(10:41):
Everyone knows that pharmacists dispense medication, but the clinical pharmacists in Diamond Pharmacy's
optics team dispense more potent resources, information and education.
The optics pharmacists are frontline medication experts for Diamond's many institutional
partners.
Whether you work as a provider in corrections or long-term care, the optics team is standing
(11:02):
by to answer your on-demand medication questions.
But optics is far more than a drug information hotline.
They also create proactive knowledge resources like webinars and this podcast to keep partners
up to speed with the latest drug developments.
And they help providers to better manage costs and therapeutic outcomes with their in-house
medication surveillance monitoring program.
(11:25):
Learn more about the optics team by going to diamondpharmacy.com and clicking the clinical
support tab.
See pharmacy care more clearly with optics.
Let's get back to podcast RX.
Thanks again for listening to podcast RX with Chris Bender.
You know, Chris, 2024 passed by in a blink, at least for me it did.
(11:47):
And I barely had time to truly reflect on anything that happened this year.
But with the impending calendar turned to 2025, I think it's a perfect time to think
about what 2025 could bring to the world of pharmacy and medicine, or at the very least,
what you hope it could bring.
And as a non-pharmacist, I'm always eager to ask you the general questions about your
profession and your impressions from your everyday work.
(12:09):
So, Chris, what are your top pharmacy and medicine wants and wishes for 2025?
Well, before I dig into what I hope we will see, I want to first discuss some notable
things that we will potentially see next year, at least from a drug approval perspective.
So depending on where you look, the numbers may vary slightly by the source.
(12:33):
But from what I've been seeing is there's going to be over 60 drugs next year that could
gain approval, with half of these considered to be, quote unquote, practice changing by
analysts.
So that's exciting.
Now, as has been the trend in recent years, the majority of these new drugs are going
to be in the oncology space, so for cancer treatment.
(12:54):
However, I am far from an expert in this area.
So I basically just wanted to make a note of this, because up to 14 different tumor
types may see important new treatment options, which is fantastic, because it's always encouraging
to have more treatment options for cancer.
There are some drugs, however, that I will be keeping my eye on.
(13:17):
So first, let's talk about endocrine drugs, which we just alluded to earlier.
So for obesity, we may be seeing a new medication called Cagre Sema, which is actually just
a combination of Cagrelin Tide, which is a new drug, and Semaglutide.
So Semaglutide is already available for obesity as we go.
(13:38):
But Cagre Sema may be slightly more potent, with reports of greater than 20% weight loss.
And as we had mentioned with that previous trial, you're looking at like 13% to 14% weight
loss with Semaglutide.
So greater than 20% weight loss, as we saw with ZetBound, is pretty considerable.
Now, it's also expected that another obesity drug, that being ZetBound, will be approved
(14:03):
to treat comorbid obstructive sleep apnea.
Since obstructive sleep apnea is often tied to obesity, it's expected that it's going
to be indicated for patients with obesity and obstructive sleep apnea.
Treating the obesity basically will kind of help treat the obstructive sleep apnea.
(14:24):
So this isn't anything revolutionary.
It would kind of make sense to have already worked for this anyway, just by addressing
the obesity.
But it is nice to see, you know, and to have an actual indication for it.
And speaking of Semaglutide, Ozempic, the formulation that is used for type 2 diabetes,
is expected to have its current indication expanded to include the treatment of kidney
(14:49):
disease in type 2 diabetes after it improved kidney function in clinical trials.
We will also see some activity among non-cancer biologics.
So we have Trimphia, which is currently approved for psoriasis, psoriatic arthritis, and ulcerative
colitis.
It's expected to also gain approval for Crohn's disease.
(15:11):
Nemluvio, which is currently approved for Prurigo, or itchy bumps, is expected to also
gain approval for atopic dermatitis.
This is a space that's been seeing a lot of activity lately in terms of specialty drugs
and biologics and stuff, so it's nice to see more entering the market for atopic dermatitis,
(15:32):
which is a pretty, you know, it can be a pretty, it can take a negative toll on patients'
quality of life for sure.
And perhaps most notably, there are six Stellara biosimilars currently approved that are going
to become available starting at the end of January with the potential to lower cost,
obviously.
So Stellara is indicated for psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's
(15:57):
disease.
I'm hopeful that with more biosimilar entry into these disease states, it can provide
some financial relief for the healthcare, you know, for the healthcare field and patients
alike.
And finally, and I actually think this is a particularly big one, we may see approval
(16:17):
of Suzetrogen, which is actually a first in-class non-opioid pain medication.
And what's interesting about this is that it would actually be the first new class of
medication to treat acute pain in over 20 years.
And just speaking, you know, you know, from my own perspective, anytime we can get a pain
medication that has not to say it's without risks, but potentially, potentially with,
(16:43):
you know, fewer risks than like chronic opioids or, you know, NSAIDs even themselves aren't
entirely benign.
I really think that it could be a potentially a good, a great thing for, for pain management.
Absolutely. And I have to ask Chris, you know, in contrast to those, to NSAIDs and opioids,
how does this one work?
Yeah. So, so basically it works well from the, from the pure pharmacy nerd perspective,
(17:08):
it works by blocking a voltage gated sodium channel called NAV 1.8. But basically all
that is to say is it basically impedes the body's nerves from being able to transmit
the pain signal from say your hand as it touches the stove to your brain. So it's basically
(17:29):
stopping the pain signal at the source before it can even, you know, even reach the brain
and elicit a response. So just from, you know, from my purely, because I haven't dug into
it entirely like a ton, but when you're talking about voltage gated sodium channels, you see
that more in the space of like anticonvulsant drugs and stuff like that. So I think this,
(17:50):
this is going to work more similar to that, to kind of like slow down the nervous system
in a way. Then, then your traditional like NSAIDs and acetaminophen and stuff like that.
Fascinating.
Yeah, it really should be. So that is probably going to be, you know, that's, that's what
we will probably, or, or at least perhaps likely see next year as with, you know, any,
(18:13):
any potential drug approvals, things could go sideways and maybe none of those things
will happen. But you know, I'd be willing to bet that at least some of those are going
to be things that we, that we will see next year. So that's the realist in me. But you
know what, if it's, it's the holidays, let's dream a little bit. So here's what I would
really want under the tree this year and in no, in by no ways in any particular order.
(18:36):
But number one, I'd like to see expanded, expanding pharmacists scope of practice across
all states and obtaining provider status at the federal level. Now the concept of the
pharmacists providing direct patient care has been growing a lot over the past decade.
And you know, it's continued to grow and it's becoming more popular, you know, throughout
(19:00):
the community and in many, many treatment locations, particularly like, like the VA
and whatnot, where it's been widely adopted. But you know, it still remains limited by
individual straight state restrictions, which may limit what types of care a pharmacist
may provide. So, you know, like for an example, some states allow pharmacists to prescribe
(19:23):
certain types of medications like birth control or medication for pre-exposure prophylaxis
of HIV or better known as PrEP. However, these instances are certainly the minority of states.
And in all of these cases, pharmacists can only provide this type of care so long as
it's in collaboration with a physician, requires, you know, signed collaborative agreements
(19:47):
and practice documents. So it limits it in that regard. Additionally, pharmacists are
not recognized as providers at the federal level, which means they cannot be reimbursed
for services under federal programs like Medicare Part D or Medicaid as your traditional provider
would, which kind of limits, you know, if you're not able to get paid for something,
(20:08):
you can't really provide that service, can't keep the lights on. So by expanding the scope
of practice and gaining provider status, I really think that pharmacists could expand
access to care for many patients across the country and, you know, at least help kind
of relieve some of the pressures that you see in terms of like demand of the health
(20:30):
care system.
Number two, let's make it easier to substitute biosimilars for originator biologics. Now,
currently, and, you know, for anyone who may not be familiar, you have medications like
I mentioned before. So there is Stelara. Stelara is the biologic medication. It was approved.
(20:52):
It was on the market for years. But now the patent is ending. And just as you would see
with like a generic drug, biologics have a biosimilar drug. It's analogous to brands
and generics, but it's not quite the same because the way that they're manufactured,
they're not just a generic because you cannot create it in a lab. It has to be, you know,
(21:15):
biologically manufactured in a living entity. So while analogous, it's not exactly the same
type of situation, which leads to a lot of regulatory hurdles for it. So currently, as
the whole system works in the U.S., not all biosimilars of a given biologic are deemed
(21:35):
to be quote unquote interchangeable. Now, this is a designation that allows the pharmacist
to automatically substitute that biosimilar at the point of dispensing, similar to how
you would get a generic atorvastatin when your prescription is written specifically for
Lipitor. Pharmacists are allowed to do that. But in this case, this makes it difficult
(21:58):
for the patient to always receive the most cost effective biosimilar because in some
cases the most cost effective biosimilar is not deemed interchangeable and cannot be substituted
without the provider rewriting for the non-interchangeable biosimilar. And in fact, the prescription
needs to be written specifically for the name of the non-interchangeable biosimilar. So
(22:23):
to be clear, there are no clinical differences between interchangeable and non-interchangeable
biosimilars. It's simply a regulatory hurdle that not every manufacturer obtains as they
seek FDA approval. Now, to further complicate things, different states have different rules
regarding provider notification and record keeping when substitution actually does occur,
(22:47):
making it logistically difficult for an entity like Diamond, who we service facilities across
the United States. So what I'm hoping to see is one, that all biosimilars, once they're
approved, are simply designated as interchangeable with their reference biologic. And this isn't
a crazy thought because this practice has already been implemented across the European
Union for a couple of years now. And number two, that all states harmonize their biosimilar
(23:12):
substitution requirements. That would make things easier for pharmacies that serve many
different states. So, long story short, by making these changes, I think it would encourage
more biosimilar use. It could potentially decrease costs and would also decrease provider
and pharmacy burden. And number three, let's try to protect against or at least minimize
(23:36):
drug shortages. So this has been huge. Drug shortages in recent years have become more
and more prevalent, particularly with generic medications. And it's becoming a bigger and
bigger problem across the healthcare system. Now, obviously there are a lot of different
factors that go into the cause of drug shortages. And I know that you actually did an episode
(23:58):
on this topic with my colleague Zane. So I'd encourage listeners to go and check that out.
But from a pure economics perspective, you know, manufacturers don't see generic medications
as a large revenue generator. Now, to be clear, there are a lot of generic manufacturers out
there, but not every manufacturer makes every generic drug. So in many cases, there may
(24:21):
only be two or three manufacturers making a particular generic drug. And in some cases,
there may only be one manufacturer of a given generic drug. So, you know, if anything goes
wrong, like they have a delay in receiving the wrong gradient, there's a recall, manufacturing
failures, what have you, we can see a shortage happen pretty quickly. So what I'm hoping
(24:44):
to see is for the government to provide some sort of incentive structure that would potentially
encourage more manufacturers to make more generic medications. This would basically
provide some degree of redundancy in the system. And you wouldn't have all of your eggs in
one basket. Kind of reminds me what happened with the baby formula during the pandemic
years. You remember that? Yes. Oh, yeah, absolutely. It's the exact it's the exact same thing.
(25:09):
When you put all your eggs in one basket, what happens, you know, when something goes
wrong with that basket. So I just think that it's more complicated than what I just said,
basically, everything is but that would be my that'd be my ultimate wishlist if I could
just, you know, because from our day to day perspective, in optics here at Diamond, we
deal with drug shortage, like we're always answering drug shortage questions, questions
(25:32):
on a daily basis, what do we use instead of this? Like, how do we handle this type of
shortage? So as Zane spoke, you know, eloquently to in that previous episode, so it'd be nice
to see. Yeah. And one thing looking at your at your wishlist, it got me thinking about
you were talking about the government incentives and just thinking about the incoming presidential
(25:54):
administration. Now, we're not going to get into politics or politicians here. But what
one thing I wanted to ask you about just that, that your last point, Bird, there are some
people associated with the incoming administration who have a wish to ban direct to consumer
advertising for pharma, and for, you know, for medications and all that. I was curious,
(26:17):
where do you land on that? Well, as a pharmacist, they follow my, you know, your, your search
history influences what you see. So I see, I see a ton of drug ads and in a way it's
conflicting because in a way it, they might be good. Like for example, and I honestly
(26:37):
cannot tell you what the drug was, the drug was, but it was for hyper obstructive cardiomyopathy
or Hocum. And I thought I have never seen a drug approved for that medic, you know,
for that indication before. And to some extent, maybe it's helpful because a patient sitting
(26:58):
there, they might identify, they might, they might identify something in themselves to
at least start a conversation with their doctor. I do think that that's probably less than
norm. I do think that they are probably more harmful than good because it does drive excessive
cost because a lot of times patients will come in and ask for the fancy new drugs simply
(27:19):
because that's how we, that's how we all are as a person. You want the newest iPhone and
stuff like that. So they think that it's better for them and it does pressure, you know, it
provides, you know, an extra source of pressure on providers to, to prescribe medications
that may not always be entirely necessary when they could get by with some of the, you
know, some generic medications. Because now, as I was looking at this next year's potential
(27:46):
new drugs and stuff, I was even thinking to myself like, man, we don't really see traditional
small molecule drugs much anymore. Like, you know, to reuse my example, like you don't
see a Torvastatin and stuff like that coming out anymore. And there's a, there's, there's
a potential reason for that. We're becoming better at targeting and, and, and whatnot
(28:08):
being more specific with, with our approach to treatment. But that also means that they're
much more expensive medications. So I think there's oftentimes you can get by with using
cost-effective generics and doing the, doing the, the, the first steps better rather than
jumping to like a, you know, like a fancy newer type of thing. So there's no, I don't,
(28:29):
I guess I'm sort of a, in the, in the middle on it, but I think it probably is more harm
than good. That makes sense.
Sure. And, and isn't it just the United States and I believe New Zealand that allow the direct
to consumer advertising? That's correct. Okay.
Yeah, that is correct. Yeah. And ultimately I do think if you were to rather than, I was
(28:53):
always, I've always been on the mindset of rather than promoting the drugs, you know,
cause promoting them directly to providers is, is, you know, kind of dubious as well,
but rather than promoting the drugs, it should be more promoting the disease state. But there's
no, you know, there's no money in that, but I, it really, the real answer is like teach,
(29:16):
you know, providing education to the providers of what is the best way to treat a disease
state and not necessarily, okay, now I know about this drug. How can I, how can I fit
it into my daily life? It's, it's almost, it's better to know about the entire algorithm
rather than just know one drug and kind of, you know, squeeze it in whenever you can.
(29:39):
Either way, Chris, you've got some big wishes for the new year. We're going to continue
to keep an eye on those and see if any of them do come to fruition. Cause I'm sure
we'll circle back and talk about them right here on podcast RX. Let's take a quick break.
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compatible correction specific electronic health records. Now back to podcast RX with
Chris Bender.
All right. So Rudolph the red-nosed reindeer, untouchable holiday classic, right? And Chris,
(31:16):
you and I were both parents of young kids and I assume our children are both discovering
Rudolph for the first time this Christmas. Mine definitely are. Is that true of your
son?
Yeah. Well, yours is, you got a couple that are a little older than mine, but yeah, I
feel like my son is now kind of, he's just now hitting the age. So he's two and he's
just now hitting that age where he can actually kind of understand and appreciate Christmas
(31:40):
this year. So we've already been enjoying some Christmas songs. He knows, he definitely
knows Santa. But I think this, I think this discussion made me realize, you know, we got
to start hitting some of the, like the holiday classics, like the, those old, those old claymation
videos.
So sure. And Rudolph is going back to, it's going to be broadcast on NBC for the first
time in 50 odd years. So there is that. Yeah. If you, I mean, of course now everything's
(32:05):
all about the streaming, but if you, if you were so inclined to watch it on TV, like we
did when we were growing up, that's, that's where it's at now. But anyway, why, why are,
why are we talking about Rudolph the Red Nose Reindeer on this pharmacy podcast? Well, when
we were discussing the planning this December episode, Chris, you told me in the most Chris
Bender way possible that you had a loose tie in between one of the more popular songs from
(32:29):
the Rudolph special. And no, it's not the title track and the use of heavy metals in medicine.
And I was intrigued. And of course, what two heavy metals feature prominently in the Rudolph
soundtrack, silver and gold. And I just have to say that, you know, after putting that
all together, you could say that Burl Ives was a heavy metal singer quite a few years
(32:51):
before the genre was even a thing. So, but, but anyway, Chris, how do heavy metals like
silver and gold enrich medicine?
Well, if you get me long enough, I'm sure I could find a way to turn a turn Rudolph's
Red Nose into a trivia capsule and workshop it for next year. So, yeah, so silver and
(33:13):
gold. Well, silver has been used since ancient times, obviously, as a form of currency and
even jewelry. But silver offered something even more utilitarian to the ancient peoples.
It's been noted that the Phoenicians, so the Mediterranean civilization that existed from
1550 to 300 BCE, well, they would keep their water, wine and vinegar in silver pots to
(33:37):
prevent them from spoilage. Now, ultimately, this was explained by Hippocrates circa 375
BC, who observed that silver had antimicrobial properties or antibacterial properties, which
not only made it useful for storage, but also effective to treat and prevent disease. Silver
was used throughout the 19th and early 20th centuries as a solution to treat eye infection,
(34:03):
as a suture to prevent surgical infection, and even taken orally to treat a variety of
diseases such as epilepsy, gonorrhea, and the common cold. Though I should note here
that oral use was limited due to its potential for toxicity. Now, although silver's use
has diminished due to the advent of antibiotics, silver still plays a role in modern medicine
(34:27):
for infection prevention in wound care. So we have things like silver nitrate, which
is used to cauterize infected wound tissue, silver sulfidazine, which is applied to burn
wounds to promote healing and prevent infection, and also many wound dressings are also infused
with other silver compounds for this same purpose. So we're using silver a lot to promote
(34:51):
wound healing and prevent infection. Now, the use of gold in medicine predates that
of silver. So gold-based remedies were documented in ancient Egyptian medical texts, highlighting
their use for treating skin diseases and alleviating joint pain, given gold's antibacterial and
anti-inflammatory properties. Now, ancient Chinese medicine also included gold. They
(35:14):
believed it had rejuvenating properties, and they used it to treat tuberculosis, smallpox,
and even impotence. And gold continued to be used throughout the ages, with records
from medieval eras suggesting its use for diseases of the eye, leprosy, quote unquote,
all blemishes of the body, and even preserving youth. In modern medicine, however, gold's
(35:37):
utility is much more limited, mainly to rheumatoid arthritis, which it's used, sold as a drug
name oranophin, which is still available today, although I've personally never seen oranophin
used to treat RA, perhaps because of the advent of more potent and safer medications. But
the future may be bright for gold, as gold nanoparticles are currently being investigated
(36:01):
as a drug delivery system for cancer therapy. So, Earl Ives, in his song, asked, for silver
and gold, how do you measure its worth? Just by the pleasure it gives here on earth? Well,
I'd suggest we measure their worth not just by the pleasure they bring, but also the utility
they've brought us throughout the ages.
Well, Chris, I want to thank you again, as always, for sharing your knowledge with us.
(36:26):
I really enjoyed that. And again, it's a real gift to the listeners, and I'm looking forward
to a prosperous new year of shows ahead. So I just wanted to say Merry Christmas, Happy
New Year, Happy Hanukkah, Happy Holidays to everyone, to Chris, to you, your family, and
of course, to all of our listeners.
Yeah, I'd like to extend the same thing as well. Happy Holidays to everyone, to you,
(36:47):
Adam. And I've really, I've really enjoyed the run we've had thus far. I know we were
still in sort of the infantile stages. So I'm looking forward to next year, whenever
we have the entire year ahead of us. So hopefully we can continue to kind of keep on keeping
on, you know?
Absolutely. And just, you know, doing new things with the format and getting some other
voices on here to definitely a goal of the new year, to get some more of your optics
(37:11):
colleagues on here. You know, they obviously we had, he had them on the previous iteration
of the show. So we want to get them back on here with us and expanding it even further
beyond them. So yeah, looking forward to that. And one gift that we definitely appreciate
this holiday season is some fresh ratings and reviews of the show, where you listen
to your podcasts. If you can, please take the time to let us know what you think of
(37:33):
the show and help us get in the ears of more listeners. So Chris, as you said, it's been
a blast so far on this short run, looking forward to 2025 and, and talking to you next
month.
Yeah. And just remember five star always fits, never needs returned. So keep that in mind.
That's right. Okay. All right, Chris. Well, I will see you in 2025. Have a great holiday.
(37:57):
Okay. Likewise. Take care.
Podcast RX features conversations with healthcare professionals. The statements and opinions
discussed herein are for informational purposes only. This podcast should not be considered
(38:20):
professional medical advice and should not be used as the substitute for the advice of
an appropriately qualified and licensed healthcare professional. Therefore listeners must not
rely on the statements made herein.
Podcast RX is a production of Diamond Pharmacy Services. Find our show on Apple Podcasts,
(38:45):
Spotify, YouTube, or wherever you enjoy podcasts. And where possible, please rate and review.
If you'd like to get in touch with the show directly, shoot us an email at PodcastRXatDiamondPharmacy.com.
Thank you again for your support.
From Diamond Pharmacy and Optics, this is Podcast RX with Chris Bender.
(00:11):
When he's not on the mic, Chris is a clinical pharmacist with the Office of Pharmacy Therapeutics
and Integrated Clinical Services, or OPTICS.
He routinely helps providers in correctional and long-term care facilities make better
medication decisions to improve patient care.
And we're so happy that he's sharing his expertise with you.
Hoping that today can be a real knowledge booster.
A classic Batman and Robin or Jordanian type scenario.
(00:35):
A full armamentarium of options that clinicians can choose from.
With the holiday season upon us and 2024 hurtling to a close, I talked with Chris about some
of the clinical, professional, and regulatory changes on his wish list for the new year.
Our conversation covers new drug approvals, provider status for pharmacists, and relieving
drug shortages among other areas.
(00:55):
Chris also details a few updated drug guidelines and approvals.
And we close out the episode with a holiday inspired look at some precious metals and
their uses in medicine.
I'm Adam Campbell, and on behalf of Chris and everyone at Diamond Pharmacy, I'd like
to wish everyone a happy and healthy holiday season.
Thanks for listening.
(01:20):
All right Chris, happy holidays to you.
You have all your shopping done, travel plans ironed out.
How's the holiday season treating you so far?
Well, it's busy as ever.
Happy holidays to you as well.
Oh, thank you.
Yeah, just finished up the Thanksgiving season and now it just feels like we jumped straight
into the next.
So as planned as it possibly can be, but there's always more shopping to be done.
(01:44):
You know how it is.
Always more shopping to be done.
Yes, yes.
And you know, with all the craziness going on this month between shopping and visiting
people and leaving the country or whatever you, you know, whatever you got going on,
you know, it's just a chaotic time.
So we thought for this episode, for the end of 2024, the December episode here, podcast
directs with Chris Bender.
(02:05):
We thought it'd be a good idea to keep December show fairly light affair and take a look at
some pharmacy and healthcare wishes for the new year.
And so Chris, you know, I'm always intrigued by the kinds of trends and developments you
see each day consulting with Optics.
And I look forward to hearing later in the show what you hope the new year will bring
regarding medications, the field of pharmacy and the like.
(02:25):
And after that, I understand you've prepped some pharmacy nerdery that ties into a beloved
holiday season TV special.
Oh, you know, I have, you know, there's nothing I like more than to sprinkle a little bit
of pharmacy info into the holidays.
Well, you are, you are very adept at it.
And I really look forward to hearing what you're going to tell us about.
So speaking of like, if you enjoy this show, please give us a rating review where possible.
(02:49):
We're still a fairly small show and Chris's pharmacy nerdery like that.
It deserves a wider audience.
It really does.
I mean, that's sincerely so please help us out if you can.
And absolutely.
Don't forget to don't forget to tell your friends because I know personally with my
podcast and my podcast listening word of mouth usually goes a very long way.
Absolutely tell your friends, tell the mailman, tell the FedEx guy, UPS, they're going to
(03:14):
be around a lot this time of year.
So you can do let us do let them know, help us get the word out there.
So all right.
Well, Chris, I have to ask first, do you have any medication news that our friends who spend
a lot of time in the clinic should know about?
(03:34):
Absolutely.
So, you know, I feel like the end of the year, things kind of slow down a little bit, not
just with us, but you know, everyone, but especially from like a medical news perspective.
But that being said, I still feel like there was a few things that did catch my eye in
(03:56):
this past month.
Now, there weren't many.
I know I talk a lot about like new drug approvals and stuff, and there weren't really many noteworthy
new drug approvals this past month.
But one drug did get an expanded approval, and that's Benzelix.
I learned that from one of their television commercials, even though it's BIMZELX.
(04:16):
I was always calling it Benzelx, but apparently it's Benzelix, which is a biologic medication
that I've been particularly excited about.
So Benzelix has only been on the market since late 2023.
So not that long of a time, but it's already been approved for five indications, which
is actually pretty impressive in that short amount of time.
(04:38):
Now, those are ankylosing spondylitis, non-radiographic axial spondyloarthritis, plaques psoriasis,
psoriatic arthritis, and now with this new approval, hydradenitis superitiva.
So basically, it works by blocking the IL-17 pathway, which is a key inflammatory pathway
that underlies all of these diseases.
(04:59):
It's one of the things they have in common.
Now, the reason I like this medication is because traditional IL-17 inhibitors have
only blocked one type of IL-17, and that is IL-17A, whereas Benzelix blocks IL-17A, 17F,
and 17AF, which ultimately leads to potentially higher efficacy and potency of this medication.
(05:22):
Now, the approval for hydradenitis came from the B-HERD1 and B-HERD2 trials, which showed
that around 50% of individuals experience at least a 50% reduction in symptoms.
Now, a 50% reduction in symptoms may not sound like it's a lot to our listeners, especially
in this era of biologics where we're seeing nearly like a 100% symptom resolution in other
(05:47):
diseases like psoriasis, for example.
But it's important to keep in mind that HS is particularly debilitating.
It's marked by painful abscesses, nodules, and even tunnels under the skin, which in
many cases can start to leak or drain.
So with that in mind, I think a 50% reduction in these symptoms can be a pretty big impact
(06:10):
for patients.
Now, it's also important to note that currently there are only two other biologics that have
been approved for HS, those being Humira and Cosentix.
So as I kind of always say, it's really great to have another option, particularly in a
different treatment, in a different medication class for those who may find these previous
(06:31):
options to have been ineffective.
Now, in other news, we had a few guideline updates.
Now, the two that I'd like to highlight are the gold COPD guidelines and the AASM restless
leg syndrome guidelines.
So the gold guidelines remain largely the same from the previous year, at least with
regard to the initial management of the disease.
(06:54):
Most individuals are recommended to receive at a minimum dual long-acting bronchodilators,
while those with exacerbation history and evidence of blood eosinophils, which are a
marker of inflammation, should receive triple therapy with dual long-acting bronchodilators
plus an inhaled corticosteroid.
What's new, however, is the inclusion of O2-Vehr and Dupixant, which listeners may recall
(07:17):
us reviewing both of these agents on previous episodes.
The O2-Vehr is now recommended as an add-on option to consider for individuals who continue
to experience dyspnea or shortness of breath, despite them already being on an optimized
dual long-acting bronchodilator therapy.
And Dupixant is now recommended as an add-on option for individuals with blood eosinophils
(07:41):
greater than or equal to 300, who continue to experience exacerbations despite being
on optimized triple therapy.
Now the other major guideline update, as I previously mentioned, is for restless leg
syndrome.
Now the most notable change is that dopamine agonists, so examples of those are perimepexol
(08:02):
and ropinol.
These are drugs that have long been a go-to option.
They're no longer recommended because, as it actually turns out, these drugs can actually
worsen the condition in the long run.
So that's actually a pretty big flip in the guidelines.
So now it's actually recommended to use gabapentin or pergabalin, more commonly known as lyrica.
(08:24):
So this is going to be a pretty big shift for our correctional partners, since gabapentin
and pergabalin are often avoided in the correctional environment, just given their potential for
abuse.
Additionally, the guidelines now recommend screening patients for iron deficiency and
providing iron supplementation if it's needed.
(08:45):
It's long been known that iron deficiency can cause and exacerbate RLS, so it's nice to
see this inclusion in the guideline.
Chris, on a real quick note, did you see the Wall Street Journal article about ZetBound
outperforming Wigovie in the first clinical trial between those two drugs?
I know that was something, obviously listeners know this is one of our favorite topics on
(09:09):
here, the GLP-1 agonists, and this is some big news.
Yeah, absolutely.
So just, you know, just breaking news yesterday before we started recording this was basically
ZetBound went head to head with Wigovie in a head to head trial and basically outperformed
ZetBound, outperformed Wigovie with an average weight loss of 20% compared to about 13%.
(09:35):
I mean, that's a considerable difference and that's not all too surprising because I think
you and I were even talking before the show.
This is something that I pretty much mentioned at least indirectly in previous podcasts.
Like I always said, you know, there's not been head to head, you know, studied head
to head, but it appears that ZetBound is, is better or more effective from Wigovie and
(09:57):
here we have it.
So it's really good to see.
It's just nice to have more.
I'm a fan of head to head trials because then you can kind of get a hierarchy and understand
where things lay in the whole treatment landscape.
But unfortunately you don't often get a lot of head to head trials.
So whenever you do get one in pharma, it's really, really cool to see.
For sure.
And maybe we could develop a podcast on the upcoming GLP wars, perhaps.
(10:20):
Oh, that'd be really good.
There's a lot, there's a lot, there's a lot in the pipeline.
In fact, one of them, one of them, one of them we'll be talking about a little bit later
here.
But yeah, it's, it's exciting times for that whole, that whole group of drugs.
Absolutely.
It is.
Let's take a quick break.
(10:41):
Everyone knows that pharmacists dispense medication, but the clinical pharmacists in Diamond Pharmacy's
optics team dispense more potent resources, information and education.
The optics pharmacists are frontline medication experts for Diamond's many institutional
partners.
Whether you work as a provider in corrections or long-term care, the optics team is standing
(11:02):
by to answer your on-demand medication questions.
But optics is far more than a drug information hotline.
They also create proactive knowledge resources like webinars and this podcast to keep partners
up to speed with the latest drug developments.
And they help providers to better manage costs and therapeutic outcomes with their in-house
medication surveillance monitoring program.
(11:25):
Learn more about the optics team by going to diamondpharmacy.com and clicking the clinical
support tab.
See pharmacy care more clearly with optics.
Let's get back to podcast RX.
Thanks again for listening to podcast RX with Chris Bender.
You know, Chris, 2024 passed by in a blink, at least for me it did.
(11:47):
And I barely had time to truly reflect on anything that happened this year.
But with the impending calendar turned to 2025, I think it's a perfect time to think
about what 2025 could bring to the world of pharmacy and medicine, or at the very least,
what you hope it could bring.
And as a non-pharmacist, I'm always eager to ask you the general questions about your
profession and your impressions from your everyday work.
(12:09):
So, Chris, what are your top pharmacy and medicine wants and wishes for 2025?
Well, before I dig into what I hope we will see, I want to first discuss some notable
things that we will potentially see next year, at least from a drug approval perspective.
So depending on where you look, the numbers may vary slightly by the source.
(12:33):
But from what I've been seeing is there's going to be over 60 drugs next year that could
gain approval, with half of these considered to be, quote unquote, practice changing by
analysts.
So that's exciting.
Now, as has been the trend in recent years, the majority of these new drugs are going
to be in the oncology space, so for cancer treatment.
(12:54):
However, I am far from an expert in this area.
So I basically just wanted to make a note of this, because up to 14 different tumor
types may see important new treatment options, which is fantastic, because it's always encouraging
to have more treatment options for cancer.
There are some drugs, however, that I will be keeping my eye on.
(13:17):
So first, let's talk about endocrine drugs, which we just alluded to earlier.
So for obesity, we may be seeing a new medication called Cagre Sema, which is actually just
a combination of Cagrelin Tide, which is a new drug, and Semaglutide.
So Semaglutide is already available for obesity as we go.
(13:38):
But Cagre Sema may be slightly more potent, with reports of greater than 20% weight loss.
And as we had mentioned with that previous trial, you're looking at like 13% to 14% weight
loss with Semaglutide.
So greater than 20% weight loss, as we saw with ZetBound, is pretty considerable.
Now, it's also expected that another obesity drug, that being ZetBound, will be approved
(14:03):
to treat comorbid obstructive sleep apnea.
Since obstructive sleep apnea is often tied to obesity, it's expected that it's going
to be indicated for patients with obesity and obstructive sleep apnea.
Treating the obesity basically will kind of help treat the obstructive sleep apnea.
(14:24):
So this isn't anything revolutionary.
It would kind of make sense to have already worked for this anyway, just by addressing
the obesity.
But it is nice to see, you know, and to have an actual indication for it.
And speaking of Semaglutide, Ozempic, the formulation that is used for type 2 diabetes,
is expected to have its current indication expanded to include the treatment of kidney
(14:49):
disease in type 2 diabetes after it improved kidney function in clinical trials.
We will also see some activity among non-cancer biologics.
So we have Trimphia, which is currently approved for psoriasis, psoriatic arthritis, and ulcerative
colitis.
It's expected to also gain approval for Crohn's disease.
(15:11):
Nemluvio, which is currently approved for Prurigo, or itchy bumps, is expected to also
gain approval for atopic dermatitis.
This is a space that's been seeing a lot of activity lately in terms of specialty drugs
and biologics and stuff, so it's nice to see more entering the market for atopic dermatitis,
(15:32):
which is a pretty, you know, it can be a pretty, it can take a negative toll on patients'
quality of life for sure.
And perhaps most notably, there are six Stellara biosimilars currently approved that are going
to become available starting at the end of January with the potential to lower cost,
obviously.
So Stellara is indicated for psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's
(15:57):
disease.
I'm hopeful that with more biosimilar entry into these disease states, it can provide
some financial relief for the healthcare, you know, for the healthcare field and patients
alike.
And finally, and I actually think this is a particularly big one, we may see approval
(16:17):
of Suzetrogen, which is actually a first in-class non-opioid pain medication.
And what's interesting about this is that it would actually be the first new class of
medication to treat acute pain in over 20 years.
And just speaking, you know, you know, from my own perspective, anytime we can get a pain
medication that has not to say it's without risks, but potentially, potentially with,
(16:43):
you know, fewer risks than like chronic opioids or, you know, NSAIDs even themselves aren't
entirely benign.
I really think that it could be a potentially a good, a great thing for, for pain management.
Absolutely. And I have to ask Chris, you know, in contrast to those, to NSAIDs and opioids,
how does this one work?
Yeah. So, so basically it works well from the, from the pure pharmacy nerd perspective,
(17:08):
it works by blocking a voltage gated sodium channel called NAV 1.8. But basically all
that is to say is it basically impedes the body's nerves from being able to transmit
the pain signal from say your hand as it touches the stove to your brain. So it's basically
(17:29):
stopping the pain signal at the source before it can even, you know, even reach the brain
and elicit a response. So just from, you know, from my purely, because I haven't dug into
it entirely like a ton, but when you're talking about voltage gated sodium channels, you see
that more in the space of like anticonvulsant drugs and stuff like that. So I think this,
(17:50):
this is going to work more similar to that, to kind of like slow down the nervous system
in a way. Then, then your traditional like NSAIDs and acetaminophen and stuff like that.
Fascinating.
Yeah, it really should be. So that is probably going to be, you know, that's, that's what
we will probably, or, or at least perhaps likely see next year as with, you know, any,
(18:13):
any potential drug approvals, things could go sideways and maybe none of those things
will happen. But you know, I'd be willing to bet that at least some of those are going
to be things that we, that we will see next year. So that's the realist in me. But you
know what, if it's, it's the holidays, let's dream a little bit. So here's what I would
really want under the tree this year and in no, in by no ways in any particular order.
(18:36):
But number one, I'd like to see expanded, expanding pharmacists scope of practice across
all states and obtaining provider status at the federal level. Now the concept of the
pharmacists providing direct patient care has been growing a lot over the past decade.
And you know, it's continued to grow and it's becoming more popular, you know, throughout
(19:00):
the community and in many, many treatment locations, particularly like, like the VA
and whatnot, where it's been widely adopted. But you know, it still remains limited by
individual straight state restrictions, which may limit what types of care a pharmacist
may provide. So, you know, like for an example, some states allow pharmacists to prescribe
(19:23):
certain types of medications like birth control or medication for pre-exposure prophylaxis
of HIV or better known as PrEP. However, these instances are certainly the minority of states.
And in all of these cases, pharmacists can only provide this type of care so long as
it's in collaboration with a physician, requires, you know, signed collaborative agreements
(19:47):
and practice documents. So it limits it in that regard. Additionally, pharmacists are
not recognized as providers at the federal level, which means they cannot be reimbursed
for services under federal programs like Medicare Part D or Medicaid as your traditional provider
would, which kind of limits, you know, if you're not able to get paid for something,
(20:08):
you can't really provide that service, can't keep the lights on. So by expanding the scope
of practice and gaining provider status, I really think that pharmacists could expand
access to care for many patients across the country and, you know, at least help kind
of relieve some of the pressures that you see in terms of like demand of the health
(20:30):
care system.
Number two, let's make it easier to substitute biosimilars for originator biologics. Now,
currently, and, you know, for anyone who may not be familiar, you have medications like
I mentioned before. So there is Stelara. Stelara is the biologic medication. It was approved.
(20:52):
It was on the market for years. But now the patent is ending. And just as you would see
with like a generic drug, biologics have a biosimilar drug. It's analogous to brands
and generics, but it's not quite the same because the way that they're manufactured,
they're not just a generic because you cannot create it in a lab. It has to be, you know,
(21:15):
biologically manufactured in a living entity. So while analogous, it's not exactly the same
type of situation, which leads to a lot of regulatory hurdles for it. So currently, as
the whole system works in the U.S., not all biosimilars of a given biologic are deemed
(21:35):
to be quote unquote interchangeable. Now, this is a designation that allows the pharmacist
to automatically substitute that biosimilar at the point of dispensing, similar to how
you would get a generic atorvastatin when your prescription is written specifically for
Lipitor. Pharmacists are allowed to do that. But in this case, this makes it difficult
(21:58):
for the patient to always receive the most cost effective biosimilar because in some
cases the most cost effective biosimilar is not deemed interchangeable and cannot be substituted
without the provider rewriting for the non-interchangeable biosimilar. And in fact, the prescription
needs to be written specifically for the name of the non-interchangeable biosimilar. So
(22:23):
to be clear, there are no clinical differences between interchangeable and non-interchangeable
biosimilars. It's simply a regulatory hurdle that not every manufacturer obtains as they
seek FDA approval. Now, to further complicate things, different states have different rules
regarding provider notification and record keeping when substitution actually does occur,
(22:47):
making it logistically difficult for an entity like Diamond, who we service facilities across
the United States. So what I'm hoping to see is one, that all biosimilars, once they're
approved, are simply designated as interchangeable with their reference biologic. And this isn't
a crazy thought because this practice has already been implemented across the European
Union for a couple of years now. And number two, that all states harmonize their biosimilar
(23:12):
substitution requirements. That would make things easier for pharmacies that serve many
different states. So, long story short, by making these changes, I think it would encourage
more biosimilar use. It could potentially decrease costs and would also decrease provider
and pharmacy burden. And number three, let's try to protect against or at least minimize
(23:36):
drug shortages. So this has been huge. Drug shortages in recent years have become more
and more prevalent, particularly with generic medications. And it's becoming a bigger and
bigger problem across the healthcare system. Now, obviously there are a lot of different
factors that go into the cause of drug shortages. And I know that you actually did an episode
(23:58):
on this topic with my colleague Zane. So I'd encourage listeners to go and check that out.
But from a pure economics perspective, you know, manufacturers don't see generic medications
as a large revenue generator. Now, to be clear, there are a lot of generic manufacturers out
there, but not every manufacturer makes every generic drug. So in many cases, there may
(24:21):
only be two or three manufacturers making a particular generic drug. And in some cases,
there may only be one manufacturer of a given generic drug. So, you know, if anything goes
wrong, like they have a delay in receiving the wrong gradient, there's a recall, manufacturing
failures, what have you, we can see a shortage happen pretty quickly. So what I'm hoping
(24:44):
to see is for the government to provide some sort of incentive structure that would potentially
encourage more manufacturers to make more generic medications. This would basically
provide some degree of redundancy in the system. And you wouldn't have all of your eggs in
one basket. Kind of reminds me what happened with the baby formula during the pandemic
years. You remember that? Yes. Oh, yeah, absolutely. It's the exact it's the exact same thing.
(25:09):
When you put all your eggs in one basket, what happens, you know, when something goes
wrong with that basket. So I just think that it's more complicated than what I just said,
basically, everything is but that would be my that'd be my ultimate wishlist if I could
just, you know, because from our day to day perspective, in optics here at Diamond, we
deal with drug shortage, like we're always answering drug shortage questions, questions
(25:32):
on a daily basis, what do we use instead of this? Like, how do we handle this type of
shortage? So as Zane spoke, you know, eloquently to in that previous episode, so it'd be nice
to see. Yeah. And one thing looking at your at your wishlist, it got me thinking about
you were talking about the government incentives and just thinking about the incoming presidential
(25:54):
administration. Now, we're not going to get into politics or politicians here. But what
one thing I wanted to ask you about just that, that your last point, Bird, there are some
people associated with the incoming administration who have a wish to ban direct to consumer
advertising for pharma, and for, you know, for medications and all that. I was curious,
(26:17):
where do you land on that? Well, as a pharmacist, they follow my, you know, your, your search
history influences what you see. So I see, I see a ton of drug ads and in a way it's
conflicting because in a way it, they might be good. Like for example, and I honestly
(26:37):
cannot tell you what the drug was, the drug was, but it was for hyper obstructive cardiomyopathy
or Hocum. And I thought I have never seen a drug approved for that medic, you know,
for that indication before. And to some extent, maybe it's helpful because a patient sitting
(26:58):
there, they might identify, they might, they might identify something in themselves to
at least start a conversation with their doctor. I do think that that's probably less than
norm. I do think that they are probably more harmful than good because it does drive excessive
cost because a lot of times patients will come in and ask for the fancy new drugs simply
(27:19):
because that's how we, that's how we all are as a person. You want the newest iPhone and
stuff like that. So they think that it's better for them and it does pressure, you know, it
provides, you know, an extra source of pressure on providers to, to prescribe medications
that may not always be entirely necessary when they could get by with some of the, you
know, some generic medications. Because now, as I was looking at this next year's potential
(27:46):
new drugs and stuff, I was even thinking to myself like, man, we don't really see traditional
small molecule drugs much anymore. Like, you know, to reuse my example, like you don't
see a Torvastatin and stuff like that coming out anymore. And there's a, there's, there's
a potential reason for that. We're becoming better at targeting and, and, and whatnot
(28:08):
being more specific with, with our approach to treatment. But that also means that they're
much more expensive medications. So I think there's oftentimes you can get by with using
cost-effective generics and doing the, doing the, the, the first steps better rather than
jumping to like a, you know, like a fancy newer type of thing. So there's no, I don't,
(28:29):
I guess I'm sort of a, in the, in the middle on it, but I think it probably is more harm
than good. That makes sense.
Sure. And, and isn't it just the United States and I believe New Zealand that allow the direct
to consumer advertising? That's correct. Okay.
Yeah, that is correct. Yeah. And ultimately I do think if you were to rather than, I was
(28:53):
always, I've always been on the mindset of rather than promoting the drugs, you know,
cause promoting them directly to providers is, is, you know, kind of dubious as well,
but rather than promoting the drugs, it should be more promoting the disease state. But there's
no, you know, there's no money in that, but I, it really, the real answer is like teach,
(29:16):
you know, providing education to the providers of what is the best way to treat a disease
state and not necessarily, okay, now I know about this drug. How can I, how can I fit
it into my daily life? It's, it's almost, it's better to know about the entire algorithm
rather than just know one drug and kind of, you know, squeeze it in whenever you can.
(29:39):
Either way, Chris, you've got some big wishes for the new year. We're going to continue
to keep an eye on those and see if any of them do come to fruition. Cause I'm sure
we'll circle back and talk about them right here on podcast RX. Let's take a quick break.
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compatible correction specific electronic health records. Now back to podcast RX with
Chris Bender.
All right. So Rudolph the red-nosed reindeer, untouchable holiday classic, right? And Chris,
(31:16):
you and I were both parents of young kids and I assume our children are both discovering
Rudolph for the first time this Christmas. Mine definitely are. Is that true of your
son?
Yeah. Well, yours is, you got a couple that are a little older than mine, but yeah, I
feel like my son is now kind of, he's just now hitting the age. So he's two and he's
just now hitting that age where he can actually kind of understand and appreciate Christmas
(31:40):
this year. So we've already been enjoying some Christmas songs. He knows, he definitely
knows Santa. But I think this, I think this discussion made me realize, you know, we got
to start hitting some of the, like the holiday classics, like the, those old, those old claymation
videos.
So sure. And Rudolph is going back to, it's going to be broadcast on NBC for the first
time in 50 odd years. So there is that. Yeah. If you, I mean, of course now everything's
(32:05):
all about the streaming, but if you, if you were so inclined to watch it on TV, like we
did when we were growing up, that's, that's where it's at now. But anyway, why, why are,
why are we talking about Rudolph the Red Nose Reindeer on this pharmacy podcast? Well, when
we were discussing the planning this December episode, Chris, you told me in the most Chris
Bender way possible that you had a loose tie in between one of the more popular songs from
(32:29):
the Rudolph special. And no, it's not the title track and the use of heavy metals in medicine.
And I was intrigued. And of course, what two heavy metals feature prominently in the Rudolph
soundtrack, silver and gold. And I just have to say that, you know, after putting that
all together, you could say that Burl Ives was a heavy metal singer quite a few years
(32:51):
before the genre was even a thing. So, but, but anyway, Chris, how do heavy metals like
silver and gold enrich medicine?
Well, if you get me long enough, I'm sure I could find a way to turn a turn Rudolph's
Red Nose into a trivia capsule and workshop it for next year. So, yeah, so silver and
(33:13):
gold. Well, silver has been used since ancient times, obviously, as a form of currency and
even jewelry. But silver offered something even more utilitarian to the ancient peoples.
It's been noted that the Phoenicians, so the Mediterranean civilization that existed from
1550 to 300 BCE, well, they would keep their water, wine and vinegar in silver pots to
(33:37):
prevent them from spoilage. Now, ultimately, this was explained by Hippocrates circa 375
BC, who observed that silver had antimicrobial properties or antibacterial properties, which
not only made it useful for storage, but also effective to treat and prevent disease. Silver
was used throughout the 19th and early 20th centuries as a solution to treat eye infection,
(34:03):
as a suture to prevent surgical infection, and even taken orally to treat a variety of
diseases such as epilepsy, gonorrhea, and the common cold. Though I should note here
that oral use was limited due to its potential for toxicity. Now, although silver's use
has diminished due to the advent of antibiotics, silver still plays a role in modern medicine
(34:27):
for infection prevention in wound care. So we have things like silver nitrate, which
is used to cauterize infected wound tissue, silver sulfidazine, which is applied to burn
wounds to promote healing and prevent infection, and also many wound dressings are also infused
with other silver compounds for this same purpose. So we're using silver a lot to promote
(34:51):
wound healing and prevent infection. Now, the use of gold in medicine predates that
of silver. So gold-based remedies were documented in ancient Egyptian medical texts, highlighting
their use for treating skin diseases and alleviating joint pain, given gold's antibacterial and
anti-inflammatory properties. Now, ancient Chinese medicine also included gold. They
(35:14):
believed it had rejuvenating properties, and they used it to treat tuberculosis, smallpox,
and even impotence. And gold continued to be used throughout the ages, with records
from medieval eras suggesting its use for diseases of the eye, leprosy, quote unquote,
all blemishes of the body, and even preserving youth. In modern medicine, however, gold's
(35:37):
utility is much more limited, mainly to rheumatoid arthritis, which it's used, sold as a drug
name oranophin, which is still available today, although I've personally never seen oranophin
used to treat RA, perhaps because of the advent of more potent and safer medications. But
the future may be bright for gold, as gold nanoparticles are currently being investigated
(36:01):
as a drug delivery system for cancer therapy. So, Earl Ives, in his song, asked, for silver
and gold, how do you measure its worth? Just by the pleasure it gives here on earth? Well,
I'd suggest we measure their worth not just by the pleasure they bring, but also the utility
they've brought us throughout the ages.
Well, Chris, I want to thank you again, as always, for sharing your knowledge with us.
(36:26):
I really enjoyed that. And again, it's a real gift to the listeners, and I'm looking forward
to a prosperous new year of shows ahead. So I just wanted to say Merry Christmas, Happy
New Year, Happy Hanukkah, Happy Holidays to everyone, to Chris, to you, your family, and
of course, to all of our listeners.
Yeah, I'd like to extend the same thing as well. Happy Holidays to everyone, to you,
(36:47):
Adam. And I've really, I've really enjoyed the run we've had thus far. I know we were
still in sort of the infantile stages. So I'm looking forward to next year, whenever
we have the entire year ahead of us. So hopefully we can continue to kind of keep on keeping
on, you know?
Absolutely. And just, you know, doing new things with the format and getting some other
voices on here to definitely a goal of the new year, to get some more of your optics
(37:11):
colleagues on here. You know, they obviously we had, he had them on the previous iteration
of the show. So we want to get them back on here with us and expanding it even further
beyond them. So yeah, looking forward to that. And one gift that we definitely appreciate
this holiday season is some fresh ratings and reviews of the show, where you listen
to your podcasts. If you can, please take the time to let us know what you think of
(37:33):
the show and help us get in the ears of more listeners. So Chris, as you said, it's been
a blast so far on this short run, looking forward to 2025 and, and talking to you next
month.
Yeah. And just remember five star always fits, never needs returned. So keep that in mind.
That's right. Okay. All right, Chris. Well, I will see you in 2025. Have a great holiday.
(37:57):
Okay. Likewise. Take care.
Podcast RX features conversations with healthcare professionals. The statements and opinions
discussed herein are for informational purposes only. This podcast should not be considered
(38:20):
professional medical advice and should not be used as the substitute for the advice of
an appropriately qualified and licensed healthcare professional. Therefore listeners must not
rely on the statements made herein.
Podcast RX is a production of Diamond Pharmacy Services. Find our show on Apple Podcasts,
(38:45):
Spotify, YouTube, or wherever you enjoy podcasts. And where possible, please rate and review.
If you'd like to get in touch with the show directly, shoot us an email at PodcastRXatDiamondPharmacy.com.
Thank you again for your support.
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