Although gray skies are hovering over the Pharmalot campus, our spirits remain sunny because, as the Morning Mayor taught us, “Every brand new day should be unwrapped like a precious gift.” And so, we are foraging for interesting stories and quaffing cups of stimulation, as you might have guessed. Our choice today is salted caramel mocha. And you? Is your schedule filled with meetings and deadlines and what-not? To help you along, here are some tidbits. Hope you conquer the world, and do keep us in mind when you see something fascinating. …

Pharmaceutical executives are ready to make deals, The Wall Street Journal says. Executives at Pfizer, Merck, and Novartis are looking for promising drugs to add to their pipelines and replenish sales as top-selling products lose patent protection in the coming years. Meanwhile, AbbVie is lifting a self-imposed $2 billion limit on the size of deals it would do to add more products. The acquisitions could help the companies add new sales to aging line-ups and suggest this year could be a busy one for industry dealmaking. The $88 billion in total deal value last year, involving 75 biopharma tie-ups of at least $100 million, was the lowest since 2017, according to Ernst & Young.

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Beyond creating difficulty in opening jars, turning doorknobs or even shaking someone's hand, a lack of grip strength could be a warning sign of a shorter life, according to a new study published in the Journal of Cachexia, Sarcopenia and Muscle.

It's been shown that after age 60, grip strength can decline by up to 25%. Dr. Mark Peterson, an associate professor of physical medicine and rehabilitation at the University of Michigan, was curious about the relationship between grip strength and the aging process.

AGING FASTER IN ADULTHOOD LINKED TO HEALTH CONDITIONS IN ADOLESCENCE

"There have been many studies showing that people with muscle weakness are at a higher risk for diseases and tend to die earlier than stronger people, but until now, there hasn’t been a great explanation for that link — aside from assuming that people who lead healthier lives are known to live longer," Peterson told Fox News Digital. 

"We were interested in exploring a cellular biological link between the measure of strength and the negative consequences that arise during aging."

For the study, researchers evaluated 43,000 men and women who were at least 51 years old, with an average age of 70. 

Every other year during an eight-year span, the participants visited a research lab to squeeze a muscle strength testing tool called a dynamometer, which measures grip strength in pounds.

The study found that those with weaker grips demonstrated "DNA methylation age acceleration" — which means they showed signs of aging faster than did those with stronger grips.

Peterson said he expected to see this link between weakness and faster aging — but he was a bit surprised by how strong the association was. 

"We’ve been using the new tagline, ‘Weakness is the new smoking,’" he said. 

LONELINESS AND UNHAPPINESS CAN AGE US FASTER THAN SMOKING

"It sounds like an exaggeration, but it's really not. There’s enough data to back up that claim."

Ideally, Dr. Peterson said doctors should do grip testing during routine office visits as a measure of functional strength.

If someone already has a weak grip, working on making those muscles stronger won’t magically add years to their life, Peterson said.

In other words, weak grip strength is an indicator of accelerated aging — but doesn’t cause it.

As the doctor explained, grip strength is correlated to overall body strength — so if your grip is strong, there’s a good chance your arms, legs, stomach and other body parts are also strong.

Conversely, a person with a weak grip likely has weakness in other areas.

"If somebody has weak grip strength, it should be a red flag that they have a high risk for age-related chronic diseases," Dr. Peterson said. 

"I won’t claim that if you improve your grip strength, you’ll also improve your health, because that is definitely not true," he said. "The solution is not to improve grip strength, but to do all the things in life that are important for improving the overall robustness of the body."

That means focusing on things such as healthy nutrition and regular physical activity. 

FRESH VEGETABLES AND OTHER FRESH FOOD CAN BE YOURS AT HOME WITH PLANNING, PURPOSE

Strength training is particularly important for middle-aged and older adults, as they tend to have less lean muscle mass. 

"Overall strength is a very powerful way to ward off functional decline with age, which is highly associated with things like osteoporosis, falls, fractures, dementia, cardiovascular disease and diabetes," Dr. Peterson added. 

"Your biology ages slower with healthy behaviors," he said.

While grip strength exercises might not be a guaranteed health booster, they can make daily life easier and more enjoyable. 

If a weak grip is keeping you from doing the activities you need or want to do — whether it’s golfing, carrying a child or shoveling snow — there are things you can do to bolster those muscles.

Brittany Ferri, Ph.D., an occupational therapist outside Rochester, New York, notes that grip strength is especially important for older people who need to use mobility devices like walkers, wheelchairs or canes.

"Grip strength can mean the difference between propelling a wheelchair on your own and requiring a caregiver to do it for you, which is a huge step between independence or dependence for somebody whose mobility is severely limited," Ferri told Fox News Digital.

To strengthen one's grip, Ferri recommends squeezing a stress ball throughout the day. She prefers the kind with some sand in them, as they offer a bit of resistance.

Therapy putty is another option. 

"It looks pretty similar to play dough, but has a much tougher texture and offers more resistance," Ferri explained. "You can squeeze it, stretch it out, roll it into a ball, separate it into two pieces — all of that will help with grip strength."

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In a pinch, a tight rubber band can also help work the hand muscles. 

Place the band around all fingers on both hands and then spread the hands and fingers apart as wide as possible.

For most healthy adults, Ferri recommends doing grip-strengthening exercises at least a couple of times per week or as often as once a day.

According to Pérez, the vaccine is called “Jynneos”, belonging to the “Bavarian Nordic” brand, it is of a “fairly known and tolerable technology, with very low adverse effects”, and only those over 18 years of age may be inoculated.

“We have been able to access an emergency stock that the World Health Organization has for cases of seismic smallpox. They are already in the country. Several months ago it was announced that vaccines had been purchased, they arrived and will be available to the vulnerable population, ”he assured, adding that the State investment for the acquisition of the medicine was more than 32 million pesos. The vaccine will be applied in two different doses and initially, the Ramón de Lara Hospital and all health personnel “who will face the disease if more cases occur, will begin to be immunized since they must be duly protected.”

In addition to this, the representative of the Health Administration indicated that the medicine is stored at temperatures above 50 degrees and can take up to five years to expire.

For the feminist organization, it is an “obligation” of this legislative body to assume its commitment to the protection of women’s rights and to resist pressure from the “more retrograde” interests of political party structures “kneeling” before “powers that be” of a religious nature. The entity stated in a note that the Senate should not continue to ignore the social claims of thousands of women, particularly poor women, who demand three exemptions from abortion penalties across the country.

She went on to say that, like many other institutions and spaces for social and community struggle, the defense of women’s rights is the bedrock of critical social transformations in today’s Dominican society. Cudem described as “unacceptable” the “dogmatic” and “anti-humanist” thought, in the strict sense of the concept, which means the defense and protection of human life of beings born “alive and viable,” as established by international recognition of human rights. She reiterated her call to legislators to remove all conditioning factors and pressures, as well as to accept social and political responsibility by siding with those who, “with our work and efforts,” bear the essential burden of families, which are women.

“It is the responsibility of congressmen and women to legislate in favor of women’s rights so that women can be free to make decisions about our lives and our bodies when a pregnancy poses risks, is not viable, or is the result of rape or incest,” Cudem said.

True to form, Ackman announced last week that he and an anonymous donor had pledged $25 million over five years toward a new research lab for David Sabatini, a former star scientist from MIT and Whitehead Institute, whose career imploded in 2021 amid allegations of workplace misconduct and sexual harassment.

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Infertility is a disease of the reproductive system and it makes a person unable to have children. It can affect a man, a woman, or both. Male infertility means that a man has a problem with his reproductive system and cannot cause a pregnancy with...

Member states discuss pandemic treaty and other key health issues at 152nd WHO Executive Board

Oscar Reyes

7 Feb 2023

Newton Solano, the health center’s director, confirmed that he uses a process of optimizing supplies and medicines, “as provided for the entire Public Network,” so that it is dispatched based on the number of patients admitted, usually doubling figures to account for unforeseen events. “It is a false complaint; reusing syringes is never permitted, and it is the nurses who remove the sealed syringes from the warehouse and place the medicines on the patients,” Dr. Solano said. He explained that he has established controls to avoid waste of supplies and medicines and that the hospital has a 24-hour pharmacy service for the first time. “As a result, if any input runs out, it is dispatched immediately,” he assured.

The doctor reiterated that the Bogaert Hospital, a Cibao Occidental Regional Health Service (SRSCO) center, has all of the necessary supplies to respond to users who seek health care at that facility. Similarly, he stated that the operating room is at total capacity, that “more surgeries are being performed than ever,” and that it has been strengthened with previously unavailable services such as laparoscopy, urological, and endoscopic surgery. Finally, Ramón Rodrguez, the director of the Western Cibao Regional Health Service, stated that Dr. Solano has proven to be a director committed to management who has made every effort to provide quality services to his patients.

Concerning the other complaints from the Nursing union, the SNS stated that they are being investigated, even though it believes some are unfounded, and that the entity is working hard, hand in hand with a dedicated team, to improve the health of the country, and that changes will be made. 

Word spread to Facebook groups, and patients started calling Coram CVS, a major U.S. supplier of the compounded IV nutrients on which they rely for survival. To their dismay, CVS Health confirmed the rumors on June 1: It was closing 36 of the 71 branches of its Coram home infusion business and laying off about 2,000 nurses, dietitians, pharmacists, and other employees.

Many of the patients left in the lurch have life-threatening digestive disorders that render them unable to eat or drink. They depend on parenteral nutrition, or PN — in which amino acids, sugars, fats, vitamins, and electrolytes are pumped, in most cases, through a specialized catheter directly into a large vein near the heart.

The day after CVS’ move, another big supplier, Optum Rx, announced its own consolidation. Suddenly, thousands would be without their highly complex, shortage-plagued, essential drugs and nutrients.

“With this kind of disruption, patients can’t get through on the phones. They panic,” said Cynthia Reddick, a senior nutritionist who was let go in the CVS restructuring.

“It was very difficult. Many emails, many phone calls, acting as a liaison between my doctor and the company,” said Elizabeth Fisher Smith, a 32-year-old public health instructor in New York City, whose Coram branch closed. A rare medical disorder has forced her to rely on PN for survival since 2017. “In the end, I got my supplies, but it added to my mental burden. And I’m someone who has worked in health care nearly my entire adult life.”

CVS had abandoned most of its less lucrative market in home parenteral nutrition, or HPN, and “acute care” drugs like IV antibiotics. Instead, it would focus on high-dollar, specialty intravenous medications like Remicade, which is used for arthritis and other autoimmune conditions.

Home and outpatient infusions are a growing business in the United States, as new drugs for chronic illness enable patients, health care providers, and insurers to bypass in-person treatment. Even the wellness industry is cashing in, with spa storefronts and home hydration services.

But while reimbursement for expensive new drugs has drawn the interest of big corporations and private equity, the industry is strained by a lack of nurses and pharmacists. And the less profitable parts of the business — as well as the vulnerable patients they serve — are at serious risk.

This includes the 30,000-plus Americans who rely for survival on parenteral nutrition, which has 72 ingredients. Among those patients are premature infants and post-surgery patients with digestive problems, and people with short or damaged bowels, often the result of genetic defects.

While some specialty infusion drugs are billed through pharmacy benefit managers that typically pay suppliers in a few weeks, medical plans that cover HPN, IV antibiotics, and some other infusion drugs can take 90 days to pay, said Dan Manchise, president of Mann Medical Consultants, a home care consulting company.

In the 2010s, CVS bought Coram, and Optum bought up smaller home infusion companies, both with the hope that consolidation and scale would offer more negotiating power with insurers and manufacturers, leading to a more stable market. But the level of patient care required was too high for them to make money, industry officials said.

“With the margins seen in the industry,” Manchise said, “if you’ve taken on expensive patients and you don’t get paid, you’re dead.”

In September, CVS announced its purchase of Signify Health, a high-tech company that sends out home health workers to evaluate billing rates for “high-priority” Medicare Advantage patients, according to an analyst’s report. In other words, as CVS shed one group of patients whose care yields low margins, it was spending $8 billion to seek more profitable ones.

CVS “pivots when necessary,” spokesperson Mike DeAngelis told KHN. “We decided to focus more resources on patients who receive infusion services for specialty medications” that “continue to see sustained growth.” Optum declined to discuss its move, but a spokesperson said the company was “steadfastly committed to serving the needs” of more than 2,000 HPN patients.

DeAngelis said CVS worked with its HPN patients to “seamlessly transition their care” to new companies.

However, several Coram patients interviewed about the transition indicated it was hardly smooth. Other HPN businesses were strained by the new demand for services, and frightening disruptions occurred.

Smith had to convince her new supplier that she still needed two IV pumps — one for HPN, the other for hydration. Without two, she’d rely partly on “gravity” infusion, in which the IV bag hangs from a pole that must move with the patient, making it impossible for her to keep her job.

“They just blatantly told her they weren’t giving her a pump because it was more expensive, she didn’t need it, and that’s why Coram went out of business,” Smith said.

Many patients who were hospitalized at the time of the switch — several inpatient stays a year are not unusual for HPN patients — had to remain in the hospital until they could find new suppliers. Such hospitalizations typically cost at least $3,000 a day.

“The biggest problem was getting people out of the hospital until other companies had ramped up,” said Dr. David Seres, a professor of medicine at the Institute of Human Nutrition at Columbia University Medical Center. Even over a few days, he said, “there was a lot of emotional hardship and fear over losing long-term relationships.”

To address HPN patients’ nutritional needs, a team of physicians, nurses, and dietitians must work with their supplier, Seres said. The companies conduct weekly bloodwork and adjust the contents of the HPN bags, all under sterile conditions because these patients are at risk of blood infections, which can be grave.

As for Coram, “it’s pretty obvious they had to trim down business that was not making money,” Reddick said, adding that it was noteworthy both Coram and Optum Rx “pivoted the same way to focus on higher-dollar, higher-reimbursement, high-margin populations.”

“I get it, from the business perspective,” Smith said. “At the same time, they left a lot of patients in a not great situation.”

***

Smith shares a postage-stamp Queens apartment with her husband, Matt; his enormous flight simulator (he’s an amateur pilot); cabinets and fridges full of medical supplies; and two large, friendly dogs, Caspian and Gretl. On a recent morning, she went about her routine: detaching the bag of milky IV fluid that had pumped all night through a central line implanted in her chest, flushing the line with saline, injecting medications into another saline bag, and then hooking it through a paperback-sized pump into her central line.

Smith has a connective tissue disorder called Ehlers-Danlos syndrome, which can cause many health problems. As a child, Smith had frequent issues such as a torn Achilles tendon and shoulder dislocations. In her 20s, while working as an EMT, she developed severe gut blockages and became progressively less able to digest food. In 2017, she went on HPN and takes nothing by mouth except for an occasional sip of liquid or bite of soft food, in hopes of preventing the total atrophy of her intestines. HPN enabled her to commute to George Washington University in Washington, D.C., where in 2020 she completed a master’s in public health.

On days when she teaches at LaGuardia Community College — she had 35 students this semester — Smith is up at 6 a.m. to tend to her medical care, leaves the house at 9:15 for class, comes home in the afternoon for a bag of IV hydration, then returns for a late afternoon or evening class. In the evening she gets more hydration, then hooks up the HPN bag for the night. On rare occasions she skips the HPN, “but then I regret it,” she said. The next day she’ll have headaches and feel dizzy, sometimes losing her train of thought in class.

Smith describes a “love-hate relationship” with HPN. She hates being dependent on it, the sour smell of the stuff when it spills, and the mountains of unrecyclable garbage from the 120 pounds of supplies couriered to her apartment weekly. She worries about blood clots and infections. She finds the smell of food disconcerting; Matt tries not to cook when she’s home. Other HPN patients speak of sudden cravings for pasta or Frosted Mini-Wheats.

Yet HPN “has given me my life back,” Smith said.

She is a zealous self-caretaker, but some dangers are beyond her control. IV feeding over time is associated with liver damage. The assemblage of HPN bags by compounding pharmacists is risky. If the ingredients aren’t mixed in the right order, they can crystallize and kill a patient, said Seres, Smith’s doctor.

He and other doctors would like to transition patients to food, but this isn’t always possible. Some eventually seek drastic treatments such as bowel lengthening or even transplants of the entire digestive tract.

“When they run out of options, they could die,” said Dr. Ryan Hurt, a Mayo Clinic physician and president of the American Society for Parenteral and Enteral Nutrition.

***

And then there are the shortages.

In 2017, Hurricane Maria crippled dozens of labs and factories making IV components in Puerto Rico; next came the covid-19 emergency, which shifted vital supplies to gravely ill hospital patients.

Prices for vital HPN ingredients can fluctuate unpredictably as companies making them come and go. For example, in recent years the cost of the sodium acetate used as an electrolyte in a bag of HPN ballooned from $2 to $25, then briefly to $300, said Michael Rigas, a co-founder of the home infusion pharmacy KabaFusion.

“There may be 50 different companies involved in producing everything in an HPN bag,” Rigas said. “They’re all doing their own thing — expanding, contracting, looking for ways to make money.” This leaves patients struggling to deal with various shortages from saline and IV bags to special tubing and vitamins.

“In the last five years I’ve seen more things out of stock or on shortage than the previous 35 years combined,” said Rigas.

The sudden retrenchment of CVS and Optum Rx made things worse. Another, infuriating source of worry: the steady rise of IV spas and concierge services, staffed by moonlighting or burned-out hospital nurses, offering IV vitamins and hydration to well-off people who enjoy the rush of infusions to relieve symptoms of a cold, morning sickness, a hangover, or just a case of the blahs.

In January, infusion professionals urged FDA Commissioner Robert Califf to examine spa and concierge services’ use of IV products as an “emerging contributing factor” to shortages.

The FDA, however, has little authority over IV spas. The Federal Trade Commission has cracked down on some spa operations — for unsubstantiated health claims rather than resource misuse.

Bracha Banayan’s concierge service, called IVDRIPS, started in 2017 in New York City and now employs 90 people, including 60 registered nurses, in four states, she said. They visit about 5,000 patrons each year, providing IV hydration and vitamins in sessions of an hour or two for up to $600 a visit. The goal is “to hydrate and be healthy” with a “boost that makes us feel better,” Banayan said.

Although experts don’t recommend IV hydration outside of medical settings, the market has exploded, Banayan said: “Every med spa is like, ‘We want to bring in IV services.’ Every single paramedic I know is opening an IV center.”

Matt Smith, Elizabeth’s husband, isn’t surprised. Educated as a lawyer, he is a paramedic who trains others at Columbia University Irving Medical Center. “You give someone a choice of go up to some rich person’s apartment and start an IV on them, or carry a 500-pound person living in squalor down from their apartment,” he said. “There’s one that’s going to be very hard on your body and one very easy on your body.”

The very existence of IV spa companies can feel like an insult.

“These people are using resources that are literally a matter of life or death to us,” Elizabeth Smith said.

Shortages in HPN supplies have caused serious health problems including organ failure, severe blisters, rashes, and brain damage.

For five months last year, Rylee Cornwell, 18 and living in Spokane, Washington, could rarely procure lipids for her HPN treatment. She grew dizzy or fainted when she tried to stand, so she mostly slept. Eventually she moved to Phoenix, where the Mayo Clinic has many Ehlers-Danlos patients and supplies are easier to access.

Mike Sherels was a University of Minnesota Gophers football coach when an allergic reaction caused him to lose most of his intestines. At times he’s had to rely on an ethanol solution that damages the ports on his central line, a potentially deadly problem “since you can only have so many central access sites put into your body during your life,” he said.

When Faith Johnson, a 22-year-old Las Vegas student, was unable to get IV multivitamins, she tried crushing vitamin pills and swallowing the powder, but couldn’t keep the substance down and became malnourished. She has been hospitalized five times this past year.

Dread stalks Matt Smith, who daily fears that Elizabeth will call to say she has a headache, which could mean a minor allergic or viral issue — or a bloodstream infection that will land her in the hospital.

Even more worrying, he said: “What happens if all these companies stop doing it? What is the alternative? I don’t know what the economics of HPN are. All I know is the stuff either comes or it doesn’t.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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