Adderall Safari
Adderall Safari
You may have noticed that finding your ADHD medicine has become rather difficult. The Adderall shortage has been ongoing for a few months now and there does not appear to be any end in sight.
You may have noticed that finding your ADHD medicine has become rather difficult. The Adderall shortage has been ongoing for a few months now and there does not appear to be any end in sight. There are many reasons for this shortage and it's almost a perfect storm of factors that have converged to leave many patients without their medication. Supply and demand are still in effect and the biggest issue has been that demand for Adderall has been growing substantially. The supply side has been littered with road bumps as well everything from supply chain disruptions limiting the availability of raw ingredients to foreign labor disputes halting factory production.
The increase in demand should come as no surprise. Adderall has become a household name, like Xanax and Oxycontin it is more popular than Taylor Swift. Pharma advertising is often blamed for this but it's also the reality that these drugs are incredibly effective. Clinicians that treat ADHD are overwhelmed with patients and the next available appointment can be months out in some areas. This led to an increase in patients seeking these prescriptions through telehealth or direct servicing apps.
You may be familiar with some of these companies that market to men; Roman, Hims, Bluechew, all these companies remove the hassle of finding a doctor and getting a prescription for Viagra. Cerebral was one of the first companies to apply this model to Adderall but it did not go so well, resulting in the company falling under investigation by the DEA & DOJ. Who knows how the court case will be decided but it does not look good for the company who is already losing the battle of public opinion. CBS News recently interviewed a mother who blames Cerebral for inappropriately prescribing stimulants that played a role in her son’s death.
One report from Trinity Health concluded that the number of prescriptions written for Adderall far exceeds the number of formal ADHD diagnoses. While this is a little obvious it creates a supply snare trap further down the line. As the prescription to diagnosis discrepancy grew larger a shortage would become almost certain. Manufacturing of Schedule II controlled substances is tightly regulated by the controlled substance act and enforced by DEA scientists who use mathematical models to predict demand. The problem is the amount of diagnosis is likely an input into those models. This resulted in an inaccurate forecast and contributed to the current supply crunch.
Teva is one of the largest generic manufacturers that produces Adderall, but they were plagued with labor shortages in their packaging plants which became a choke point producing further delays in other drugs as well. These companies only have so many manufacturing facilities and they are making one product at a time, so everything gets backed up. In the background of all these issues is a looming global recession that has these vital companies not expanding to meet demand but predictably shrinking to protect profitability. Teva has been steadily closing manufacturing facilities around the world despite that though they are currently operating 56 production facilities that make 76 billion tablets/capsules a year. They produce 3700 products spread across those 56 plants, so it is very easy to see why bottlenecks occur.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health and Medicine Reporter
https://substack.com/discover/pharmacoconuts
@hyattjn
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Further Reading and References
https://www.cnbc.com/2022/12/07/adhd-medication-demand-us-healthcare.html
https://www.cbsnews.com/news/adderall-online-prescription-cerebral-mental-health-elijah-hanson/
https://pubchem.ncbi.nlm.nih.gov/compound/DEXTROAMPHETAMINE#section=Human-Metabolite-Information
China's Zero Covid & no mRNA mystery
China had their large communists party conclave not too long ago with Xi Jinping essentially becoming president in perpetuity and further consolidating power. No surprise on the political front but many expected them to use this as an opportunity to pivot from the blatantly unreachable zero covid policy.
China had their large communists party conclave not too long ago with Xi Jinping essentially becoming president in perpetuity and further consolidating power. No surprise on the political front but many expected them to use this as an opportunity to pivot from the blatantly unreachable zero covid policy. Instead, they would publicly double down on that policy but did make a few interesting changes from a western perspective. Vaccine mandates for example have largely been given up by the government. The vaccines that they do offer are local only; they have no interest in allowing Moderna or Pfizer vaccines into the mainland.
Politics may be able to explain the resistance to allowing a western product approval, but they are perfectly capable of creating their own versions. Despite that, mRNA technology appears to be the one piece of intellectual property they are not interested in reproducing for their own benefit. This raises lots of questions, it’s practically narrative on narrative violence with the west screaming that these products are effective until they are blue in the face, but the Chinese have deemed them not even worth stealing. Meanwhile the threat from covid is still severe enough that GPS data from your cell phone alone is enough to justify a government abduction and subsequent detainment. A great piece documenting this was recently published by Thomas Hale, the Shanghai correspondent for the Financial Times who was swept up for a ten-day detention. The full article is behind a paywall, but a free synopsis can be found here.
https://www.zerohedge.com/covid-19/take-rare-glimpse-inside-chinas-zero-covid-madhouse
The United States government excels at hiding information from the public especially if it does not align with their goals. Even a former president can't handle classified information without concerns of legal liability. Releasing any of this information in the states requires an inordinate amount of time, lawyers and FOIA requests. Even if you do manage to pry that data from their clutches it is redacted to the point of uselessness often in the name of national security. Pfizer's recent documents and even Dr. Fauci's emails are good examples. Fortunately, we do have one entity on the planet that sees everything like the eye of Sauron. Chinese espionage operations are unequaled and generational in scope, it really makes me wonder what information about these products they must have to warrant such hesitance even in the face of mounting internal pressure.
They did start down the mRNA road over a year ago and Chinese companies Walvax Biotechnology & Suzhou Ai Biotechnology would publish their first study on 120 volunteers in January. The data from that trial in particular looks pretty good with no real concerns or adverse events reported. To their credit there are quite a few studies comparing the DNA based chinese vaccine (CoronoVac/Sinovac) and the pfizer mRNA product in the one market where they can both be found, Hong Kong. One study showed that both products have the potential to increase herpes zoster related hospitalizations, but the overall risk was still very low. Another study with over 2 million participants would track adverse events from both shots. The most frequent adverse event reported across both treatment groups was thromboembolism. This large study showed few differences in adverse events between the products but a slight increase in Bell's Palsy for the CoronaVac. Finally, a third study with about a quarter of a million diabetic patients was conducted and found no increased adverse events in this population.
Yes, all this data needs to be taken with a grain of salt; the Chinese certainly have a vested interest in pushing their product on the rest of the world (as do we). The conflict-of-interest statements in all these papers are mind bogglingly long as well. The takeaway though is that if you are the Communist party there is not a ton of public evidence even in their own scientific literature to support the actions they have taken. Even the joke that is the associated press managed to ask a Chinese health official what the delay was. Their response given under the conditions of remaining anonymous is that they have held back because they want to master the technology in China and not depend on foreign suppliers.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Further Reading and References
https://www.thelancet.com/action/showPdf?pii=S2666-5247%2821%2900280-9
https://www.cnn.com/2021/12/13/china/china-western-mrna-vaccine-mic-intl-hnk/index.html
https://www.scmp.com/comment/letters/article/3171044/chinas-omicron-surge-whats-stopping-beijing-reaching-mrna-vaccines
https://www.scmp.com/news/china/science/article/3194787/vaccines-shouldnt-be-deciding-factor-chinas-zero-covid-policy?module=perpetual_scroll_0&pgtype=article&campaign=3194787
https://www.voanews.com/a/china-s-bet-on-homegrown-mrna-vaccines-holds-back-nation-/6587593.html
https://www.npr.org/sections/goatsandsoda/2022/02/24/1082529219/looks-like-non-mrna-vaccines-can-be-as-good-as-pfizer-and-moderna-in-certain-sce
https://pubmed.ncbi.nlm.nih.gov/35590336/
Saving the Children
The CDC & FDA unanimously approved the new omicron specific boosters for use in children aged five to twelve, going beyond what even the Moderna CEO is recommending. This created a lot of uproar in certain circles, but it should come as no surprise.
The CDC & FDA unanimously approved the new omicron specific boosters for use in children aged five to twelve, going beyond what even the Moderna CEO is recommending. This created a lot of uproar in certain circles, but it should come as no surprise. Anyone who would have thought differently or had concerns about the risk benefit of the vaccines was long ago pushed out. Even with the first round of vaccines the push to market them to children has been dumbfounding. The reason children do not have the same problems with covid is well known and has been for some time. A recent analysis has even confirmed this by reporting that the fatality rate for ages 0-19 from the original Wuhan strain was 0.0003%
.
The virus binds to the ACE2 receptor to gain access into the cell. It binds so well to this receptor it is as if thousands of generations of virus were screened and selected for such a result. Perhaps Mother nature hit the lottery several times in a row to achieve this evolutionary advantage, but it is far more likely that human tinkering is the culprit. Call it viral research, gene amplification, bioterrorism, or the search for future cures. The end result is the same with viruses making incredible evolutionary leaps that while theoretically possible in nature are incredibly unlikely. Meanwhile the risk of an accidental release outweighs the potential benefits of this research.
Whatever the original source, the reality is we have a novel coronavirus that sticks to the ACE2 receptor like super glue. This is incredibly unfortunate for the elderly and the obese who have greater expression of the enzyme and thus a greater chance of infection. It is a blessing from God however that children simply do not express this enzyme to the same extent as their parents. Therefore, they contract the virus less often and if they do the cases are mild or asymptomatic. This is not new information, but it may seem that way since it is rarely discussed. Despite that fact fear mongering, intimidation and outright lies have been used to market an unlicensed product to the population least likely to receive a benefit. Call me old fashioned but I believe pharmaceutical intervention in children especially needs to have a clear and demonstrable benefit which I have not seen.
Speaking of children, however we do currently have an issue with RSV in children. Emergency room and urgent care visits have shown a recent spike in these diagnoses. The chart below is for Virginia, but other states are seeing a sharp increase as well. Some have argued that this is due to a lingering immunity gap left over from the lockdowns. Human isolation is known to have a negative effect on the immune system and the theory is that these children and potentially their mothers never had the opportunity to build immunity to these common pathogens; and the bill is now coming due.
If that were the case, I would expect to see some discrepancy between the states that locked down differently. Texas and California are about as opposite as can be when it comes to lock down policy, but they are both seeing the same increased caseload. The graphs for New York and Florida also look remarkably similar. Whatever is happening here appears to be across the board despite differences in lockdown policy or vaccination. This early spike of RSV is a foreboding sign as we head into the fall with flu season around the corner and covid is going nowhere soon. The press is referring to this convergence as a "tridemic".
That thought reminded me of an opinion article posted yesterday to the Washington Post saying it is time to push for an RSV vaccine for children. They are truly prescient because Moderna just so happens to have a new mRNA RSV vaccine in development. If you are feeling frisky and over 60 you can sign up for the trial here https://conquerrsv.com/.
MRNA technology is the latest and greatest tool, and the pharmaceutical industry is planning to use it extensively for anything they can get away with. A recent BBC interview features the founders of BioNTech publicizing the technology as a cure for cancer by 2030. We have a long way to go before we are at that point, but the following statement made during the interview is very telling.
Türeci told Kuenssberg that BioNTech had learned how to manufacture mRNA vaccines faster during the pandemic and had a better understanding of how people’s immune systems responded to mRNA. The intense development and rapid rollout of the Covid shot had also helped medicines regulators work out how to approve the vaccines. “This will definitely accelerate also our cancer vaccine,”
I am certainly glad that the process of making these products has advanced our understanding of them, better late than never but the kicker here is the line about figuring out how to get it approved. There is of course the old-fashioned way of obtaining approval by proving it is safe and effective but that takes forever and there is no guarantee you will even make it to market. Daily cancer deaths dwarf covid deaths so the argument for an emergency use authorization practically makes itself. President Pfizer has been promising a moonshot to cure cancer for a while now and he may be closer than he is aware.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Further Reading and References
https://www.theguardian.com/society/2022/oct/16/vaccines-to-treat-cancer-possible-by-2030-say-biontech-founders
https://www.thelancet.com/article/S0140-6736(22)01277-6/fulltext
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02046-8/fulltext
https://pubmed.ncbi.nlm.nih.gov/32496587/
https://www.zerohedge.com/covid-19/closer-look-covid-mortality-rate
https://pubmed.ncbi.nlm.nih.gov/33168188/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461228/
https://pubmed.ncbi.nlm.nih.gov/34735717/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9277324/
https://pubmed.ncbi.nlm.nih.gov/35992140/
https://pubmed.ncbi.nlm.nih.gov/36209167/
https://www.washingtonpost.com/opinions/2022/10/27/rsv-surge-pediatric-vaccine/
Getting to the Heart of things
This week a lawsuit against the CDC has given us access to some of the V-safe data. This is the smartphone app created by the CDC that lets you register for the vaccine and report side effects and other health information
This week a lawsuit against the CDC has given us access to some of the V-safe data. This is the smartphone app created by the CDC that lets you register for the vaccine and report side effects and other health information. As with any user reported data it should be taken with a grain of salt but there are people who argue that reporting systems like this and VAERS undercount adverse events because most people don’t bother reporting. Either way this is data that the CDC has been sitting on and only released due to a recent court order. The data provided is from 10.1 million users and the headline number is 7.7% of those required medical attention after vaccination. It is such an absurdly high number that if I was working at the CDC, I would insist it was incorrect and there must be something wrong with the software. It will be very interesting moving forward to know how many employees were privy to this information or if there was any internal debate about releasing or debunking it. Data like this would create a liability nightmare, that is if liability existed for such a thing.
The dashboard for the data can be found here https://www.icandecide.org/v-safe-data/
The Florida surgeon general has also released a statement recently recommending that males 18-39 should not receive mRNA vaccines. Along with the statement was an analysis conducted by the state revealing an 84% increase of cardiac related incidence of death within 28 days of vaccination.
The guidance statement can be found here
The analysis itself is here
The most egregious example of a drug product causing excess heart attacks was not that long ago. Vioxx was brought to market in 1999 ironically as a safer alternative to traditional NSAID drugs like naproxen or aspirin which can cause ulcers and other gastrointestinal complications. In that respect the drug did work but the cardiovascular risks far outweighed that benefit. Merck was very aware of these risks and that would be proven in court with internal memos and even unpublished studies showing heart attacks and strokes were six times more likely in Vioxx compared to placebo. Despite that knowledge they would turn into a magician selectively hiding data to make the product appear less dangerous in their VIGOR trial. Even worse, the data they did publish still showed more heart attacks compared to aspirin, but they would double down insisting that aspirin was known to reduce heart attacks. So, the problem was not the Vioxx causing heart attacks, but the pesky aspirin preventing them.
Merck would manage to sell Vioxx for five years to an estimated twenty million patients before voluntarily recalling the drug as the APROVE study would reveal an increased risk of heart attacks. Later the Lancet would estimate that Vioxx caused 88,000 heart attacks of which 32,000 were fatal. Lawsuits would begin piling up and despite several successful trial defenses Merck would establish a settlement fund to the tune of 4.85 billion dollars.
NSAIDS work to reduce inflammation by reducing the activity of cyclooxygenase or Cox enzymes. These enzymes help turn arachidonic acid into prostaglandins. Traditional NSAIDS like aspirin are much more selective for the Cox-1 enzyme by about 170-fold. Decreased prostaglandin production does reduce inflammation but those same prostaglandins have a protective effect on the gut and disrupting them leads to ulcers. The thought was if we could develop more Cox-2 selective drugs we could avoid negative side effects. Vioxx, Bextra, and Celebrex all selective Cox-2 inhibitors would be developed and marketed extensively. Vioxx would be the most advertised prescription product in the year 2000 and Pfizer would promote Bextra for so many off-label indications that it would be part of a 2.3-billion-dollar settlement with the Justice Department for fraudulent marketing. Bextra was removed from the market in 2004 leaving Celebrex as the real winner and the only Cox-2 inhibitor on the market. Celebrex would enjoy essentially a monopoly on the market that was so extensive they would halt advertising the product. Celebrex would stay on the market despite the FDA adding a black box warning to its label.
If the vaccines are causing an issue all signs seem to point to the young male age group as where the signal will be found. I have been looking through the CDC database to track the number of reported cardiovascular and cerebrovascular deaths in males between the age of 15-34. Going back to 2011 the amount of these reported deaths is rare and consistent but begins to spike in 2020 the last year we have complete data for. I would bet that this line continues to increase as we get data for 2021 the only question is how much? The good news is that if we are accidentally causing excess heart attacks the Moderna CEO has promised a new breakthrough MRNA treatment to repair damaged heart muscle. God bless his heart for being so far ahead of the curve.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Additional Reading and References
https://scholarship.law.stjohns.edu/cgi/viewcontent.cgi?article=1054&context=jcred
https://money.cnn.com/2006/09/19/news/companies/celebrex/index.htm
https://pubmed.ncbi.nlm.nih.gov/18030055/
https://www.fdanews.com/articles/75244-black-box-warning-added-to-celebrex-labeling
https://www.npr.org/2007/11/10/5470430/timeline-the-rise-and-fall-of-vioxx
Measuring Cognitive Function
Science can only advance as far as we can accurately measure, and this applies to healthcare as well. There are lots of lab values that we can obtain to get a better picture of your overall health, if we are concerned about your diabetes your blood sugar can now be tracked 24/7.
Science can only advance as far as we can accurately measure, and this applies to healthcare as well. There are lots of lab values that we can obtain to get a better picture of your overall health, if we are concerned about your diabetes your blood sugar can now be tracked 24/7. Some things in healthcare are not as easy to measure though, depression, pain, anxiety these are all subjective issues that are highly dependent upon patient perception. The murkier the measurements the harder these conditions are to properly treat and the potential increases for that treatment to go awry. The traditional pain scale is a good example of a vague and practically useless metric.
Perhaps nothing is harder to measure than cognitive ability. As we age our mental faculties decline and diseases like Alzheimer's and dementia become more and more prevalent. Brain fog has become an increasingly popular term as long covid spreads throughout the population with patients reporting decreases in executive function. The pharmacy is usually the first to notice these issues because managing multiple medications for these patients becomes an increasingly impossible task. Unfortunately, by the time friends, family, or the pharmacy are noticing these issues it may be too late. Identifying and treating cognitive impairment early and aggressively is key to preserving what brain function remains. You may think that this is only for the elderly but that is not the case. Concussions and head trauma in sports is another great reason to have a baseline test like this on file. Currently the Miami Dolphins are dealing with a sad situation which has resulted in their star quarterback being injured after multiple concussions. The physician who cleared him to play has now been fired. I cannot help but think that better testing has the potential to better quantify damage from head trauma to avoid incidents like this in the future.
To help in this endeavor Williamsburg Drug has purchased a new testing device to offer patients called the Cognivue Thrive. This test is designed to measure three domains memory, visuospatial, and executive function. It also provides two metrics to measure your cognitive speed and performance. The test only takes a few minutes to complete and is a standard part of our health checkup consultations. If you would like to come in and check it out, you can schedule a consult at williamsburgdrug.com
Example of test results
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Thank you for Reading feel free to share!
Further reading and references
https://www.theatlantic.com/health/archive/2022/09/long-covid-brain-fog-symptom-executive-function/671393/
https://pubmed.ncbi.nlm.nih.gov/34327120/
https://www.wjgnet.com/2220-3206/full/v10/i1/1.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993067/
https://www.cognivue.com/product-tour/cognivue-thrive/
Huffing for your Health
While water is an essential element to life that can be found for free most everywhere you look that does not stop industry from turning it into a profitable commodity. There is a whole aisle at the store dedicated to bottled water in a variety of forms and while some of us are too cheap to splurge on fancy water it still manages to be a 283-billion-dollar global industry. With that in mind it was only a matter of time before we circled fully around an went full Spaceballs selling air in a can.
Boost Oxygen is the most popular brand of OTC pure oxygen in a can. I have noticed these popping up at a variety of retailers during covid. Compressed pure oxygen available in a variety of flavors and small enough to fit in your purse.
Oxygen as a medical treatment has been around forever and is incredibly effective in patients who have trouble breathing or maintaining their oxygen saturation on room air. Normally a prescription is needed to supply Oxygen tanks which can be large and obtrusive while also a fire hazard. To improve access modern portable oxygen concentrators have been developed and now are small enough to fit in a backpack. Monitoring of your oxygen saturation can be accomplished quickly and easily by using a pulse oximeter or smartwatch. This is an excellent tool to use especially when sick at home with a respiratory illness and wondering when to seek professional care, being unable to maintain a steady oxygen saturation is your seek medical care now sign.
Like all therapies under the proper conditions oxygen makes a ton of sense, but how about just as a supplement or to enhance athletic performance? Oxygen supplementation is routinely used by mountain climbers when exploring extreme elevations so if it’s good enough for them why not for you? One man’s stairs are another man's mountain, and the thing oxygen supplementation has been shown to do is increase the V02 Max for a brief period. Still the human respiratory system is designed to match your oxygen supply with demand and if you need more oxygen your respiration rate increases to provide it and auxiliary oxygen should only be necessary in extreme environments. For the average healthy person oxygen concentration is not the rate limiting step and if the athletic benefits were that great, we would see it all over the sidelines of professional sports. They are missing a big marketing angle here and a NASCAR sponsorship practically writes itself.
The reality is that if you truly need supplemental oxygen the concentrators are your best bet, but these O2 cans are a perfectly safe and interesting product. They may have a diagnostic function as well to help identify elderly patients who are not currently receiving therapy but may benefit from it. Hyperbaric Oxygen therapy has always had a place in the training regimen for world class athletes, but recent studies are showing its effectiveness against a variety of age-related cognitive concerns.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
Bitcoin GtjoZgxE7WpTkWRE6JiEiXfUpqbWKxH4g
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Further reading and references
https://pubmed.ncbi.nlm.nih.gov/32548235/
https://pubmed.ncbi.nlm.nih.gov/11581334/
https://pubmed.ncbi.nlm.nih.gov/32630465/
https://pubmed.ncbi.nlm.nih.gov/36018403/
https://www.verywellhealth.com/top-portable-oxygen-concentrators-915001
Masks Mania
Duality of Masking
We live in a very bipolar society and one of the most obvious examples of this is the tenacity of masking. The unfortunate truth is that an aerosolized virus particle is so small that the only sure way to prevent an encounter with it is with your own self-contained breathing apparatus. How many scuba suits are you seeing on the streets of New York? Can a surgical mask stop a particle or two? Well, it is certainly possible in the same way that fishnet stockings may prevent some sunburn but not what anyone would call overall effective. Early on there were multiple articles exaggerating the necessity of public masking, none of them particularly convincing or well done but they danced around the truth and pushed their preconceived notions in the name of public health.
The reality is very few wear masks of any quality, and nobody is wearing them properly. Even in healthcare settings where a fresh N-95 may be handed out daily most opt for the regular mask so they can breathe easier. I have seen people in public however pick one off the ground and put it on to enter their doctor's office, one of the last places where they are still mandated around here. Most of the time I consider masks to be ineffective and silly but not harmful for adults. Children on the other hand is another story and government actions have been crimes against the speech and societal development of our future generation.
Prior to covid it was commonly known that oxygen masks in young children could cause rebreathing resulting in elevated carbon dioxide. This was such a concern that redesigned masks to limit rebreathing and improve oxygen efficiency would be brought to the market. It appears to be a success and is called an OxyMask. Proper respiration is essential to human health and beneath all of this is the subtle acid base chemistry constantly maintained by our breathing. Inhaled carbon dioxide mixes with water in our bodies to produce carbonic acid. This simple and reversible chemical reaction is one of the ways our bodies maintain their pH balance. If you have not seen it, The Andromeda Strain (1971) is an excellent film where this concept plays a critical role in the story, it is based on the Michael Crichton book of the same name from 1969 so not exactly new science.
https://link.springer.com/article/10.1007/s00431-021-04157-1
https://media.lanecc.edu/users/driscolln/RT127/Softchalk/Acid_Base_Lesson/Acid_Base_Lesson6.html
Last summer amid our muzzle the children to protect the adults debate a German article was published in JAMA Pediatrics examining if there was any risk of rebreathing with nose and mouth coverings in children. It was quickly retracted though with the following vague statement.
"Given fundamental concerns about the study methodology, uncertainty regarding the validity of the findings and conclusions, and the potential public health implications, the editors have retracted this Research Letter."
This raises the question that if the study methodology was so bad why was it ever accepted and published in the first place? There does appear to be some back and forth between the authors and the editor because the retraction clearly states that the authors were invited to respond to these concerns but were unable to provide sufficiently convincing evidence. I have the suspicion that if the authors conclusions were different then the methodology would not have been suspect. Article and retraction links are below.
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2781743 (FULL ARTICLE)
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2782288 (RETRACTION)
The lead author of the study Dr. Harald Walach did respond to a request for comment, and he believes the retraction to be unjustified and has since republished it in another journal where it has undergone three rounds of triple-peer review. That article in its entirety can be found at the link below. The editors who retracted the article have chosen not to respond to my request for comment.
https://pubmed.ncbi.nlm.nih.gov/35636467/
The article concludes that masking increased the carbon dioxide content in inhaled air upwards of 13,000 PPM (parts per million). 2000 PPM is considered the acceptable limit and 1000 PPM is normal for air in enclosed rooms. The most troubling part of this is that the experiment used a brief time interval to achieve these results meanwhile in the real-world children are wearing these masks for a much longer period and sometimes even during physical exertion.
The effects of environmental exposure to carbon dioxide have been a real topic of investigation in certain professions. This exposure can be commonplace for miners, astronauts, and submariners. The data from these appears to be mixed with some suggesting that it could have negative impacts upon cognition, they do all seem to agree that further research is warranted. Extra credit for the conspiracy theorists out there we also have an animal study that concludes carbon dioxide is a robust fear inducing stimulus that discourages exploration in mice.
https://pubmed.ncbi.nlm.nih.gov/31240239/
https://pubmed.ncbi.nlm.nih.gov/29789085/
https://pubmed.ncbi.nlm.nih.gov/33103571/
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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For Love of the game
A wise man once warned about the growth of the military industrial complex and the consequences that would follow. If you did not believe him just look at the money spent recently on the war in Ukraine with no oversight and no opposition.
A wise man once warned about the growth of the military industrial complex and the consequences that would follow. If you did not believe him just look at the money spent recently on the war in Ukraine with no oversight and no opposition. To the companies that make money off war it is simply a game to be monetized and they do it well with bipartisan support because both parties are full of warmongering fools. The collusion he warned of has now infiltrated the entire federal government and the game is being played on multiple fronts healthcare included.
The largest factor in a drug's ability to generate revenue is its exclusive time on market as a brand name; this is where lucrative prices can be charged with no competition. Patents are awarded early on in development and that kicks off a race to the market as fast as possible. Extending the patent life by any means necessary has become a common strategy that expresses itself in a variety of ways. Make a few changes to your drug and it can be turned into an extended-release product with a fresh patent. Ambien turns into Ambien CR and the whole marketing mechanism simply pivots to the latest and greatest for example. Sometimes the new product is an actual improvement and other times it is obvious what is going on.
Flexeril (cyclobenzaprine), a muscle relaxer that's older than I am, was first approved and marketed at 10mg three times a day, because of its long half-life ~32 hours it would become immensely popular for non-muscle relaxer reasons. Decades later this would make a good reason to reduce the dose and we have the strange situation where a bottle of 10mg tablets that cost nothing is sitting beside a 5mg bottle that cost hundreds. Lots of money spent for little actual benefit is the hallmark of the game. Eventually cyclobenzaprine would also perform the previously mentioned extended-release trick and get a new name Amrix (15mg cyclobenzaprine ER) and a new price in the thousands. You may ask why an extended-release product is necessary for a drug with such a long half-life, I certainly did.
Hydrocodone and Oxycodone in differing combinations with other products were the most popular painkillers of the past two decades and they have had a variety of brand names over the years while performing the ole patent shuffle. Ironically reducing the amount of acetaminophen in these products in the name of safety was the most common maneuver but based on the list below they exhausted all pathways
List of Brand name Oxycodone & combination products
List of Hydrocodone & combination products
Claritin (Loratadine) however is the true winner of gaming the system because they realized going over the counter was the ultimate way to protect their patent. If it had remained a prescription product no insurance would have paid for it and the generic would have been mandated. Going over the counter however allows their marketing machine to roll onward and here they are selling brand name Claritin decades after the patent has expired. Clever ideas do not go unnoticed and other prescription antihistamines would follow this lead Zyrtec, Xyzal, Allegra just to name a few. Of course, if the patient is going to decide what to buy there is a limit to what you can charge. If its prescription, however there is no ceiling because the end consumer is not paying the bill directly. All these forms of patent recycling add incredible costs to the overall system for little or no added benefit.
The guiding principle here is a corporate maxim that next week we expect you to be more productive with less resources of course. A few hundred cycles later things start to get a little silly as all the rules are exploited in any way possible. The next evolution of the game is expanding your customer base; therefore, we have commercials for restless leg syndrome and every other manner of problem because it is hard to sell drugs for conditions that people do not know exist. The consumer must be constantly bombarded with information about all the ways they could be sick and what their doctor can write for to fix it. The excessive pushing of the covid vaccines despite a lack of convincing evidence for certain populations is merely the latest example of the game upping its game.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Gila Spit to Diabetes treatment
In 1964 researchers discovered something interesting about glucose and its effects upon insulin. Giving glucose by mouth would cause a large and rapid increase in plasma insulin levels. Giving the exact same amount parentally would result in lower levels.
In 1964 researchers discovered something interesting about glucose and its effects upon insulin. Giving glucose by mouth would cause a large and rapid increase in plasma insulin levels. Giving the exact same amount parentally would result in lower levels. The difference was about 65% and it would become known as the “incretin effect”. The hormones behind this effect would eventually be discovered glucagon-like peptide (GLP1) and gastric inhibitory protein (GIP). These hormones are produced when you eat and stimulate your pancreas to produce more insulin, GLP1 also slows down gastric emptying and peristalsis which results in you feeling full and not eating that fourth/fifth cupcake. These hormones do not hang around long because they are quickly metabolized by a small glycoprotein called dipeptidyl peptidase 4 (DPP4). DPP4 is widely expressed and found on the surface of nearly every cell so it makes quick work shredding up GIP/GLP1 giving you that second wind for the sixth cupcake.
These hormones would become obvious therapeutic targets for reducing blood sugar. The race was on to find something that could replicate the marvelous effects and the first candidate would come from the most unlikely of places: the saliva of a Gila monster. The drug discovered is now known as Byetta (exenatide) and it has been used successfully in millions of patients. Exenatide does many of the same things that GLP1 does with one key difference: it could hang around for hours as opposed to minutes. The only downside was the drug was not well absorbed orally and must be given as an injection. Recent developments in nanoparticle technology may have solved the absorption issue so an oral form of the drug may be on the horizon. Similar products would soon follow, Victoza, Bydureon, Trulicity, and Ozempic are all GLP1 receptor agonists.
GLP1 receptor agonists are NOT insulin which is a common misconception since they are an injectable medication for diabetes. They are also not approved for weight loss although many patients lose weight taking them Ozempic in particular. The newest drug to enter this class is called Mounjaro (tirzepatide) from Eli Lilly and it is getting all the attention because it is the first drug to act on both GLP1 and GIP receptors. While it is approved for diabetes the average weight loss for patients receiving the drug was between 12 and 25 pounds! When you add DPP4 inhibitors like Januvia and traditional drugs like metformin into the mix we pretty much have diabetes surrounded from a biochemistry perspective.
The cure for obesity is no mystery but exercise and self-control are tough to accomplish and difficult to monetize. Drugs however are easy to take and incredibly commercially viable, the price tag for this new medicine is about a thousand dollars a month. They could probably charge more if it lives up to the hype especially if they were to pursue an actual approval for weight loss. This drug could be a golden goose for Eli Lilly. An effective weight loss product with minimal side effects is like stumbling onto the holy grail for a drug company. If it ever gets that far I am curious if it will be mandated, after all the costs to society from obesity are astronomical.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Further reading and references
https://pubmed.ncbi.nlm.nih.gov/35651477/
https://pubmed.ncbi.nlm.nih.gov/35513765/
https://pubmed.ncbi.nlm.nih.gov/35593668/
https://pubmed.ncbi.nlm.nih.gov/33325008/
https://pubmed.ncbi.nlm.nih.gov/32730231/
https://www.multivu.com/assets/53897/documents/53897-Exenatide-History-FINAL-original.pdf
https://jnanobiotechnology.biomedcentral.com/articles/10.1186/s12951-020-00619-0
HEALING HONEY
Honey may be one of the oldest forms of natural medicine. Its wound healing and antimicrobial properties can be found mentioned in some of our oldest medical literature. The bible mentions it in proverbs 16:24 "Gracious words are a honeycomb, sweet to the soul and healing to the bones."
Honey may be one of the oldest forms of natural medicine. Its wound healing and antimicrobial properties can be found mentioned in some of our oldest medical literature. The bible mentions it in proverbs 16:24 "Gracious words are a honeycomb, sweet to the soul and healing to the bones." Hippocrates, the father of modern medicine who is turning a few thousand RPMs in his grave, was convinced that honey had a variety of healing properties, and he would use it in many of his treatments. He would treat pain with a combination of honey and vinegar. He also encouraged his patients to drink Mead, one of the oldest alcoholic beverages made by fermenting honey with water grains and other spices, the Greeks would refer to it as the "nectar of the gods".
Perhaps the earliest pharmacy compound in history was theriaca andromachi. A mixture of multiple ingredients including opium, cinnamon, and viper flesh was pulverized with honey and arabic gum into a paste. It would go viral as something could back then and we find it mentioned often in historic text. Galen the famous Greek physician would author an entire book on the remedy, and it was taken regularly by his most famous patient Marcus Aurelius. Pliny the Elder would note in his encyclopedic book "historia naturales" that the Arabians were producing honey strictly for medicinal purposes including applying it to wool and wrapping wounds.
The healing effects of honey are due to a combination of its antibacterial and antioxidant properties. The high viscosity provides a protective barrier to pathogens while maintaining a moisture rich environment that promotes healing. All honey is not created equal, and the chemical composition will depend on many factors. The polyphenol content of the honey will determine its antioxidant potential, the darker the honey appears the higher the content of polyphenols. A polish study examining several types of honey would show a significant variability depending upon what type of nectar the bees are using and the chemical composition of the resulting honey
Commercially there are now several medical grade honey products on the market around the world. Medihoney is the one you may be familiar with, but other trade names include Revamil, Mebo, Melladerm, and L-Mesitran. Studies have shown their effectiveness in breaking up biofilms of Pseudomonas Aeruginosa, one of our most notorious and commonly drug resistant infections. There have also been promising results in treating recurrent vaginal yeast infections and cold sores. Using honey or other bee products for therapeutic purposes or apitherapy has become an alternative therapy of sorts. It can be marketed in many ways from the benign consumption of honey all the way to the extreme of getting stung by bees on purpose. Of course, no alternative therapy would be complete without the possibility of covid prevention so here is an article on that topic https://pubmed.ncbi.nlm.nih.gov/32945590/
While the domestication of the honeybee certainly goes as far back as hungry humans do, modern beekeeping has not changed much over the past hundred and fifty years. The Reverend Lorenzo Langstroth's book "On the Hive and the Honeybee" first published in 1853 is still considered to be the foundation of modern beekeeping. The Langstroth beehive still bears his name and is what comes to mind when most people picture one. The book is also a great read albeit a bit preachy, but the man was a Reverend so finding God in his honeybees should not be a surprise.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Further reading and references
https://www.buzzaboutbees.net/Honey-And-Ancient-Medicine.html
https://pubmed.ncbi.nlm.nih.gov/23569748/
https://pubmed.ncbi.nlm.nih.gov/30126199/
https://pubmed.ncbi.nlm.nih.gov/21530807/
https://pubmed.ncbi.nlm.nih.gov/33291554/
https://pubmed.ncbi.nlm.nih.gov/34436203/
https://pubmed.ncbi.nlm.nih.gov/31505796/
https://pubmed.ncbi.nlm.nih.gov/34959664/
https://pubmed.ncbi.nlm.nih.gov/35047540/
Fentanyl
The wave of overdose deaths that swept across the nation in this past year claimed over a hundred thousand lives according to the CDC in a recent statement. Overdose deaths are one of the few things increasing faster than inflation. Drug use is part of the human condition and like everything else it is only getting worse. People have been seeking to expand their mind or numb their pain forever and drugs have always been a popular option for achieving that. Today though it is a much more dangerous game than it once was, the line between potion and poison is blurrier than ever.
The wave of overdose deaths that swept across the nation in this past year claimed over a hundred thousand lives according to the CDC in a recent statement. Overdose deaths are one of the few things increasing faster than inflation. Drug use is part of the human condition and like everything else it is only getting worse. People have been seeking to expand their mind or numb their pain forever and drugs have always been a popular option for achieving that. Today though it is a much more dangerous game than it once was, the line between potion and poison is blurrier than ever.
The illicit drugs of the previous generation while having the potential to kill you did so far less often. The big reason is there were only a few different things you could be getting and if it were adulterated or cut with something it was usually with something inert that would reduce the potency of the product while expanding the seller's margin. This has always been a problem with powdered substances like cocaine, heroin, methamphetamine mix a little of that with a little of this and one pound of drugs can turn into two or ten. Today potent opiates like fentanyl or one of its derivatives are produced in mass quantities and used to turn one pound of drugs into one hundred pounds or more.
As a prescription fentanyl is normally prescribed as a patch in varying strengths that deliver micrograms over the course of three days. As the potency of these chemicals increases the window of forgiveness decreases. Poorly made street products are not always homogeneous mixtures. The cook measured wrong, his boss did the math wrong, or maybe the product they were starting with was not what they thought it was. Any one of these mistakes can turn profitable street products into powdered Russian roulette. Mistakes happen, we are all human or it could have been intentional, tainting a competitor's product is not unheard of even if it is bad business. Good news though a study using the IMF and DEA database revealed that the price of powdered drugs was down significantly between 2016-2021. Street drugs may be the only thing that is becoming more affordable even if the quality can be suspect.
Legal settlements for the opioid crisis are now so common you can easily get lost in the articles reporting them. Purdue usually gets the bulk of the blame and the largest financial settlement but even Mckinsey the consulting firm paid out 600 million for its role in marketing Oxycontin. While there is plenty of legal liability to go around at the root of it all is a problem that pre-existed any of these corporations or heck even any of these drugs. Preventing opioid overdoses is now a cash cow that can be targeted. The Naloxone nasal spray market has what investors would call growth potential. There is even talk of an opioid vaccine but don’t worry it's still in the animal testing phase but perhaps a decade from now they will be required for college admission.
Historically our current Fentanyl crisis has some striking similarities to the Opium wars. British and American merchants working with Chinese smugglers were moving large amounts of opium into China, the increased availability took what was once a rarely used medicine and turned it into a popular recreational drug. Between 1787 and 1833 the opium trade would grow extensively from 4000 chests annually to over 30,000. The emperor would issue several edicts over this time outlawing opium but their war on drugs was an even greater failure then ours. They would finally get fed up and in 1839 the emperor would command his Viceroy Lin Tse-Hsu to end the opium trade once and for all.
His first action was to seize all the opium in Canton, and this would start a standoff that would last several days until finally Charles Elliot, a representative of the British government would arrive and essentially pay a ransom for the drugs which were immediately then destroyed. By the end of the standoff, it is estimated that about 1300 tons of opium was destroyed. The British government would not take kindly to this action and by 1840 they would authorize troops to impose reparations for the financial losses to English traders. By summer the Royal Navy was shelling the port of Macao. The combination of superior English firepower and a weakened Qing dynasty would result in a lopsided victory resulting in the Treaty of Nanking which opened China up to trade and ceded control of Hong Kong to Britain.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Further reading and references
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm
https://pubmed.ncbi.nlm.nih.gov/35528111/
Endothelial Insult
Cardiovascular disease is a leading cause of death in the western world despite our vast knowledge on the subject. The pump gets the bulk of the attention when you think of your cardiovascular system, but the hoses are where the degradation begins. Inside all our blood vessels is a thin single cell layer known as the endothelium.
Cardiovascular disease is a leading cause of death in the western world despite our vast knowledge on the subject. The pump gets the bulk of the attention when you think of your cardiovascular system, but the hoses are where the degradation begins. Inside all our blood vessels is a thin single cell layer known as the endothelium. Think of it as a smooth protective film that helps keep the lumen open and flowing properly. Imagine over time this film becomes damaged and must repair itself, like how a superficial wound will scab over. The technical term for this scab is atherosclerotic plaque and it clogs up our blood vessels in the same manner that a hair can clog a drainpipe. As our endothelium ages it simply becomes less efficient and inflammatory particles accumulate over time. In extreme dysfunction scabs upon scabs accumulate on top of one another creating what is called a fibrous cap. The larger this becomes the more it sticks out from the vessel wall exposing it to the sheer forces of your blood pumping, worst case scenario it can snap off and be whisked away by the blood stream resulting in a heart attack or stroke depending upon the end location.
There is an interesting test that can be done to help determine endothelial dysfunction, using an ultrasound of the brachial artery and a blood pressure cuff. Pumping the cuff up and releasing it causes a rush of blood that can be measured with the ultrasound. A recent study using this method showed that covid survivors almost a year post infection displayed increased endothelial dysfunction compared to matched controls. Labs in these same patients would also show an elevated high sensitivity CRP and tumor necrosis factor that far out as well. They were even able to pull and compare labs to when the patients were hospitalized (table 2). These further confirm the inflammatory aftermath of infection and all the negative consequences that may follow. The study also raises a particularly important question: how long do these effects last?
The past two years have of course been the single largest endothelial insult in human history with the widespread transmission of Covid-19. The cardiovascular complications of infection are well documented and in no small part due to the inflammatory state that infection can induce. Some parties have used this as an argument for more extensive covid-19 vaccination of the population, downplaying potential adverse events from the vaccine in exchange for the potential benefits. If the vaccines were truly preventing transmission, then their adverse events may be worth the cost, but if you are on booster number five and you still get covid, we must now ask what role did five rounds of immunization play in your current inflammatory status? Is the inflammation caused by the vaccine additive or synergistic with repeat doses? The recent guidance from the CDC to increase the time in between shots to prevent adverse events seem to suggest this idea has merit.
A few months ago, some brave soul had the stones to publish some comments looking at cardiovascular biomarkers post vaccination in his patients at a preventative cardiology practice. The original version can be found below; it is a short read.
Honestly not sure how it was allowed to be published due to the author’s conclusion that sets off every alarm at thought police headquarters.
““mRNA [vaccines] dramatically increase inflammation on the endothelium and T cell infiltration of cardiac muscle and may account for the observations of increased thrombosis, cardiomyopathy, and other vascular events following vaccination.”
I waited several months to see if the author would continue to exist, which is the case because several corrections were made in December (link below).
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001053
There were indeed multiple corrections including grammar, spelling, and rewording that appears to obfuscate the conclusion but no corrections to the underlying data. The idea that the vaccines would cause an increase in inflammatory biomarkers is not far-fetched; it is exactly how they are supposed to work. The hope is that these elevated levels are transient and issues due to it are mild and worth the benefit. The labs were drawn between 2 weeks and 2.5 months after vaccination and compared to the patient’s own baseline scores.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Thank you for Reading feel free to share!
Further reading and references
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8882598/
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001053
https://pubmed.ncbi.nlm.nih.gov/35064792/
https://pubmed.ncbi.nlm.nih.gov/35013457/
Pfizer Advertisements
Pharmaceutical companies advertise with extreme prejudice, their ad budgets alone sponsor entire television channels and is second only to their lobbying division. Only two countries in the world allow direct consumer marketing of prescription products: the United States on free speech grounds and New Zealand because they have more sheep than people and sheep love commercials
Pharmaceutical companies advertise with extreme prejudice, their ad budgets alone sponsor entire television channels and is second only to their lobbying division. Only two countries in the world allow direct consumer marketing of prescription products: the United States on free speech grounds and New Zealand because they have more sheep than people and sheep love commercials. Advertising works, it is extremely effective at driving customer demand. As always though there is regulation and that is why your drug commercials must be so long and drawn out so they can inform you of both the good and the bad that the drug could cause. The side effects listed on these commercials can be quite disturbing and much like the surgeon general's warning on cigarettes they usually go ignored, but they are there at least to give the appearance of balance.
Recently though I have noticed in my limited television watching that Pfizer changed the advertising game with their new commercials. At first it seems like any other commercial, happy people, sunny skies, healthy children playing everything needed to link Pfizer with raw emotional bliss, but it ends right there. There is no horrible list of side effects because there is no product they are selling in this commercial. It is a brilliant proactive advertising campaign, even if a bit dystopian. Long past having to bother marketing products to you they can leave that to their best sales representative, the state. Meanwhile they launch this new ad campaign telling us how great they are while never having to mention anything negative much less the over two billion in settlements against the company for alleged violations of the FDCA and False Claims Act in the past. Their skirting of regulation is impressive and if you believe in preventative medicine why not a proactive public relations campaign to protect against future legal liability the magnitude of which may be correlated with public opinion.
Advertisings place in health care has always been a little dubious; the best doctors are rarely also the best salespeople. If a product works then advertising should not be necessary and it should stand on its own merit. Sales can still be supercharged by a good marketing campaign though and it occurs at many more levels than just magazine and tv ads. Teams of attractive sales representatives for drug companies heavily promote new products to prescribers. Free drug dinners to learn about the latest branded product were common, often getting continuing education credit for attending. All drug companies would play these games pushing their most profitable products at the time. As patents would expire so would the marketing campaign for the drugs, the lunches and free pens would continue but with a different pharmaceutical sponsor every so often a lot like NASCAR. Today drug advertising is heavily regulated but pervasive as ever seeming almost symbiotic with mass media. Looking to the past we can find the best examples of malfeasance due to this collusion.
At the turn of the previous century, we lived in an age with zero regulation, and this would lead to the rise of patent medicines. Drugs claiming to have radical benefits and sold under brand names like Hamlin's Wizard Oil and Lydia E. Pinkham’s Vegetable Compound would saturate the market. These products were big sellers at the time and big buyers of advertising in the newspaper accounting for half of the ad revenue. James Harvey Young would write a more detailed history in his 1961 book The Toadstool Millionaires: A Social History of Patent Medicines in America before Federal Regulation. Unfortunately, a few of these products would sometimes contain dangerously addictive substances like morphine or heroin.
This would lead to the 1906 Pure Food and Drug Act which required drug products to be labeled with what they were and require them to disclose dangerous substances like alcohol or cocaine and no detail of the label could be false or misleading. The wording of the act was unfortunately vague enough to invite different interpretations and it would be challenged in the 1911 supreme court case U.S. vs Johnson. The result of that decision was the clarification that the law only applied to false or misleading statements regarding its ingredients. False therapeutic claims however were not forbidden by the 1906 act.
Congress realizing its intentions had been subverted would respond with the 1912 Sherley Amendment prohibiting false therapeutic claims intended to defraud the purchaser. Once again however the language of the law “intended to defraud” would be a high prosecutorial hill to climb and so it would do little to curb the problem. It would be almost three decades later before another wave of public outrage over a hundred deaths linked to a liquid sulfanilamide product would once again cause congressional action. The 1938 Food Drug and Cosmetic act would require products to prove they were safe and require FDA approval prior to marketing. Pfizer ranks second behind only Glaxo-Smith-Kline for settlements due to alleged violations of this act, those settlements are in the billions, a liability their new advertising campaign elegantly avoids.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Further reading and references
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690298/
Donohue J. A history of drug advertising: the evolving roles of consumers and consumer protection. Milbank Q. 2006;84(4):659-699. doi:10.1111/j.1468-0009.2006.00464.x
https://americanhistory.si.edu/collections/search/object/nmah_1215373
https://www.fda.gov/files/about%20fda/published/The-Sulfanilamide-Disaster.pdf