September 17, 2024 • 37 mins
It's the debut episode of PodcastRx with Chris Bender! Regular listeners know Chris is a clinical pharmacist with Diamond's Office of Pharmacy Therapeutics and Integrated Clinical Services (OPTICS) team and a repeat guest many times over on PodcastRx. We liked his appearances so much that we asked him to stay permanently- and he accepted! We're pleased to bring you a more segment driven-show centered around one of Diamond's most enthusiastic pharmacy nerds (his term, not ours :-)
In our first segment, which we've dubbed "Into the Clinic", Chris delves into some recent medication headlines and recent studies of note, including:
-Kisunla Approval
-PSA Levels in Transgender Women
-Saline Nasal Sprays and Sick Days
Then we shift into our main discussion block around some "mature" topics, as September is Healthy Aging Month. We explore:
-Effectiveness of Multivitamins
-Ways to Prevent Falls
-Advancements in Alzheimer's Medication
And in our final segment, we take a somewhat lighthearted (but serious) look at some crazy contaminants found in OTC vitamins and supplements.
Thanks so much for listening. Please rate, review, and share!
Links to supporting material found in today's episode.
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
Quiz Countdown by PaoloArgento
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hi, this is Adam for PodcastRx.
(00:02):
If you're wondering why we haven't had any new episodes lately, well, consider it a summer
vacation.
While we were on vacation, we took some time to rethink and retool this show.
We decided it was time to freshen up the format and bring in a new voice, a pharmacist voice
to be exact.
And long-time listeners of PodcastRx know there was no pharmacist more supportive of
this show than Chris Bender from the Optics team.
(00:25):
And so we asked him if he would be willing to be that new voice.
And I'm happy to say that he accepted.
So I'm pleased to present you the new PodcastRx with Chris Bender.
Here we go.
From Diamond Pharmacy and Optics, this is PodcastRx with Chris Bender.
(00:47):
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.
I'm hoping that today can be a real knowledge booster.
A classic Batman and Robin or Jordan and Pippin type scenario.
(01:11):
A full armamentarium of options that clinicians can choose from.
For this debut episode of September 2024, Chris rounds up and reviews some relevant
medication news.
We discuss healthy aging topics, including multivitamins, fall prevention, and Alzheimer's
drugs in our main segment.
And we finish out the show with a light but serious look at contaminants in vitamins and
(01:31):
supplements.
I'm Adam Campbell, and thank you for listening.
Well hello everyone, and welcome back to PodcastRx.
As you can tell from the introduction, we've done a bit of remodeling around here.
(01:52):
Loyal listeners will know that clinical pharmacist Chris Bender from the Optics team has been
the guest on this show many times over its history, has been a guest on this show many
times over its history.
I know it's at least 10 episodes out of the 53 that we produced.
And well because of this, I've joked many times over that the show would become Chris
Bender's PodcastRx.
Well, we've gone and done just that, more or less.
(02:15):
I want to say that we're really excited to transform the show and center it around Chris
and his work with the Optics team.
Listeners know that Chris' enthusiasm for podcasting and his facility for transforming
dry and often dense clinical material into a fun and engaging listening experience.
And we're really looking forward to having that on a permanent basis now.
And this new PodcastRx will be more of a segment-driven show, so that's going to give you a more even
(02:40):
listening experience and a more enjoyable listening experience too.
Well that's enough from me.
Chris, welcome to the new PodcastRx and thank you for being the guy.
Well, thanks a lot, Adam.
Love what you've done with the place.
And listen, I'm just glad that I kept all my punch cards from all the previous episodes.
Turns out, you know, if you're on enough episodes, you eventually become a permanent host.
(03:04):
So it's nice to be here.
But in all seriousness though, you know, I'm really honored that you and your team thought
highly enough of me to make me a permanent fixture on the show and obviously I'm really
excited to be part of this revamp.
Now just from our, you know, discussions offline, I really think that this new format is really
going to be a great change and hopefully our listeners will feel the same.
(03:29):
I couldn't agree more, Chris, and I no doubt that they will feel the same about it.
I think it is going to be a really enjoyable experience going forward.
I mean, you know, we've got so many ideas and so many things to get into, so can't wait
to do it.
But you know, getting started now in September for this first show of the new PodcastRx,
if you will, it's September, it's the end of summer.
(03:51):
So that means shorter days and Steeler football on TV.
Well, at least in our part of the country.
But with September also comes a few important health observances that I wanted to talk with
you about today.
And those observances are geared toward the more senior members of our population.
So specifically, September is home to healthy aging month and also falls prevention week.
(04:11):
And within those two areas, there's a myriad of medication issues that we can discuss.
And there's also the start of a, sorry, and there's also the start of respiratory disease
season and all the attendant vaccine concerns.
So Chris, I wanted to dig into those later in the show, but first let's start this debut
episode of Chris PodcastRx with Chris Bender with a new segment, the first new segment
(04:34):
that we're calling into the clinic.
Now this is based on an optics resource that you've generously adapted for this show, the
clinical watch.
So give us the introduction to this segment.
Sure.
So the clinical watch actually started off as a sort of a spin off of a preexisting optics
resource that is called the clinical update, which the clinical update is a quarterly publication
(04:58):
that gets sent out to all of our clients.
And the idea is to provide a deep dive on 10 ish topics that we feel are applicable
to our book of business.
So this could include anything like guideline updates, new drug approvals, FDA warnings
and stuff like that.
But what I found, you know, is that oftentimes there are many topics that either get left
(05:19):
on the cutting for cutting room floor, or they're simply not big enough to warrant a
deep dive, you know, from like a long form reading perspective.
You know, I'm also aware that not everybody has the time to read lengthy articles like
that.
And that's where the clinical watch comes in, comes in.
So in the clinical watch, I provide, again, 10 ish topics, but more of like a quick, easy
(05:41):
to read fashion geared toward our clients, our executive consultant pharmacists, as well
as our production pharmacists.
So these topics could still include things like guideline updates and drug approvals,
but they could also range into notable drug shortages, new generics, and even recent clinical
trials.
So basically, my approach to the clinical watch has always been to provide the reader
(06:05):
with a quick overview of the news, as well as a bit of context to help them employ that
information in their day to day clinical responsibilities.
It's a really great concept, Chris, and I'm sure that it's going to lend itself perfectly
to podcasting.
And so let's let's jump right into it.
Let's head into the clinic.
(06:31):
All right.
Well there have been a couple new drug approvals, one of which is particularly applicable today's
main segment.
And that is Kisumla, which was approved for adults with early symptomatic Alzheimer's
disease.
But of course, we'll leave that one for a little bit later.
The other was O2VeR, which was approved for adults with COPD.
(06:56):
Now it's a nebulized PDE3 and 4 inhibitor, which is a somewhat new mechanism of action
for the disease state.
But I want listeners to note that Roflumelast is a PDE4 inhibitor, and that's been approved
for COPD since 2011, and it's actually available as a generic.
Now basically, O2VeR improved FEV1 by an average of 90 milliliters over placebo across its
(07:23):
phase three trials, which is respectable, but it falls slightly below what is considered
to be the minimum clinically important threshold of about 100 milliliters.
Now additionally, patients in these trials were only being treated with one long acting
bronchodilator, which might limit the applicability of these results.
(07:43):
So namely because one, guidelines recommend adding a second bronchodilator to those who
are not well controlled on one bronchodilator, and clinical trials have shown that adding
a second bronchodilator can yield larger improvements than those seen with this medication.
So overall, obviously not to poo poo it, it's always good to have more treatment options,
(08:06):
but in my opinion, O2VeR would probably be best reserved for those patients who remain
symptomatic despite using dual bronchodilators plus an inhaled corticosteroid if they have
inflammatory markers, as well as oral roflumelast.
Now moving on, there were also some interesting studies that came out.
(08:28):
So the first of these was regarding PSA levels for transgender women who are receiving estrogen
therapy.
Now this trial was interesting because transgender women will still require screening for prostate
cancer, but because they're receiving estrogen, their PSA levels will be artificially low,
leading to potentially missed cases.
(08:49):
So this study showed that among this population, the median PSA was 0.02 nanograms per ml,
which is substantially lower than the median PSA of one nanogram per ml among cisgender
men.
Now traditionally speaking, prostate cancer suspicion starts when PSA exceeds four nanograms
(09:11):
per ml, but because of these findings, providers may need to rethink the utility of this threshold
when evaluating transgender women.
Another study to highlight showed that using a saline or gel-based nasal spray can reduce
the number of sick days from respiratory infections in higher risk individuals.
So the trial involved enrolled individuals who either had frequent respiratory infections,
(09:35):
that was at least three or more per year, or those who were more likely to have serious
respiratory infections like those who are older, obese, immunocompromised, diabetic,
or those who have heart or lung diseases.
Now participants were randomized to receive either a saline nasal spray, a gel-based nasal
spray, behavioral interventions via a website, or just usual acute sick care.
(10:03):
And what they found is those using, well essentially those using nasal sprays were instructed to
use them six times a day at the first sign of illness or after potential exposure to
infection.
What they found is that over the course of six months, participants reported an average
of 11.8 sick days in the saline nasal spray group, 12 sick days in the gel-based nasal
(10:26):
spray group, 14.2 days in the behavioral website group, and 15.1 days in the usual care group.
Those in the nasal spray groups were the only ones to have significantly fewer sick days
compared to usual care.
Now because saline nasal sprays are easily obtained over the counter, this strategy,
(10:46):
if it were widely implemented, could potentially have positive impacts for not only reducing
sick days, but also potentially decreasing antibiotic prescribing.
Chris, I want to say that this last item, this last study, it's particularly interesting.
It's a UK study and it would be really fascinating to see a larger study done here in the States
(11:09):
and build on these conclusions because it seems so simple.
Yeah, and with it being so accessible and relatively affordable, if someone is high
risk, it's one of those things where it doesn't have any harm in trying it out, especially
at the onset of sick season.
So it might be good.
Yeah, for sure.
(11:31):
And thank you for those clinical highlights, Chris.
With that out, we're going to take a quick break.
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(12:36):
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Now back to Podcast RX with Chris Bender.
All right.
Welcome back to Podcast RX with Chris Bender.
And for our main discussion today, September is healthy aging month.
And Chris, I wanted to pick your brain on some fairly popular pharmacy and medication
(12:57):
topics related to healthy aging, particularly multivitamin use, preventing falls and a breakdown
of the newer Alzheimer's drugs developed in the past few years.
Sure.
So the concept of healthy aging really encapsulates so much, but there's been a lot of movement
in those few areas that you mentioned.
So I think it's good to highlight those first.
(13:18):
And then of course, we can kind of round it out with some brief recommendations to encourage
healthy aging as a whole.
So first, let's talk multivitamins, which is of course, one of the biggest markets in
the United States and the world.
One in three U.S. adults take a daily multivitamin.
Sometimes they take it to restore deficiencies, but in many cases, they're taking it to simply
(13:41):
promote general health and well-being.
But the question has always been whether they actually work.
And if so, what do they work for?
Well, recently, we've had some clinical trials come out that shed some light on multivitamins.
And the biggest of these trials was Cosmos, which is the largest trial studying multivitamin
supplementation, and it evaluated the effects of daily multivitamin use on cancer, cardiovascular
(14:06):
disease, and even mortality.
So it assessed individuals over an average of three and a half years.
Unfortunately, multivitamin use wasn't beneficial in any of these areas.
To add insult to injury, another recent study that followed individuals for 20 years showed
no benefit of daily multivitamin use on the risk of death.
(14:30):
Were there any positive outcomes?
Yeah.
And it was a pretty big one from a subset of three of the Cosmos, from a subset of three
Cosmos trials.
So these ones were specifically Cosmos Mind, Cosmos Web, and Cosmos Clinic, which all
showed that use of a daily multivitamin for a duration of two years improves episodic memory.
(14:55):
So individuals were better able to recall events from the past, like their 16th birthday,
for example.
But more, it also improved global cognition, which is a composite assessment, including
things like memory, verbal fluency, attention, et cetera.
The magnitude of effect on global cognition was equivalent to, the researchers concluded,
(15:20):
to reducing cognitive aging by two years, which obviously can be pretty profound.
So what were the main takeaways from this large trial?
Yeah.
So in all, your daily multivitamin probably isn't going to reduce your risk of cancer,
cardiovascular disease, or death, but it does likely provide some cognitive benefit.
(15:42):
Now it should be noted that the exact type of multivitamin studied in the Cosmos trial
was Centrum, hashtag, not an ad, which is a broad multivitamin that includes both basic
vitamins like A, B, C, D, E, and K, along with multiple minerals like calcium, chromium,
copper, magnesium, selenium, and zinc.
(16:04):
Chris, how exactly do you think these multivitamins are helping with cognition, in particular,
of all things?
What's pharmo-kinetically, if I'm saying that right, is going on here?
Yeah.
So we don't, researchers don't know exactly, but obviously it's probably likely the result
(16:25):
of correcting some sort of vitamin or micronutrient deficiency.
And we can speculate this because there have been studies showing that deficiencies in
vitamins B and D and micronutrients such as zinc and iron have been associated with cognitive
decline.
There's also some research to suggest associations between vitamin E and neurocognitive protection
(16:51):
as well.
So some of the researchers and experts in the area suggested that the only downside
is that we don't know exactly what component in the Centrum worked, but it may work for
multiple people because it contains so many different minerals and vitamins.
So individual A might've been deficient in vitamin B, while individual B might've been
(17:15):
deficient in vitamin D. And just so happened that all of those things were included in
the one vitamin.
So they kind of worked for every patient regardless of their deficiency, which is why it's important
to make the distinction that this trial used such a broad spectrum multivitamin.
So that's why we can only really recommend that one as opposed to something that's a
(17:37):
little more narrow and may not include every particular nutrient.
Yes.
And I did want to say to the listeners that everything that Chris is sharing here, whether
in the clinical watch or in this segment, all these studies, we will have links to all
these materials in the show notes for every episode if you want to go and do some additional
reading.
(17:57):
Great mention.
So next, I know you had mentioned fall prevention, which is obviously important to consider as
we age because falls can result in fractures, which can then have significant downstream
effects like impaired mobility, decreased quality of life, and in some cases, even an
increased risk of death.
(18:17):
So for that reason, the United States Preventative Services Task Force or USPSTF recommends exercise
to prevent falls for adults 65 years and older who are at increased risk of falls.
So who exactly is considered to be at an increased risk for falls and what kind of exercises
(18:40):
are we talking about here?
Yeah.
So individuals at risk for falls would obviously include those with a history of falls, but
would also include those with other key risk factors.
So particularly impairments in their mobility, their gait, and their balance.
Unfortunately, those latter criteria are a bit vague.
(19:00):
So provider discretion is going to play a large role in identifying qualifying individuals.
Now with regard to the exercises, the majority of clinical trial data shows benefit for supervised
physical therapy and group exercise classes, but they don't really shed a lot of light
on individual exercises themselves.
(19:21):
The most commonly studied exercise routines are typically related to gait, balance, and
functional training, followed by strength and resistance training, flexibility, and
endurance training.
The most common frequency that is seen in clinical trials is two to three sessions per
week.
Now obviously, structured programs have been the best studied and will therefore be preferred,
(19:46):
but my opinion is that so long as it's done in a safe manner and of course in agreement
with one's healthcare provider, home exercises can obviously be just as beneficial.
Is there anything else to keep in mind from a general prevention perspective?
Yeah, obviously we can talk for hours about what constitutes a generally healthy lifestyle.
(20:13):
So let's try to simplify it across a few key domains.
So for one, maintain your physical wellbeing.
So this means engaging in moderate intensity physical activity in whatever capacity works
for you for a minimum of 150 minutes per week and incorporate strength training twice a
(20:35):
week.
Second, maintain a healthy diet.
So there is an infinite amount of information online regarding diet and it always seems
like the new IT diet is changing weekly.
So I like to keep it simple and recommend the Mediterranean diet since it's shown to
have the greatest benefits from an overall health perspective in clinical trials.
(20:57):
Now essentially, the Mediterranean diet is an eating style that encourages fruits, vegetables,
whole grains, nuts, legumes, and healthy oils like olive oil.
It recommends dairy products daily, but in moderation, fish and poultry a few times
a week in moderation, red meat in small amounts and infrequently, and minimizing sugary processed
(21:22):
foods.
And finally, don't forget to maintain a healthy social life.
This can involve volunteering, keeping close friends, finding new activities to meet new
people or heck, even just getting a dog.
Those are all great recommendations, Chris.
And one thing I'm surprised you didn't mention, just being a pharmacist yourself, I'm surprised
you didn't mention regular medication reviews to reduce risk of falls.
(21:47):
Ah, yes.
Nice catch, Adam.
That of course is a very important thing, especially as we age, the number of medications
seem to increase as well.
So it's always a good thing to have your medications regularly reviewed to make sure there's nothing
contributing to the risk of falls.
But of course, that's not as much fun as a dog.
No, definitely not.
(22:07):
I know you could speak to that directly, but either way, it's always great to have those
proactive steps.
But in some cases, we got to talk about treatment such as with Alzheimer's disease.
And there have actually been some recent advancements in this space.
Could you talk to me about that?
Sure.
So if you know, for decades, we really only had two medication options.
(22:28):
We had colon esterase inhibitors, which include dinapazil, rivastigmine and galantamine.
And then we had the NMDA receptor antagonist, which is memantine.
And those options really just have modest benefits at best, even when they're taken
together.
So, you know, this unfortunately, this has been an area of serious need for quite some
(22:49):
time.
Fortunately, we are starting to see some new advancements with the with the introduction
of the amyloid beta reducing monoclonal antibodies.
And these include the brand products, aduhelm, lekembe and the newest member, Kisumma.
All three are approved to treat mild cognitive impairment or dementia in Alzheimer's disease.
(23:14):
Now, since the first approval in 2021, these medications have been a bit controversial
because their mechanism is rooted in the beta amyloid hypothesis.
So let me explain.
Essentially, the current consensus regarding the development of Alzheimer's disease suggests
that amyloid beta accumulation in the brain leads to tau protein formation within neurons.
(23:37):
And this leads to neuronal death and cognitive impairment.
So by this rationale, the elimination of beta amyloid should result in reductions in cognitive
impairment.
So the first two drugs approved, aduhelm and lekembe.
Mainly these were studied to see if they could reduce beta amyloid, which they did.
(23:58):
Unfortunately, our clinical outcomes weren't really a huge focus of those trials.
And honestly, this is likely due to the fact that because these drugs work so far upstream
of the end damage, clinical trials of these drugs would need to be significantly longer
in duration than what is typically seen in clinical trials of new drugs.
(24:18):
Now the newest drug, Kisumma, is a little bit different for a couple of reasons.
First, the clinical trial for Kisumma actually did focus a little bit more on the hard clinical
outcomes compared to its predecessors.
And second, it's the only one of the three that can be stopped once amyloid plaques are
no longer detectable, which means that Kisumma could potentially be more cost effective and
(24:44):
easier for patients in the long run.
So for perspective, Kisumma reduced amyloid plaques by an average of 84% at 18 months.
So patients may only need to be on Kisumma for maybe up to two years.
Well, these new agents seem pretty cool, to put it very mildly and potentially game changing.
(25:04):
But you had mentioned that a lot of their effectiveness was wrapped up in the theoretical.
So how well do these drugs actually work and clinically work?
Yeah, ultimately, you know, that's the most important question.
I said originally that the majority of the data for adu home and leukembi was based on
amyloid beta lowering capability.
(25:25):
But those trials did still look at cognitive outcomes to an extent.
So we can sort of indirectly look at those data compared to the data for Kisumma.
And what we see is somewhat modest improvements in cognition.
So the one clinical outcome that all three clinical trials looked at was the clinical
(25:46):
dementia rating scale sum of boxes.
And this is basically a global measure of cognition that gives the patient a score of
zero to 18.
The closer to 18, the worse the cognitive impairment.
Now, typically, untreated patients, as you could guess, will continue to progress closer
to a score of 18 over time.
(26:08):
So these trials compared these drugs to placebo to see if they were able to slow patients
worsening based on this scale.
And what they found is that placebo patients worsened by 0.37 points compared to adu home,
0.45 points compared to leukembi, and 0.68 points compared to Kisumma.
(26:32):
So yes, by this measure, these drugs slow worsening compared to placebo.
But you and our listeners may be wondering, does a 0.37 or 0.68 point difference in a
clinical trial result in a real world difference?
And that's the question everyone is trying to grapple with at the moment.
(26:52):
Unfortunately, it may not be.
Current consensus suggests that you'd hope to see a 0.9 point improvement over placebo
for people with mild cognitive impairment and 1.63 for those with mild Alzheimer's disease.
Now, that being said, these drugs appear to be more effective in those with earlier and
(27:14):
less advanced disease.
So these may really help the earlier that you give them.
And we may see more robust if it is excluded, if it's limited to those patients.
And obviously, these drugs are still so new, and they've only been studied for a couple
of years in clinical trials.
So we don't know if this initial benefit is big enough to translate into even more profound
(27:38):
long term benefits, like almost like like ripples in a stream, so to speak.
And one final note on these drugs, I know I'd mentioned three, three brand name drugs.
Well, add you home is actually being discontinued in November of this year, namely so that the
manufacturer can focus more on its other drug, leukemba.
(27:59):
I'm sure we're going to be revisiting these drugs in the coming years.
Again, so much more study to do on them.
But interesting that add you home, which had a lot of controversy surrounding it.
And as you mentioned at the top of the discussion, especially that controversy that it was sort
of seemed to be fast tracked for approval despite the late evidence.
(28:19):
And it was also that it was expensive as well, and poised to make a lot of money for the
manufacturer.
So it's just interesting that now it's going away.
I know it causes a lot of a lot of waves.
And now it's gone.
You know, just for my own speculation, it's probably because they have two drugs.
The same manufacturer has both add you home and leukemba.
(28:40):
Leukemba had somewhat better looking data in clinical trials.
And if we're being honest, add you home kind of had a bit of a stigma surrounding its name.
So maybe they think, hey, let's just stick with the other one.
Yeah.
Moving forward.
Right.
Makes a lot of sense.
All right.
Let's take another break.
(29:02):
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Let's get back to Podcast RX.
(30:05):
And in today's final segment, we're going to take a somewhat lighthearted look at something
very serious, contaminants and over-the-counter supplements.
And Chris, you've given plenty of Optics presentations on vitamins and supplements and what we just
talked about.
And you did one of these for NCCHC pretty recently.
We know how popular vitamins are with the healthy aging crowd, and we also know that
(30:25):
supplements aren't regulated the same way as prescription drugs.
So that leaves a lot of room for impropriety and impurity.
Regarding the latter, I was curious, what are your personal top five craziest contaminants
that have been found in vitamins and supplements?
All right.
So I don't know if we should start with a number five or something like that.
(30:50):
I like that.
We have the most common and perhaps the least surprising one.
Of all adulterated supplements reported, 45% of them are sexual enhancement products.
In some cases, these supplements contain actual drugs used for erectile dysfunction like Viagra
(31:10):
and Cialis.
So no wonder they work so well.
You know, I just have to ask with that one.
I do have to wonder how Smiling Bob from the N-Zyte commercials is doing.
Just wonder.
That's a fantastic hit of nostalgia right there.
And fun fact, the owner of that company, not Bob himself, the actor, but the person who
actually started the company, is currently in jail for fraudulent activity.
(31:34):
So just speak to your point.
Exactly.
Number four, we have weight loss supplements.
So these can actually be contaminated with stimulants like Cebutramine, which actually
used to be a prescription medication used for appetite suppression.
But it's been discontinued in many countries, including the U.S., as it's been associated
(31:59):
with increased risk of cardiovascular disease and strokes.
Just like weight gain is.
Yeah, exactly.
Double-edged sword.
Number three, we have muscle building supplements.
These have been contaminated with anabolic steroids or steroid like substances.
(32:21):
Just like you said with number five, no wonder they work so well.
Exactly.
Sometimes if it works, it's got the actual stuff in it.
Number two, these one, this is where it starts to get a little scary too, bacterial and fungal
contamination.
In one assessment, researchers found bacteria in all 138 products they investigated with
(32:44):
many also containing toxic fungi.
Fungal contamination of dietary supplements has been has been linked to serious liver,
intestinal and appendix damage.
Well, this is straight up horror movie stuff when you get into this.
And I just want to also give a shout out to another podcast out there, Swindled.
I don't know if you're familiar, but it's a true crime podcast, but not the murder kind,
(33:10):
more about financial crimes and fraud and things like that.
And they recently did an episode on a compounding pharmacy up in Massachusetts, I believe, that
their unclean manufacturing practices sickened people with a fungus that was really hard
to treat.
I think it was the largest fungal outbreak of that nature in American history.
(33:31):
So yeah, it's very serious stuff.
Yeah, I am not familiar with the podcast, but I'm familiar with the story.
And that was absolutely massive when that came out.
So yeah, fungal, a systemic fungal infection is no joke.
So we got to be careful with everything, but you know, definitely these, these supplements
(33:52):
and stuff.
Good number one, heavy metal contamination, which is not as good sounding as the music
in a study of 121 products, 5% surpassed the safe daily consumption limit for arsenic.
2% had excess lead, cadmium and aluminum, and 1% had too much mercury.
(34:16):
Now, if you're familiar with the mad hatter, too much mercury is probably not a good thing.
Now, all of these underscores the importance of purchasing supplements whose quality has
been verified by one of three highly recommended independent laboratories.
These include the United States Pharmacopeia, NSF International, and consumerlabs.com.
(34:39):
Manufacturers whose products pass inspection will have a seal of approval on their bottle.
So as a consumer, whenever you're in doubt, you can of course always ask your pharmacist,
but look for those products with the seal of approval to make sure that you're protecting
yourself.
That is most excellent and practical advice, Chris.
(35:00):
And that also takes us to the end of our time.
So that does it.
This is the debut episode of Podcast RX with Chris Bender.
And Chris, I want to thank you for taking this on.
And I look forward to hearing you break down many more topics like you did today.
Absolutely.
Always a pleasure talking with you.
And as I said, links to the material mentioned in today's segments will be included in the
(35:21):
show notes.
If you like what you hear, please follow us on the podcast platform of your choice.
We actually just started our show, hosting our show on rss.com to get it out there better.
And you can find the podcast RX on all the major players, podcast, Apple podcasts, Spotify,
iHeartRadio, Amazon.
We also post our episodes to YouTube.
(35:42):
Look for Diamond Pharmacy Services on YouTube and you'll find the podcast RX show there.
Please rate, review us if you can.
And we appreciate your help building this show.
Chris, thank you again.
We'll be talking very soon, I think.
Yes, sir.
Take care.
(36:04):
Podcast RX features conversations with healthcare professionals.
The statements and opinions discussed herein are for informational purposes only.
This podcast should not be considered 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.
(36:32):
Podcast RX is a production of Diamond Pharmacy Services.
Find our show on Apple podcasts, 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.
(36:53):
Thank you again for your support.
Hi, this is Adam for PodcastRx.
(00:02):
If you're wondering why we haven't had any new episodes lately, well, consider it a summer
vacation.
While we were on vacation, we took some time to rethink and retool this show.
We decided it was time to freshen up the format and bring in a new voice, a pharmacist voice
to be exact.
And long-time listeners of PodcastRx know there was no pharmacist more supportive of
this show than Chris Bender from the Optics team.
(00:25):
And so we asked him if he would be willing to be that new voice.
And I'm happy to say that he accepted.
So I'm pleased to present you the new PodcastRx with Chris Bender.
Here we go.
From Diamond Pharmacy and Optics, this is PodcastRx with Chris Bender.
(00:47):
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.
I'm hoping that today can be a real knowledge booster.
A classic Batman and Robin or Jordan and Pippin type scenario.
(01:11):
A full armamentarium of options that clinicians can choose from.
For this debut episode of September 2024, Chris rounds up and reviews some relevant
medication news.
We discuss healthy aging topics, including multivitamins, fall prevention, and Alzheimer's
drugs in our main segment.
And we finish out the show with a light but serious look at contaminants in vitamins and
(01:31):
supplements.
I'm Adam Campbell, and thank you for listening.
Well hello everyone, and welcome back to PodcastRx.
As you can tell from the introduction, we've done a bit of remodeling around here.
(01:52):
Loyal listeners will know that clinical pharmacist Chris Bender from the Optics team has been
the guest on this show many times over its history, has been a guest on this show many
times over its history.
I know it's at least 10 episodes out of the 53 that we produced.
And well because of this, I've joked many times over that the show would become Chris
Bender's PodcastRx.
Well, we've gone and done just that, more or less.
(02:15):
I want to say that we're really excited to transform the show and center it around Chris
and his work with the Optics team.
Listeners know that Chris' enthusiasm for podcasting and his facility for transforming
dry and often dense clinical material into a fun and engaging listening experience.
And we're really looking forward to having that on a permanent basis now.
And this new PodcastRx will be more of a segment-driven show, so that's going to give you a more even
(02:40):
listening experience and a more enjoyable listening experience too.
Well that's enough from me.
Chris, welcome to the new PodcastRx and thank you for being the guy.
Well, thanks a lot, Adam.
Love what you've done with the place.
And listen, I'm just glad that I kept all my punch cards from all the previous episodes.
Turns out, you know, if you're on enough episodes, you eventually become a permanent host.
(03:04):
So it's nice to be here.
But in all seriousness though, you know, I'm really honored that you and your team thought
highly enough of me to make me a permanent fixture on the show and obviously I'm really
excited to be part of this revamp.
Now just from our, you know, discussions offline, I really think that this new format is really
going to be a great change and hopefully our listeners will feel the same.
(03:29):
I couldn't agree more, Chris, and I no doubt that they will feel the same about it.
I think it is going to be a really enjoyable experience going forward.
I mean, you know, we've got so many ideas and so many things to get into, so can't wait
to do it.
But you know, getting started now in September for this first show of the new PodcastRx,
if you will, it's September, it's the end of summer.
(03:51):
So that means shorter days and Steeler football on TV.
Well, at least in our part of the country.
But with September also comes a few important health observances that I wanted to talk with
you about today.
And those observances are geared toward the more senior members of our population.
So specifically, September is home to healthy aging month and also falls prevention week.
(04:11):
And within those two areas, there's a myriad of medication issues that we can discuss.
And there's also the start of a, sorry, and there's also the start of respiratory disease
season and all the attendant vaccine concerns.
So Chris, I wanted to dig into those later in the show, but first let's start this debut
episode of Chris PodcastRx with Chris Bender with a new segment, the first new segment
(04:34):
that we're calling into the clinic.
Now this is based on an optics resource that you've generously adapted for this show, the
clinical watch.
So give us the introduction to this segment.
Sure.
So the clinical watch actually started off as a sort of a spin off of a preexisting optics
resource that is called the clinical update, which the clinical update is a quarterly publication
(04:58):
that gets sent out to all of our clients.
And the idea is to provide a deep dive on 10 ish topics that we feel are applicable
to our book of business.
So this could include anything like guideline updates, new drug approvals, FDA warnings
and stuff like that.
But what I found, you know, is that oftentimes there are many topics that either get left
(05:19):
on the cutting for cutting room floor, or they're simply not big enough to warrant a
deep dive, you know, from like a long form reading perspective.
You know, I'm also aware that not everybody has the time to read lengthy articles like
that.
And that's where the clinical watch comes in, comes in.
So in the clinical watch, I provide, again, 10 ish topics, but more of like a quick, easy
(05:41):
to read fashion geared toward our clients, our executive consultant pharmacists, as well
as our production pharmacists.
So these topics could still include things like guideline updates and drug approvals,
but they could also range into notable drug shortages, new generics, and even recent clinical
trials.
So basically, my approach to the clinical watch has always been to provide the reader
(06:05):
with a quick overview of the news, as well as a bit of context to help them employ that
information in their day to day clinical responsibilities.
It's a really great concept, Chris, and I'm sure that it's going to lend itself perfectly
to podcasting.
And so let's let's jump right into it.
Let's head into the clinic.
(06:31):
All right.
Well there have been a couple new drug approvals, one of which is particularly applicable today's
main segment.
And that is Kisumla, which was approved for adults with early symptomatic Alzheimer's
disease.
But of course, we'll leave that one for a little bit later.
The other was O2VeR, which was approved for adults with COPD.
(06:56):
Now it's a nebulized PDE3 and 4 inhibitor, which is a somewhat new mechanism of action
for the disease state.
But I want listeners to note that Roflumelast is a PDE4 inhibitor, and that's been approved
for COPD since 2011, and it's actually available as a generic.
Now basically, O2VeR improved FEV1 by an average of 90 milliliters over placebo across its
(07:23):
phase three trials, which is respectable, but it falls slightly below what is considered
to be the minimum clinically important threshold of about 100 milliliters.
Now additionally, patients in these trials were only being treated with one long acting
bronchodilator, which might limit the applicability of these results.
(07:43):
So namely because one, guidelines recommend adding a second bronchodilator to those who
are not well controlled on one bronchodilator, and clinical trials have shown that adding
a second bronchodilator can yield larger improvements than those seen with this medication.
So overall, obviously not to poo poo it, it's always good to have more treatment options,
(08:06):
but in my opinion, O2VeR would probably be best reserved for those patients who remain
symptomatic despite using dual bronchodilators plus an inhaled corticosteroid if they have
inflammatory markers, as well as oral roflumelast.
Now moving on, there were also some interesting studies that came out.
(08:28):
So the first of these was regarding PSA levels for transgender women who are receiving estrogen
therapy.
Now this trial was interesting because transgender women will still require screening for prostate
cancer, but because they're receiving estrogen, their PSA levels will be artificially low,
leading to potentially missed cases.
(08:49):
So this study showed that among this population, the median PSA was 0.02 nanograms per ml,
which is substantially lower than the median PSA of one nanogram per ml among cisgender
men.
Now traditionally speaking, prostate cancer suspicion starts when PSA exceeds four nanograms
(09:11):
per ml, but because of these findings, providers may need to rethink the utility of this threshold
when evaluating transgender women.
Another study to highlight showed that using a saline or gel-based nasal spray can reduce
the number of sick days from respiratory infections in higher risk individuals.
So the trial involved enrolled individuals who either had frequent respiratory infections,
(09:35):
that was at least three or more per year, or those who were more likely to have serious
respiratory infections like those who are older, obese, immunocompromised, diabetic,
or those who have heart or lung diseases.
Now participants were randomized to receive either a saline nasal spray, a gel-based nasal
spray, behavioral interventions via a website, or just usual acute sick care.
(10:03):
And what they found is those using, well essentially those using nasal sprays were instructed to
use them six times a day at the first sign of illness or after potential exposure to
infection.
What they found is that over the course of six months, participants reported an average
of 11.8 sick days in the saline nasal spray group, 12 sick days in the gel-based nasal
(10:26):
spray group, 14.2 days in the behavioral website group, and 15.1 days in the usual care group.
Those in the nasal spray groups were the only ones to have significantly fewer sick days
compared to usual care.
Now because saline nasal sprays are easily obtained over the counter, this strategy,
(10:46):
if it were widely implemented, could potentially have positive impacts for not only reducing
sick days, but also potentially decreasing antibiotic prescribing.
Chris, I want to say that this last item, this last study, it's particularly interesting.
It's a UK study and it would be really fascinating to see a larger study done here in the States
(11:09):
and build on these conclusions because it seems so simple.
Yeah, and with it being so accessible and relatively affordable, if someone is high
risk, it's one of those things where it doesn't have any harm in trying it out, especially
at the onset of sick season.
So it might be good.
Yeah, for sure.
(11:31):
And thank you for those clinical highlights, Chris.
With that out, we're going to take a quick break.
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(12:36):
Sapphire EHR, cloud-based compatible correction specific electronic health records.
Now back to Podcast RX with Chris Bender.
All right.
Welcome back to Podcast RX with Chris Bender.
And for our main discussion today, September is healthy aging month.
And Chris, I wanted to pick your brain on some fairly popular pharmacy and medication
(12:57):
topics related to healthy aging, particularly multivitamin use, preventing falls and a breakdown
of the newer Alzheimer's drugs developed in the past few years.
Sure.
So the concept of healthy aging really encapsulates so much, but there's been a lot of movement
in those few areas that you mentioned.
So I think it's good to highlight those first.
(13:18):
And then of course, we can kind of round it out with some brief recommendations to encourage
healthy aging as a whole.
So first, let's talk multivitamins, which is of course, one of the biggest markets in
the United States and the world.
One in three U.S. adults take a daily multivitamin.
Sometimes they take it to restore deficiencies, but in many cases, they're taking it to simply
(13:41):
promote general health and well-being.
But the question has always been whether they actually work.
And if so, what do they work for?
Well, recently, we've had some clinical trials come out that shed some light on multivitamins.
And the biggest of these trials was Cosmos, which is the largest trial studying multivitamin
supplementation, and it evaluated the effects of daily multivitamin use on cancer, cardiovascular
(14:06):
disease, and even mortality.
So it assessed individuals over an average of three and a half years.
Unfortunately, multivitamin use wasn't beneficial in any of these areas.
To add insult to injury, another recent study that followed individuals for 20 years showed
no benefit of daily multivitamin use on the risk of death.
(14:30):
Were there any positive outcomes?
Yeah.
And it was a pretty big one from a subset of three of the Cosmos, from a subset of three
Cosmos trials.
So these ones were specifically Cosmos Mind, Cosmos Web, and Cosmos Clinic, which all
showed that use of a daily multivitamin for a duration of two years improves episodic memory.
(14:55):
So individuals were better able to recall events from the past, like their 16th birthday,
for example.
But more, it also improved global cognition, which is a composite assessment, including
things like memory, verbal fluency, attention, et cetera.
The magnitude of effect on global cognition was equivalent to, the researchers concluded,
(15:20):
to reducing cognitive aging by two years, which obviously can be pretty profound.
So what were the main takeaways from this large trial?
Yeah.
So in all, your daily multivitamin probably isn't going to reduce your risk of cancer,
cardiovascular disease, or death, but it does likely provide some cognitive benefit.
(15:42):
Now it should be noted that the exact type of multivitamin studied in the Cosmos trial
was Centrum, hashtag, not an ad, which is a broad multivitamin that includes both basic
vitamins like A, B, C, D, E, and K, along with multiple minerals like calcium, chromium,
copper, magnesium, selenium, and zinc.
(16:04):
Chris, how exactly do you think these multivitamins are helping with cognition, in particular,
of all things?
What's pharmo-kinetically, if I'm saying that right, is going on here?
Yeah.
So we don't, researchers don't know exactly, but obviously it's probably likely the result
(16:25):
of correcting some sort of vitamin or micronutrient deficiency.
And we can speculate this because there have been studies showing that deficiencies in
vitamins B and D and micronutrients such as zinc and iron have been associated with cognitive
decline.
There's also some research to suggest associations between vitamin E and neurocognitive protection
(16:51):
as well.
So some of the researchers and experts in the area suggested that the only downside
is that we don't know exactly what component in the Centrum worked, but it may work for
multiple people because it contains so many different minerals and vitamins.
So individual A might've been deficient in vitamin B, while individual B might've been
(17:15):
deficient in vitamin D. And just so happened that all of those things were included in
the one vitamin.
So they kind of worked for every patient regardless of their deficiency, which is why it's important
to make the distinction that this trial used such a broad spectrum multivitamin.
So that's why we can only really recommend that one as opposed to something that's a
(17:37):
little more narrow and may not include every particular nutrient.
Yes.
And I did want to say to the listeners that everything that Chris is sharing here, whether
in the clinical watch or in this segment, all these studies, we will have links to all
these materials in the show notes for every episode if you want to go and do some additional
reading.
(17:57):
Great mention.
So next, I know you had mentioned fall prevention, which is obviously important to consider as
we age because falls can result in fractures, which can then have significant downstream
effects like impaired mobility, decreased quality of life, and in some cases, even an
increased risk of death.
(18:17):
So for that reason, the United States Preventative Services Task Force or USPSTF recommends exercise
to prevent falls for adults 65 years and older who are at increased risk of falls.
So who exactly is considered to be at an increased risk for falls and what kind of exercises
(18:40):
are we talking about here?
Yeah.
So individuals at risk for falls would obviously include those with a history of falls, but
would also include those with other key risk factors.
So particularly impairments in their mobility, their gait, and their balance.
Unfortunately, those latter criteria are a bit vague.
(19:00):
So provider discretion is going to play a large role in identifying qualifying individuals.
Now with regard to the exercises, the majority of clinical trial data shows benefit for supervised
physical therapy and group exercise classes, but they don't really shed a lot of light
on individual exercises themselves.
(19:21):
The most commonly studied exercise routines are typically related to gait, balance, and
functional training, followed by strength and resistance training, flexibility, and
endurance training.
The most common frequency that is seen in clinical trials is two to three sessions per
week.
Now obviously, structured programs have been the best studied and will therefore be preferred,
(19:46):
but my opinion is that so long as it's done in a safe manner and of course in agreement
with one's healthcare provider, home exercises can obviously be just as beneficial.
Is there anything else to keep in mind from a general prevention perspective?
Yeah, obviously we can talk for hours about what constitutes a generally healthy lifestyle.
(20:13):
So let's try to simplify it across a few key domains.
So for one, maintain your physical wellbeing.
So this means engaging in moderate intensity physical activity in whatever capacity works
for you for a minimum of 150 minutes per week and incorporate strength training twice a
(20:35):
week.
Second, maintain a healthy diet.
So there is an infinite amount of information online regarding diet and it always seems
like the new IT diet is changing weekly.
So I like to keep it simple and recommend the Mediterranean diet since it's shown to
have the greatest benefits from an overall health perspective in clinical trials.
(20:57):
Now essentially, the Mediterranean diet is an eating style that encourages fruits, vegetables,
whole grains, nuts, legumes, and healthy oils like olive oil.
It recommends dairy products daily, but in moderation, fish and poultry a few times
a week in moderation, red meat in small amounts and infrequently, and minimizing sugary processed
(21:22):
foods.
And finally, don't forget to maintain a healthy social life.
This can involve volunteering, keeping close friends, finding new activities to meet new
people or heck, even just getting a dog.
Those are all great recommendations, Chris.
And one thing I'm surprised you didn't mention, just being a pharmacist yourself, I'm surprised
you didn't mention regular medication reviews to reduce risk of falls.
(21:47):
Ah, yes.
Nice catch, Adam.
That of course is a very important thing, especially as we age, the number of medications
seem to increase as well.
So it's always a good thing to have your medications regularly reviewed to make sure there's nothing
contributing to the risk of falls.
But of course, that's not as much fun as a dog.
No, definitely not.
(22:07):
I know you could speak to that directly, but either way, it's always great to have those
proactive steps.
But in some cases, we got to talk about treatment such as with Alzheimer's disease.
And there have actually been some recent advancements in this space.
Could you talk to me about that?
Sure.
So if you know, for decades, we really only had two medication options.
(22:28):
We had colon esterase inhibitors, which include dinapazil, rivastigmine and galantamine.
And then we had the NMDA receptor antagonist, which is memantine.
And those options really just have modest benefits at best, even when they're taken
together.
So, you know, this unfortunately, this has been an area of serious need for quite some
(22:49):
time.
Fortunately, we are starting to see some new advancements with the with the introduction
of the amyloid beta reducing monoclonal antibodies.
And these include the brand products, aduhelm, lekembe and the newest member, Kisumma.
All three are approved to treat mild cognitive impairment or dementia in Alzheimer's disease.
(23:14):
Now, since the first approval in 2021, these medications have been a bit controversial
because their mechanism is rooted in the beta amyloid hypothesis.
So let me explain.
Essentially, the current consensus regarding the development of Alzheimer's disease suggests
that amyloid beta accumulation in the brain leads to tau protein formation within neurons.
(23:37):
And this leads to neuronal death and cognitive impairment.
So by this rationale, the elimination of beta amyloid should result in reductions in cognitive
impairment.
So the first two drugs approved, aduhelm and lekembe.
Mainly these were studied to see if they could reduce beta amyloid, which they did.
(23:58):
Unfortunately, our clinical outcomes weren't really a huge focus of those trials.
And honestly, this is likely due to the fact that because these drugs work so far upstream
of the end damage, clinical trials of these drugs would need to be significantly longer
in duration than what is typically seen in clinical trials of new drugs.
(24:18):
Now the newest drug, Kisumma, is a little bit different for a couple of reasons.
First, the clinical trial for Kisumma actually did focus a little bit more on the hard clinical
outcomes compared to its predecessors.
And second, it's the only one of the three that can be stopped once amyloid plaques are
no longer detectable, which means that Kisumma could potentially be more cost effective and
(24:44):
easier for patients in the long run.
So for perspective, Kisumma reduced amyloid plaques by an average of 84% at 18 months.
So patients may only need to be on Kisumma for maybe up to two years.
Well, these new agents seem pretty cool, to put it very mildly and potentially game changing.
(25:04):
But you had mentioned that a lot of their effectiveness was wrapped up in the theoretical.
So how well do these drugs actually work and clinically work?
Yeah, ultimately, you know, that's the most important question.
I said originally that the majority of the data for adu home and leukembi was based on
amyloid beta lowering capability.
(25:25):
But those trials did still look at cognitive outcomes to an extent.
So we can sort of indirectly look at those data compared to the data for Kisumma.
And what we see is somewhat modest improvements in cognition.
So the one clinical outcome that all three clinical trials looked at was the clinical
(25:46):
dementia rating scale sum of boxes.
And this is basically a global measure of cognition that gives the patient a score of
zero to 18.
The closer to 18, the worse the cognitive impairment.
Now, typically, untreated patients, as you could guess, will continue to progress closer
to a score of 18 over time.
(26:08):
So these trials compared these drugs to placebo to see if they were able to slow patients
worsening based on this scale.
And what they found is that placebo patients worsened by 0.37 points compared to adu home,
0.45 points compared to leukembi, and 0.68 points compared to Kisumma.
(26:32):
So yes, by this measure, these drugs slow worsening compared to placebo.
But you and our listeners may be wondering, does a 0.37 or 0.68 point difference in a
clinical trial result in a real world difference?
And that's the question everyone is trying to grapple with at the moment.
(26:52):
Unfortunately, it may not be.
Current consensus suggests that you'd hope to see a 0.9 point improvement over placebo
for people with mild cognitive impairment and 1.63 for those with mild Alzheimer's disease.
Now, that being said, these drugs appear to be more effective in those with earlier and
(27:14):
less advanced disease.
So these may really help the earlier that you give them.
And we may see more robust if it is excluded, if it's limited to those patients.
And obviously, these drugs are still so new, and they've only been studied for a couple
of years in clinical trials.
So we don't know if this initial benefit is big enough to translate into even more profound
(27:38):
long term benefits, like almost like like ripples in a stream, so to speak.
And one final note on these drugs, I know I'd mentioned three, three brand name drugs.
Well, add you home is actually being discontinued in November of this year, namely so that the
manufacturer can focus more on its other drug, leukemba.
(27:59):
I'm sure we're going to be revisiting these drugs in the coming years.
Again, so much more study to do on them.
But interesting that add you home, which had a lot of controversy surrounding it.
And as you mentioned at the top of the discussion, especially that controversy that it was sort
of seemed to be fast tracked for approval despite the late evidence.
(28:19):
And it was also that it was expensive as well, and poised to make a lot of money for the
manufacturer.
So it's just interesting that now it's going away.
I know it causes a lot of a lot of waves.
And now it's gone.
You know, just for my own speculation, it's probably because they have two drugs.
The same manufacturer has both add you home and leukemba.
(28:40):
Leukemba had somewhat better looking data in clinical trials.
And if we're being honest, add you home kind of had a bit of a stigma surrounding its name.
So maybe they think, hey, let's just stick with the other one.
Yeah.
Moving forward.
Right.
Makes a lot of sense.
All right.
Let's take another break.
(29:02):
Informa knows that pharmacists dispensed medication.
But the clinical pharmacist and 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
(29:22):
team is standing 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
(29:42):
medication surveillance monitoring program.
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.
(30:05):
And in today's final segment, we're going to take a somewhat lighthearted look at something
very serious, contaminants and over-the-counter supplements.
And Chris, you've given plenty of Optics presentations on vitamins and supplements and what we just
talked about.
And you did one of these for NCCHC pretty recently.
We know how popular vitamins are with the healthy aging crowd, and we also know that
(30:25):
supplements aren't regulated the same way as prescription drugs.
So that leaves a lot of room for impropriety and impurity.
Regarding the latter, I was curious, what are your personal top five craziest contaminants
that have been found in vitamins and supplements?
All right.
So I don't know if we should start with a number five or something like that.
(30:50):
I like that.
We have the most common and perhaps the least surprising one.
Of all adulterated supplements reported, 45% of them are sexual enhancement products.
In some cases, these supplements contain actual drugs used for erectile dysfunction like Viagra
(31:10):
and Cialis.
So no wonder they work so well.
You know, I just have to ask with that one.
I do have to wonder how Smiling Bob from the N-Zyte commercials is doing.
Just wonder.
That's a fantastic hit of nostalgia right there.
And fun fact, the owner of that company, not Bob himself, the actor, but the person who
actually started the company, is currently in jail for fraudulent activity.
(31:34):
So just speak to your point.
Exactly.
Number four, we have weight loss supplements.
So these can actually be contaminated with stimulants like Cebutramine, which actually
used to be a prescription medication used for appetite suppression.
But it's been discontinued in many countries, including the U.S., as it's been associated
(31:59):
with increased risk of cardiovascular disease and strokes.
Just like weight gain is.
Yeah, exactly.
Double-edged sword.
Number three, we have muscle building supplements.
These have been contaminated with anabolic steroids or steroid like substances.
(32:21):
Just like you said with number five, no wonder they work so well.
Exactly.
Sometimes if it works, it's got the actual stuff in it.
Number two, these one, this is where it starts to get a little scary too, bacterial and fungal
contamination.
In one assessment, researchers found bacteria in all 138 products they investigated with
(32:44):
many also containing toxic fungi.
Fungal contamination of dietary supplements has been has been linked to serious liver,
intestinal and appendix damage.
Well, this is straight up horror movie stuff when you get into this.
And I just want to also give a shout out to another podcast out there, Swindled.
I don't know if you're familiar, but it's a true crime podcast, but not the murder kind,
(33:10):
more about financial crimes and fraud and things like that.
And they recently did an episode on a compounding pharmacy up in Massachusetts, I believe, that
their unclean manufacturing practices sickened people with a fungus that was really hard
to treat.
I think it was the largest fungal outbreak of that nature in American history.
(33:31):
So yeah, it's very serious stuff.
Yeah, I am not familiar with the podcast, but I'm familiar with the story.
And that was absolutely massive when that came out.
So yeah, fungal, a systemic fungal infection is no joke.
So we got to be careful with everything, but you know, definitely these, these supplements
(33:52):
and stuff.
Good number one, heavy metal contamination, which is not as good sounding as the music
in a study of 121 products, 5% surpassed the safe daily consumption limit for arsenic.
2% had excess lead, cadmium and aluminum, and 1% had too much mercury.
(34:16):
Now, if you're familiar with the mad hatter, too much mercury is probably not a good thing.
Now, all of these underscores the importance of purchasing supplements whose quality has
been verified by one of three highly recommended independent laboratories.
These include the United States Pharmacopeia, NSF International, and consumerlabs.com.
(34:39):
Manufacturers whose products pass inspection will have a seal of approval on their bottle.
So as a consumer, whenever you're in doubt, you can of course always ask your pharmacist,
but look for those products with the seal of approval to make sure that you're protecting
yourself.
That is most excellent and practical advice, Chris.
(35:00):
And that also takes us to the end of our time.
So that does it.
This is the debut episode of Podcast RX with Chris Bender.
And Chris, I want to thank you for taking this on.
And I look forward to hearing you break down many more topics like you did today.
Absolutely.
Always a pleasure talking with you.
And as I said, links to the material mentioned in today's segments will be included in the
(35:21):
show notes.
If you like what you hear, please follow us on the podcast platform of your choice.
We actually just started our show, hosting our show on rss.com to get it out there better.
And you can find the podcast RX on all the major players, podcast, Apple podcasts, Spotify,
iHeartRadio, Amazon.
We also post our episodes to YouTube.
(35:42):
Look for Diamond Pharmacy Services on YouTube and you'll find the podcast RX show there.
Please rate, review us if you can.
And we appreciate your help building this show.
Chris, thank you again.
We'll be talking very soon, I think.
Yes, sir.
Take care.
(36:04):
Podcast RX features conversations with healthcare professionals.
The statements and opinions discussed herein are for informational purposes only.
This podcast should not be considered 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.
(36:32):
Podcast RX is a production of Diamond Pharmacy Services.
Find our show on Apple podcasts, 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.
(36:53):
Thank you again for your support.
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