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The U.S. Department of Health and Human Services (HHS) has recommended that the Drug Enforcement Administration (DEA) ease federal restrictions on marijuana. The HHS recommendation suggests moving marijuana from a Schedule I drug to Schedule III, which would have significant implications for the industry, including the ability to deduct ordinary business expenses for tax purposes. This move comes after President Joe Biden ordered a review of marijuana policy, and it is seen as a significant step toward aligning federal law with the growing number of states that have legalized marijuana in some form. However, the ultimate decision rests with the DEA, and the timing of any potential rescheduling remains uncertain.

The opioid overdose antidote Narcan will soon be available over the counter at major retailers, including Walgreens, Walmart, Rite Aid, and CVS, as well as online. This move aims to increase access to Narcan to combat the rising number of overdose deaths in the United States, which reached an all-time high in 2021. However, the cost of a two-pack of Narcan, priced at $44.99, has raised concerns that it may be out of reach for some individuals, limiting its accessibility to those who need it most.

A study has found that patients could save millions of dollars by purchasing prescription drugs through online pharmacy discount programs like Amazon Pharmacy or GoodRx, compared to traditional insurance plans. Researchers at the University of Toledo College of Pharmacy and Pharmaceutical Sciences in Ohio analyzed 20 commonly prescribed generic drugs and found that at least 1 out of 5 prescriptions were cheaper through these discount programs. The potential savings were estimated at about $969 million for Amazon Pharmacy users and about $1.83 billion for GoodRx users. This study highlights the potential benefits of such online pharmacy discount programs for reducing out-ofpocket costs for Americans, particularly those without adequate insurance coverage.

The U.S. Food and Drug Administration (FDA) has announced that it still plans to finalize rules that would prohibit the sale of menthol cigarettes and flavored cigars this year, but the agency is running behind schedule. The deadline to work out the details of this ban was originally set for August 2023, but the FDA now states that it will complete work on the rule "in the coming months." Many public health leaders have expressed frustration with the lengthy process, as they believe that regulations on menthol, the last flavor allowed in cigarettes, are urgently needed to reduce the harms associated with smoking.

Roz Brewer has stepped down as the CEO of Walgreens Boots Alliance, leaving the company's board as well. This decision was characterized as mutual, and Ginger Graham, the lead independent director and a healthcare industry veteran, will serve as interim chief while the company searches for a replacement. Brewer had led Walgreens since March 2021 and during her tenure, the company pursued a transition to position itself more as a healthcare company rather than a pharmacy chain. However, Walgreens has struggled with a drop in demand for COVID-19 testing and vaccines, and its retail sales have faced strong competition from retailers like Walmart and Amazon. As Walgreens aims to become more of a healthcare provider, Brewer's skillset was seen as less aligned with the company's goals. This transition aligns with a broader industry trend of pharmacy chains seeking to expand their healthcare services and offerings.

The Centers for Medicare and Medicaid Services (CMS) has announced the first 10 prescription drugs that will be subject to Medicare price negotiations under the Inflation Reduction Act. Popular — and pricey — blood thinners and diabetes drugs are on the list.

• Medicare, which provides health insurance coverage to 65 million people in the United States, has been barred from negotiating drug costs until next year. Negotiated prices will go into effect in 2026. The negotiations could also save taxpayers billions of dollars.
• The drugs selected for negotiations include popular and costly medications like blood thinners and diabetes drugs, with the aim of reducing the financial burden on Medicare recipients.
• However, the pharmaceutical industry has pushed back against these negotiations, with several major drug companies filing lawsuits claiming that they would reduce spending on research and development. More drugs will be added to the negotiation list in the coming years, with the goal of lowering drug costs for older Americans.

Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University: "This is just the first 10," Gostin said. "There are many more shoes to drop. I think the claims that they are making are without merit," Gostin said. "But I think the pharmaceutical industry are going to pay whatever it takes in lobbying, paying legal bills and legal challenges that they can to save their most valuable products."

Atrial fibrillation, often abbreviated as AF, is a prevalent cardiac arrhythmia that disrupts the normal rhythm of the heart’s beating. Instead of contracting in a coordinated manner, the upper chambers of the heart quiver or fibrillate, leading to an irregular and oftentimes rapid heartbeat. This article will help us explain atrial fibrillation and the evolution of patient outcomes.

Key takeaways

• Since the FDA's initial warning in 2018 about a potential link between grain-free pet foods and dilated cardiomyopathy (DCM), over 1,382 cases of diet-related DCM in dogs have been reported. Certain breeds, like Golden Retrievers, Dobermans, and Great Danes, are more susceptible to DCM, especially when diets leave them deficient in taurine.
  
  
• Recent studies suggest that high levels of peas in some pet foods may contribute to heart damage, but the exact cause remains unclear. Symptoms of DCM include decreased activity, coughing, and decreased appetite, but dogs often show no signs until they experience heart failure.
  
  
• Veterinary cardiologists had observed cases of diet-related DCM as early as 2017, but reporting has been inconsistent due to factors like time constraints. This suggests that the reported cases are just a fraction of the actual instances. The cause of diet-related DCM is believed to be multifactorial, with some pets having a genetic susceptibility triggered by certain diets.
  
  
• Pet owners who prefer to stick with nontraditional pet foods can check their pets' heart health through blood tests measuring biomarkers like BNP. Cornell University advises avoiding pet foods with ingredients like peas, lentils, chickpeas, and potatoes in the top ten suggestions.

Is There a Doctor in the House?

A 46-year-old woman, gravida 1, para 1, comes to the office because of a 2-week history of black discharge from her right nipple. The patient had mammography and ultrasonography of the breasts 2 months ago for evaluation of increased glandularity, palpated in the upper outer quadrant of the right breast, noted at her most recent annual examination. The studies showed likely benign findings with recommended follow-up in 6 months. Medical history is otherwise unremarkable, and she takes no medications. BMI is 30 kg/m2. Vital signs are normal. Palpation of the right breast discloses glandularity in the upper outer quadrant but no other masses. There is scant, black discharge from the right nipple.

Which of the following is the most appropriate next step in diagnosis?

A genetic study of Lyme disease bacteria has uncovered insights into why some patients experience long-lasting symptoms. Researchers found that certain strains of the bacteria have a protective outer layer containing proteins that shield them from the human immune system, potentially leading to more severe and persistent symptoms. This research may aid in the development of better therapies for Lyme disease, which affects nearly half a million people in the U.S. each year.

A study has found that some marijuana users have elevated levels of lead and cadmium, two heavy metals linked to long-term health issues, in their blood and urine. Compared to people who didn't use marijuana or tobacco, marijuana users had 27% higher levels of lead in their blood and 22% higher levels of cadmium. These heavy metals can be absorbed by cannabis plants from soil, and while there are some regulations for contaminants in legal marijuana products, there are no standardized rules at the federal level, and illegal sales of unregulated products continue to pose risks.

New research indicates that Asian Americans in the United States have significantly higher exposure to cancer-linked "forever chemicals" known as PFAS compared to other racial groups. PFAS are synthetic chemicals found in various consumer products due to their resistance to stains, grease, and water. This study found that Asian Americans had a median level of PFAS 88% higher than that of whites. The reasons for this disparity are not yet clear, but it could be related to factors such as immigration from countries with different PFAS regulations and cultural dietary preferences.

A new study suggests that individuals who experience severe pain one year after a heart attack may have a higher risk of death over the following eight years. This research, which analyzed health data from over 18,000 heart attack patients in Sweden, found that those who reported extreme pain, even if unrelated to heart problems, were more than twice as likely to die during the study period. Pain levels, especially when moderate or extreme, appeared to be a significant predictor of mortality and should be closely monitored by both doctors and patients after a heart attack.

Thank you for reading! More next week,

My best wishes for a productive and idea-filled week ahead. Thanks for your ongoing efforts to improve the lives of the patients we all serve. Please send any news, comments, suggestions and ideas to hello@morningmed.email.

Quiz answer: The correct answer is A) "Ductography"

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