SUPERmarket PHARMACIST

A pharmacist's look at the supermarket and beyond

Month: July 2016

Boob News

I’m in the middle of training for the Susan G. Komen 3-Day Walk for breast cancer. I’ll be joining my wife and her team to walk 60 miles in 3 days in the Twin Cities (August 19-21). I’ve helped out the team in the past 8 years by running errands, fetching jackets, taking jackets away, bringing ice cold Diet Cokes or G2 and ferrying the team from day’s end to the hotel and back again in the morning. In that role I’ve been called “team bitch,” “walker stalker,” and last year a lady gave me my personal favorite, “underwire.”
You have to realize that there are hundreds of teams and thousands of walkers for these events and their team names often eschew normal political correctness with team names proudly flaunted, using every variation of slang for breasts from ta-ta’s to tits (including itty bitty titties), boobs and boobies, of course, hooters, second base, cupcakes, and many more. So pardon any lack of decorum on my part.

It’s no wonder then, that I am attuned to breasts and stories about breasts when I see them. Who am I kidding? I’ve been tuned into breasts since my first ex utero meal. Here are couple developments that I recently noticed:

I caught this headline in USA Today: “Why Millennials are Going Braless” and I just had to see what was going on (or coming off!). It seems that this generation of young women are opting for lighter, wireless “bralettes” of simply doing without. As a teenager in the 60’s, I recall stories of women burning their bras as a statement of liberation for women. For young men like myself, our solidarity in that cause may have been somewhat tainted by the desire to see nearly naked boobies parading around our neighborhoods. Right on, sister!
This new phenomenon of minimal breast support is even having an impact of sales at places like Victoria’s Secret, where bra sales are are sagging and its stock price is down 30% this year. With about 1/3 of their revenue traditionally coming from bra sales, that is no surprise. The Wonder Bra is on the way out in favor of the more natural style preferred by Millennials. Victoria’s Secret now offers bralettes that are very light, offering little support or padding but are stylish and meant to be exposed. Maybe sales will bounce back. Celebrities are leading the way as they do in most areas of fashion. It looks like my underwire nickname may be in jeopardy. Also, according to Plastic Surgery News there were 279,000 breast augmentations in 2015 and that is down 2% from the previous. For the record, I like ’em natural.

About half of US states have breast density notification laws. Now before you guys start running around hefting the boobs in your lives, this is actually medically important because high breast density is a risk factor for developing breast cancer. The problem is that there is huge variation in how mammogram density results are interpreted and/or obtained. The human reading the results is the primary cause of variation as different providers must be subjective in their finding. There are no clearly measurable results that can be shared in a uniform manner. Even different brands of mammography equipment will show differing degrees of tissue density. Of course, BMI, race and ethnicity are also factors. Finally, the amount of compression used on the breast during the procedure can result in a different appearance. Talk about having your tit caught in a wringer! Roughly 2 out of 5 women have dense breasts and would be considered for additional tests such as MRI or ultrasound. There is hope that computer models will bring some objectivity to the measurement of breast density. Until that happens keep doing your self exams and always discuss your options with your trusted doctor.

Support a 3-Day walker!

Medical Food Gets Served

We do not dispense much medical food in the pharmacy where I work. It’s been limited in the past to products like Axona and we may have ordered in some Pulmocare too. Some folks might even consider products like Ultrase (pancreatic enzymes) to be a medical food. Others would add those special folate products like Cerefolin and Folgard to the list. Most of these have been covered by prescription insurance but I wonder if that will continue considering a recent FDA action: the final guidance reiterates FDA’s original premise that medical foods cannot bear the term “Rx only” because that term can only be used in the labeling of prescription drugs, and that medical foods should not bear an NDC number, which could cause the product’s labeling to be misleading. Of course, if these products are not prescription products, I expect many prescription plans will not cover them and if they bear no NDC number, pharmacies will have no easy way to bill them through normal Rx billing methods. The NDC is universally used as a drug identifier on pharmacy claims. Note that the recent FDA guidance is the final one, so now these specifications will become fully enforceable.

To be fair, I never understood why something like Folgard was Rx, other than to generate sales via insurance coverage. Here is what is in Folgard: 2000 IU vitamin D3, 800 mcg folic acid, 12 mg vitamin B6, 120 mcg vitamin B12. You can see that there is nothing there that makes you jump ump and say “Wow! That stuff should be prescription only!”

The FDA guidance says that Inborn Errors of Metabolism (IEM) could be managed by a medical food, so long as the specific IEM cannot be managed with modification of the normal diet alone. An example used is phenylketonuria, the impaired metabolism of phenylalanine. Interestingly, Lofenalac, an infant formula created by Mead Johnson, is considered the first commercially developed medical food brought and was brought to market in the late 1960s. Conversely,the FDA reasons that the galactosemia (an IEM of impaired galactose metabolism) is commonly managed by limiting intake of lactose and galactose.

All this is relatively new and will take some time to all shake out. My guess is that we will see fewer and fewer of these products covered by Rx insurance, whether Medicare or private. The sad part is that many patients could benefit from good medical foods that in many cases are superior to drug therapy or are, in fact, the only option to manage their IEM.

You can find an FAQ on the latest guidance on the FDA web site.

My DNA Makes Me Wonder

A while back I send some spit into ancestry.com for a DNA analysis that would show my general genetic origins. Having heard speculation that we had some American Indian blood in our family tree, I was quite anxious to see if this was true. I have also researched my family tree using the resources on ancestry.com and other web sources, tracing my patriarchal line back to some of the earlier colonizers of Quebec. I was able to identify when some of my ancestors came from France to the areas around Quebec and Montreal. Much of this research is quite murky and found me brushing up on my French skills as I tried to decipher scans of birth, death, and wedding records that were written over 400 years ago in various styles of cursive and in French. Challenging to say the least!

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Anyhow, with information like what I found about some of my possible ancestors leading me to discover many liaisons with native Americans which gave rise to a mixed race dubbed “Metis,” I fully expected my DNA to show some native genetic trace. Here is an example of the stories that led me to that conclusion:

647 December 3: (I)-Medard Chouart Des Groseillier (1618-1696?) married Helene Martin, in Fort Quebec and settled down in Trois Rivieres; being the first wedding in several years (this is not true). Helene is the daughter of a river pilot, Abraham Martin, whose land would become known as the Plains of Abraham. Medard’s second marriage after the death of his first wife, is to (II)-Marguerite Hayet dit Radisson,a half sister of (II)-Pierre Esprit Radisson, Metis, (1632-1710). Pierre Radisson, at age 15, while out on a duck shoot, is captured by the Mohawks and taken to Lake Champlain. He is adopted by the tribe and became an Indian. He and a Algonquin escaped but were soon captured. The Algonquian is killed and (II)-Pierre Esprit Radisson, Metis (1632-1710) is tortured but rescued by his adoptive family. He later escaped to the Dutch Fort Orange near Albany, New York, worked as an interpreter for the Dutch, and then made his way back to Trois Rivieres- all before turning 21 years old. (see Radisson 1631)

1649 January 19: A female of age 15 or 16 is hung at Quebek (Quebec) for theft and Monsieur (I)-Abraham Martin, dit I’ecossois (1589-1664) a Scotsman is accused of violating (raping) her. Some suggest a sixteen year-old girl in Quebec, sentenced to death for theft, escaped death by acting as her own executioner. Still others suggest the executioner is a pardoned criminal and the girl is hung.

1649 February 15: Kebec, (I)-Abraham Martin dit L’Ecossais (1589-1664) is imprisoned on a scandalous charge concerning a girl 15-16 years old who was executed this year for theft. It is said this old pig Abraham had debauched the girl. This could be the reason the birth and marriage records are not retained, the Jesuits likely cleared the files?

from New France: Quebec Cultural Roots by D. Garneau

Apparently the Jesuits were some of the few people reading and writing and thus controlled what records were kept and there was a bit of sanitizing going on. Also plenty of shenanigans!

Here too is a record of showing the mingling of New World and Old World DNA:

1638 May 22: Kebec, marriage (I)-Etienne Racine, b-1607 to (II)-Marguerite Martin, Metis (1624-1679) daughter (I)-Abraham Martin dit L’Ecossais (1589-1664) and Huron savagesse and/or Marguerite Langlois, Metis b-1611?, see 1624: It was on May 22, 1638 that, Father Nicolas Adam fulfilled his parish duties at Quebec. He blessed the union of (I)-Etienne Racine and (II)-Marguerite Martin, Metis, b-1624, now fourteen years old. Olivier Tardif/LeTardif and Guillaume Couillard were present. Promise of marriage was made November 16, 1637.

And then I get my DNA results back and it shows 100% European ancestry! Here’s what it shows:
Europe 100%
Ireland 28%
Europe West 19%
Italy/Greece 17%
Iberian Peninsula 15%
Scandinavia 12%
Great Britain 8%
Trace Regions 1%

Everything that I learned first-hand from my family elders and everything that I learned from my research on-line makes me doubt the accuracy of these results. Everybody that I met in the family had very strong French roots. So now I wonder if a different agency might use different technology for their DNA testing and I am tempted to spend a few bucks to get a second opinion.