The Blue Vanguard Vol.23

Yonsei Student Pharmacist

THE BLUE VANGUARD

MAIN ARTICLES

Intervie ws

From genetic analysis to new drug development-3billion interview Orphan Drugs in 2023 - Growing Hope for Rare Disease Patients

Column

Sports pharmacy: New specialty of pharmacist

National Issuevs

Changes in pharmaceutical industry in the aged society

International Issues

Changes in the Pharmaceutical Industry brought by ChatGPT Fighting the Fentanyl Crisis

Life issues

Is the Diet Pills really Helpful or Not?

2023 :

23 volume Number

JULY 2023

The year of transition to complete six-year system of the college of pharmacy

Editor's note

Daeun choi

Greetings, esteemed readers!

It gives me great pleasure to present to you the 23rd edition of the Blue Vanguard. Within its pages, we delve into a diverse array of topics, ranging from the digitalization of pharmacy to the transformative potential of Chat GPT, and from the worldwide Fentanyl Crisis to the cutting-edge advancements in pharmaceuticals and healthcare. Our goal, as always, is to furnish you with invaluable knowledge and insights into these industries. One of the most prominent trends shaping the future of pharmaceuticals is the fusion of technology with medicine. We anticipate a landscape brimming with novel modalities, including cell and gene therapy, as well as mRNA vaccine technology. In light of these exciting developments, the roles of pharmacists as communicators and lifelong learners are set to become ever more crucial. Rest assured, our esteemed Blue Vanguardians have already demonstrated their exceptional competence in these areas, as evidenced by their curiosity for the latest pharmaceutical research and their willingness commitment to sharing their knowledge with our readers.

I extend my heartfelt gratitude to each and every member of our Blue Vanguard members. It has been an honor to collaborate with such exceptional individuals. I trust that you will thoroughly enjoy reading our 23rd issue, which we have written and designed with utmost dedication and care. Thank you for your unwavering support, and may the knowledge and insights gleaned from the Blue Vanguard brighten your path towards a brighter future.

Contents

Interview

• From genetic analysis to new drug development-3billion interview

Pharmaceuticals

• Synthetic biology in drug development

• Pharmacogenetics and personalized medicine

• Orphan Drugs in 2023- Growing Hope for Rare Disease Patients

• Weight-loss prescription medication: Wegovy

Column

• Roles of pharmacists during and post COVID-19

• Current trends and future of pharmacies around the world

• Ethical marketing of drugs

• New specialty of pharmacist

National issues

• Changes in pharmaceutical industry in the aged society

• Drug Problems and Countermeasures in Korea

• Phenomenon of motion sickness medicine sold out

International issues

• Insulin for diabetes

• Changes in the Pharmaceutical Industry brought by ChatGPT

• Fighting the Fentanyl Crisis

• Growing trends for dermocosmetics

Life Issues

• Digitization of pharmacy

• Alcohol and Medicine

• Fake news and pharmacists

• Is the Diet Pills really Helpful or Not?

From genetic analysis to new drug development 3billion interview

Journalist | Jinyoo Park | truthfree@yonsei.ac.kr

Designer | Jinyoo Park | truthfree@yonsei.ac.kr

What drugs will pharmaceutical companies develop and generate profits from in the future? Looking at the world trends, cancer, mental illness, and rare diseases are receiving a lot of investment. In addition, in the Corona era, the development of new drugs using artificial intelligence has received a lot of attention. This is because of the advantages of saving time and money. There is a company that has captured both future food and artificial intelligence, 3 Billion. The story of 3 Billion was captured through an interview with 3 Billion’s artificial intelligence team leader and current CSO KyoungYeul Lee.

Introducing the interviewee

KyoungYeul Lee, (Kyle Lee)

2008~2012 : KAIST Undergraduate student

2012~2014 : KAIST Master student

2014~2020 : KAIST Researcher Ph.D. student

2020~2023 : 3billion AI Team Leader

2023~ : 3billion Chief Scientific Officer

Keyword of 3billion: Rare disease

What is target of 3billion’s?

He introduced 3billion as a company that aims to “diagnose and treat patients with rare diseases.”

There are about 7,000 to 8,000 rare diseases, and 250 new ones are discovered every year. It is difficult to make a diagnosis according to the speed at which the disease is discovered. Because Diagnosis of rare genetic diseases is necessary to verify which genes cause diseases in a large amount of genetic information and whether they actually affect them.

“The diagnosis of a rare disease is a task that requires a lot of calculation compared to common diseases that are diagnosed through symptoms. That is why artificial intelligence can only be applied more and more,” he explained.

3billion rare disease diagnosis assistance

3billion’s diagnosis assistant provides a report summarizing the patient’s expected disease name and causative genetic mutations through sequencing of the genetic sample and internal data processing when the patient’s genetic sample and symptoms are provided.

What stands out among them is the daily re-diagnosis service.

Regarding the daily re-diagnosis service, he said, “3billion’s database improves as more genomes are tested. Therefore, a patient’s specimen that was not diagnosed in the past can be diagnosed after a certain period of time. We provide a daily re-diagnosis service that stores the data of the specimens that have been tested and re-diagnoses as the database is updated”

3billion’s artificial intelligence team

3billion’s artificial intelligence team can be largely divided into diagnosis and new drug development.

In the field of diagnosis, a mutation pathogenic prediction model using deep learning is developed. 3Cnet was developed that way. 3Cnet is an AI variant pathogenic predictor using Clinical Data, Common Variants, and Conservation Data. If this model simply produced scores, 3billion is aiming for explainable AI with the following model. AI learning has become so complex that it can no longer be understood at the human level. This is expressed as a black box, something that cannot be looked into. Explainable artificial intelligence is to improve this and explain the decision-based indicators from which artificial intelligence derived scores so that artificial intelligence users can use them with more confidence, or further utilize them.

In the new drug development AI team, we are developing our model for drug creation verification and new drugs. Some of the drug design done by medicinal chemists in the past was entrusted to artificial intelligence.

He emphasized that the database of biology itself is highly biased, especially in the field of new drug development.

Since the learning data of artificial intelligence already has a bias, the learning result also has a bias and presents a structure similar to the existing one rather than a creative structure.

Regarding these issues, “The structure of newly approved drugs that have passed clinical trials is not confined to the bias of the database. To break away from the bias of the existing database, we are trying to create a realistic synthesis and new structure as much as possible by developing correction artificial intelligence.” He replied, adding that artificial intelligence is presenting drugs that can be synthesized with a probability of about 90%.

Pharmacist with 3billion 3billion has 2 pharmacists working. One is on the diagnosis side, contributing to the final judgment based on an understanding of rare diseases. The other person belongs to the artificial intelligence team and checks whether there are any problems with the drug in the medicinal chemistry project and whether the results of the insilico are inconsistent with reality.

“It’s called Human in the Loop,” says Kyle Lee. “At the end of the day, AI gets better and better when people are in the process. If artificial intelligence makes a new drug, experts should evaluate it and make up for the weaknesses of artificial intelligence.” he said, mentioning the need for experts.

Pharmacists working on the AI team are selected through practical tests. Although programming skills are not looked at during subsequent interviews, it is said that pharmacists who want to enter 3billion are usually interested in programming. That’s because 3billion is a computer-based company rather than an experiment-driven.

He said, “3billion has an artificial intelligence team, as well as a mix of people who have specialized in other fields such as chemistry. In this environment, it seems that we grow while interacting with each other,” explaining the learning atmosphere of the company.

How should pharmacy students prepare for artificial inteligence?

With artificial intelligence receiving attention, more and more pharmacy students are setting their careers in the field of artificial intelligence. For those pharmacy students, Kyle Lee emphasized the background.

He said, “I think there are three necessary abilities. The first is background knowledge of biology. After all, knowledge is fundamental. Data is more important than models, and knowledge is more important than data. Without knowledge, no matter how good the data is, it cannot be accurately interpreted. After that, you need mathematical and statistical skills to determine if the data is really meaningful. After that, you develop your computational abilities to solve problems you want to solve through programming. Once this is in place, you will be an AI engineer in no time. An essential skill of an AI engineer is to define and solve problems. But it’s not just simple computational knowledge. Understanding the field is a priority. Computational knowledge is so easy to learn these days. So, take your time and polish the background knowledge first.”

How far can new drug development using artificial intelligence go?

As AlphaFold, a protein structure prediction artificial intelligence, predicts most protein structures, studies on interactions beyond this are being conducted.

Regarding the trend in the industry, he said, “The focus has already shifted towards interactivity. Structural prediction is just the beginning, and it’s time to look at the next interaction. But it is also growing at a tremendous rate. When artificial intelligence is applied, results are showing that it is more accurate than algorithms made with pure calculations. The future solution is to have multiple types of interactions. There are many types of bonds besides protein-protein, protein-lipid, etc. There are so many different types, so I thought there was a lot to develop.”

Also, when asked how far artificial intelligence can go in this field, he said, “Until now, using computer-designed proteins and RNAs as drugs was a fantasy, and it was simply a matter of research. But now it seems that we are getting closer to the time when it will be used in drugs. At the current pace of development, eventually drugs created by drug generation models will account for the majority of approved drugs.” B

Synthetic Biology in Drug Development

Journalist | Jungyoon Ryu | jungyoon_r@yonsei.ac.kr

Designer | Soyun Kang | soyun525@yonsei.ac.kr

The past few decades were marked by blooming innovations in genetic engineering where existing genes were explored and exploited to satisfy human needs. However, we are currently facing the introduction of a new era in biotechnology, which is highlighted by an emerging field, synthetic biology. Taking a step further from simply analyzing and altering existing DNA sequences, synthetic biology aims to code and synthesize novel DNA sequences that are expected to function in a desired way. Thusly designed DNA sequences consisting of an assortment of genes and elements of choice can be applied in cells to create redesigned biological systems. Currently, researchers in the field are attempting to artificially synthesize the whole genome of unicellular organisms such as yeast and have partially succeeded. The availability to completely design from scratch and put together biological systems and modules make synthetic biology a valuable apparatus in various areas that deal with live organisms. Especially since cell and gene therapy is of growing importance in therapeutics, tools and technology of synthetic biology are foreseen to be a powerful asset in drug discovery and development.

Advantages over prior forms of genetic engineering

The major difference between ‘conventional’ (pre-‘synthetic biology’) genetic engineering and synthetic biology is that the latter bestows a greater degree of freedom on the engineer. Genetic engineering in the conventional sense concerns with inflicting slight alterations to existing DNA sequences to confer enhancements on existing traits. Synthetic biology is rather likened to putting together a set of blocks to build something new than making improvements to a preexisting entity. The builder is provided with a bundle of building blocks, i.e., useful genes and DNA parts, and can readily choose which ones to adopt when assembling the blocks into a wanted form. The concept is more engineeringwired since procedures are modularized and standardized; biological parts are treated like components of a circuit.

So to speak, synthetic biology enables the creation of programmed cells or original forms of organisms that possess precisely the traits targeted to be exhibited. This aspect of synthetic biology makes it a substantial step forward from the status quo in genetic engineering since processes to attain a common objective are shortened. For instance, biological modules can be designed to express complex end products at high rates while previous methods aimed to obtain intermediates that are preferable over natural products. Intermediate substances must be processed further to gain the desired product. Hence, synthetic biology arranges more time- and cost-effective solutions with more room for revision of traits.

Tools and methodologies of synthetic biology

Methodologies in synthetic biology employs the technical tools established in genetic engineering, while being organized in a cycle of four essential parts: design, build, test, and learn. First, a biological system of a predictable function is designed based on the idea that biological functions can be modeled via assembly of standardized biological parts. A chassis, a physical platform (or host cell) on which designed DNA can be applied, is selected. Biological components deconstructed into bioparts are chosen and aligned in a way that is expected to produce a specific function when applied on the selected chassis. Bioparts applicable in the designs include enzymes, biosensors, protein or nucleic acid scaffolds, and other regulatory elements. Then, based on the design, DNA is engineered and assembled into bioparts or novel genomes through various strategies that exploit recombinant DNA technology or DNA synthesis techniques. The next stage includes prototyping and testing of the biological system. The cycle culminates in the ‘learn’ stage, where data acquired from the ‘test’ stage is analyzed by machine learning and statistical methods for optimization of development pathways and for information useful in the next round of design.

Applications in drug discovery and development

Since synthetic biology allows the creation of a biological system or module directly aimed to serve the engineer’s targeted purpose, it is open to application in countless stages in drug discovery and development. Synthetic biology systems can act as new tools for studying and uncovering the molecular mechanisms involved in disease development, as well as for discovery and production of testable molecules. Drugs can be developed from the products of synthetic biology which range from chemicals to engineered cells themselves. Chemicals derived from engineered cells can be of greater complexity from the ones that could be produced through genetic engineering methods since genetic circuits consisting of multiple enzymatic reactions can be designed. Hence, such methods can cut time and cost required for production. When the engineered cells themselves are the aimed product, they can be used as pharmaceuticals in cell therapy and personalized medicine. The next generation of CAR-T cell therapy designed through genetic circuits will be able to overcome issues of the previous generation including resistance and off-target toxicity. Therapeutic designer cells which are whole cells redesigned by putting together bioparts will be able to attend to more specific needs of individual patients. Even more, the integration of synthetic biology with automation technology leads to the arrangement of highthroughput procedures for creating new biological systems, which will enable faster screening and analyses for suitable bioparts.

Restraints and opportunities

As many possibilities synthetic biology confers to the productive mind, it can give way to possibilities of adverse usage of the technology. For instance, it can become an easily accessible and cost-effective means to invent and manufacture biological weapons such as virulent strains of genetically modified viruses. Moreover, since methods in synthetic biology inevitably entail alteration of genetic sequences, it is important to contemplate the repercussions of tampering with natural genetic combinations. Most importantly, synthetic biology is not free of bioethical implications that are concerned with human embryo and germ-line genetic modification. Nevertheless, it is undoubtedly a promising field in the sense that it presents a breakthrough for treatment of formerly incurable diseases.

To date, the main object of the synthetic biology department of drug development was to create synthetic bioparts that can generate complex molecules and chemicals essential in the synthesis of useful drugs. However, it is anticipated that attempts in the field to build an entire cellular system through means of synthetic biology will enable the assembly of therapeutic designer cells that are capable of exhibiting a long-lived and target-specific therapeutic action while residing as a part of the patient’s bodily system. B

Pharmacogenetics and Personalized Drug Therapy

Journalist | Su Yeon Kim | sooyeon0112@yonsei.ac.kr

Designer

| Jin Yeong Kim | kimjin02000@yonsei.ac.kr

Pharmacogenetics is a field of study that investigates how genetic factors influence an individual’s response to drugs. According to a report by the American Medical Association, 2 million patients, which is 6.7% of all US patients, have been hospitalized due to serious adverse drug reactions even though they follow prescribed medication properly. Furthermore, among them, about a hundred thousand patients have experienced fatal drug reactions leading to death. This report indicates that some patients can experience adverse drug reactions even when taking medication as directed, not just due to drug misuse. Experts believe that it is due to genetic variations related to drug reactions. Therefore, if an individual’s genetic variation caused by drug reactions can be predicted in advance, personalized treatment would be efficient to prevent adverse reactions.

Personalized Drug Therapy Using Pharmacogenetics

1) Codeine, a narcotic pain reliever, is commonly used to suppress pain or coughing. It is effective only for individuals who possess specific genetic factors within their bodies. However, many people have taken the medicine without confirming its effectiveness. In the UK, it has been reported that about 8% of the population who take codeine do not experience its intended effects.

2) There are several endogenous drug receptors involved in the metabolism of anticancer drugs in the body. Depending on the genetic variations of these biomarker genes, the actual serum drug concentrations can vary greatly in patients. While medicines with a wide safety margin, such as antibiotics or other drugs, may show little difference in adverse reactions, anticancer drugs with a narrow safety margin can cause toxicity severely enough to be lifethreatening. For example, 5-Fluorouracil (5-FU), a representative anticancer drug, is metabolized in the body by dihydropyrimidine dehydrogenase (DPD). Patients with a congenital lack of DPD enzyme activity experience serious 5-FU toxicity, which could even lead to death.

3) The breast cancer treatment drug, Herceptin (Trastuzumab), is an immune-targeted therapy that selectively acts only on HER2 (human epidermal growth factor receptor 2). It is known to be effective only for breast cancer cells that produce an excess of HER2 protein without affecting normal cells. Therefore, it is used only when HER2 is positive according to genetic testing.

4) 6-Mercaptopurine (6-MP) and Azathioprine (AZA) are commonly used as drugs for the treatment of rare inflammatory bowel diseases. These drugs keep converting into inactive and active metabolites in the body, and during this process, important enzymes such as thiopurine S-methyltransferase (TPMT) play a role. The activity of this enzyme is determined by the genotype of the TPMT gene. Thus, by analyzing the TPMT genotype, the drug dosage can be determined to consider differences in efficacy and side effects between individuals, making it clinically useful.

Following the advancement of science, more and more genetic variations in individuals will be revealed in the future. If we discover biomarkers related to the drug response of each patient and develop genetic diagnostic tools, it will be possible to design a drug therapy for each individual. However, there are several challenges in applying personalized drug therapy based on pharmacogenomics in clinical practice. Even in the United States, data for interpreting genomic and genetic information used in actual clinical settings are insufficient. Also, clinicians have a lack of understanding of pharmacogenomics, which makes it difficult to apply it in clinical practice. To address these issues, the United States has established organizations such as CPIC and PharmGKB to provide data for clinical application, jointly research, and develop treatment guidelines based on the reaction between drugs and genomics. They also utilize health information technology (HIT) such as EMR and Clinical Decision Support systems (CDS) to support clinical decision-making and facilitate the implementation of personalized drug therapy in clinical settings. Likewise, in Korea, an effort for an advanced precision medical and pharmaceutical system is essential. In particular, people should prepare measures of personalized drug therapy based on pharmacogenomics through the introduction of a “specialized pharmacist system”. For example, in the field of organ transplantation medication, pharmacists are encouraged to learn how to adopt personalized drug therapy so that they can select adequate medication and decide the dosage of immunosuppressive agents based on each patient’s genotype. In this way, every patient will be able to get fully effective medication therapy by taking a genetic test only once in their lifetime. B

Orphan Drugs

Growing Hope For Rare Disease Patients

Journalist | Jimin Seo | jmdemi@hanmail.net Designer | Seungwoo Lee | seungwu210@yonsei.ac.kr

Orphan drugs are, per definition, pharmaceutical agents that are developed for the prevention, diagnosis and treatment of specific rare medical conditions. In the US, rare diseases qualify when they affect fewer than 200,000 people while in Europe the standard is fewer than 5 in 100,000 people. In South Korea, a rare disease is defined as a disease or condition that affects less than 200,000 people of its population with no available treatment. Currently in Korea, orphan drugs are supplied to patients via pharmaceutical companies or the Korea Orphan Drug Center.

No more than four decades ago, patients suffering from life-threatening, chronically debilitating conditions were presented with very few - if none - options. The nature of such ailments poses many challenges not just to the patients, but to their families, communities, healthcare systems, and healthcare professionals as well. Developing orphan drugs that uniquely target rare conditions can be seen as risky and complex for pharmaceutical companies since the pool of patients is small and widely dispersed. Additionally, there are relatively fewer clinical centers or expertise available, which leads to major regulatory and logistical issues. The prices o f drugs naturally skyrocket to reflect R&D investments, while the difficulty of carrying out randomized controlled trials provides limited clinical evidence compared to other drugs.

Prior to 1983, a mere number of 38 drugs were approved to treat rare diseases.

1983, the Turning Point

The United States was the first to take legislative action to address this niche problem. In 1979, the Food and Drug Administration (FDA) task force issued a report that called for action to tackle the “orphan drug problem”, labeling it a significant healthcare issue. This cause was supported by a group of lawmakers, celebrities like the Klugman brothers, along with the tireless efforts of parents and patients, and combined they finally managed to push the Orphan Drug Act (ODA) over the finish line. The bill was signed into law by President Reagan on January 4th, 1983.

Since then, the ODA has paved the way for innovation and change. It financially incentivized pharmaceutical companies to allocate more of their time and resources into research, development, and distribution of therapeutics for patients with rare diseases, who before had been ‘orphaned’ by the medical community. The benefits include tax credits for qualified clinical testing, a Waiver of the Prescription Drug User Fee (which is almost $3 million for a new drug), and potential 7 years of market exclusivity. The impact of this law was undeniable - since its passage, more than 7,000 rare diseases have been identified and over 1,100 orphan treatments have obtained approval from the FDA.

Similar bills and policies that encourage the development of orphan drugs have been issued in 1993 in Japan, 2000 in the EU, and 2015 in Korea. The market exclusivity in Korea is 4 years.

2023 marks the 40th anniversary of the ODA.

The Trend

Currently, orphan drugs are the fastest growing segment of the pharma market and dominate FDA approvals. The number of orphan drug designations being awarded has rapidly increased in the last 20 years, although this cannot be attributed singularly to the ODA. The acceleration in the development of orphan drugs can also be due to the growing understanding of the underlying disease pathophysiology which has greatly improved thanks to advances in genomic research, the identification of new disease subtypes and their molecular etiology, the development of personalized medicine, growing public awareness and patient advocacy, and the integration of technology and artificial intelligence (AI) tools in research.

According to the trajectory, the top ten biggest orphan drugs will be worth $64 billion globally by 2028, in which orphans will make up almost a fifth of all non-generic drug sales. Over a third of global drug sales at Johnson & Johnson and AstraZeneca in 2028 will come from orphans (mostly in oncology). The trend is familiar - orphan drugs have outgrown their non-orphan counterparts apart from Covid-19 boosted 2021 and 2022, and even a global pandemic wasn’t enough to fundamentally affect this trajectory. Consensus predicts that orphan drugs will grow two-thirds faster than non-orphan drugs, and by 2028, they will be worth a staggering $300 billion.

The statistics speak for themselves - there is no doubt that orphan drugs will be a major focus in the pharmaceutical industry this year and upcoming years.

Notable Breakthroughs

Complicated by financial incentives, the ethical concerns of advertising strategies lead to the question: How can drugs be ethically marketed? In order to further reduce illegal rebates and rising prices, the implementation of DCTPA seems to be an effective solution, with some adjustments.

Product-specific ads should be prohibited and DCTPA should be focusing more on non-branded information such as common medical conditions and classes of prescription drugs. Quantitative Information should also be included, removing qualifying statements in order to display the realistic benefits and the risks. Through these crucial modifications, we move a step closer to achieving ethical marketing of pharmaceutical products. B

Despite the growing graphs and increasing pie of orphan drugs currently being developed, the scene is far from perfect when it comes to the drugs actually being administered to the patients that need them. Extended market exclusivity, while definitely a giant incentive for pharmaceutical companies, is often associated with high drug pricing and limited patient access. Apart from financial uncertainty, there are also inherent scientific risks since the small patient population makes designing clinical trials much more complicated. The lax standards for clinical evidence used to obtain regulatory approval - as well as the sustainability of drug prices - are still major concerns among stakeholders in the industry. Orphan drugs, when released, hit the market with high prices that sometimes do not reflect the clinical benefits. Also, the prices rarely go down even when additional indications are added. Some have even found a loophole in the ODA that allows them to maintain exclusivity for diseases that affect 200,000 or more patients by ‘piggybacking’ on older orphan drug designations. This problem is expected to be alleviated if the Fairness in Orphan Drug Exclusivity Act is passed by the senate, which will be able to close the loophole. As for the clinical trials and the quality of trial evidence presented by the companies, the FDA collects patient experience from patients, family members, caregivers, advocacy groups and foundations in the form of patient-focused drug development meetings. This is an attempt to help drug developers determine relevant endpoints for clinical trials.

The US Inflation Reduction Act (IRA) was also signed in 2022, and put the costliest Medicare drugs on course for price cuts. This includes 6 out of 2028 forecast’s top 10 orphan drugs. Meanwhile, as several blockbuster drugs will lose their exclusivity within this decade, the “big pharma” might do better to look towards drugs for big diseases to fill in the gaps left by Humira or Keytruda. For instance, Pfizer announced in January that it will cut in-house R&D in rare neurology and cardiology indications.

Now, there are ongoing court cases and petitions to amend the ODA. Lore Wilkinson, a 91-year-old patient diagnosed with Lambert-Eaton myasthenic syndrome (LEMS), is a patient advocate. She is now faced with having to pay $9,000 a month for her medication after Firdapse was granted orphan drug status from the FDA in 2018, making it impossible for her to be supplied with any alternative drugs. Similarly, there was a prior case concerning the exclusivity of Gralise, an orphan drug that treats nerve pain. Although Gralise was not deemed to be clinically superior to another drug already on the market, it was still granted exclusivity following the conditions laid out by the ODA.

“They have to change the law,” Wilkinson said. She claims that pharmaceutical companies should be designated orphan drug status and be granted exclusivity only when a “really new medication” is developed, not when they simply change one molecule.

“I’m an old lady, and I don’t know if it is going to get fixed.”

The Other Side of the Coin that is ODA

Weight-loss Prescription medication: Wegovy

Journalist | Hyunjin Lee | jennylee_525@yonsei.ac.kr

Designer | Dahyun Ryu | dahyunryu17@gmail.com

Over 70% of American adults have obesity or are overweight. Having them is a serious health issue as it could cause heart disease, diabetes, and stroke, resulting in premature death. Furthermore, these symptoms are linked to an increased risk of certain types of cancer. Losing 5-10% of body weight through diet and exercise is essential to reduce the risk of cardiovascular disease in patients with obesity. Therefore, many people use weight loss medications, such as Qsymia, Imcivree, Saxenda, Contrave, and Xenical, to lose weight. Hollywood celebrities, influencers, and even Elon Musk have reportedly used the popular injection, a new weight loss medication called “Wegovy” to get rid of unwanted weight.

What is Wegovy?

Wegovy is the first FDA-approved injection for chronic weight management in adults with obesity since 2014. Wegovy is a brand name for semaglutide, a GLP-1 receptor agonists. To be more specific, it works by mimicking a hormone called glucagon-like peptide-1 (GLP-1) that targets areas of the brain that regulate appetite and food intake. However, different names of the product including Semaglutide are currently used; as a treatment for diabetes (oral and injections) and obesity. Rybelsus is used as an oral drug for diabetes, Ozempic is used as an injection for diabetes, and Wegovy is used as an injection for obesity. In addition, Saxenda and Wegovy both are appetite-regulating hormone GLP-1 agonists, but the injection interval varies due to the difference in half-life.

Wegovy is a liquid solution in a prefilled, single-dose pen and is injected under the skin. It is mostly prescribed to people who have a particular BMI, usually 30kg/m2 and over, or 27kg/m2, and at least one weight-related health condition, such as type 2 diabetes, high blood pressure, or high cholesterol. Furthermore, in the case of considering injections in intractable obese adults, Semaglutide is suggested rather than other drugs. Wegovy should be injected under the skin once a week for 4 weeks with 0.25mg at first and should be increased gradually until patients reach a maintenance dose.

https://www.medpagetoday.com/endocrinology/obesity/96425

Wegovy and Weight Loss

Wegovy can lead to weight loss since it is designed to suppress appetite, so people eat less. Semaglutide acts on the appetite center of the hypothalamus of the brain, suppressing appetite and increasing satiety, losing weight while maintaining blood sugar. Moreover, it mimics the action of a gut hormone called GLP-1 and it stimulates incretins, a gastrointestinal hormone, which promotes insulin secretion in pancreatic beta cells, slowing down the rate at which food travels from the stomach to the intestine.

According to the study from NEJM, there was a weight loss of 14.9% in the gastropod group (2.4mg subcutaneous injection once a week), and a weight loss effect of 2.4% in the placebo group, in an experiment that was conducted for 68 weeks for 1961 people. Additionally, the experimental group that lost more than 5% reached 86.4%, and the experimental group that lost more than 15% was more than 50%. In other words, one out of two subjects who injected Wegoby had a weight loss effect of 15% or more. Compared to previous obesity treatments, including Saxenda, which showed a weight loss effect of around 10%, Wegovy proved to be very effective. It has become a blockbuster “game changer” drug in the obese market by reducing Saxenda’s seven-time subcutaneous injection discomfort by 1/7 and improving its medicinal effect by more than 1.5 times.

Side effects of Wegovy

Wegovy may cause some mild or serious side effects, but it may depend on age, other health conditions, or other medications. The most common side effects of Wegovy are vomiting, constipation, diarrhea, nausea, headache, dyspepsia, hypoglycemia in patients with type 2 diabetes, gastroenteritis, allergic reaction, and gastroesophageal reflux disease. Moreover, weight loss is not permanent and thus not a complete cure for obesity. Most patients regain their lost weight at the end of the course since they’ve been promised a ‘miracle instant cure’, not a sustainable lifestyle change.

Safe Use Guideline for Wegovy

Wegovy should not be used in combination with other Semaglutide-containing products, other GLP-1 receptor agonists, or other products intended for weight loss, including prescription drugs, or herbal products. Semaglutide for weight management requires twice the dose, thus there is a risk of hypoglycemia when administered by diabetic patients with insulin or other oral blood sugar-lowering drug. Also, it should not be used in patients with a history of severe allergic reactions to Semaglutide or any of the other components of Wegovy.

Conclusion

As the perception that “obesity is a disease that needs treatment” is growing around the world, the obesity treatment medication market is gradually growing. The fact that obesity can be treated with the help of drugs is good news. However, the limitations and other adverse factors like out-of-pocket costs without insurance or long-term side effects have forced some people to stop taking Wegovy. Moreover, after people stopped taking Wegovy, they regained two-thirds of the weight they had lost on the drug. Wegovy was a new “miracle” drug that promised to revolutionize the weight-loss industry and change the paradigm of obesity treatment, however, there are some concerns about this drug. Therefore, rather than relying too much on weight-loss medication, people should first control their weight with healthy habits and be aware of using Wegovy if needed. B

roles of pharmacists during and post COVID-19

Journalist | Chaerin Oh | cherin02@naver.com

Designer | Jini Jeong | 6265mmm@naver.com

Since the outbreak of COVID-19, problems in the supply of masks have occurred nationwide. At this time, pharmacists cooperated as helpers of the "public mask" system promoted by the government, and the supply of public masks through pharmacies was effectively secured. Not just making every citizen get their own mask, the public mask system also made the price of mask decrease. This had a significant effect as masks became a musthave item, and lots of mask factories increased the price. At this time, the pharmacist community showed the spirit of solidarity and cooperation and showed the role as the basis for the local community.

1 Decrease in mask price via system

And now, 3 years had passed since the outbreak of COVID-19. Now we are at last living a life without a mask and lots of regulation related to the virus is now getting alleviated. From now on, we should think about the future. Then what is the role of pharmacists at this point when COVID is ending?

Currently, the shortage of medicines in pharmacies is becoming severe. We can easily inductively reason that this kind of lackage is due to COVID-19 as it geometrically increased the number of patients. And this growth of patients had increased the demand for medicines as well.

However, this supply and demand problem is also occurring in products that are not related to the COVID-19 period. Although there is a precedent for solving the shortage of medicines for the common cold due to increased productivity through increased drug prices of acetaminophen, different causes of drug sellouts are slowing the resolution of the situation. Pharmacists’ inconvenience in dispensing leads to infringement of the people’s right to health. Therefore, it is necessary to quickly identify the cause of the pharmacist community and supplement the system. We look forward to reviving the solidarity and cooperation of pharmacists shown at the beginning of COVID-19 at the end of COVID-19.

To solve this phenomenon, generic substitution could be the solution. Generic substitution is the conversion of the original drug into a generic drug. In this way, all factors, including composition, formulation, and capacity, must match. Then, generic drugs are approved through biological equivalence tests. Korea has used generic substitution for more than 10 years, but there are still many restraints. Mainly, generic drugs are usually traded at a lower price than the original drugs, but in Korea, the price does not differ significantly even though the market share is 65%. In addition, there is a unique system that generic drugs can have a product name. If the alternative preparation system is improved more practically, it will be a solution to this problem. B

2 Public mask system

Current trends and future of retail pharmacies

Journalist | Chanyoung Kim | kkimchanyoung@gmail.com Designer | Youngseo Park | selly4577@yonsei.ac.kr

One of the most frequently asked questions that most pharmacy students encounter is, “Wouldn’t the roles of pharmacists be replaced by AI(Artificial Intelligence) in the future?”. Indeed, there have been countless estimates in the media referring that pharmacists are one of the jobs to be gone as a consequence of the 4th revolution.. The truth is, no one really knows what might exactly happen. However, considering the complexity and the specialty that pharmacists have, it wouldn’t be likely that they will easily lose their jobs and wander around the street. Through this article, I will mention both the trends and the possible future that retail pharmacies have, and explain what is really LIKELY, for pharmacy stores to turn out.

To begin with, there are currently five key trends in retail pharmacy.

1. Specialization: There are specialty pharmacies, in which specialty drugs that cure chronic diseases and various types of cancer are sold. Specialty drugs are renowned to be the fastest growing segment of the pharmacy industry and are expected to account for 40 percent of pharmacy revenue in upcoming years. Along with the development of specialty drugs, specialty pharmacies could increase access to these medications and provide safer medical services to patients.

2. Utilizing AI: This involves optimizing stock availability in pharmacy stores, accessing patients’ medical data via ‘Pharmacy POS’ mobile phone service, and personalized approach to customers.

3. Virtual retail: As e-commerce and digital marketing are important nowadays, it is inevitable for pharmacies to engage in virtual retail, in other words, providing medication online.

4. Preventive medicine: Preventive medicine is another key term that gains importance post COVID 19, and as more chronic diseases pervade.

5. Customer care service: As labor processes such as dispensation could be replaced by machines, pharmacies are now focusing more on human interactions (expert advice, explaining medicine instructions, health care services, etc)

Considering these five key trends, retail pharmacies in the future would be different from the way we experience them nowadays. Even now, there are robots and automated tools in hospitals that help streamline various processes and improve the speed and precision of medication. Medicine online delivery and vending machines are also either present or available in the vicinity and are seemingly a threat to pharmacy stores.

However, due to the increased use of technology, the human component would be more vital and crucial to an pharmacist-patient relationship. Thus, the role shifts from merely filling prescriptions to interacting more with patients and fulfilling the social duty of healthcare experts. Pharmacists will be there for patients to actively ask for medication advice and receive one-to-one safety instructions for prescribed medicine. Not only confined to pharmacy stores, patients would also be able to receive consultation from pharmacists via phones and laptops, easing the difficulties for the ones who have difficulty moving or in remote regions.

In the case of retail pharmacies, it is expected to be owned as ‘self-service’, a blend of innovative technology with traditional pharmacy practices. The patient would receive the prescription from their doctor with a QR code, and then take this to a self-service pharmacy. Digital pharmacies would have QR scanning machines so that patients scan the code, and automatically receive their medicine from the dispensing machine. This could save time for the patient and manual work for the pharmacist who could focus more on value-added activities related to the patient.

As the issue of retail pharmacies is intertwined with factors such as government legislation or unemployment, the future of it is, unfortunately, obscure. However, it is certain that, as promising AI technologies sounds, humanto-human interaction could never be replaced. Therefore, as future pharmacists, our most concern should be what method we could take to help patients in need, rather than how technology would ever replace us. B

Ethical Marketing of Drugs Pharmaceutical Products

Ethics – a moral principle shaped by subjective views, is an insoluble dilemma in marketing, particularly when it comes to pharmaceutical products which are seen as a health concern. The price of pharmaceutical drugs, in an economical as other consumer goods. Thus, pharmaceutical companies must consider the marketability and profitability of their products as well as their targets. However, medicine and health care have long been established as a personal necessity, as it is unequivocal that increased health care provision improves health as well as promotes society’s well-being. Thus, as medications became more normalized for personal use and have been integrated into people’s lives, the government has also intervened, setting a price ceiling for certain medications and restricting the purchase of potent drugs over the counter. This creates a more public nature for drugs and medical devices, distinguishing the market for pharmaceutical products from other commercial goods.

Categories of Medication

Medication is generally classified into two categories: general sales list (GSL)/ over the counter (OTC) and prescription medicines. Under these two categories, there could be further classifications such as complementary medicine, controlled drugs, etc. OTC drugs have very few legal restrictions and can be bought almost anywhere such as in health and beauty stores, not just in pharmacies. OTC drugs include aspirin, antacids, antihistamines, paracetamols, and other vitamin supplements. Although these drugs are less potent than other medications, they still pose a risk of developing an addiction and can be harmful when consumed with other drugs. Abusing OTC drugs long-term can result in severe health problems such as memory loss and kidney failure.

Prescription medicines must be prescribed by a health care professional such as a doctor, who is licensed to prescribe medication. These prescription medicines must be taken directly as prescribed as it has a greater risk of addiction and other harmful effects if misused. Similarly, pharmacy medicines are only available for purchase behind the counter and the pharmacist has the right to refuse the sale if they believe that it is not a suitable medication for the individual.

Marketing Dilemma of pharmaceutical products

Specifically, in South Korea, the marketing of prescription medicines is restricted while OTC drugs are allowed to be advertised to the public. In that, the law allows OTC drugs to be actively purchased while ensuring that a prescription is needed for the purchase of prescription medicine. Since pharmaceutical companies are then unable to promote their products to consumers directly, they then target medical practitioners. At the surface level, this simply means that medication is promoted to the clinicians who are then updated with the latest information regarding pharmaceutical options for patients as well as advancements in treatment. However, due to this marketing process, certain problems have arisen.

Rebate is the act of refunding a partial amount to be paid by one party to the counterparty by giving a benefit equivalent to that amount. This could mean that both parties could benefit in their transaction, however, in the case where the buyer is an intermediary consumer, the cost is passed on to the final consumer. Thus, as the rebate does not go to the patients/consumers of pharmaceutical products, the rebate ultimately influences the price determination of the drug and adversely affects the decision of the clinicians to select the optimal drug. Although cases of illegal rebate have reduced significantly, it has not been eradicated. The act of prescribing medication by health care professionals can be viewed as part of the medicine business, but the fundamental purpose of prescription is for the well-being of patients which differentiates medication from other commercial relationships which seek to maximize profit and utility. If such commercial activities between the clinician and pharmaceutical companies are deemed more beneficial to these two parties than the patients they are helping, there are questions regarding ethics.

In other countries, such as the U.S. and New Zealand, direct-to-consumer pharmaceutical advertising (DTCPA) is allowed and has been growing rapidly. This method shifts from the conventional advertisements targeting medical professionals to consumers themselves. The Food and Drug Administration (FDA) oversees the DCTCPA of prescription drugs, requiring that the pharmaceutical companies provide the generic name of the drug, at least one approved use, and all the adverse effects listed in the “prescribing information” of the drug. DTCPA empowers patients as it educates them, allowing the patients to take charge of their health. Furthermore, DCTPA encourages patients to discuss with medical professionals about adverse reactions, and the optimal options for their treatment. However, DCTPA has been criticized with arguments against it. To begin with, it could misinform patients, omitting certain information such as risk factors. Additionally, the benefits of the drugs could be overemphasized, and as the patient may lack the skills to evaluate medical information, they may choose drugs that could potentially be harmful to them. Thus, this could lead to inappropriate prescriptions or choosing a different medication than the one that was prescribed by a medical professional.

Promoting ethical marketing of drugs

Complicated by financial incentives, the ethical concerns of advertising strategies lead to the question: How can drugs be ethically marketed? In order to further reduce illegal rebates and rising prices, the implementation of DCTPA seems to be an effective solution, with some adjustments.

Product-specific ads should be prohibited and DCTPA should be focusing more on non-branded information such as common medical conditions and classes of prescription drugs. Quantitative Information should also be included, removing qualifying statements in order to display the realistic benefits and the risks. Through these crucial modifications, we move a step closer to achieving ethical marketing of pharmaceutical products. B

SPORTS PHARMACY :New specialty of pharmacist

Journalist | Jeongwoo Shin | steven1020@yonsei.ac.kr

Designer | Lee Hwan | zkou3859@yonsei.ac.kr

You’ve often heard a player say, “Please call the team doctor here” when he is injured during a soccer game. However, I wonder whether you have ever heard of sports pharmacists. In this column, we will find out the background and necessity of sports pharmacists and the activities of sports pharmacists suggested by Mottram, a pioneer in sports pharmacology.

SPORT

It will come to mind to anyone interested in swimming that the 2019 World Swimming Championships awards ceremony was a hot topic. It was that the gold medalist Sun Yang cursed at Britain’s Scott, who refused to take a picture with him, saying he was a loser. In this situation, Scott deserved criticism for not following the ceremony’s manners, but the arrow of criticism was aimed at Sun Yang. This was because Sun Yang avoided the doping tests of the International Doping Test Management (IDTM) inspectors that he had to take before the competition. Even though the World Anti-Doping Agency filed a complaint with the Court of Arbitration for Sport (CAS), Sun Yang was able to participate in the competition due to the delay in CAS’s ruling. That was the reason why Scott boycotted the award against Sun Yang, who unjustly won the medal. (Actually, it was later revealed that Sun Yang had taken a banned drug called trimetazidine, so he was suspended for eight years!)

The previous instance of Sun Yang and the Russian government’s direct intervention at the 2014 Sochi Olympics show doping management problems of international organizations. To prevent these intended or unintended doping problems, ‘sports pharmacists’, drug experts in the sports field were needed and sports pharmacology could be born.

Furthermore, it is noteworthy that the public’s interest in sports has increased. According to the “National Sports Survey” conducted by the Korea Sports Policy Research Institute, the participation rate in sports has steadily been increasing despite Covid-19. In other words, people’s interests are focused on health and well-being, and accordingly, the demand for appropriate OTC drugs has increased. These factors have led to the birth of a drug specialist who functions in sports.

Then, who are sports pharmacists and what do they do? Based on the activities of pharmacists in sports pharmacy presented by Mottram, we will discuss the basic knowledge that pharmacists should know and their role as sports pharmacists.

Awareness of sports medications

The World Anti-Doping Agency (WADA) is an independent international organization that promotes, coordinates, and monitors efforts to prevent all forms of sports doping around the world. The WADA updates the Prohibited List every year as part of its efforts to prevent doping through educational programs. For example, caffeine which was a prohibited drug in the past was excluded in 2004, and alcohol and cannabidiol as well in 2018. On the other hand, nebivolol, a β-blocker, was added in 2021. Since WADA’s drug list is constantly updated, experts are needed to systematically manage drugs. In a 2008 “doping awareness, view, and experience: a comparison between general procedures and pharmacists” study in Slovenia, the pharmacist group had a higher understanding of the drug as shown in the graph. It has been shown that pharmacists can act as advisors to provide accurate and appropriate knowledge to athletes and athlete support personnel.

PHARMACY

Therapy: The use of therapeutic drugs in athletes

Drug treatment for athletes is not common. However, when using drugs to treat diseases or recover from injuries, pharmacists can mediate for the purpose of drug treatment and improvement of athletic ability. Drugs should not be used for the purpose of preventing pain and injury and sports pharmacists should have a high understanding of prohibited drugs and therapeutic use exemption (TUE).

TUE means the use of specific drugs or methods contained in prohibited drugs for therapeutic purposes in the event of serious damage to the athlete’s health condition. However, in this case, the drug should not have the effect of improving performance and there is no alternative medicine. In addition, TUE approval is required before drug use. In other words, the treatment of athletes should be considered in various aspects such as performance impact and regulatory restrictions. This is why sports pharmacists exist in the international competitions to prevent unintended doping due to unrecognized TUE.

As the popularity of sports increases, the profession of sports pharmacist will grow. It’s time to focus on how far their specialty will develop! B

Korean Pharmacists Preparing for Aging Society

Journalist | Yoonah Jung | nyoonah@yonsei.ac.kr

Designer | Youngseo Park | selly4577@yonsei.ac.kr

Changes in Korea’s Population

Korea is currently entering a super-aged society where aging is accelerating. The proportion of the population aged 65 or older was 17.5% in 2022, which is the highest among OECD countries. This aging trend is bringing about demand in the health and welfare sectors, and as a result, new measures and professional roles are needed in areas such as health care, pharmacy, and health.

Why are Pharmacists Needed for the Elderly?

The reason why older people need pharmacists is that older people often take multiple drugs. In this case, the probability of interaction problems between drugs increases. Pharmacists have professional knowledge and experience in taking multiple drugs, so they can help patients take drugs correctly and minimize risks such as side effects and allergies.

The second reason is that elderly people often have chronic diseases or health conditions. For this reason, the history of drugs taken varies in each individual. Pharmacists need to provide patients with personalized drug management to improve patient’s understanding of drugs and support their healthy lives.

Certified Senior Care Pharmacist

A senior care pharmacist provides expert advice on the use of medications to individuals and older adults, wherever they live. This senior pharmacist system is implemented in 10 countries, including the United States, Colombia, Canada, Australia, and Sweden. In other countries, a certification or license system for senior pharmacists is selected through difficult procedures to provide high-quality clinical services to the elderly and show expertise in drug treatment.

As of April 8, 2023, Korea also introduced a specialized pharmacist system in nine specialized fields (endocrine, elderly, children, cardiovascular, tumor, and critically ill). Passing the professional pharmacist qualification test, completing the mandatory curriculum, and having experience working as a pharmacist (more than 3 years) are needed to be a specialized pharmacist. Based on the cases of other countries, an implementation plan for the establishment and settlement of the elderly pharmacist system in Korea.

Home Medication Service

Home medication Service is a system in which pharmacists visit elderly patients who are exposed to misuse of drugs, and then provide medication guidance and counseling. According to National Insurance Service (Korea) in 2021, elderly patients had a higher rate of taking multiple drugs, which led to a surge in drug costs and a decrease in quality of life due to side effects. Since direct communication with patients and medical personnel is the most effective way to prevent these phenomena, the visiting pharmacist system is in the spotlight.

Bucheon-si Pharmaceutical Association carried out the system to contribute to the expansion of visiting pharmaceuticals. They set up pharmacists who work fewer on pharmacies in workdays, and provided services for seven months. Pharmacists were paid up to 100,000 won per session, and the performance and satisfaction of the elderly were high due to door-to-door counseling and management. The main advantage is the possibility to visit the elderly on a specific date, efficient care, and maintenance of direct communication and improvement with patients. Currently, the wage is lower than that of pharmacists working in pharmacies, so it is hard to activate Home Medication Service in Korea. It is necessary to promote the system to the elderly and guardians, and to secure the number of pharmacists by increasing remuneration.

Community Pharmacy Services

The community pharmacy system is currently actively operated in Japan and Germany. Through by this system, pharmacists manage patient’s drug information and shares this information with local hospitals. A community pharmacy system will bring great help to the elderly who need careful management of drug medication. In addition, in the event of an accident, such as a side effect on the elderly, the institution that can help the elderly the fastest would be the community pharmacy.

The reason why such a system could be only activated in Japan and Germany, is that the fee for community pharmacies’ caring is separately guaranteed in those countries. It is necessary for Korea to benchmark the community pharmacy system as soon as possible and provide institutional support accordingly.

As the aging population is accelerating further, it is urgent to come up with measures against the use of drugs by the elderly. Cases such as senior care pharmacists, home media systems, and community pharmacy systems should be urgently modified to suit the situation in Korea. B

Drug Problems in Korea

Journalist | Seoyeon Choi | sy_iloveu@naver.com

Designer | Soyun Kang | soyun525@yonsei.ac.kr

While medical standards are improving around the world, the degree of drug misuse is getting worse. In the international community, $500 billion worth of drugs are illegally traded annually, and more than 200 million people abuse them. Misuse of drugs means not only the use of banned drugs, but also the intentional use of certain drugs for other purposes. Until a few years ago, Korea was recognized as a drug-free country, and globally, Korea was recognized as a simple drug-intermediate distribution country. However, according to data from the Supreme Prosecutors’ Office, 12,613 drug offenders were cracked down last year. According to international standards, if there are less than 20 drug offenders per 100,000 people, the country can be evaluated as drug-free, but Korea has already exceeded that standard and lost its status as a drug-free country numerically. In addition, due to the nature of drug crimes, they are likely passed without being cracked down. The hidden rate of domestic drug crimes is expected to be 28.57 times more than is revealed. The production team, which organized the “Talking about Drugs in Korea” series, conducted various coverage and concluded that “drug addiction is a social and medical disease in which treatment is essential.” The time is coming to change the policy and social atmosphere, which focuses on punishment rather than treatment. It is time to reflect on how our society, which has lost its status as a drug-free country, will approach the drug case.

What are Drugs?

Drugs are substances that relieve irritation in the nervous system. In general, the term “drug” has been used in two ways, as a narrow meaning of drugs, hemp, and psychotropic drugs. But recently, the term “drug” has been used collectively as narcotics. Narcotics are divided into natural drugs, synthetic drugs, psychotropic drugs, and cannabis.

Natural drugs are divided into opium and coca; opium contains opium, morphine, heroin, and codeine, and cocaine and crack in the coca. Synthetic drugs include pethidine and methadone. Psychotropic drugs are largely divided into psychedelics, stimulants, and inhibitors. Psychedelics include LSD, ecstasy, and mescaline, stimulants include amphetamines and YABAs, and inhibitors include sedative sleepers and tranquilizers. Cannabis includes cannabis, cannabis resin, and cannabis oil. All of them can be collectively called narcotics, but it should be noted that the effects and mechanisms on the human body are different.

Problems

According to the composition of drug offenders, addiction (25.7%), curiosity (13.5%), and temptation (10.5%) are the most common causes of drug usage, and the highest composition of addiction suggests that drug offenders often show recidivism. Therefore, to prevent recidivism, it seems that active treatment and rehabilitation-oriented policies are needed, focusing on treatment protection rather than strong criminal punishment. In addition, the growing proportion of teenage addicts shows that drug dealing by SNS such as the Internet, darknet, and telegram have become active.

Domestic drug control policies consist of strengthening punishment, professional treatment, preventive education, promotion, maintenance of harmful environments, strengthening investigative power, and international cooperation. International cooperation is constantly striving through the creation and operation of APICC, the creation and operation of the International Cooperation Council for Drug Abatement, and drug control is implemented by cracking down on entertainment establishments and strengthening punishment in case of detection.

However, professional treatment, prevention education, and promotion are very poor and have many problems. There are only 21 drug addiction treatment and protection institutions nationwide. The condition is very poor and the budget is insufficient. In addition, drug-related education for teenagers to prevent drug abuse is mainly focused on smoking and drinking. About 70% of students said they have never received education on hallucinogenic substances, and even for those who had, the effectiveness is low. The low effectiveness means that the educational content is poor or that it is common and superficial content that can be easily accessed on the Internet.

Drug Policies That Need Improvement

1) Stigma Reduction

The Stigma around drug use and addiction remains a significant issue in South Korea, which can prevent individuals from seeking help for their addiction. Improving public awareness and education about addiction as a disease and reducing the stigma associated with drug use could encourage more people to seek treatment.

2) Access to Treatment

Despite efforts to improve addiction treatment services, access to treatment remains limited in South Korea. Increasing the number of addiction treatment facilities and providing more resources for addiction treatment could help address this issue.

3) Decriminalization

Some experts suggest that Korea should consider decriminalizing drug use and possession and treating drug addiction as a public health issue rather than a criminal one. This approach could also reduce the stigma associated with drug use and encourage more people to seek help for their addiction. B

The Phenomenon of Motion Sickness Medicine Sold Out

Journalist | Jaeeun Park | ong114164@naver.com

Designer | Jinyoo Park | truthfree@yonsei.ac.kr

Last year, as the COVID-19 pandemic worsened and home treatment became common, there was a shortage of cold medicine, so-called ‘cold medicine sold out’. It made people difficult to buy cold medicine at pharmacies. Following cold medicine, motion sickness medicine has become a difficult drug to lay hands on at this time. Pharmacists are puzzled because all related products of motion sickness are sold out even though they don’t take the season separately like cold medicine. There are various causes behind the shortage of medicines, but the main problem is that the shortage of motion sickness medicine was due to a surge in demand and a lack of domestic supply. In this article, we will explore the phenomenon of motion sickness medicine selling out.

Soaring in demand

As regulations established during COVID-19 were eased, there was a surge in demand for traveling. Several pharmaceutical companies, including Ilyang Company, said that this seems to have led to a lack of distribution to pharmacies. In particular, Dongsung Company’s “Toslong Solution,” a major product and drinkable motion sickness medicine, exhibited a drop in supplies to Korea. It was that the demand has soared in Vietnam since last year so exports have increased. As such popular motion sickness drugs ran out, supply and demand for other motion sickness drugs also became unstable.

Problem with raw materials and circulation

This phenomenon is also a result of a complex global supply chain that is dependent on raw materials from different parts of the world. Since the COVID-19 pandemic was serious all over the world, it has disrupted the supply chain of many products, including medical supplies and raw materials. Several countries have implemented restrictions on international trade and transportation, resulting in delays and shortages of essential ingredients.

Furthermore, domestic pharmaceutical market heavily relies on raw materials imported from abroad. In the case of motion sickness medicine, Korea imports the majority of raw materials from China. Any disruptions in China, such as the Shanghai Lockdown that lasted over two months, or even war-related issues can lead to delays and shortages of essential ingredients.

Overcoming the problem

Currently, pharmacists have set up out-of-stock notifications on the drug wholesale site and quickly purchase when the notification appears. However, the situation continues in which drugs cannot be obtained because supply and demand do not match. Therefore, pharmacists are arguing that there is a need for a public system that can be responsible for the distribution of medicines. In the case of the United States, FDA operates an integrated management system that can seize the overall supplies and demand for medicines. In Korea, a similar system like the United States should be operated to find out how much production of medicines there is. Even if this public system is not the answer, it is important to improve communication and cooperation between the government and pharmaceutical companies to come up with countermeasures.

Another essential solution is to take steps to increase the domestic production of motion sickness medicine. Diversifying the supply chain by sourcing raw materials from different countries can be the approach of the solution. This would provide a more stable supply chain for pharmaceutical companies and reduce the risk of shortages. The main way to achieve this is by investing in research and development to find alternative sources of raw materials, and having our own technology. It seems to take a long time, but it is the main task left for us and the pharmaceutical professionals. B

Insulin for Diabetes Mellitus

Journalist | Lee Dawon | dalee5451@yonsei.ac.kr

Designer | Lee Seungwoo | seungwu210@yonsei.ac.kr

What is Insulin?

Insulin is a hormone that plays an important role in maintaining glucose homeostasis. It promotes the absorption of glucose from the blood into body cells, such as fat, liver, and skeletal muscle cells, lowering blood glucose levels. Excess glucose is stored in the form of glycogen to form energy. The beta cells of the endocrine pancreas secrete insulin in response to a high level of glucose.

What is Diabetes Mellitus?

Deficient or absent insulin action impairs the body’s ability to take up and use glucose as the primary energy source. The failure to control blood sugar levels within a narrow range causes diabetes mellitus.

One type of this disease is called diabetes mellitus type 1, which usually occurs in children. Type 1 diabetes occurs when the immune system destroys beta cells. Breaking down the manufacturing system of insulin results in insulin deficiency, and the incapability of regulating the level of glucose. 15% of diabetes patients belong to this type. These patients are treated by insulin injection, fulfilling the lacking hormone. If this type 1 diabetes is not treated promptly, a severe shortage of insulin can develop and incur diabetic coma.

Another type is diabetes mellitus type 2, which is more common in adults. Unlike type 1 diabetes, the beta cells of type 2 diabetes can synthesize insulin, even though the amount of insulin is not enough. Instead, the reactivity in target cells of insulin reduces. These cells become resistant to insulin, not responding to lower blood sugar. Furthermore, serious complications such as heart disease, vision loss, and kidney disease can develop. Some type 2 diabetes patients also take insulin as a medication.

Insulin Delivery Options

Currently, insulin is used in the form of a hypodermic injection. The first option is shots or pens. Insulin can be injected by using a needle, a pen device, or a syringe into the fat. Recently, insulin pens are often used, as the syringe is inaccurate in preparing the insulin dose. Pen needles are developed to be shorter and thinner, incurring less pain. These injections should be done several times each day depending on the blood sugar levels. Another option is the insulin pump. Insulin is delivered separately during the day using an inserted thin tube underneath the skin. It has a sensor, which continuously monitors the levels of glucose. The sensor reduces human errors, improving glycemic control in patients. Both methods require penetrating through the skin, stirring up fear and discomfort. Also, only a small amount of insulin that enters the bloodstream reaches the liver by injection. Those disadvantages of insulin delivery demand an alternative, other than the injection.

Why is it Difficult to Make Oral Insulin?

If injecting insulin causes pain in the patients, then people can wonder why pharmaceuticals are not producing oral insulin. However, barriers to oral insulin exist regarding its constituent and, - protein. Until now, no other type of hormone has been taken orally because protein-digesting enzymes would attack and convert hormones into a useless form, amino acids. Therefore, these hormones must be administered by non-oral routes; for example, insulin injections. Insulin deficiency is treated with daily injections of insulin.

Challenges to Achieving Oral Insulin

A movement to change the mode of insulin delivery orally is arising to better diabetes patients and to jump the hurdle of protein-digesting enzymes. Lately, one of the pharmaceutical companies that worked on developing oral insulin is “Oramed Pharmaceuticals (NASDAQ: ORMP)”. A soft gel insulin capsule named “ORMD-0801” uses a protease inhibitor to endure under the condition of proteolytic enzyme and absorption enhancer to permeate the membranes of the intestine. It was designed to dissolve in the small intestine though they failed to achieve ORMD-0801 in the phase 3 clinical trial. Still, -attempts to invent oral insulin are worthwhile. Every attempt to manufacture new drugs will contribute to improving the lives of diabetes patients eventually. B

Changes in the Pharmaceutical Industry Brought by Chat GPT

What is Chat GPT? Chat GPT is an AI Chatbot developed by Open AI. The chatbot has a language-based model that the developer fine-tunes for human interaction conversationally. People are starting to realize that certain knowledge and sets of skills that humans have, may be starting to become less valued. Chat GPT is a technology that we can always leverage in the field of pharmacy to create a deeper and more meaningful patient relationship. Thus, this is just another step in the journey for people to work out the best way to integrate this into the pharmaceutical industry.

<Utilization of Chat GPT in Pharmacy>

Some of the applications of Chat GPT in the pharmaceutical future can be classified into two main areas. The first one is as a pharmacist. One of Chat GPT’s abilities is to talk to patients and get the context of the provided data. Also, questions can be asked in natural human language as real-life patients would. For example, if patients ask about their remaining prescriptions or whether to get a new prescription, Chat GPT will look up the patient’s data file to provide the required information. Therefore, pharmacists will be able to spend more time looking into more complex medication management issues than simply looking up what’s remaining on the digital file . The two can have a great partnership. Pharmacists also must make sure that the information is always correct. Thus, it will work with appropriate programs and algorithms to enhance the patients’ experience. In doing so, Chat GPT will increase the pharmacist’s efficiency and the patient’s satisfaction.

The second area of its usage is the pharmaceutical industry. These days, several new drug development companies are boosting their corporate value by using Chat GPT. Outwardly, it may seem to be of great help. However, the reality is that Chat GPT is still relatively less professional and has not practically helped develop new drugs. This is because AI algorithms similar to Chat GPT were already being used in the pharmaceutical field. If the ‘GPT-3.5’ language technology currently used is upgraded to ‘GPT-4’, it will show six times higher intelligence than now. This is expected to determine key competitiveness in the development of new drugs. It is necessary to improve Chat GPT skills so that they can learn drug-related knowledge and synthesize the design drawings to present candidate materials. If it develops further, it will shorten the development period of new drugs. It will process large amounts of data quickly and efficiently, processing and analyzing vast amounts of biological data. Also, it will provide important information for use in new drug development. For example, it will reduce the time and manpower required to search and select new drug candidates during drug development, ultimately reducing the time to market new drugs. Afterward, the effects and side effects of new drugs can also be predicted. Data analytics can also be assigned to Chat-GPT to reduce the time it takes pharmaceutical companies to select the most effective drugs and market them.

< Ability that Pharmacists Must Develop for Coexistence >

It is actually wrong to say that the pharmacist’s domain is violated or will be replaced by Chat GPT. The role of pharmacists must change in line with the rapidly changing trend. Since Chat GPT obtained professional knowledge that previously only pharmacists had, pharmacists should provide more value than conveying information to patients. Providing accurate information is the most basic of a pharmacist’s role. But since relaxing information alone cannot maintain the strength of a pharmacist, it is necessary to be able to make information-based value judgments.

The expertise of pharmacists and pharmacies should be constantly differentiated. When considering only pharmacies, both differentiation and customer value should be considered. Customers want an improvement on the accessibility and convenience of pharmacies. Also, they will want specialized information and personalized health care from pharmacists. Therefore, pharmacies should highlight both the advantages of the distribution industry and the retail industry. In addition, pharmacists should restore their strengths and strengthen their functions as medical personnel. With the advent of Chat GPT, the establishment of an AI-based environment is becoming a reality. Consumers can easily access vast amounts of information from anywhere. This is leading to changes in the distribution market and consumption patterns, especially making it difficult to predict consumption patterns. Therefore, it is essential to establish a customer-centered business environment based on artificial intelligence. Chat GPT should be regarded as an opportunity for both pharmacists and patients and as a win-win for each other.

Fighting the Fentanyl Crisis

Journalist | Jungeun Kim | dragon22@yonsei.ac.kr Designer | Youngseo Park | selly4577@yonsei.ac.kr

What is Fentanyl?

Fentanyl is a synthetic opioid, originally for use as an analgesic and anesthetic. It is 50 times more powerful than heroin and 100 times more potent than morphine. Fentanyl can be given in various routes: a shot, a transdermal patch, or lozenges. Similar to other opioid drugs, fentanyl binds to the body’s opioid receptors in parts of the brain that control pain and emotions. Repetitive intake of opioids allows the brain to adapt to opioid drugs. Fentanyl produces effects including drowsiness, nausea, confusion, sedation, hallucinations, extreme happiness, unconsciousness, constipation, etc. Most importantly, an overdose of fentanyl can decrease the amount of oxygen reaching the brain, resulting in hypoxia. The consequences of hypoxia can result in a coma, permanent brain damage, and even death.

There are two types of fentanyl: pharmaceutical and illicitly manufactured. Pharmaceutical fentanyl can be given to a patient only when prescribed by a doctor, especially after surgery and for advanced-stage cancer. Recently, however, illicitly manufactured fentanyl has been sold through black markets for its heroin-like properties. In the illegal drug market, fentanyl is a profitable product due to its high potency and low cost of production.

Illicit fentanyl is produced in clandestine laboratories worldwide without any official oversight and restrictions. Drug dealers also mix fentanyl with other illegal drug substances to increase addictiveness. Thus, people consuming an illicit drug might not be aware of the fact that it contains fentanyl. Fentanyl is lethal even with just 2mg. It also comes in a variety of bright colors, shapes, and sizes. Illicit fentanyl is found in all street drugs these days, and it has also been identified in counterfeit prescription pills. Actions must be taken to resolve this fentanyl crisis.

Overdose Crisis in the US

In the past few years, fentanyl analogs have been responsible for overdose deaths in the US, especially in areas linked to illegally-made fentanyl. The COVID-19 pandemic has accelerated the crisis, with an increasing share of the supply coming from Mexico. According to the Texas Department of State Health Services, there has been a 120% increase in fentanyl-related deaths in Texas. The CDC reported that 107375 people in the US died of drug overdoses in the 12 months period ending in January 2022. Of which, 67% of those deaths were due to synthetic opioids like fentanyl and fentanyl mixed with other illicit drugs. The fentanyl crisis can be seen as one of the worst-ever drug crises in the US.

The United States Drug Enforcement Administration (DEA) has also reported an increase in the threat of xylazine and illicit fentanyl. A mixture of xylazine (a non-opioid sedative, analgesic, and muscle relaxant) and fentanyl can cause the blood vessels to constrict, leading to tissue necrosis and deadly soft tissue ulcers. What makes xylazine more deadly than fentanyl is that it is not an opioid, and it has no medication to adverse the effect. Therefore, a mixture of this deadly xylazine and fentanyl, death tolls can be fatal.

Actions Needed for Combatting the Fentanyl Crisis

Many global leaders refer to the fentanyl overdose crisis as an “epidemic”. However, fentanyl is not a viral pathogen. Its increase is simply a response to the market demand. The fentanyl crisis is now a global crisis, one that requires collaborative global actions.

The Center for Disease Control and Prevention (CDC) has issued a Health Alert Network Advisory recommending the actions appropriate against fighting fentanyl. These actions include:

1. Expanding the distribution and use of naloxone and overdose prevention education

2. Expanding awareness and access to and availability of treatment for fentanyl use disorders

3. Intervening early with individuals high at risk

4. Improving the detection of overdose outbreaks to facilitate a more effective response

Furthermore, May 10th has been designated as the National Fentanyl Awareness Day in the US in order to educate the public about the threats that fentanyl poses. DEA has also observed August 21st as National Fentanyl Prevention and Awareness Day. Facing Fentanyl is a campaign providing prevention education, and honoring those who lost their lives to a fentanyl overdose.

The US government has consistently made efforts to cut both foreign and domestic supplies of opioids by limiting the number of prescriptions and providing counternarcotics assistance abroad. Regulations are increasing related to the production of fentanyl around the world. Additionally, infrastructures for fentanyl test strips as well as naloxone are increasing. Naloxone is a life-saving medication that can reverse an overdose from opioids when given in time. Recently, some LA schools have allowed students to carry Narcan (Intranasal Naloxone Spray) after a series of teen opioid overdose cases. Experts are looking towards other states to do the same.

Conclusion

Over the past few decades, drug overdose deaths have claimed far too many lives. Still, the fentanyl crisis is ongoing and its prevalence is driving many deaths around the world. The CDC has worked relentlessly to prevent overdose and to help people with addiction to recover. The scientific community is also actively looking for alternatives that offer similar therapeutic benefits of fentanyl, while minimizing the toxic risks. To further prevent fentanyl overdose cases, a persistent, coordinated effort across multiple countries will be vital. B

Growing trends for Dermo-cosmetics

Journalist | Seoyeong Kim | katherina623@naver.com

Designer | Jini Jeong | 6265mmm@naver.com

What is Dermocosmetic?

Dermocosmetics are skincare products that incorporate medical considerations and advanced active ingredients to provide direct support or treatment for various skin conditions. These products encompass a range of items such as skin cleansers, moisturizers, sunscreens, topical sebum-controllers, skin antimicrobial/antiinflammatory agents, and camouflage products.

The key distinction between dermocosmetics and cosmetics lies in their origin. Unlike cosmetics, dermocosmetic products are developed by pharmacists and dermatologists and are tailored to address specific skin problems like eczema, acne, or sensitive skin. They offer a targeted solution that goes beyond the cosmetic benefits of traditional skincare products.

Why are Dermocosmetics Popular?

Dermocosmetics are increasingly in demand, as more people are finding they have delicate skin and react sensitively to conventional cosmetics. A lot of dermocosmetic products on the market use well-known molecules like hyaluronic acid, retinoids, or niacinamide. However, we are also seeing brands adding new and trendy solutions to their existing formulations – such as natural ingredients, microbiome-friendly technologies, or well-known peptides. The main objective of these products is to offer efficient and sensorial appealing options to complement prescription solutions for skin challenges.

The dermocosmetics industry’s revenue growth is being driven by the increasing awareness among customers about spending on appearance. In addition, the market is expected to be significantly influenced by customers’ busy lifestyles and the convenience of online shopping. The market is also being propelled by factors such as pollution and other external agents that cause skin damage.

Individuals who have sensitive skin often encounter issues such as rashes, redness, dryness, and general skin complaints like tingling, tightness, or itching. In such cases, “normal” cosmetic products may no longer be effective and could even cause further irritation. Dermocosmetics, on the other hand, combines expertise and experience in cosmetics with knowledge from medicine and dermatology, making it a reliable option for such individuals. With increasing awareness, customers now prefer to invest more in dermocosmetic products to protect and brighten their skin, thereby reducing the appearance of aging, fine lines, acne, and wrinkles. even cause further irritation. Dermocosmetics, on the other hand, combines expertise and experience in cosmetics with knowledge from medicine and dermatology, making it a reliable option for such individuals. With increasing awareness, customers now prefer to invest more in dermocosmetic products to protect and brighten their skin, thereby reducing the appearance of aging, fine lines, acne, and wrinkles.

“Dexeryl cream”-Example of Dermocosmetic

An example of a dermocosmetic product is Dexeryl cream, which is an emollient and moisturizing cream from Pierre Fabre Dermatologie that was launched in 2008. This cream is specifically designed to treat signs and symptoms of skin dryness, particularly in various skin diseases such as atopic dermatitis and ichthyosis. Dexeryl is a medical device cream that contains a minimum formula of 13 ingredients, excluding 43 steroids, 7 parabens, lanolin, and fragrance.

According to data, during the clinical period, acute exacerbation occurred once or more with a frequency of 67.6% in patients who did not use moisturizers, 52.6% in the control group, and 35.1% in the Dexeryl group, confirming that Dexeryl could reduce the probability of acute exacerbation when used. Additionally, steroid usage in the Dexeryl group decreased by 57.1% compared to the non-use group. Dexeryl also proved to be effective in treating dryness, one of the main symptoms of atopic dermatitis. In a phase III clinical trial of 251 children aged 2 to 6 with atopic dermatitis dryness, the effect was compared for 28 days, showing that 42.5% of the Dexeryl group and 29% of the control group improved in dryness symptoms.

Dermocosmetics are skincare solutions inspired by medical considerations that use sophisticated active ingredients to directly support or care for the symptoms of various skin conditions. These products include skin cleansers, topical sebum-controllers, skin antimicrobial/anti-inflammatory agents, moisturizers, sunscreens, and camouflage products. The main difference between dermocosmetics and cosmetics lies in the origin of the products, since dermocosmetic products are designed by pharmacists and dermatologists to offer solutions for specific skin problems such as sensitive skin, eczema, or acne.

Future of Dermocosmetics

Furthermore, the Asia Pacific region is anticipated to have the fastest growth rate from 2022 to 2030 in the dermocosmetics market. The pharmacy and drug stores distribution channel segment accounted for more than 35% of the overall dermocosmetic revenue in 2021 and is projected to retain its dominance throughout the forecast period due to high product sales through these channels. As the demand for dermocosmetics continues to rise, pharmacists and dermatologists will likely play an essential role in developing and recommending these products to patients with specific skin conditions. To sum up, pharmacy students should pay more attention and show a lot of interest in this field. B

Digitization of Pharmacy

Journalist | Haoyen Tan | sjk28ho@gmail.com

Designer | Youngseo Park | selly4577@yonsei.ac.kr

Nowadays, numerous fields have undergone digitalization. Even in unexpected areas, for example, ordering food or drinks through kiosks not man-to-man, and tending to ask convenient and efficient ChatGPT. Digitalization has accelerated since it could make things done easier and quicker

In modern society, digitalization in local pharmacy also breaks the boundaries between on/offline. Patients who visited the local pharmacy still can consult about the medicine with a pharmacist using online service even they step out of the pharmacy. However, compared to other countries, South Korea’s speed of digitization in pharmacy is relatively slow.

Let’s look at where other countries are currently heading to. Countries like the United States has already started to deliver medicine via online. For example, Medly Pharmacy is one of the most popular online pharmacies in New York City, where people can conveniently order prescription drugs and have them delivered to their home. Once customers upload their prescription, a pharmacist will review it, prepare the medication, and then initiate the delivery. Delivery typically takes within 1-2 days, with same-day delivery available in some areas of New York City. In addition, the shipping is free, and insurance can be billed for added convenience. Medly Pharmacy provides convenient services to its customers and operates in a way that meets their needs, which made many people to use it frequently. However, it is important to be cautious, and verify the safety and accuracy of medication when using delivery services. Moreover, among digitalization functions, the prescription order, and the medicine bill receipt service are quite popular. Mobile pharmacy applications will be more utilized to fully guarantee consumer choice and strengthen core functions through pharmacist-led customer care services.

Pharmaceutical distributor ‘Online Farm’ provides a kiosk service that combines prescription transfer and payment. If the customer registers the barcode marked on the prescription, the prescription is sent to the dispensary, and the payment service will be sent from the dispensary. Nevertheless, the introduction of kiosks was found ineffective, the reason is that it cannot replace the role of the pharmacist in providing consultation and giving advice regarding medication. The kiosk may provide basic information about medication, but it cannot consider an individual’s specific medical history, such as allergies, or other important factors that the pharmacist can consider when making recommendations. Additionally, some people may have difficulties using a kiosk due to technical barriers or other factors, making it even less effective for them. Therefore, while the kiosk can be a useful tool for basic information, it should not be relied on as a substitute for the pharmacist’s expertise and advice.

To maximize the use of kiosks, there are several methods. First, the kiosk should be easy to use and intuitive. Each button should be clearly and concisely displayed so that users can find information without assistance. Second, medication information should be updated regularly. Whenever new information on medication or side effects is updated, it should be provided through the kiosk as well. Lastly, supports from pharmacists is also needed; a pharmacist can be stationed next to the kiosk to provide consultation and give advice on medication use for customers who have questions or concerns and help those who are not familiar with the kiosk. By considering these methods it will increase customer satisfaction and improve the level of service at the pharmacy.

Currently in Korea, some pharmacies have introduced kiosks within their pharmacies to allow customers to easily locate their desired medication or obtain information about specific medicines. Additionally, some pharmacies have launched mobile apps for users to check information about their medication purchases, as well as to receive updates on events offered by the pharmacy. With the growing demand for online services and the increasing use of mobile devices, it is expected that more pharmacies will adopt digital technologies to improve their services. This could include the use of artificial intelligence and big data analytics to manage inventory and monitor customer trends. There may be further regulatory changes to promote the growth of online pharmacies and encourage greater innovation in the industry. Overall, the digitalization of pharmacies in Korea is likely to continue to advance in the coming years, offering new opportunities for improved healthcare services and greater convenience for customers. According to the CEO of Healthport, the combination of IT technology and pharmaceutical devices is inevitable, and it makes digital blind spots diminish. As interest in personal health gradually increased, strategies for differentiating pharmacies began to emerge. Even if the Pharmacist Society doesn’t want to, the world will continue to change, and the prospects will alter depending on how much they adapt to digitalization. B

4 Drugs To Absolutely Avoid With Alcohol

Journalist | Daeun Choi | daeundownchoi@naver.com Designer | Jinyoo Park | truthfree@yonsei.ac.kr

Almost all medicines should not be taken with alcohol. When medicine and alcohol interact, serious side effects may occur. Alcohol has the potential to interact with many medications by altering its metabolism or activity. However, during the beginning of a new semester when social events and gatherings become more frequent, it’s hard to avoid drinking alcohol. Also, it’s difficult to remember which drugs are okay and which are NOT to take with alcohol. As a pharmacy student, let’s try to remember at least the following 4 medicines that should absolutely be avoided when drinking alcohol.

4 Medicines That Should Be Avoided With Alcohol

1.Anti-Inflammatory And Antipyretic Painkillers

Acetaminophen-based antipyretic painkillers such as Tylenol are drugs with high liver toxicity. Tylenol and alcohol are both chemicals that are broken down in the liver. While each substance individually puts some strain on the liver, the strain multiplies when both are used together. Acetaminophen is metabolized in the liver in three ways, one of which uses an enzyme called “CYP2E1”. When acetaminophen is metabolized by CYP2E1, 5-15% of the enzymes can be converted to NAPQ1, a substance that destroys liver cells. Since alcohol is also metabolized by the same CYP2E1 enzyme, taking acetaminophen-based painkillers after drinking increases the amount of CYP2E1 in the body and the amount of NAPQ1 production. People who drink alcohol frequently may already have increased levels of the CYP2E1 enzyme. In turn, enhanced CYP2E1 activity increases the formation of the toxic acetaminophen product. Thus, such patients must take extra care in taking acetaminophen-based painkillers.

2.Drugs That Act On The Central Nervous System

Drugs such as sedatives, sleeping pills, and anesthetics that act on the central nervous system when taken with alcohol may lead to life-threatening side effects such as shortness of breath and hypoxia. For example, phenobarbital activates some of the same molecules in the CNS as does alcohol, resulting in pharmacodynamic interactions between the two substances. The interaction may be synergistic, resulting in an enhanced effect of central nervous system-acting drugs. Consequently, alcohol consumption while taking phenobarbital synergistically enhances the medication’s sedative side effects. This can increase dizziness, drowsiness and lead to decreased driving skills.

Antihistamines are available both by prescription and OTC(Over The Counter drugs) and are used in the management of allergies and colds. Through pharmacodynamic interactions, alcohol may substantially increase the sedating effects of these drugs and may cause increased drowsiness and sedation. The risk of walking accidents and falls may increase.

3.Antihistamines

4.Antibiotics

Antibiotics such as metronidazole and linezolid can have various side effects when taken with alcohol. For example, ketoconazol, which is used as an antibiotic for treating fungal infections, can cause side effects such as nausea, vomiting, abdominal cramps, headaches, redness and liver damage. This is because alcohol prevents the decomposition of drugs in the liver. The drug remains in the form of acetaldehyde, a toxic substance of the drug, which eventually causes serious liver damage.

Drugs that do not cause serious Harm with alcohol

Contrary to the common belief that “Drugs should not be taken with alcohol”, there are some drugs that do not cause a big problem even if taken together with alcohol. For example, alcohol does not directly affect the effects of contraceptives, so contraceptive pills and alcohol are generally safe to use together. However, hormones contained in contraceptives affect alcohol reactions, so you may become drunk faster. Also, antibiotics that are not metronidazole and linezolid do not interact with alcohol. Moderate alcohol consumption probably does not interfere with antibiotic effectiveness.

Non-steroidal anti-inflammatory drugs (NSAIDs), Aleve, ibuprofen and aspirin can be used as alternatives to Tylenol. These drugs are generally safe to use with alcohol, but may cause gastrointestinal pain or even bleeding. Ultimately, you should always consult your doctor before using drugs at the same time as alcohol.

Conclusion

Not drinking alcohol at all is the best way to reduce side effects. However, if you must drink alcohol with medicine, avoid drinking within 30 minutes to 2 hours after taking the medicine. Most drugs show the highest blood concentration during this time. Due to the high blood concentration of the drug, the risk of side effects increases. If possible, you should take the medicine at least 8 hours before or after drinking. It is also recommended to drink less than two cups of alcohol. When taking either prescription or OTC medications, you should always read the product’s warning labels to determine whether alcohol may interfere with the desired therapeutic actions of the medication. B

Infodemic and Pharmacists

Journalist | Ha Neul Roh | skyroh0416@yonsei.ac.kr

Designer | Jin Yeong Kim | kimjin02000@yonsei.ac.kr

In recent years, along with the rapidly growing information technology industry, people can easily access information in many fields. This is true of the medical field as well. Accessing a lot of information easily may seem to be good on one hand, but without the ability to understand and analyze the information accurately, it can be rather poisonous. Then why are people deceived by fake news? Some may think that being deceived by fake news is just because they are foolish, but actually, that is not true. The reason why people are deceived can be explained by psychology and communication studies. According to the “Truth-default Theory”, we tend to believe that the information others say is true. It is not because people are nice, but because of the efficiency of communication. It is easy to understand the reality of the object once you recognize the idea or information you first heard from someone as true. It is quite inefficient and tiring to verify every piece of information you encounter for the first time. This theory works because it brings efficiency to communication and many people are actually honest. Also, it is easier to be deceived if multiple pieces of information are poured out at once. This is because the more you are distracted, the less you can afford to recognize the truth. Even if you know in advance that it is a lie, overload with cognition or external pressure limits you to making improper decisions.

The most recent case in this regard can be found in the COVID-19 vaccine. When the COVID-19 vaccine was first released, various fake news was rampant. At a rally against COVID-19 vaccination, a gynecologist said, “I looked at the vaccine ingredients under a microscope. Something strange was there with hair on the head and tail.” He claimed that there were unknown microorganisms in the vaccine. As such, some medical professionals came forward and expressed distrust of vaccines. Since the person who claimed this opinion was a doctor, such claims quickly spread around online. In addition, conspiracy theories about vaccines spread indiscriminately through SNS. Also, a large number of articles have been presented in some online communities, such as “fewer mosquito bites after vaccination” or “vaccinated people cannot donate blood.” However, these claims were mostly just groundless speculation. In response, the COVID-10 Vaccination Response Promotion Team said that they would respond strictly to the spread of fake news and explained that they are cooperating with Korea Communications Commission and the Cyber Investigation Unit.

Another case was a case about the anti-cancer effect of animal anthelmintics. This has been controversial after a video clip that Joe Tippens (62, male), a terminal lung cancer patient in the U.S. in 2019, was reported to have been completely cured after taking fenbendazole. Fenbendazole is used as animal anthelmintics especially for dogs. At the time of 2019, the National Cancer Center in Korea decided that it was “impossible” to promote clinical trials on the effectiveness of chemotherapy in humans for “fenbendazole.” The news about fenbendazole and its anti-cancer effect rapidly spread around the world through SNS, and other online platforms. In Korea, a comedian Chulmin Kim, who was suffering from lung cancer, also opened a channel on YouTube to film and upload videos with open clinical trial contents while taking fenbendazole for more than a month. At that time, Chulmin Kim claimed that the pain caused by lung cancer was reduced while taking fenbendazole.

Fenbendazole is said to have been used in animals for more than 40 years. But suddenly, starting in 2019, there have been claims on the internet such as YouTube that it has anti-cancer effects. The person claims that it has an anti-cancer effect believes that anthelmintic has an anti-cancer effect because it has a mechanism to suppress the intracellular organs that make up the skeleton of the cancer cells. Also, some online contents claimed that “it is a safe drug which has been used for 40 years” and “it is safe because the absorption rate in the body is as low as 20 percent.” However, the FDA has refuted online claims that long-term effects have not been reported in humans because it has been used only for “animals ” for more than 40 years, and that low-absorption anticancer drugs need specialized research on dosage control because their toxicity increases as the dose increases.

Since SNS and online platforms are activated like this, the speed at which fake news spreads is so fast that people are not able to control it. However, fake news related to medicine should be judged more carefully as it is directly related to human health and life. As medical professionals, people such as doctors, pharmacists, and nurses should work hard to convey information on the accuracy of knowledge. B

Are Diet Pills really Helpful or Not?

When you look at Youtube, Instagram, etc, you can see so many advertisements that promote diet pills. Also, it is common to see acquaintances around you getting help from diet pills when they go on a diet. It may be questionable whether these pills are really helpful or harmful to the body, so in this article, we will look at the mechanism of diet medicine and what side effects exist.

First, we have to clearly distinguish diet pills from diet supplements. Diet medicines can be taken only when prescribed by doctors. On the other hand, diet supplements are health functional foods that can be easily purchased at online shopping malls.

Diet supplements are made by extracting ingredients from food. Examples include the bark of the Garcinia cambogia tropical fruit, tea skins, catechin in green tea, and narinjin extracted from grapefruit. Supplements have less risk of side effects than medicines, but they are not obligated to conduct clinical trials in drug licensing, making it difficult to know information about which ingredients are mixed. And the reported cases of side effects of diet supplements are also increasing every year.

In the case of diet medicines, there are anorectic which suppresses our appetite, and colipase which inhibits the decomposition of fat and prevents it from being absorbed into the body. Anorectics include fenfluramine, and colipase includes orlistat(Xenical).

gracepark02@naver.com

zkou3859@yonsei.ac.kr

Fenfluramine, a clinically effective appetite suppressant, releases serotonin from nerve terminals and inhibits its reuptake. Considerable evidence suggests that these effects mediate its anorectic activity. The d-isomer of fenfluramine is particularly specific in affecting serotonin mechanisms.

Orlistat is a reversible inhibitor of lipases. It exerts its therapeutic activity in the lumen of the stomach and small intestine by forming a covalent bond with the active serine residue site of gastric and pancreatic lipases. The inactivated enzymes are thus unavailable to hydrolyze dietary fat in the form of triglycerides into absorbable free fatty acids and monoglycerides. As undigested triglycerides are not absorbed, the resulting caloric deficit may have a positive effect on weight control.

Through the pandemic season, many people have tried to lose weight, but they have to be careful when relying on medicine. You should carefully examine what drugs you take, what mechanisms they work on, and what side effects they have. I hope many people will be able to read this article and go on a healthy diet in the future. B

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