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ERNEST MARIO SCHOOL OF PHARMACY VOL.3 ISSUE 4 MARCH 25, 2014

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CHRONICLES x brought to you by Pharmacy Governing Council

by Yimin Xu, P4

CVS to Stop Selling Tobacco

CVS Caremark recently announced that it would stop selling tobacco products in its 7600 stores by October of this year. Larry J. Merlo, the CEO of the corporation, stated that CVS “came to the decision that cigarettes and providing health care just don’t go together in the same setting,” and that this is "the right thing for [CVS] to do for our customers … to help people on their path to better health." Such a move is commendable given the numerous adverse results of tobacco use, including lung cancer, COPD, and increased risk of heart disease and stroke. However, this decision will adversely impact the CVS bottom line. There is an anticipated decrease in annual sales by $2 billion, not only from direct tobacco sales, but also from incidentals such as gum or breath strips commonly bought by smokers. Nev-

Table of Contents Healthcare Reform.........................2 ZoHydro.........................................3 School News...............................5-6 Nutrition Labels.............................7 Interview with Professor Minko....8 Social Media..................................9

Photo Credit: http://info.cvscaremark.com/cvs-insights/cvs-quits

ertheless, this is but a small percentage of the $125 billion CVS makes annually, and will generate a lot of good will in some other industry sectors. Whether this translates to more sales will be seen as the year advances. This move by CVS is commendable, and it is important that other retail settings emulate their plan to promote better public health.

References: 1. Memmott M. CVS to Stop Selling Tobacco Products. The Two-Way (NPR). Available from: http://www.npr.org/blogs/thetwoway/2014/02/05/271906167/cvs-to-stop-selling-tobacco-products. Published February 5, 2014. Accessed March 9, 2014. 2. Strom S. CVS Vows to Quit Selling Tobacco Products. The New York Times. Available from: http://www.nytimes.com/2014/02/06/ business/cvs-plans-to-end-sales-of-tobacco-products-by-october.html. Published February 5, 2014. Accessed March 9, 2014. 3. Wahba P. CVS sticks to 2014 sales forecast despite tobacco exit. Reuters. Available from: http://www.reuters.com/article/2014/02/11/uscvscaremark-results-idUSBREA1A0VC20140211. Published February 11, 2014. Accessed March 9, 2014.

New Delivery System to Patch Up the Flu by Cindy Tu, P1 Fewer than half of Americans get the flu shot every year1. That amount may change for the better, however, with the help of researchers at Georgia Institute of Technology. The researchers have a new delivery system for the flu vaccine up their sleeve – a 50-microneedle, self-administered patch. They recently conducted a study to test people’s ability to self-administer the patch, as well as to determine whether they would consider the option of a patch for immunization. The results showed that 76% of the volunteers chose the patch over a shot, with 65% stating that they would get vaccinated in the next year if the patch was available1.

In the study itself, ninety-one volunteers, none of whom had any prior experience with microneedle patches, were instructed to apply three patches on themselves. A researcher then administered a fourth patch. Two types of patches were used – one a standard patch and the other bearing a snapon device that clicked when the patch was applied correctly. A hypodermic needle injection of saline solution was given as well. On a scale of 1 to 100, the users rated the pain associated with the patch versus that of the injection. The patch, on average, was given a score of 1.5 while the shot received a 151. To see how well the volunteers could self-apply the patch, the researchers added dyes to visualize the holes. All patches were applied correctly, but subjects with the snap did better2.

Continued on page 4


Healthcare Reform: An Update

by Yimin Xu, P4

Many changes have occurred in health insurance reform over the past few months; the employer health insurance mandate has once again been pushed back. Employers with less than 100 employees now have until 2016 to comply with the insurance mandate, though larger businesses must continue to offer insurance coverage throughout 2015. Currently, employers must offer insurance to at least 70% of full-time employees, which is defined as employees working at least 30 hours per week. These cutoffs, however, are still controversial and may be adjusted as 2015 nears. This will add an additional postponement from the original 2014 deadline to 2015, which had been announced in 2013. However, there has been no change in the individual enrollment deadline, and individuals have until the end of March 2014 to comply. Thus, the Small Business Health Options Program (SHOP) health insurance marketplace is not being used this year. Nevertheless, the individual plan marketplace is still up and functional for individuals and families. The government has been working to improve the website functionality, after the debacle of its reveal. Yet, there are still issues with the website, leading some insurance companies to urge patients to enroll directly

with the desired insurance company. As the deadline for individual enrollment looms, hopefully the government will fix the problems in time. Else, both patients who are willing and unwilling to enroll may be paying the penalty this year from their tax returns.

On a separate but related note, New Jersey Governor Chris Christie’s administration forfeited $7.6 million from the federal government on behalf of New Jersey. The funds were originally granted in 2012 to establish a state-based health insurance marketplace, which NJ has yet to do. New Jersey residents must instead rely upon the federal exchange system and healthcare. gov, with all of its past and current issues. Christie’s administration sought permission to use the funds for a call center for Medicare questions and to aid patients with long-term conditions, but the federal government repeatedly denied this request. Therefore, New Jersey must return the $7.6 million received, despite the fact that Christie has already begun to establish the call center proposed. Only time will tell how this impacts the bottom line of this year’s state budget. It is prudent to inform and remind those

without health insurance of the March 31, 2014 deadline. The benefits from having health insurance must be weighed against the cost, factoring in the annual penalty for not having insurance. The penalty may be as high as the national average annual premium for a bronze plan (based on 1% of household income) – in such an instance, it may be better to enroll in a health coverage plan. One thing is for certain: the issues surrounding healthcare reform are far from over. As issues are resolved, hopefully the insurance marketplace, will be fully functional and available for use for the public. References: 1. Cassidy J. Is Healthcare.org working now? Yes and No. The New Yorker. December 2, 2013. Available from: http://www.newyorker.com/ online/blogs/johncassidy/2013/12/is-healthcaregov-working-now-yesand-no.html. Accessed March 8, 2014. 2. Christie missed ObamaCare deadline, state to forfeit $7.6 million. NJToday.net. February 21, 2014. Available from: http://njtoday. net/2014/02/21/christie-missed-obamacare-deadline-state-forfeit7-6-million. Accessed March 2, 2014. 3. Healthcare.gov. What if someone doesn’t have health coverage in 2014? U.S. Centers for Medicare & Medicaid Services. Available from: https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014. Accessed March 8, 2014. 4. Healthcare.gov. We’re working to improve HealthCare.gov. U.S. Centers for Medicare & Medicaid Services. February 13, 2014. Available from: https://www.healthcare.gov/blog/how-we-are-working-toimprove-healthcare-gov. Accessed March 8, 2014. 5. Kennedy K. Another part of the Affordable Care Act delayed for a year. USA Today. February 10, 2014. Available from: http://www. usatoday.com/story/news/nation/2014/02/10/aca-no-longer-applies-to50-employees-and-under-in-2015/5370055. Accessed March 2, 2014. 6. Washburn L. NJ loses $7.6 million in Obamacare aid as grant expires. NorthJersey.com. February 20, 2014. Available from: http://www. northjersey.com/news/New_Jerseys_76M_grant_for_marketing_marketplace_for_Obamacare_expires_without_plan.html. Accessed March 2, 2014.

HPV Vaccine Reduces Risk for Cervical Cancer, but Low Rates of Immunization by Jennifer Kim, P3 Human Papillomavirus (HPV) is an insidious sexually transmitted infection (STI) that affects both men and women. It is one of the most common STIs as well as one of the most preventable, and it can be transmitted through several forms of sexual activity. In the past year, HPV has usurped tobacco usage as the leading cause of oral forms of cancer. HPV seems to be making its way into common knowledge; even actor Michael Douglas of Wall Street once famously attributed his tongue cancer to HPV. Once the virus gains entry and remains in the body, it can lead to genital warts, cervical cancer, and other cancers.1 Despite vigilance for HPV and its related cancers, and promoting vaccination, only about 50% of both boys and girls in the appropriate age ranges have been immunized against HPV.2

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A recent study conducted in Denmark has shown that vaccination for HPV significantly reduced abnormal cervical cells as well as cervical intraepithelial neoplasia, grade 2 or 3 (CIN2/3) in women born in the years 1991 through 1994. There was also a reduction in abnormal cells in women born between 1989 and 1990 – but not in CIN2/3. Ultimately, unvaccinated women had two times the risk for abnormal cervical cells and cervical cancer compared to vaccinated women. The quadrivalent HPV vaccine, known as Gardisil® in the US, was used in the study. There has been previous evidence that immunization against HPV is effective, but even today, vaccination rates remain lower than expected.3 As pharmacists gain more immunization rights in the US, the rate of vaccination for HPV can be increased through pharmacist

intervention. By counseling and informing patients about the HPV vaccine, we can help prevent infections and help further decrease the rate of infections. As future pharmacists, it is imperative to keep in mind that every little bit of counseling can contribute to a decrease in preventable illnesses. Referemces: 1. Centers for Disease Control and Prevention – STD Facts, HPV [homepage on the Internet]. Centers for Disease Control and Prevention.; c2014 [updated 2014 January 23; cited 2014 Mar 4]; [about 1 screen]. Available from: http://www.cdc.gov/std/hpv/stdfact-hpv.htm 2. Centers for Disease Control and Prevention – Teen Vaccination Coverage, NIS [homepage on the Internet]. Centers for Disease Control and Prevention.; c2014 [updated 2013 August 29; cited 2014 Mar 4]; [about 1 screen]. Available from: http://www.cdc.gov/vaccines/who/ teens/vaccination-coverage.html 3. Pharmacy Times. (2014). HPV Vaccine May Reduce Risk for Cervical Lesions. Retrieved from http://www.pharmacytimes.com/news/ HPV-Vaccine-May-Reduce-Risk-for-Cervical-Lesions


ZoHydro® -- the Introduction of a High Abuse Potential Substance and Public Response

By Saera Murtaza, P1

Zohydro® has only been on the market for a short period of time, but has already been huge a source of controversy for the Food and Drug Administration (FDA). The extended-release, opioid painkiller pill produced by the San Diego based pharmaceutical company, Zogenix Inc., contains hydrocodone in 10 times the amount normally found in Vicodin® – a drug not a stranger to controversy itself. Due to such a high concentration of active ingredients in this opioid drug, certain addiction-treatment groups believe that one pill is fatal for a child and 2 pills are fatal for an adult. However that is only one of the many concerns politicians and law enforcement share about this drug. Zohydro’s® current formulation has no safeguard measure against being snorted or crushed by abusers. New York State Senator Charles Schumer expressed his disbelief over the drug’s release and has called upon the FDA to take it off the market. He feels that the FDA’s approval to allow the drug on the market is bad enough as it is. He says, “...not having the protection that is required for drugs of lesser potency, it’s hard to believe [that this drug was passed].” Schumer held a press conference recently after the product’s launch on the market. He spoke with family members who have personally experienced the tragedy of having a relative suffer from prescription drug abuse. The members included a relative of a victim in the Medford Pharmacy massacre in Long Island during which four people lost their lives during a fatal robbery of prescription painkillers. The FDA’s

Photo Credit: http://www.salem-news. com/articles/february172014/zohydro-erms.php

decision is contradictory to that of its own scientific advisory board, which voted last fall against the drug’s approval with 11 vs. 2 decision. In their own defense, the FDA, along with the manufacturer of Zohydro®, believe that this synthetic opioid drug will be a safe and necessary alternative to patients who have become opioid tolerant to what is already available on the market, or who have low tolerance to opioids in combination products with other medicines such as acetaminophen. A petition protesting against Zohydro®, backed by 42 members of addictiontreatment facilities and advocates against prescription drug abuse, was sent to FDA commissioner Dr. Margaret Hambury. Addiction specialist Dr. Richard Blondell, based in Buffalo, NY, feels that there are more cons than benefits to prescribing Zohydro®. He expressed concern over the FDA’s reasoning that there may be an ulterior motive to releasing such a product when there are already so many painkillers on the market, citing that releasing painkillers is a lucrative business. Another concern about this opiod drug is that it is manufactured by Alkermes, the same company that produces Vivitrol®, which is used to treat individuals suffering from painkiller or alcohol addiction. According to a New York Times report, not only is Alkermes involved in manufacturing the drug as per an affiliation with Zohydro’s® parent company Zoegenix, Inc., but Alkermes also provides funding to professional groups that interact with substance abuse experts in the American Society of Addiction Medicine. This is a conflict of interests that troubles doctors who specialize in addiction treatment. There are ethical concerns about Alkermes, a company that has responsibility towards aiding patients, and at the same time, earns profits from manufacturing a new substance with high addition potential. Families who have lost their loved ones to opioid related overdoses have expressed much grief over Zohydro’s® release onto the market. The availability of more prescription opioids available at pharmacies

Photo Credit: http://www.rappler.com/ science-nature/life-health/52475-potentnew-painkiller-stokes-alarm-in-us is not something families, politicians, or addiction specialists are pleased to hear about. In time, this situation may change in favor of the families who have lost their loved ones, but time will tell whether Zohydro® will continue to be available on the market. References: 1. Meir, Barry. Addiction Specialists Wary of New Painkiller. The New York Times. Published November 13, 2013. http://www.nytimes. com/2013/11/16/business/addiction-specialists-wary-of-new-painkiller. html?_r=1& Accessed March 05, 2014. 2. Schumer: ‘Hard To Believe’ Potent New Painkiller Approved Without Protections In Place. http://newyork.cbslocal.com/2014/03/03/schumer-hard-to-believe-potent-new-painkiller-approved-without-protections-in-place/ Published March 03, 2014. Accessed March 05, 2014. 3. Michel, Lou. Impending debut of potent prescription painkiller Zohydro fuels debate over dangers. The Buffalo News. Published March 04, 2014. http://www.buffalonews.com/city-region/impending-debutof-potent-prescription-painkiller-zohydro-fuels-debate-over-dangers-20140304. Accessed March 05, 2014.

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U.S. Judge Blocks Sale of Controversial Execution Drug to Missouri

by Melanie Chen, PP2

On Wednesday, February 12th, a U.S. judge temporarily blocked The Apothecary Shoppe, a compounding pharmacy based in Tulsa, Oklahoma, from selling the execution drug pentobarbital to the Missouri Department of Corrections. Missouri jailers were intending to use the drug for the execution of Michael Taylor, who was found guilty in the rape and death of a 15-year-old Kansas City girl1. After the pharmacy was named in a lawsuit filed by death row inmate Michael Taylor alleging that the drug could cause “severe, unnecessary, lingering and ultimately inhuman pain”, U.S. District Court Judge Terence Kern granted a temporary restraining order preventing the pharmacy from supplying compounded pentobarbital, a fast-acting barbiturate, to the Missouri jailhouse2. States that have the death penalty, such as Missouri and Ohio, have found it increasingly difficult to obtain the execution drugs they seek. Major drug-makers, many of which are based in Europe with longtime opposition to the death penalty, have stopped selling to prisons and correctional facilities. As a result, some states have turned to compounding pharmacies as they look for alternate drug sources. However, the FDA does not regulate the drugs produced in small quantities, which are furnished by independent compounding pharmacies. This controversy has prompted defense attorneys to question the quality of the drugs and whether they can induce undue pain during executions1. “This is not an acceptable method for carrying out executions – to use an unlawful and dangerous drug – so we are hoping to stop that from happening,” said Matthew Hellman, one of Taylor’s defense attorneys1. Pharmacists are also not the most eager to be providing this service. In an interview with National Public Radio (NPR), CEO of the International Academy of Compounding Pharmacists David Miller said, “I don’t think it’s a question that you’re going to see compounding pharmacists storming

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Capitol Hill saying we want to be able to provide medications for lethal injections. That’s actually contrary to what we do as a profession…We should not, certainly as pharmacists, be put in the position of having to prepare those medications without having direct input into what that protocol looks like.” One of the concerns that both Miller and U.S. district courts share is that the drugs produced by compounding pharmacies are not exactly the same as those produced by pharmaceutical companies. This compounding procedure could bring up unknown effects of the drugs during the execution process. Miller explains, “…A manufacturing process involves some proprietary steps. So, for example, the formulas that a compounding pharmacist uses, they may be different from those used by the pharmaceutical manufacturers, which maintains a certain level of confidentiality and privacy. So there might be buffering agents, for example, that a manufacturer uses. A compounding pharmacy may use a different kind of buffering agent…And that’s one of the concerns that we have, also.”3 Experts say they are not surprised that some compounding pharmacies are starting to back away too, given the ethical concerns, potential legal costs, and unwanted negative publicity2. With less than a week before Taylor’s scheduled execution, Missouri announced that The Apothecary Shoppe would be willing to supply the drug. Under that time limit, there would have been no way to perfect and test the drug. In Oklahoma, a death row inmate who survived the execution process said he felt burning throughout his body when the drugs used to kill him were injected into his system. Taylor’s attorneys cited the Oklahoma case in their lawsuit1. References: 1. Johnson, Eric. “U.S. judge blocks sale of controversial execution drug to Missouri.” Reuters. Thomson Reuters, 13 Feb. 2014. Web. 3 Mar. 2014. 2. “Federal judge rips death penalty states for secretive execution methods - RT USA.” RT USA. N.p., n.d. Web. 3 Mar. 2014. 3. “Compounding Pharmacies Called On To Make Execution Drugs.” NPR. NPR, n.d. Web. 3 Mar. 2014.

Flu Patches Continued from front page While the patches used in the study did not actually contain the flu vaccine, there are many implications with this alternative method. With its patient tolerability, ease of use, and convenience, the patch can decrease hospitalizations due to influenza by increasing the number of people who get the vaccine. Unlike the flu shot, which has to be refrigerated, the patch can be stored at room temperature. Patients can put the patch on themselves, saving them a trip to the clinic or pharmacy to wait for a healthcare professional. With the hopes of protecting more patients and reducing cost, researchers are currently collaborating with a manufacturing company to begin testing with the real vaccine next year, pushing for the patch to be released within the next five years1. References: 1. Fox, Maggie. Slap on a Flu Patch? New Vaccine Would Skip the Needle. NBC News. Feburary 28, 2014. http://www.nbcnews.com/health/ health-news/slap-flu-patch-new-vaccine-would-skip-needle-n40726. Accessed March 3, 2014. 2. If The Flu Vaccine Was Available As A Patch, Would You Be More Likely To Get It? Huffington Post. March 3, 2014. http://www.huffingtonpost.com/2014/03/03/vaccine-patch-flu-injection_n_4861358.html. Accessed March 3, 2014.

Announcement: We invite you to join us to our visit to the Metropolitan Area's first accredited compounding pharmacy. Belvidere Pharmacy specializes in individualizing medications for people and pets. Do not miss out on this unique opportunity to see the operation of a very successful pharmacy in a field that is currently flourishing. Space is limited so please let us know as soon as possible if you are interested in attending by emailing: ap2292@gmail.com.


School News

Pharmacy Organization and Events on Campus

SNPhA Celebrates and Reflects on the Meaning of Light backgrounds. These ethnic performances included the Indian Christian Fellowship, Orphansporks, Chinese Bandits, Rutgers Asian A’cappella, Rutgers Belly Dancers, Jhoom Dynamix, and Deep Treble. Each performance showcased their own unique culture and traditions at the event and brought about a true sense of appreciation for diversity among the audience.

Photo Credit: Vivian Wu by Vivian Wu, P2 Once again, SNPhA brought together the whole of the Rutgers community to celebrate their annual Celebration of Lights, which took place in the UMDNJ Great Hall on December 2, 2013. There were about 80 guests that attended the event. The hall was decorated to reflect the cultural diversity of Rutgers students, from posters of various national flags to centerpieces of candles adorning popular cultural landmarks

around the world. This celebration is the culmination of all of SNPhA’s efforts as an organization: to embrace the diversity of all groups at Rutgers and enjoy time with friends before the holidays. Students brought and shared homemade cultural dishes and dessert for everyone to taste and try something new. Not only did the event feature a grand cultural buffet, but also featured a wide variety of entertainment from many different

Photo Credit: Vivian Wu SNPhA members also took an opportunity to describe several of their own cultural holidays that are celebrated by their families in the months of December and January. Some of these holidays included Christmas in Taiwan, Simbang Gabi, Diwali, and Eid. Overall, by the closing of the celebration the event truly left the audience with a sense of pride in their own cultures, but also a feeling of unity with those of different nationalities. It is a rewarding experience for all to accept and embrace as SNPhA continues to spread a sense of unity in being diverse as one of our main goals as an organization.

Photo Credit: Vivian Wu

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ISPOR/IPhO Host HEOR Fellowship Event

by Alex Wei, P3

On March 6th, ISPOR, in collaboration with IPhO, invited 5 Health Economics and Outcomes Research Industry Fellows from Novartis to Rutgers for an HEOR Fellowship Roundtable event. Dr. Kimberly McGuigan, Executive Director of the new Health Outcomes, Policy and Economics Institute at Rutgers opened the event with remarks on her role as Executive Director of the new Institute and a new Masters program co-sponsored with the School of Public Health. The Fellows represented 4 different programs: Rutgers, Jefferson, UTAustin, and Maryland. Together, they were able to provide valuable insight on their respective programs and give students a better understanding of the role of HEOR in the pharmaceutical industry. The students in attendance also had the opportunity to network extensively with the fellows afterwards and build up their professional network.

Photo Credit: Sonia Liu

Ethical Dilemma: Irish Teenager Dies After Pharmacist Refuses to Sell EpiPen® Without Prescription By Linda Maa, P1 Late December 2013, 14-year old Dublin teenager Emma Sloan mistakenly consumed satay sauce, which contains peanuts, at a Chinese restaurant. This triggered her severe allergy, and she went into anaphylactic shock on the street. Her mother ran to a nearby pharmacy. The pharmacist was faced with a dilemma. He could either dispense or refuse to dispense the EpiPen®. In this precarious situation, ultimately the pharmacist abided by the law and refused to dispense the EpiPen® without a valid prescription. Consequently, the girl died before paramedics reached the site. This caused a major uproar in the media across the world, and a majority of readers assigned the blame to the pharmacist. In this ethical debate, there is no right or wrong answer; however, both courses of action can be rationalized. Had the pharmacist dispensed the EpiPen®, there may have been a number of consequences. Legally, the pharmacist is not allowed to dispense prescription medi-

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cations without a prescription, so he might have had his license suspended or revoked. A pharmacist is not allowed to leave the premises of the pharmacy, and he would have been liable for incorrect usage of the EpiPen® if the mother took it and administered it herself. The pharmacist would not have known if there was a legitimate medical need since he did not see the patient directly. Furthermore, the pharmacist did not know if the patient would have an adverse reaction to the epinephrine because he did

Photo Credit:http://www.medchannel. com.au/training-equipment/first-aidtrainer-supplies/epipen-trainer

not have access to her medical history. On the other hand, the purpose of the medical profession is to help save lives. If given the opportunity, medical practitioners are ethically obligated to “do no harm” and help patients. The death of a patient could have long-lasting effects on the conscience and psyche of the pharmacist. Ultimately, pharmacists and students alike should understand that emergency ethical situations like this may arise at any given time. Anyone who is pursuing a medical degree must be prepared to make split-second decisions that may cost patients their lives.

References: 1. Caba, Justin. "Emma Sloan, 14, Dies On Street After Pharmacist Refuses Life-Saving EpiPen." Medical Daily. N.p., 23 Dec. 2013. Web. 04 Mar. 2014. <http://www.medicaldaily.com/dublin-girl-emma-sloan14-dies-street-after-pharmacist-refuses-life-saving-epipen-265670>. 2. "Girl Dies after Pharmacist Refuses to Give EpiPen without Prescription." Fox News. FOX News Network, 23 Dec. 2013. Web. 04 Mar. 2014. <http://www.foxnews.com/health/2013/12/23/girl-dies-afterpharmacist-refuses-to-give-epipen-without-prescription/>.


Prescription Painkiller Abusers Rely on Friends and Family for Drugs

by Smita Juggernauth, P1 Pharmacists and other healthcare workers commonly cite treating prescription drug abuse as one of the most trying hurdles faced in their professions. This growing problem has necessitated that pharmacists become adept at recognizing the signs of abuse. However, even the most seasoned professional can fail to recognize the most common route of abuse.

According to a new study taken by the Centers for Disease Control and Prevention, more than half of prescription painkiller abusers acquired their drugs from friends

and family. Only 15% of abusers obtained painkillers from illegal drug dealers, and they tended to be high-volume, more deeply addicted users. In contrast, the majority of abusers were reported to receive drugs in smaller quantities from close relations. Although the idea of close friends and family “slipping a pill” to an addict every once in a while may not seem to be a very pressing issue, the same patients are part of the group with the highest risk of death from overdose. While many commonly abused drugs, such as cocaine and heroin, are currently seeing

a downward trend in deaths from overdoses, prescription opioid overdoses have more than tripled from 1999 to 2010. There is a growing trend away from illegal street drugs towards legally prescribed medications. In light of this growing phenomenon and the new drug diversion tactics being implemented by patients, we as pharmacists should come together to expand our role as part of the nation’s fight against illegal drug use. References: 1. Associated Press. Friends common source of abused meds. USA Today Web site. http://www.usatoday.com/story/news/nation/2014/03/03/ prescription-painkillers-friends study/5996957/. Published March 3, 2014. Accessed March 5, 2014.

Nutrition Labels Get a Much-Needed Transformation undergoing significant changes. The new

by Brittany Yalamanchili, P1

We all know that American foods are under increasing scrutiny from the public for the numerous artificial ingredients, unpronounceable additives, and loaded up sugar in many food products. Although nutrition labels are meant to help people make informed decisions about their food, for many, they are an overwhelming mass of information. Just like the food pyramid, however, nutrition labels are now also getting a much-needed makeover. On March 3rd, the Food and Drug Administration stated that the old black-and-white nutrition labels on all food products would be

changes seek to make the labeling more clear and simple to understand, and this marks the first time that nutrition labeling is being updated since its launch in 1993

One of the biggest modifications is an increased focus on calories per serving. The calorie information will bolded and made larger than the rest of the labeling. This will ensure that the public is more aware of their total calorie consumption, especially if they choose to forgo the recommended serving size. In order to help the public understand serving size portions, the new label will also state the calories per serving

and calories per package. Additionally, the table layout of the label will be modified so Percent Daily Values (DV) are listed the left of the values, which will enhance the design and allow people to clearly track the percentages. Calories from fat will be removed. This is because the type of fat an individual consumes is more significant than the total amount of fat. Potassium and vitamin D will be required to appear on the label, in addition to the already mandatory vitamins A and C. This will help consumers track which foods are heavily processed, since heavily processed foods have a significantly lower potassium level. The recommended daily amount of sodium will decrease to 2,300 milligrams, whereas fiber recommendations will increase by 4 grams. There will also be a new category clearly indicating the amount of sugar in the product, with a separate line for added sugars. Once this proposal is submitted, the public will be given 90 days to comment on the updates. Afterwards, companies will be given 2 years to comply with the new requirements. Undoubtedly the food industry and health experts will hotly debate these changes, but it is clear that these modifications are a step in the right direction towards a healthier nation.

Left: Current Nutrion Label; Right: Newly Proposed Nutrion Label Photo Credit: http://www.nytimes.com/2014/02/27/health/new-fda-nutritionlabels-would-make-serving-sizes-reflect-actual-servings.html?_r=3

References: 1. Food and Drug Administration. Food Labeling: Revision of the Nutrition and Supplement Facts Labels. By Leslie Kux. Available at: https:// s3.amazonaws.com/public-inspection.federalregister.gov/2014-04387. pdf. Accessed March 4, 2014. 2. Tavernise, Sabrina. New F.D.A. Nutrition Labels Would Make ‘Serving Sizes’ Reflect Actual Servings. New York Times. February 27, 2014. http://www.nytimes.com/2014/02/27/health/new-fda-nutrition-labelswould-make-serving-sizes-reflect-actual-servings.html?_r=2. Accessed March 4, 2014.

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Professor Tamara Minko’s Pulmonary Fibrosis Research Receives $1.8 Million Funding by Lydia Chou, P1

The first step to creating her drug delivery system is to screen for the most appropriate siRNA sequence. After screening sequences of siRNA, Professor Minko tests them in-vitro using cell-cultured fibroblasts to discover which siRNA is most effective in limiting signs of fibrosis. Once the best siRNA sequence is selected and combined with the medication, the research can progress onto pre-clinical animal studies right inside Rutgers pharmacy building.

I would like to thank Professor Minko for taking the time to discuss her research with me. Tamara Minko is a Distinguished Professor and Chair of the Department of Pharmaceutics at Rutgers, The State University of New Jersey. She is an author and co-author of more than 400 publications (peerreviewed papers, books, textbook chapters, and patents) that are published in many prestigious journals. In our very own pharmacy building at Rutgers University, where we attend classes and sit in the burgundy seats of lecture halls, groundbreaking research simultaneously occurs a mere few floors above us. Most recently, Professor Tamara Minko received an impressive $1,842,195 for her innovative research in pulmonary fibrosis. Joining Rutgers University in 2000, Professor Minko has an extensive science background. She holds a masters degree in Biochemistry, a Ph.D in Cellular & Molecular Physiology, and completed post-doctoral training at the University of Utah in the Department of Pharmaceutics and Pharmaceutical Chemistry. The grant comes from the National Institutes of Health (NIH), and provides four years of funding for her pulmonary fibrosis research. Professor Minko devotes her career to creating novel drugs for incurable diseases that have challenges with patient survival. In particular, she focuses on ovarian and lung cancers because of their low survival rates, tendency to metastasize, and development of drug-resistance in cancer cells. She researches on how to deliver drugs exactly to a tumor; focusing heavily on targeted delivery systems that increase treatment efficiency as well as decrease adverse drug effects on bystander organs. With her strong education and history of experience, she hopes to change the bleak outlook for difficult disease states. Professor Minko's latest focus, pulmonary fibrosis, is the condition of normal lung

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Photo Credit: pharmacy.rutgers.edu

tissue transforming into fibrotic tissue and preventing the lungs' major function of oxygen-carbon dioxide exchange. As more fibrotic tissue spreads throughout the lungs, patients experience breathing complications that may ultimately lead to death. Although more rare than lung cancer, pulmonary fibrosis patients need to rely on supplemented oxygen, and in severe cases, must get a lung transplant. Currently, there is no cure for pulmonary fibrosis, but Professor Minko is attempting to renew hope in treatment possibilities. Her inventive research includes combining three tactics into a simultaneous, targeted drug delivery system. Firstly, the patient will use an inhaler for local, pulmonary delivery of the drug directly to the lungs. Secondly, prostaglandins are delivered to the lungs to suppress the development of fibrotic tissues in them. Thirdly, Professor Minko is using gene therapy to deliver siRNA, which is short interfering or silencing RNA, in order to inhibit the signaling pathways of fibrosis, decrease cell resistance, and enhance treatment efficacy of prostaglandins. The three approaches will be conducted at the same time using an advanced nanotechnology design that uses special lipid nanoparticles composed of the medication, siRNA, and a special inhaler device. Through this unique combination therapy, Professor Minko hopes to successfully prevent the formation of new fibrosis and destroy existing fibrotic tissue in the lungs.

Though, not everything may be smooth sailing – Professor Minko expects to encounter challenges in balancing drug stability and release profile. In storage, the nanotechnology needs to be stable enough to not degrade and lose its effectiveness. Inside the lungs, however, the active components need to be able to be released from the nanocarriers in exactly the right location and time in order to induce the maximal effect. Professor Minko will need to

“If you have an interest, and if you are enthusiastic and can work hard, you will be successful.” - Prof. Minko find creative methods to combat this problem if the drug is to pass the Food and Drug Administration’s stringent requirements. On a closing note, Professor Minko expresses that all her work is worthwhile because she loves to see if her ideas of inhalation treatment for pulmonary fibrosis will come to fruition. There is nothing more rewarding than knowing that she played a hand in the process that truly affected another person's health and life. As a piece of advice for students interested in pursuing pharmacy research, Professor Minko encourages, "If you have an interest, and if you are enthusiastic and can work hard, you will be successful. It is an interesting life where you need to write papers, read papers, and when you start experiments they may not work at first. But make sure you do not get discouraged and continue to work!"


Inside Industry Explore Career Paths in Pharma

Social Media as the Next Marketing Outlet for Pharmaceutical Industry by Stephen May, P1, IPhO The current US pharmaceutical industry is fiercely competitive, and as drug development process and regulatory procedures grow more extensive, pharmaceutical companies are pushing to employ new distinct means to differentiate their product from competitors. The new way to reach consumers may be, however, something that many in the United States already interacts with on a daily basis: social media. According to a report by the Pew Internet and American Life Project in 2008, 73% of internetactive American teens regularly used social networking websites and 47% of internetactive adults used social networking -- both totals which are expected to continue to increase.1 With such a large demographic of consumers regularly participating on social media sites, it seems like a natural progression for pharmaceutical companies to utilize this outlet as a unique means of marketing to their customers. The ability of a pharmaceutical company to find a specific social media outlet to communicate and market directly with their consumer base would give them a substantial advantage over competitors without this access. Though the potential for competitive advantage through social media has been clearly noted, especially with different national industries, a recent report by Pharmaceutical Executive and the SAS Institute detailed the lack of experience of the pharmaceutical industry in implementing social media outlets as part of their marketing strategy.2 The report then depicted several additional points of concern in regards to the pending expansion of the pharmaceutical industry onto the social media outlet. The first and most prominent of the concerns brought to light was the lack of Food and Drug Administration (FDA) regulations of limitations and requirements on pharmaceutical marketing activities within

the social media space.2 Companies are hesitant to devote resources heavily in social media marketing before the FDA publishes guidelines on the matter. The FDA, whose lack of resources and appropriate funding has been previously noted,3 faces a daunting challenge in regulating pharmaceutical marketing within the growing field of social media. It should be noted, however, that some companies, such as Johnson & Johnson and Roche have taken it upon themselves to proactively set up internal guidelines about the utilization of social media outlets within the companies.2

and do not frequently utilize social media sites. Pfizer may then choose, instead, to adapt the social media marketing campaign to communicate with caregivers or family members of Alzheimer’s patients in order to effectively promote their product. All-in-all, social media is a viable, unique opportunity for pharmaceutical companies to differentiate themselves from competitors with their consumer base. Nevertheless, there are still numerous regulatory and optimization challenges that need to be addressed before social media can be fully utilized by the pharmaceutical industry.

Although the utilization of social media appears to be an inevitable extension of pharmaceutical marketing, there are some companies for whom this benefit appears less applicable. Industry giant Pfizer, for example, may face a unique challenge in marketing Aricept®, a popular Alzheimer’s medication, through a social media outlet as Alzheimer’s patients are often elderly

References: 1. Lenhart, Amanda, Kristen Purcell, Aaron Smith, and Kathryn Zickuhr. "Social Media & Mobile Internet Use Among Teens and Young Adults." Pew Internet & American Life Project. Pew Research Center, 03 02 2010. Web. 3 Mar 2014. <http://www.pewinternet.org/2010/02/03/ social-media-and-young-adults/>. 2. "Social Media: Humanizing the Brand." SAS Institute. Pharmaceutical Executive in association with the SAS Institute. Web. 3 Mar 2014. <http://www.sas.com/resources/asset/pharmaceutical-executive-special-report.pdf>. 3. Institute of Medicine (US) Forum on Drug Discovery, Development, and Translation. Challenges for the FDA: The Future of Drug Safety, Workshop Summary. Washington (DC): National Academies Press (US); 2007. Available from: http://www.ncbi.nlm.nih.gov/books/ NBK52930/

Editor-in-Chief: Jennifer Kim Co-Editor-in-Chief/Layout Director: Maryann Torres Associate Editors: Melanie Chen, Smita Jaggernauth, Jazmin Turner, Yingzhi Zhang Staff Editors: Yimin Xu, Jenny Shah Layout Editors: John Daniel, Jane Lee, Cindy Tu, Stephanie Wo Staff Writers: Lydia Chou, Linda Maa, Saera Murtaza, Cindy Tu, Yimin Xu Disclaimer: The opinions expressed in EMSOP CHRONICLES do not reflect the views of the Pharmacy Governing Council (PGC) or Ernest Mario School of Pharmacy (EMSOP). For questions, comments, and information on how to get involved, e-mail emsopchronicles@gmail.com

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EMSOP Chronicles Spring 2014 Issue 1