EMSOP Chronicles Vol.15 Issue 4 (Spring 2024)

EMSOP CHRONICLES x

TikTok Shop’s Supplemental Surge

by Justin Vatanapradit,

Health trends, often involving diets, supplements, herbals, and vitamins, constantly cycle in and out of popularity in our consumer-heavy culture. Health products initially appear to be promoted by someone trustworthy and helpful, perhaps a charismatic salesman or even a celebrity. However, a commercial often allows one to see past the paid promotion and recognize these individuals as a salesperson. With the new age of social media platforms such as TikTok, anybody and everybody can create high-paced short-form content. The reach of health trends have not only found a new audience, but also new advertisers. Rather than an overt commercial with a high production value and a well-spoken salesperson, videos consist of a random personpointingattextwhilefilmedbytheir iPhone camera. One of the appeals of TikTok is how "real" it seems; the people posting are everyday people just like you. The candid nature that individuals speak

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with and non professional, low budget video quality makes many videos on the app seem trustworthy. Additionally, some social media platforms have become a “one-stop shop,” where you can watch a videoaboutsomeone’sexperienceandsubsequently buy those products in the very same app. While “TikTok Shop” is not limited to just health products, some of the items that receive the most "advertising" through users are health-related. Moreover, TikTok will pay any creator, not just large influencers, whenever someone buys a product through their page, creating an incentive towards peddling these products. An example of one of these items is the GuruNanda Oil Pulling kit, which is an oil said to promote teeth health and whitening. Oil pulling is a traditional medicine with thousands of years of history.1 There has been research done on the benefits and efficacy of the therapy, and it was found to be beneficial to dental hygiene routines and dental health overall.1 However, the rise in

popularity of oil pulling has seen many outlandish claims, backed without research, such as the miraculous healing of serious dental issues. Users post videos comparing how white their teeth have gotten since they took the oil pulling treatment. Some even claim miraculous outcomes, such as regrowing a chipped tooth, preventing a root canal,andremovingplaque.However,there is not universal praise for these products. Some users post videos in protest of oil pulling, arguing that while it can help with dental hygiene, it is not the miracle supplement some users claim it to be. Dentists on TikTok tend to be the latter in this situation, and "debunk" many of the claims made, saying that some of these claims are simply impossible or that the claims were unfounded and misinformed. In an example of a video from a user claiming that oil pulling removed their plaque, the dentist Huzaifa Kapadia (@dentite on TikTok) explains that the person actually removed calculus, which is a different substance than

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Hidden Costs, Hidden Struggles: The Increase in the Financial Burden of Mental Healthcare for Children

by CarlaArca-Sedda, P2

In recent years, there has been a growing recognition of the importance of mental health care for children and adolescents. Yet, as awareness increases, so do the costs associated with providing necessary services. Particularly concerning is the sharp rise in healthcare costs for children with mental health issues. The cost of caring for a child with a mental health condition has increased almost one third since 20171. This article delves into the underlying factors contributing to this alarming trend and its implications for families and society as a whole.

Before delving into the rising healthcare costs, it's essential to understand the context in which this issue arises. Mental health issues among children and adolescents are on the rise, with conditions such as anxiety, depression, ADHD, and autism spectrum isorders becoming increasingly

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prevalent2. This trend is influenced by various factors, including genetic predispositions, environmental stressors, social media usage, and societal pressures. For families of children with mental health issues, the financial burden can be overwhelming. The costs associated with therapy sessions, medication, specialized treatments, and other interventions can quickly

add up, placing a strain on household finances3. Moreover, families may also face indirect costs such as missed workdays to attend appointments and travel expenses to access care.

The healthcare system itself also contributes to the increase in costs for children with mental health issues. Fragmentation of care, lack of coordination between

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Beta Blockers for Stage Fright?

By Sanjana Ojha, P3

For those who watched the Golden Globes, you may have heard Robert Downey Jr.’s statement before his acceptance speech, "Yeah, yeah, I took a beta-blocker so this will be a breeze."1 Beta blockers are primarily used for cardiovascular conditions like hypertension, coronary artery disease, and tachyarrhythmias.2 The beta blocker that Robert Downey Jr. may have been referring to is propranolol, a nonselective beta blocker can cross the blood brain barrier, exerting its effects in the brain and heart.2

Propranolol is one of the few medications that has shown efficacy in instances of stage fright or situational anxiety.2 This drug decreases the physiological symptoms of anxiety such as increased blood pressure, heart rate, respiration rate, and skin conductance.2 A study found that propranolol severely decreased the physical aspects of anxiety and also significantly relieved other symptoms including shortness

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of breath, chest pains, and weakness associated with beta stimulation.3 Not only has performance quality been reported to improve, but also the degree of pre-performance anxiety has been shown to decrease after taking propranolol.2

It is important to note that no well designed clinical studies specifically examining beta blockers and stage fright currently exist. It is also important to note that although betablockers are generally considered safe,

contraindications to use and side effects do exist.3 Some of these side effects may include bronchospastic effects, bradycardia, and hypotension.3 Ultimately, it is important for those suffering from this form of anxiety to consult a professional and determine if a beta blocker is a good option for them.

References

1. Robert Downey Jr. announces on Golden Globes stage: “I took a beta-blocker.” What do they do?. USA TODAY. Reviewed January 8, 2024. Accessed March 7, 2024. https://www.usatoday.com/story/life/health-wellness/2024/01/08/robert-downey-jrat-golden-globes-raves-about-beta-blockers/72147699007/

2. Szeleszczuk L, Frączkowski D. Propranolol versus Other Selected Drugs in the Treatment of Various Types of Anxiety or Stress, with Particular Reference to Stage Fright and Post-Traumatic Stress Disorder. Reviewed September 2022. Accessed March 7, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9456064/#B88ijms-23-10099

3. Kathol R.G., Noyes R., Jr., Slymen D.J.,et al. Propranolol in Chronic Anxiety Disorders. Arch. Gen. Psychiatry. Reviewed December 12, 1980. Accessed March 7, 2024. https://pubmed.ncbi.nlm.nih.gov/7447618/

No Patience for Patients

byAshley Huang, P1

The race for drug development is propelled by one primary limiting factor, time. Within the past year, the FDA approved a wide range of 55 new drugs and biological products.1 Though there is an overwhelming pressure to meet unmet medical needs and alleviate the burden of illness, it is striking that the drug development process requires a delicate balance of patience and unwavering urgency. On average, the timeline for a drug to reach the market is 10-15 years.2 Not only must companies be committed to the long process of creating regulatory submissions, researching safety, and conducting long and costly clinical trials, but they must also be willing to make the decision to stop development at any moment, divert time and resources towards a more viable product.

For patients who are unresponsive to current treatments, time can mean the difference between the release or discovery of a new drug and a disease progressing in severity. 2023 saw the initiation of 22,338 clinical trials with another 6,234 trials completed and another 777 terminated.3 No

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definite number can quantify the lives impacted by these trials, but the promise of improving the human condition feeds scientific innovation.

As students navigating our academic journeys, it is easy to lose ourselves in the hours and hours pouring over notes and lectures. However, it is important to remember that with the passage of time comes with patients awaiting a life changing treatment. Though it can feel overwhelming, learning

to time manage as to not be intimidated by time, or the lack of it, allows for it to become a motivator rather than a limiter.

References

1. Center for Drug Evaluation and Research. Novel drug approvals for 2023. U.S. Food and Drug Administration. Accessed March 8 , 2024. https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals2023.

2. How long a new drug takes to go through clinical trials. Cancer Research UK. March 3, 2022. Accessed March 8, 2024. https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/how-clinical-trials-areplanned-and-organised/how-long-it-takes-for-a-new-drug-to-gothrough-clinical-trials#:~:text=There%20is%20no%20typical%20length,a%20drug%20to%20be%20licensed.

3. Beaney A. Most significant clinical trials of 2023. Clinical Trials Arena. January 5, 2024. Accessed March 12, 2024. https://www.clinicaltrialsarena.com/features/most-impactful-clinical-trials-2023-round-up/?cfview.

Wegovy a Week, Keeps the CardiologistAway!

by Riya Mankad, P2

Photo Credit: (NEJM, 2023) DOI: 10.1056/NEJMoa2307563

On March 8, 2024, based on the landmark latestage SELECT trial, FDA approved a new cardiovascular risk indication for Wegovy (semaglutide).1 Initially launched as an antidiabetic medication by Novo Nordisk, it has gained many new indications over the years, including weight loss and more recently, cardiovascular risk reduction. In the SELECT trial conducted by Novo Nordisk, it was shown that semaglu-

tide can reduce the risk of adverse cardiovascular events in overweight or obese patients compared to a placebo.

Semaglutide is a glucagon-like peptide-1 (GLP-1) analog, working by mimicking our body’s natural hormone GLP-1.2 GLP-1 is a hormone produced by the intestines to help control blood sugar. It works via multiple mechanisms to help control glycemic index, including stimulating insulin release and

delaying gastric emptying. Alongside other contributors, insufficient production of this hormone can contribute to diabetes and metabolic conditions that elevate cardiovascular risk.

Affecting nearly 40% of US adults, obesity is one of the leading US public health issues and contributors to cardiovascular disease.3 Therefore, working to expand treatment that targets both weight loss and cardiovascular disease is a step towards advancing public health.

References

1. FDA. (n.d.). FDA approves first treatment to reduce risk of serious heart prob lems specifically in adults with obesity or overweight. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or

2. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. The New England Journal of Medicine. (2023, December 14). https://www.nejm.org/ doi/full/10.1056/NEJMoa2307563

3. Frac, & Boone, K. (2019, October 3). Obesity in the U.S. Food Research & Action Center. https://frac.org/obesity-health/obesity-u-s-2

4. Annikakimc. (2024, March 8). Novo Nordisk’s WEGOVY wins FDA approval for cutting heart disease risks, in move that could expand insurance coverage. CNBC. https://www.cnbc.com/2024/03/08/novo-nordisks-wegovy-wins-fda-approval-for-heart-health-benefits-in-move-that-could-expand-insurance-coverage. html

5. Semaglutide effects on cardiovascular outcomes in people with overweight or obesity. American College of Cardiology. (2023, December 14). https://www.acc. org/Latest-in-Cardiology/Clinical-Trials/2023/11/09/15/04/select

providers, and a fee-for-service payment model that incentivizes volume rather than outcomes all contribute to inefficiencies and higher costs4. Additionally, insurance companies' reluctance to cover certain mental health services or their imposition of strict limitations on coverage further exacerbate the problem4

Addressing the rising healthcare costs for children with mental health issues requires a multifaceted approach. This includes increasing access to affordable mental health services through expanded insurance coverage, integrating mental health care into primary care settings, improving coordina-

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plaque.2 While oil pulling therapy has real benefits, its skyrocketed popularity has prompted it to be reviewed by dentists, researchers, and the overall larger user population.

When it comes to smaller, less popular products, it becomes harder to discern what is fact from fiction. One of these products isamagnesiumfootspraythatseveralusers claim helps anxiety, energizes, improves sleep, and prevents sugary and salty cravings. When one looks up "magnesium foot spray" on Google, there are no reputable sources or articles discussing the therapy. The most relevant article merely discusses transdermal magnesium as a method of drug administration, but does not discuss any effects of the magnesium foot spray. While there are magnesium products with researched effects currently available as supplements, the foot spray is not one of them.

An example of one of these over-thecounter medications is magnesium glycinate, which are tablets that doctors may recommend to patients to improve sleep.3 Due to TikTok’s ease of access and chance that these videos may show up on someone's page, users may misconstrue the foot spray as something new and radical even when proven products already exist on the market. Furthermore, almost all videos discussing the magnesium foot spray almost always contain the same claims: "more energy," "less stress," and "no more cravings for sugary and salty foods."4 Anumber of these videos only contain text on the screen or an AI voice repeating these claims, without any proper research or

tion and continuity of care, reducing stigma surrounding mental illness, and investing in early intervention and prevention programs.

The increasing healthcare costs for children with mental health issues represent a pressing and complex challenge that requires urgent attention. By addressing the underlying factors contributing to these rising costs and implementing comprehensive solutions, we can ensure that all children have access to the mental health care they need to thrive. Failure to act not only jeopardizes the well-being of individual children and families but also has far-reaching implica-

medical professional to back them up.5 While it may be easy for a health professional to discern what may be a stretch of the truth, it may be harder for the average consumer to sift through all the information. Regardless of whether there is scientific evidence or not, these consumers can still be influenced by the fancy claims made by users.

In the ever-evolving landscape of health trends, the advent of platforms like TikTok has reshaped how these products are disseminated and consumed. What once relied on celebrity endorsements or influencer marketing has now shifted to a more grassroots level, with everyday individuals showcasing products directly to their peers. While platforms like TikTok offer unprecedented access to diverse perspectives, they also require vigilance to separate fact from fiction. This vigilance must be addressed as something many users of TikTok may not have, since a majority of the TikTok user base consists of a younger, less experienced demographic. TikTok's "TikTok shop" feature further blurs the lines between content and commerce, providing a seamless pathway for viewers to purchase products promoted in videos.

This democratization of advertising, coupledwiththeperceivedauthenticityofusergenerated content, has created an environment where even dubious health claims can gain traction. The case of products like the GuruNanda Oil Pulling kit illustrates the potential pitfalls of this system. While oil pulling may indeed offer some benefits supportedbyresearch,itspromotiononTikTok often veers into exaggerated claims and

tions for society as a whole.

References

1. Mundell E. Medical costs for kids' mental health jumped 31% in 5 years. U.S News. 11 March 2024. https://www.usnews.com/news/healthnews/articles/2024-03-11/medical-costs-for-kids-mental-healthjumped-31-in-5-years

2. Abrams Z. Kids’ mental health issues are in crisis. Here’s what psychologists are doing to help. American Psychology Association. 1 January 2023n https://www.apa.org/monitor/2023/01/trends-improvingyouth-mental-health

3. Loo TM, Altman M, Bravata DM, Whaley C. Medical spending among US households with children with a mental health condition between 2017 and 2021. JAMA Netw Open. 2024;7(3):e241860. doi:10.1001/ jamanetworkopen.2024.1860

4. A human-centered vision for improving the mental health care ecosystem. Deloitte. 14 July 2024. https://www.deloitte.com/global/en/ourthinking/insights/industry/government-public-services/mental-healthequity-and-creating-an-accessible-system.html

misinformation. The lack of oversight and accountability allows such narratives to proliferate unchecked, leading to confusion among consumers and skepticism from professionals. Similarly, the proliferation of niche products like magnesium foot spray underscores the challenge of navigating the vast sea of health information available online. Without reliable sources or expert guidance, individuals may be swayed by anecdotal testimonials rather than scientific evidence. With the new era of rapid information and short form content, it is important for individuals to recognize that health claims on the internet from seemingly “real” and “candid” people does not make them true. Consumers must be vigilant as to what is being advertised to them, especially in regards to their own health, before deciding to purchase.

References

1. Sharma, Satish, et al. "Oil pulling and importance of traditional medicine in oral health maintenance." Journal of Traditional and Complementary Medicine, vol. 7, no. 1, 2017, pp. 106-109. PubMed Central, doi:10.1016/j. jtcme.2016.05.004.

2. @dentite. “Dentite.” TikTok, TikTok, [3/11/24].

https://www.tiktok.com/@dentite/video/7233536736490622254?is_from_webapp=1&sender_device=pc&web_id=7209518488677975598

3. "Magnesium Glycinate: Is this supplement helpful for you?" Mayo Clinic Press, Mayo Clinic, [3/11/24].

[https://mcpress.mayoclinic.org/nutrition-fitness/magnesium-glycinate-is-thissupplement-helpful-for-you/ ].

4. @millennial.mama.hustle. “Millennial Mama Hustle.” TikTok, TikTok, [3/11/24].

[https://www.tiktok.com/@millennial.mama.hustle/video/ 7325617245143518507?is_from_webapp=1&sender_device=pc&web_ id=7209518488677975598 ].

5. @betr4you. “Betr4you.” TikTok, TikTok, [3/11/24].

[https://www.tiktok.com/@betr4you/video/7307303659761569067?is_from_ webapp=1&sender_device=pc&web_id=7209518488677975598 ].

By Radiya Rahman, PP2

How to Get Involved at EMSOP

Rutgers is a big university with lots to offer, and EMSOP is no different. Just as Rutgers has a variety of organizations and extracurricular activities to choose from, EMSOP has an assortment of organizations that cater to one’s liking. While it can be quite intimidating at first, getting involved has many benefits that will carry through both the pre-professional and professional years at EMSOP. Here are three main points to consider before venturing off to see what EMSOP has to offer.

1. Find out what interests you. Many in-person and online resources are available to learn more about EMSOPorganizations, so take some time to look into them. The Pharmacy Governing Council Canvas site is another great resource to find information on the latest activities around EMSOP, where every organization gets a chance to promote their events and activities during the monthly meetings. Most of the organizations at EMSOP have social media platforms where they post about events and meetings they will be hosting in

the future. Following them on their social media accounts is a great way to stay updated on their latest events and meetings and see which ones peak your interest.

2.Attend GIMs.

At the beginning of each semester, organizations host general interest meetings, or GIMs, to allow students to meet each organization and see what activities and events they do throughout the semester. It’s a great way to meet E-board members in charge of the organization and find people with similar interests. With a variety of clubs and organizations to choose from, attending GIMs allows you to explore the different fields in pharmacy and see which ones are to your liking.

3. Step outside of your comfort zone. Trying new things can be tricky, especially if you don’t know what to expect, and pharmacy school is no exception. Whether it’s talking to other peers in class or attending club meetings, there’s always something

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new that will come out of it. The beauty of trying something new is that you never really know what to expect, so take advantage of that and seize any new opportunities that come your way.

Considering these three points will create a more memorable experience as a pharmacy student, especially at EMSOP. Getting involved at EMSOP means being part of a warmhearted community with people who are willing to help you every step of the way, so take this moment to explore the abundant opportunities at EMSOP.

Merck'sAdvancements in Promoting the Pneumococcal Vaccine

by Dhristi Raval, P2

Merck, a leading pharmaceutical company, has been at the forefront of promoting awareness and increasing access to the pneumococcal vaccine. Pneumococcal disease, caused by the bacterium Streptococcus pneumoniae, poses a significant health threat worldwide, particularly among children, the elderly, and immunocompromised individuals.

Merck's commitment to combating pneumococcal disease is evident through its comprehensive approach that includes research, development, and advocacy efforts.1 The company has invested heavily in developing innovative vaccines to prevent pneumococcal infections, aiming to reduce the burden of illness and save lives.1

One of Merck's notable achievements in this area is the development of pneumococcal conjugate vaccines (PCVs), which pro-

tect against multiple strains of the pneumococcal bacterium.2 These vaccines have demonstrated efficacy in preventing pneu-

mococcal infections, including pneumonia, meningitis, and bacteremia, in

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Shivam Prajapati,

Class of 2026

What was your favorite show as a kid?

“My favorite show as a kid was Ben 10! I would wake up at the absolute crack of dawn every Saturday morning to watch the new episode and then go back to bed and sleep in.”

Mary Kopchick, Class of 2025

What color would you use to describe yourself?

“I feel a deep connection with the color blue. Not only because it’s my favorite color, but also because it is a reflection of my personality. Blue reminds me of calmness, depth, and wisdom, which are qualities I admire and strive for!”

Tiffany Chao, Class of 2026

What is your favorite thing to do outside of school?

“One of my favorite things to do is play music. I learned a few instruments when I was younger, notably the piano starting at age seven and the oboe starting at age 11, and music quickly became a big part of my life. While pharmacy school takes up most of my time, I do enjoy finding opportunities to perform for others.”

Pablo Becerra, Class of 2025

What’s a trait you most admire in people?

“I admire people’s ability to overcome hardship. It doesn’t matter what we face in our day to day lives, we always learn how to deal with it and keep moving forward. That’s our superpower as people.”

by Jasmine Vo, P3

Chlormequat Oats: The Pesticides in Your Breakfast Cereal

A study published in February 2024 found that there has been an increased presence and concentration of a certain pesticide, chlormequat chloride, found in humans while sampling urine across three geographical regions of the United States between 2017 and 2023. Additionally, the study tested several oat-based (25 conventional and 8 organic) and wheat-based (9 conventional) foods and found that nearly all of the products had detectable levels of the pesticide residue, including on major brands’ products such as General Mills Cheerios, Quakers Foods Old Fashioned Oats, and other oatmeal, granolas, and cereal products. This pesticide has been linked to developmental and reproductive toxicity in animal studies.

This pilot investigation report collected convenience samples of human urine as a measure of chlormequat levels for people residing in the U.S..Urinary concentrations were reported in mcg chlormequat / g creatinine, with the limit of detection being 0.1 mcg/L chlormequat. Of the 96 samples tested, 77 of them (80%) had detectable levels of chlormequat in them. The levels were more frequent in 2023 samples compared to samples of the previous years also collected for (2017, 2018, and 2022), which suggest either more accumulation or greater exposure of the chemical in humans. The limit of detection and limit of quantitation used in the study were 10 ppb and 100 ppb, respectively, for testing the foods. Of the oat- and wheat-based products, there was a higher prevalence of the presence of chlormequat in the oats, though the study did still observe low concentrations found in the wheat-based products.

Chlormequat is an allowed chemical in food crops such as grains in the European Union, the United Kingdom, and Canada, but in the U.S. it is not approved for use on edible plants, only ornamental ones. Chlormequat is used in agriculture as a “plant growth regulator,” specifically used to decrease stem height of crops for the purpose of making harvesting easier, since shorter stems reduce the likelihood of the crops bending over. Legislative decisions made by the Environmental Protection Agency (EPA) in 2018 recently allowed

https://www.healthline.com/nutrition/are-breakfast-cereals-healthy

importation of foods treated with this chemical, as well as in 2020 where the EPA increased the permitted levels of chlormequat that can be found in oats and gram from 10 ppm to 30 ppm. Additionally, a recent proposal submitted by a major manufacturing company of chlormequat, Taminco, wants to allow the use of chlormequat in U.S. crops, including barley, wheat, and oats. This decision is heavily opposed by the advocacy organization Environmental Working Group, and is also evident in the Center for Food Safety’s expressed comments in 2021. The decision is up for review by the EPAas of 2023.

Although there has been an increase in biomarker levels since after the 2018 and 2020 decisions were made, the study discusses limitations about the interpretation between the two, as other factors such as product shelf life, natural formation of the chemical from food processing and production, and the differing geographic locations, dietary patterns, or occupational exposure may also play a role in what data was collected. Additionally, the urine collection samples of this study had individual ranges of concentrations much less than the EPA’s “reference dose” for the amount of acceptable chlormequat exposure (0.05 mg/kg bw/day), but the study does bring up that in some toxicological studies on animals that those safety thresholds may need reevaluation, as some lower dose equivalents in their animal models already have impacts. Current regulatory thresholds also

are not considering adverse effects of cumulative doses of exposures less than the set limit at one given time point. So, with more decisions about the use of chlormequat for U.S. crops starting to be reviewed by the EPA, the question becomes what do we do now with what we know?

These findings of increased concentrations found in humans and in foods combined with the known toxicity data found in various animal models raise concerns for whether this chemical should be more regulated in the agricultural industry and what impacts this consumption has on human health. There are only a relatively small amount of biomonitoring studies in assessing human exposure to chlormequat not outside of the U.S.. The impact of pesticides does not just stop at the obvious environmental and ecological consequences; especially when considering its use in crops for food and ultimately human consumption, the risk-vs-benefit of whether it should be used still carries relevance to the public health field. Further studies need to be done to understand the implications of chlormequat levels in humans, including low dose adverse effects, epidemiological testing, and reproductive harms.

References

• Temkin, A.M., Evans, S., Spyropoulos, D.D. et al. A pilot study of chlormequat in food and urine from adults in the United States from 2017 to 2023. J Expo Sci Environ Epidemiol (2024). https://doi.org/ 10.1038/s41370-024-00643-4

• https://www.ewg.org/research/ewg-investigation-dangerous-agricultural-chemical-chlormequat-found-popular-oat-based

• https://www.federalregister.gov/documents/2020/05/26/2020-10331/ chlormequat-chloride-pesticide-tolerances

• https://www.centerforfoodsafety.org/files/cfs-chlormequat-pid-comments--final-12-20-21_61757.pdf

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both pediatric and adult populations.2

Merck has also been actively raising awareness about the importance of pneumococcal vaccination among healthcare professionals, policymakers, and the general public. Through educational campaigns and collaborations with healthcare organizations, Merck aims to ensure that individuals at risk are informed about the benefits of vaccination and have access to appropriate immunization services.3

Furthermore, Merck has been working to improve vaccine access and affordability, particularly in underserved communities and low-income countries where pneumococcal disease burden is high. By partnering with global health organizations and participating in initiatives such as Gavi, the VaccineAlliance, Merck has helped expand

access to pneumococcal vaccines to those who need them most.4

In addition to its efforts in promoting pneumococcal vaccination, Merck continues to invest in research and development to further enhance vaccine effectiveness, safety, and accessibility. Through ongoing clinical trials and scientific collaborations, the company remains dedicated to advancing the field of vaccinology and addressing unmet medical needs related to pneumococcal disease.5

In conclusion, Merck's progress in promoting the pneumococcal vaccine reflects its commitment to public health and disease prevention. By developing innovative vaccines, raising awareness, and expanding access, Merck plays a vital role in reducing the global burden of pneumococcal disease and improving health outcomes for individuals worldwide.

References

1. Merck. "About Merck’s Commitment to Vaccines." Merck.com.

2. World Health Organization. "Pneumococcal Conjugate Vaccines." WHO.int.

3. Centers for Disease Control and Prevention. "Pneumococcal Vaccination: Summary of Who and When to Vaccinate." CDC.gov.

4. Gavi, the Vaccine Alliance. "Gavi's Work on Pneumococcal Vaccines." Gavi.org.

5. Merck. "Research and Development Pipeline." Merck.com.

Advancing Cancer Care: Discussing the Potential ofArtificial Intelligence

by Mary Kopchick, P3

Cancer, unlike many other disease states, presents a unique set of challenges: it behaves as a moving target, deftly evading the immune system’s defenses, mutating, and infiltrating various areas of the body. This dynamic nature underscores the need for vigilant screening, precise diagnosis, effective treatment, and continuous monitoring. However, these essential services come at a significant cost, both in terms of time and finances. In the United States healthcare system, cancer care expenses continue to exceed those of other sectors, accounting for 7% of total healthcare spending related to cancer diagnosis, treatment, and survivorship.1 Moreover, an estimated 2 million individuals are projected to receive a cancer diagnosis in 2024, with about 1 in 2 males and 1 in 3 females expected to face cancer in their lifetime.2 Given these daunting statistics, innovative strategies are certainly needed to help mitigate cancer's devastating impact.

In the realm of oncology, a wave of innovative approaches is emerging to reduce mortality rates, mitigate costs, and improve patient care. Among these innovations, artificial intelligence (AI) stands out as a promising tool. AI refers to computer systems capable of performing tasks that traditionally require human intelligence, such as learning and recognizing patterns from var-

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ious inputs and applying this information towards decision-making processes. For example, AI can interpret radiologic images, generate predictive algorithms to aid clinical decisions, and automate documentation tasks through large language models (LLMs). These capabilities can expedite diagnosis and streamline patient care processes, ultimately affording practitioners more time to cultivate the patient-practicioner relationship and conserve resources.3 Furthermore, AI can also be harnessed across various aspects of cancer management, including screening, detection, genomic analysis, evaluating tumor microenvironments, and assessing biomarkers for prognostic and predictive purposes, and drug discovery.4

By harnessing the capabilities of AI, healthcare professionals can enhance their ability to diagnose cancers earlier, tailor treatments more precisely, and ultimately improve patient outcomes. However, it is important to note that AI is most effective when utilized to support clinical decisionmaking processes rather than as a substitute for the expertise of healthcare professionals. AI can help alleviate some of the workload, allowing providers to dedicate more time to addressing the emotional needs of patients and strengthening the patient-provider relationship.

Vitamin D: D for DepressionAntagonist

by Joanna Kusmierski, P2

The United States finds itself in various epidemics, including vitamin D deficiencies. Almost 42% of the American population has a deficiency of vitamin D, a vitamin essential for bone health and calciumphosphate homeostasis.1 As pharmacy students, we might find ourselves at risk of vitamin D deficiency due to lack of exposure to vitamin D from the sun as we are constantly studying indoors. Recent studies have shown that the lack of vitamin D levels is associated with symptoms of anxiety

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and depression—two common mental health disorders that may affect us students. One study in particular, a randomized controlled clinical trial, found that vitamin D supplementation is effective in reducing depression and anxiety symptoms by raising serum vitamin D levels through a high dose supplementation of 10,000 ID.2

As students, it is vital to take care of our health, especially when it affects our mental health. With an increased risk of having a vitamin D deficiency, increasing vitamin D intake is important. So, how can we raise our serum levels of vitamin D? There are many ways to do this. We can modify our diet with mushrooms, fish, and fortified dairy products, increase sun exposure safely with appropriate time and sunscreen, or with supplementation.3 For ages 9-70, where college students fall within, we should be taking the recommended dose of

600 IU/day or up to the upper limit of 4,000 IU/day.3 Regardless of our current mental state, vitamin D supplementation can help any deficiencies our American population has and it wouldn’t hurt to help combat anxiety and depression that may come with the stresses of pharmacy school. Before taking a vitamin D supplement, make sure to consult with your healthcare provider on getting a routine lab panel to determine a vitamin D deficiency and establish the appropriate dose of vitamin D!

References

1. Ltd HP. 42% Of Americans Are Deficient In Vitamin D. Are You At Risk? If So, What Can You Do About It? HealthMatch. Published November 30, 2022. https://healthmatch.io/blog/42-of-americansare-deficient-in-vitamin-d-are-you-at-risk-if-so-what-can#:~:text=Vitamin%20D%20deficiency%20is%20more

2. Increased Vitamin D Intake Can Decrease Symptoms of Depression, Anxiety. Pharmacy Times. Published September 8, 2023. https://www. pharmacytimes.com/view/increased-vitamin-d-intake-can-decreasesymptoms-of-depression-anxiety

3. Harvard School of Public Health. Vitamin D. The Nutrition Source. Published July 2, 2019. https://www.hsph.harvard.edu/nutritionsource/vitamin-d/

LSD-Based Drug forAnxiety Treatment

by Ushnaa Zaman, P3

MM120 (lysergide d-tartrate), an LSD formulation developed by Mind Medicine (MindMed) Inc. for the treatment of generalized anxiety disorder (GAD), has received breakthrough therapy status by the FDA. A phase 2b clinical trial has found that a single oral dose, which is just 100 micrograms, of MM120 has led to a 48% clinical remission rate as well as a 65% clinical response rate at 12 weeks following administration of the drug.

GAD is identified as excessive and persistent feelings of anxiety that interfere with day-to-day life, and it affects 6.8 million adults in the United States. GAD is generally treated with psychotherapy – most commonly cognitive behavioral therapy (CBT) – and pharmacotherapy, such as antidepressants – like selective serotonin reuptake inhibitors (SSRIs) and serotoninnorepinephrine reuptake inhibitors (SNRIs) – and anti-anxiety medications –like benzodiazepines. However, the clinical trial has found that a single dose of MM120 does not require the adjunct of psychotherapy to be considered effective.

Lysergic acid diethylamide, or LSD, is a psychedelic that acts as a partial agonist at human serotonin-2A receptors and induces

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hallucinations. It currently has no accepted medical use in the U.S. with a high probability of abuse, making it a Schedule I drug. It can cause an alarming experience, called a “bad trip,” in which a person undergoes a disturbing hallucination and can thus cause risky behaviors. MM120, on the other hand, is a tartrate salt form of LSD that is produced to pharmaceutical industry standards and does not induce these “bad trips.”

In the clinical trial, MM120 has been found to be generally well-tolerated and adverse effects were rated as mild to moderate, transient, and occurring on the day of administration. The most common adverse effects include, but are not limited to, illusions and hallucinations, abnormal thinking, nausea. vomiting, headache, dizziness,

mydriasis, and hyperhidrosis. The breakthrough drug status granted to MM120 by the FDAspeeds up the development and approval process; the decision is said to provide “further validation of the important potential role this treatment can play” by MindMed Inc. A phase 3 clinical trial for MM120 is expected to be started in the second half of 2024.

References

• Brooks, Megan. “LSD-Based Med for Anxiety Receives FDA Breakthrough Status.” Medscape, 8 Mar. 2024, www.medscape.com/viewarticle/lsd-basedmedication-gad-receives-fda-breakthrough-sta tus-2024a10004hf?form=fpf.

• Gashi, Liridona, et al. Making “Bad Trips” Good: How Users of Psychedelics Narratively Transform Challenging Trips into Valuable Experiences, International Journal of Drug Policy, Jan. 2021, pubmed.ncbi.nlm.nih.gov/ 33080454/.

• “Generalized Anxiety Disorder: When Worry Gets out of Control.” National Institute of Mental Health, U.S. Department of Health and Human Services, 2022, www.nimh.nih.gov/health/publications/generalized-anxiety-disordergad.

• LaMotte, Sandee. “Single Dose of LSD Provides Immediate, Lasting Anxiety Relief, Study Says.” CNN, 7 Mar. 2024, www.cnn.com/2024/03/07/health/ lsd-anxiety-fda-breakthrough-therapy-wellness/index.ht ml.

• “LSD.” Alcohol and Drug Foundation, 23 Nov. 2023, adf.org.au/drug-facts/lsd/. “LSD.” United States Drug Enforcement Administration, www.dea.gov/factsheets/lsd.

• “MindMed Announces Positive Topline Results from Phase 2B Trial of MM120 in Generalized Anxiety Disorder.” Mind Medicine (MindMed) Inc., 14 Dec. 2023, ir.mindmed.co/news-events/press-releases/detail/131/mindmedannounces-positive-toplin e-results-from-phase-2b-trial-of-mm-120-in-generalized-anxiety-disorder#xd_co_f=ZWF mODRhMmMtMjUxNi00NDhlLWIxYTAtZDllOTYzNTJhNDQ0~.

• “MindMed Receives FDA Breakthrough Therapy Designation and Announces Positive 12-Week Durability Data from Phase 2b Study of MM120 for Generalized Anxiety Disorder.” Business Wire, 7 Mar. 2024, www.businesswire. com/news/home/20240307733599/en/MindMed-Receives-FDA-Brea kthrough-Therapy-Designation-and-Announces-Positive-12-Week-Durability-Data-From -Phase-2B-Study-of-MM120-for-Generalized-Anxiety-Disorder#xd_co_f=ZWFmODRh MmMtMjUxNi00NDhlLWIxYTAtZDllOTYzNTJhNDQ0~.

• Park, Brian. “LSD Drug Candidate Gets Breakthrough TX Status for Generalized Anxiety Disorder.” Medical Professionals Reference, 7 Mar. 2024, www.empr.com/home/news/drugs-in-the-pipeline/lsd-drug-candidate-getsbreakthrough-t x-status-for-generalized-anxiety-disorder/.

• Rainey, Clint. “Psychedelic News: The Government Finally Fast-Tracked LSD as an Anxiety Treatment.” Fast Company, 7 Mar. 2024, www.fastcompany. com/91050854/government-fast-tracked-lsd-as-anxiety-treatment-as-p sychedelics-psilocybin-mdma-near-

Bonus! Chronicles Rx Crossword Challenge

byArt Director Mary Kopchick

Due to popular demand, we are including one more crossword for the puzzle lovers! As rated by the crossword creator herself, this is P3 level difficulty, but we encourage ALL of you test your knowledge— answer key is on the next page (if you need help… or to check your own work, of course).

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).

Answer Key to Chronicles Rx Crossword Challenge

How did you do?

Did you make it through P3 year?

RU NAPLEX-ready?!

Want more? See other crosswords in Volume 15 Issues of EMSOP Chronicles!

Thank you to all the contributors in this publication of EMSOP Chronicles!

Editor-in-Chief: Dhristi Raval

Associate Editor: Ashley Huang

Layout Director: Jasmine Vo

Layout Director-Elect: Radiya Rahman

Secretary: Ushnaa Zaman

Humans of EMSOP Directors: Meha Pandejee and Sanjana Ojha

Artistic Directors: Mary Kopchick and Justin Vatanapradit

Public Relations: Carla Arca-Sedda and Joanna Kusmierski

PGC Representative: Riya Mankad

Staff Writers: Ashley Huang, Carla Arca-Sedda, Dhristi Raval, Jasmine Vo, Joanna Kusmierski, Justin Vatanapradit, Mary Kopchick, Radiya Rahman, Riya Mankad, Sanjana Ojha, Ushnaa Zaman

Staff Editors: Ashley Huang, Carla Arca-Sedda, Dhristi Raval, Jasmine Vo, Joanna Kusmierski, Justin Vatanapradit, Mary Kopchick, Radiya Rahman, Riya Mankad, Sanjana Ojha, Ushnaa Zaman

Humans of EMSOP Staff: Meha Pandejee, Sanjana Ojha

For questions, comments, and information on how to get involved, e-mail emsopchronicles@gmail.com.