The UK’s chief medical officers have warned the coronavirus vaccine will only have a “marginal impact” on hospital numbers over the winter as each of the four nations prepares to start administering the first doses next week.
Festive gatherings are likely to put additional pressure on healthcare services, with a tough few months still ahead, experts said.
In a letter to colleagues, the four chief medical officers said this winter would be “especially hard” for the health service due to coronavirus.
“Although the very welcome news about vaccines means that we can look forward to 2021 with greater optimism, vaccine deployment will have only a marginal impact in reducing numbers coming into the health service with Covid over the next three months,” they said.
“The actions and self-discipline of the whole population during lockdowns and other restrictions have helped reduce the peak and in most parts of the four nations hospital numbers are likely to fall over the next few weeks, but not everywhere.
“The social mixing which occurs around Christmas may well put additional pressure on hospitals and general practice in the New Year and we need to be ready for that.”
The letter, signed by chief medical officer of England, Professor Chris Whitty; of Scotland, Dr Gregor Smith; of Wales, Dr Frank Atherton; and of Northern Ireland, Dr Michael McBride, said they did not expect the virus to “disappear” even once full vaccination had occurred.
The first jabs will be administered in each of the UK nations on Tuesday. In Northern Ireland it will be administered at a mass vaccination centre at the Royal Victoria Hospital in Belfast, while in Wales frontline NHS and social care staff will receive the country’s first coronavirus vaccine.
The first vaccinations will also take place in Scotland next week, while jabs will be administered at hospital hubs in England.
Meanwhile, in a letter sent out across England’s primary care networks, NHS England and NHS Improvement said GP-led vaccination centres would start administering doses from December 14.
The letter said centres would be set up with the necessary IT equipment and a fridge, while staff would be given training to ensure they are ready to administer 975 doses of the vaccine to priority patients within three-and-a-half days of delivery.
The first to receive the vaccine in these centres will be those aged 80 and over, as long as other risk factors, “clinical or otherwise”, have been taken into account.
There remain issues around how to ensure elderly residents in care homes, who have been recommended as the top priority, get access to a jab due to difficulties in storing and transporting the Pfizer/BioNTech version as its cold temperature – minus 70C – limits how often it can be moved.
(PA Graphics) Credit: PA Graphics
NHS England has not yet committed to a date to roll the vaccine out in English care homes, but Dr June Raine, chief executive of the Medicines and Healthcare products Regulatory Agency, told the BBC on Friday that she estimated the vaccine would begin to be delivered to care homes “within the next two weeks”.
In total, some 40 million doses of Pfizer’s inoculation are on order – enough to administer it to 20 million people, with two jabs required 21 days apart.
Vaccines will only have ‘marginal impact’ on NHS winter pressures, chief medical officers warn COVID-19 will keep hospitals under continued strain in the coming months as new vaccines will only have a “marginal impact” on patient numbers over winter, the UK’s chief medical officers have warned. In a letter written to healthcare colleagues, the group – which includes England’s Professor Chris … Home remedies refer to “practical cure or treatment that cures, heals or relieves” using certain common substances such as spices, vegetables, fruit, herbs and modern materials. Click Here: https://remediesnew.com
For every condition, there is often a branded over-the-counter remedy we instinctively reach for. And yet there will be a cheaper version with identical contents that could save you a small fortune. Pharmacist GEMMA FROMAGE reveals the definitive guide to the best buys to fill your medicine cabinet.
Painkillers
Best buys: Aspar Paracetamol 500mg, 16 caplets, 25p, sainsburys.co.uk; Bell’s Ibuprofen 200mg, 16 tablets, 45p, lloydspharmacy.comAnnual saving: £55.20* (Based on the average person buying eight packs of paracetamol a year, and for women, 12 packs of ibuprofen — one for each menstrual period.)
Some branded versions have special coatings, or are contained in soft capsules, and may dissolve more quickly in the body — however, the difference in speed of pain relief will be minimal
Expert says: The price of painkillers can vary hugely, yet the own-brand or cheaper versions will contain the same active ingredient in the exact same doses. As a result, they will do the exact same job as any expensive, branded options despite being up to ten times cheaper in some cases.
Some branded versions have special coatings, or are contained in soft capsules, and may dissolve more quickly in the body — however, the difference in speed of pain relief will be minimal.
Also, despite some products claiming to be designed for a specific type of pain, such as migraine or back pain, oral painkillers do not target one type alone, they work throughout the body so it won’t be targeted relief (but gels may offer this, see below).
Paracetamol and ibuprofen work differently: paracetamol can reduce a fever and ease cold and flu symptoms, whereas ibuprofen (which may also ease some of these problems) is an anti-inflammatory and so is beneficial for muscle aches and period pain.
Antibacterial mouthwash
Wisdom Chlorhexidine Antibacterial Mouthwash fresh mint
Best buy: Wisdom Chlorhexidine Antibacterial Mouthwash fresh mint, 300ml, £1.49, groceries.asda.com Annual saving: £35.10 (Based on going through ten bottles a year.)
Expert says: Studies have shown that chlorhexidine is the most effective mouthwash ingredient for killing bacteria that cause plaque and lead to gum disease (specifically gingivitis).
Despite the difference of more than £3.50 for the same size bottle of the branded version, the cheapest product contains the same active ingredient and will be just as effective in easing inflammation, swelling and bleeding associated with gum disease.
As with all mouthwash, use at a different time from brushing, as slooshing straight after will wash away most of the protective fluoride in toothpaste.
Allergy tablets
Best buys: Galpharm Cetirizine Hayfever And Allergy Relief, 30 tablets, £1.45, cooppharmacy.coop
Annual saving: £34.20 (Based on getting through four boxes over a year.)
Expert says: With an astounding £8.55 difference in price compared to the leading brand, it is hard to believe that the products contain the exact same 30 tablets of cetirizine at the same dose.
This medicine blocks the effects of histamine in your body, which immune cells release during an allergic response to a perceived irritant, such as pollen, which in turn causes symptoms such as sneezing and a runny nose. Take one a day.
Rehydration sachets
Best buy: Asda Rehydration Treatment blackcurrant flavour, six sachets, £2.25, asda.com Annual saving: £6.16 (Based on buying a box four times a year.)
Asda Rehydration Treatment blackcurrant flavour
Expert says: Rehydration sachets — which you dissolve in a glass of water — contain electrolytes, vital salts such as sodium citrate and potassium chloride which keep the muscles and nervous system functioning properly (as well as sugar for energy). The body loses these as a result of diarrhoea, through dehydration, causing symptoms such as dizziness, headaches and tiredness.
Rehydration salts restore the natural balance of salts and fluid in the body, and help eliminate symptoms of dehydration.
There may be slight differences in the salts themselves, from one more expensive product to the next (and prices can be more than double this Asda option), but the overall effect will be the same.
Adults should mix one sachet with water and drink immediately after a loose bowel motion. (Do not give to children under two unless told to do so by a doctor.) If symptoms persist for more than 48 hours, seek medical advice.
LloydsPharmacy Chloramphenicol Eye Ointment
Eye ointment
Best buy: LloydsPharmacy Chloramphenicol Eye Ointment, 4g, £4.99, lloydspharmacy.com
Annual saving: £5.22 (Based on buying two tubes a year.)
Expert says: Eye infections such as bacterial conjunctivitis are common, and the ointment used to treat them contains the active ingredient chloramphenicol, an antibiotic which stops the bug from growing and spreading.
There are many versions on pharmacy shelves, but the ointment always contains 1 per cent chloramphenicol (the drops always contain 0.5 per cent).
You apply a small amount to the infected eye three to four times a day for five days. A tube has to be binned 28 days after opening.
Nasal spray
Wilko Decongestant Nasal Spray
Best buy: Wilko Decongestant Nasal Spray, 15ml, £1.75, wilko.com
Annual saving: £10.56 (Based on using four a year.)
Expert says: As part of the immune response during a cold, blood vessels swell, membranes become congested, and as a result the nose feels blocked.
Decongestant nasal sprays contain oxymetazoline hydrochloride which can help relieve symptoms by narrowing the small blood vessels in the nose. This brings down the swelling and helps open up the nasal passages to make breathing easier.
All sprays should work within minutes and the effects last for up to 12 hours. Identical sprays can cost up to four times as much.
Cold sore cream
Best buy: Bell’s Lipsore, 2g, £1, wilko.com Annual saving: £20.80 (Based on needing four a year.)
Expert says: At some point an estimated seven in ten of us will be infected with the virus HSV-1 (also known as herpes simplex virus type 1), which causes cold sores.
And once you have the virus, it is always in your body, where it lies dormant and is reactivated by triggers such as sunlight, stress and cold weather.
Treatments can speed up healing or try to halt outbreaks.
One of the most effective over-the-counter remedies is acyclovir, which stops the virus from reproducing, and in turn reduces the duration and severity of blisters.
Some products cost more than six times as much as this cut-price option, for the same size bottle with the same active dose.
Simply apply to the affected area with a cotton bud five times a day.
Bell’s Lipsore
For cystitis
Galpharm Cystocalm cystitis relief
Best buy: Galpharm Cystocalm cystitis relief, pack of six, £1.20, wilko.com
Annual saving: £7.40 (Based on using two packets a year.)
Expert says: Cystitis is an inflammation of the bladder, usually caused by a bladder infection, which causes acidic urine, irritation and an unpleasant burning sensation when passing water.
An effective remedy like this contains sodium citrate, which will make the urine less acidic, thus providing relief of the symptoms in a few hours — but some remedies can cost four times as much.
Mix with water and drink three times a day.
If you have no improvement in symptoms in three days, suffer regularly, or have blood in your urine, then see your GP.
Ibuprofen gel
Best buy: Tesco Ibuprofen Gel, 35g, £1.85, tesco.com
Annual saving: £12.42 (Based on buying three a year.)
Expert says: This anti-inflammatory gel contains 5 per cent ibuprofen — but identical versions can cost from £1.85 to £6 for the same size tube.
The gels are beneficial for massaging into muscular aches and pains.
Unlike oral painkillers, which get into the bloodstream and travel around the body, the ibuprofen in the gel is locally absorbed into the skin where it is applied.
This means that pain relief can be accurately targeted.
Massage the gel into the skin until fully absorbed, up to a maximum of three times a day.
Expert says: This anti-inflammatory gel contains 5 per cent ibuprofen — but identical versions can cost from £1.85 to £6 for the same size tube
Best buy: Tesco Health Chesty Cough Relief, 300ml, £2.25, tesco.com
Annual saving: £11.48 (Based on using two bottles a year.)
Expert says: A common ingredient in cough syrups is guaifenesin, which reduces chest congestion caused by colds or infections. It does this by loosening phlegm and making it easier to cough out.
Differences in these cough mixtures tends to be due to ingredients that make it taste better. However, this has no effect on how the product works, yet can cost four times more.
Cold and flu remedy
Asda Max Strength Cold & Flu Relief sachets blackcurrant
Best buy: Asda Max Strength Cold & Flu Relief sachets blackcurrant, pack of ten, £1.59, asda.com
Annual saving: £10.40 (Based on using four boxes a year.)
Expert says: There are several cold and flu sachets on the market and the most effective — such as this Asda option — will contain the painkiller paracetamol and decongestant phenylephrine, which reduces inflammation of the nasal tissue to open the airway.
Yet some can cost up to four times as much for the same effect. Mix with boiling water and drink every six hours. Don’t use with other medicines containing paracetamol.
Arjun Olive Oil Ear Drops
Ear drops
Best buy: Arjun Olive Oil Ear Drops, 10ml, £1.99, weldricks.co.uk
Annual saving: £7.08 (Based on needing three bottles a year.)
Expert says: Ear drops can contain medical-grade olive oil (which, unlike that in your kitchen, is licensed for use in the body) to soften hardened ear wax gently and make it easier to remove via syringing.
Despite containing just this basic ingredient, some cost up to four times as much.
✱ Annual savings based on a comparison with the most expensive branded products at time of writing. Advertisement Read more:
Most Americans probably remember that hydroxychloroquine became the focus of numerous clinical trials following the president’s statement that it could be a “game changer.” At the time, he appeared to base this statement on anecdotal stories, as well as a few early and very limited studies that hydroxychloroquine seemed to help patients with COVID-19 recover.
Regardless, some scientists continued to study it in hopes of finding a cure for this deadly virus.
How the work was done
The new study was carried out by scientists in Germany who tested HQC on a collection of different cell types to figure out why this drug doesn’t prevent the virus from infecting humans.
Their findings clearly show that that HQC can block the coronavirus from infecting kidney cells from the African green monkey. But it does not inhibit the virus in human lung cells – the primary site of infection for the SARS-CoV-2 virus.
In order for the virus to enter a cell, it can do so by two mechanisms – one, when the SARS-CoV-2 spike protein attaches to the ACE2 receptor and inserts its genetic material into the cell. In the second mechanism, the virus is absorbed into some special compartments in cells called endosomes.
Depending on the cell type, some, like kidney cells, need an enzyme called cathepsin L for the virus to successfully infect them. In lung cells, however, an enzyme called TMPRSS2 (on the cell surface) is necessary. Cathepsin L requires an acidic environment to function and allow the virus to infect the cell, while TMPRSS2 does not.
In the green monkey kidney cells, both hydroxychloroquine and chloroquine decrease the acidity, which then disables the cathepsin L enzyme, blocking the virus from infecting the monkey cells. In human lung cells, which have very low levels of cathepsin L enzyme, the virus uses the enzyme TMPRSS2 to enter the cell.
But because that enzyme is not controlled by acidity, neither HCQ and CQ can block the SARS-CoV-2 from infecting the lungs or stop the virus from replicating.
Why it matters
This matters for several reasons. One, much time and money has been spent studying a drug that many scientists said from the very beginning was not going to be effective in killing the virus.
The second reason is that the studies that have reported antiviral activity for hydroxychloroquine were not in epithelial lung cells. Thus, their results are not relevant to properly studying SARS-CoV-2 infections in humans.
What’s next?
As scientists proceed with investigating new drugs as well as trying to repurpose old ones, like hydroxychloroquine, it is critical that researchers take the time to think about their study design.
In short, those of us involved in antiviral drug development should all take a lesson from this study. It is important not only to focus our efforts on pursuing drugs that will directly shut down viral replication, but also to study the virus in the primary site of infection.
If you asked 100 people about psychedelics, you’d most likely get 100 opinions based on their firsthand experience, strong condemnation or stories from their adventures at Woodstock in the ’60s. No matter what people might know or think they know about psychedelics, the 40-year moratorium that closed down related research in the ’70s is now coming to an end. Psychiatrists are beginning to realize that strategic, supervised use of these psychopharmacological drugs is helping people with mental disorders including obsessive-compulsive disorder, post-traumatic stress disorder, alcoholism, depression and cluster headaches. Still, are there enough scientific studies to warrant the use of these drugs in mainstream society?
I’ll admit that talk of psychedelic therapy to treat depression makes me nervous. In researching my book, Unstoppable, I looked at other key triggers that can mimic psychological disorders like depression and anxiety, such as inflammation, nutritional deficiencies, hormonal changes, side effects from medications, gut imbalances and food sensitivities. The reality is, depression is complex. What works for one may not work for another. Any successful treatment must first identify the root cause of one’s depression successfully, which can be a complex process if not done under the right medical care. A psychedelic treatment isn’t suddenly going to fix a nutritional deficiency, for example, but it may help target other symptoms and behaviors that correspond with depression. This is why it was critical to set my own biases aside and speak to an expert.
I was fortunate enough to interview Dr. Domenick J. Sportelli, who is board-certified by the American Board of Neurology and Psychiatry for General Psychiatry and fellowship-trained and Board Certified in Child and Adolescent Psychiatry. He also specializes in human behavior and psychopharmacology. I wanted to get the most current information on the use of psychedelics in treatment for depression, anxiety and PTSD, so I first asked him first to clarify what psychedelics were.
“The term ‘psychedelic substance’ refers to an exogenous substance [derived outside the body] that, when taken into the body in various ways, physiologically, neurologically and psychologically manifest an internal personal experience of altered states of consciousness,” he explains. “This includes perceptual distortions, hallucinations, synesthesia [a mixing of the senses], altered sense of time and space, as well as potentially inducing what researchers call a ‘mystical experience’ — a sense of oneness, of noetic experience and an undefinable but profoundly spiritual quality.”
Is there enough evidence to support psychedelic therapy?
Sportelli wants to make clear that the most researched psychedelics — LSD, psilocybin (mushrooms), peyote, MDMA, DMT and ketamine — have different mechanisms of action and even induce subtle, subjective experiential differences. Although each is grouped under the term “psychedelics,” they are quite disparate.
Dr. Sportelli is cautiously optimistic about the multitudes of large-scale, university-based testing and prior research compiled decades ago, but worries about the abiliity to circumvent bureaucracy and conduct safe, credible and substantial testing today. He does add that recent testing of psilocybin, LSD, ketamine and MDMA in particular has generated cause for optimism, and that they will likely have a place not only in continued, diverse research design and protocol, but eventually in therapeutic use.
What types of depression can psychedelics treat?
If we were to look at the onset of most mental illnesses, the majority start to become evident between the ages of 11 and 24, according to the National Institute of Health. With only 42 percent of people getting treatment, most typically do not seek out assistance until a secondary mental illness occurs several years later.
When asked how broadly psychedelics might be able to help treat people with depression, Sportelli concedes that, “Unfortunately, research hasn’t determined the level of scientific data to specify the type of depression or mood disorder that psychedelic therapy will benefit.” But he does add that research and data are beginning to show statistically significant improvements in mood, reduced anxiety, change in positive personality traits over time, the possibility of reducing addictive behaviors, reduction in suicidal tendencies and increased personal insight.
Do psychedelics treat the symptoms or the cause?
According to Dr. Sportelli, depression stems from a mix of genetic, biological, neurological, psychological and sociological factors. Recent research has demonstrated how the chemical breakdown of psilocybins closely resembles that of serotonin, and indicated the promising interplay of select hormone transmission. Dr. Sportelli stresses the critical role that these drugs might offer in mood disorders is at the forefront of the pharmaceutical quest for treatment.
“We have never seen substances like these that can potentially change the way that we look at our life and change perspective with lasting results,” he says, noting that they might be able to help “supercharge psychotherapy.”
Is this ultimately a recommend treatment, and where does one turn for it?
“At this time, in the U.S., I would only recommend this treatment be a part of, and under the close supervision of, a university-based IRB [Institutional Review Board]-monitored clinical trial,” Sportelli emphasizes. Before any psychiatric treatment, Dr. Sportelli also recommends a full medical and neurological evaluation to rule out any of the multitudes of medical circumstances that can manifest as a primary mood disorder, and reiterates that significant and often profoundly adverse outcomes associated with such powerful, mind-altering chemicals need to be weighed further as well. That’s why, as part of any regulated trial, all the necessary medical workups would be completed before participation.
Is the stigma around psychedelic therapy warranted?
Sportelli acknowledges that there is a safety concern associated with psychedelics, and does not condone their recreational or illict use. But he does believe that regulated clinical trials, judicious and ethical research methodology and the progression for therapeutic intervention should not be overlook based on previous stigma and possible misclassification.
I’ve never been one to throw the baby out with the bathwater. After interviewing Dr. Sportelli, I hold hope for the future, but also a concern for those who may seek out this kind of treatment without an accurate medical diagnosis. My number-one hesitation remains — that is we simply do not have the studies to show which types of depression psychedelic therapy successfully treats, which may result in people attempting to use a hammer when in fact they need a nail.
Either way, if you are to venture into this arena, find someone who specializes in it. The risk of going it alone could come at too a high price.
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Drug screening has now become an important tool for promoting a safe working environment. Be it absenteeism, low employee productivity, potential liabilities or healthcare costs, drug screening can help bring about a positive change within a few months. Make sure your drug screening policy meets all federal and state requirements for drug testing.
Here in this post, we’re listing out four most important considerations for administering a drug screening program:
Employee Drug Testing Consideration #1: How Often Should You Conduct Drug Tests On Your Employees?
The overall effectiveness of your drug testing policy will largely depend on how frequently you conduct drug tests on your employees. Some businesses may need to conduct drug tests more frequently than others.
Pre-employment drug testing: You can test a candidate, once an offer of employment has been made. In some states, businesses are legally required to make an offer of employment before a drug test is carried out on a candidate. Make sure the policy is consistent. Businesses shouldn’t be selective in drug testing certain individuals for the same position.
Random drug testing: Such drug tests can be conducted without any advance notice at any time of the year. Make sure the selection process is completely random. You can use a software program to generate a random set. In some states, businesses are required to engage a third-party for random selection of employees for drug testing.
Incident based drug testing: In case your organization employs people in safety-sensitive positions regulated by the government, you may be required to carry out post-accident testing. If the state law permits, an employee in the event of a fatality or accident should be drug tested within 24-32 hours. In some states such as in San Francisco, post-accident drug testing is illegal.
Regular drug testing: You may drug test employees once every month, six months or a year.
An organization may also want to have a policy of drug screening employees on the basis of reasonable suspicion.
Employee Drug Testing Consideration #2: Which Drug Testing Method Will You Adopt?
Different drug testing methods vary in cost and accuracy. Testing urine samples, for example, is cheaper in comparison to testing a hair sample.
Certain drug-testing methods may also be illegal in some states. For example, oral fluid or blood testing is illegal in many states (consider learning more about your local government laws regarding regulations and practices of workplace drug testing).
You will also need to decide on the type of substance (alcohol, cocaine, marijuana, etc.) that you want a drug test to detect. There are mutlple drug tests and some are meant to detect different illicit drugs, alcohol, tobacco, etc.
While a credible drug testing kit supplier will patiently study your unique requirements and advise on the best possible drug testing methods for your organization, it is important that you understand the various options available and applicable state laws concerning drug testing.
Employee Drug Testing Consideration #3: How to Inspire Employees to Create a Drug-Free Workplace?
The fundamental objective of drug testing employees is to promote a drug-free workplace. Therefore, your HR department needs to devise strategies for making employees see drug screening in a positive light. Listed below are some useful tips:
Create a drug-free workplace policy; it should be easy to understand and free from any technical jargon. The policy should clearly state what’s expected from the employees. There should be no ambiguities on how a test positive employee would be dealt with or what happens in case an employee is found faking the test.
Conduct monthly sessions on the benefits and necessity of drug testing; the objective is to make employees understand and respect the drug testing policy of the organization.
Make sure your employees understand the entire drug testing process and its key objectives.
Allow a minimum of one month between implementation and enforcement of your company’s new drug testing policy; some states may require a longer time frame before an organization enforces drug testing policy on its employees.
Employee Drug Testing Consideration #4: What Happens When Some Employees Fail the Drug Test?
As you proceed with drug testing, some employees are likely to test positive. Your organization needs to have a clear policy on how to deal with test positive employees. While some may recommend a zero-tolerance policy and terminate employees who fail drug tests, others may devise an employee assistance program to keep valuable talent.
In some states, employers can legally fire employees who fail drug tests. In the case of ‘second-chance’ states, businesses are required to provide employee assistance programs. Typically, test positive employees who participate in such programs are offered to counsel and need to later pass the drug test.
Keep in mind that marijuana laws in the United States are continually evolving. It is advisable to have a good understanding of rules for drug testing in medical marijuana states. Make sure your company-wide drug testing policy adheres to the applicable state laws.
I was barely getting any sleep,” Umar Afridi, cofounder and CEO of Truepill, says of the tech-enabled pharmacy company’s early days. From 9 a.m. to 4:30 p.m. each day, he worked at Truepill’s distribution center in Hayward, California. Then he drove to his job as a pharmacy manager at a 24-hour CVS in East San Jose. On the side, he studied for a dozen state pharmacy exams so that Truepill, which at the time had no other pharmacists on staff, could legally ship to those states. “It was a pretty crazy first year,” he says with characteristic understatement.
That craziness has paid off for Afridi, 37, and his cofounder, Sid Viswanathan, 35, who hope to upend the staid, heavily regulated pharmacy business with technology. Truepill, which is based in San Mateo, California, shipped its first prescriptions in 2016. Last year its revenue reached $48 million, helped by the fast growth of direct-to-consumer customers like Nurx, which sells birth control, and Hims, which focuses on remedies for hair loss, erectile dysfunction and acne. This year Truepill could double its revenue to $100 million, as it expands its customer base beyond direct-to-consumer medications to prescriptions that treat more serious illnesses.
Truepill’s Sid Viswanathan (left) and Umar Afridi
Timothy Archibald for Forbes
Those revenue numbers gained Truepill a spot on Forbes’ Next Billion-Dollar Startups list this year, despite its having raised just $13 million in venture funding led by Initialized Capital at a valuation of $80 million in its last round. That valuation makes Truepill an outlier on the list, as does the fact that Afridi and Viswanathan own the majority of the business and plan to continue to do so after raising the next round of capital, expected before the year’s end.
Afridi and Viswanathan—and their investors—are betting that Truepill will see a big payoff as consumers move away from in-person doctor visits and to a new model of telemedicine. “This is the building block of digital health and the future of healthcare,” says Initialized managing partner Garry Tan.
Pharmacy is a roughly $400 billion business in the United States, yet only recently have entrepreneurs begun tackling the market. In 2013, two young founders launched PillPack, a retail pharmacy startup that was acquired by Amazon last year for around $750 million. Other newcomers followed, including New York City’s Capsule, which grabbed $270 million in funding to do same-day prescription delivery refilled via text.
Truepill’s difference: Its business-to-business model makes it a behind-the-scenes player, invisible to retail customers, who will never have reason to know its name. That’s by design, and it allows Truepill to sign agreements with drugmakers and pharmacy benefit managers, those industry intermediaries that sit between insurers and drugmakers, without directly competing with them. “We’re not a traditional mail-order pharmacy,” Afridi says. “We’re way more than that.”
Afridi was born in Salt Lake City and grew up in Manchester, England, where his mother’s family was from. He studied pharmacy at the University of Manchester and worked as a relief pharmacist, filling in for those who went on vacation, in England. After passing the tests to practice in the United States, he took a job at Fred Meyer near Seattle. Unlike the typical pharmacist, Afridi always had an entrepreneurial side gig. During college, he imported performance cars, like the Mazda RX-7 and the Mitsubishi Evo 5, from Japan and sold them at a profit.
While working as a pharmacist, he taught himself computer programming and began playing around with the idea of an on-demand pharmacy. His goal: to ease customers’ frustrations with waiting in line to pick up medications and to cut back the phone calls and faxes required for pharmacists to do their job. “I’ve always had a passion for technology, and every time I see a problem, I think, ‘How can technology fix this?’” he says.
Viswanathan, an Indian immigrant, had worked at Johnson & Johnson, then cofounded CardMunch, a business-card scanning app. In 2011, LinkedIn bought the startup for a reported $3 million. Viswanathan stayed at the larger company after the deal, and when LinkedIn went public the stock he owned made him wealthy for the first time. “It was fairly life-changing coming from no money to having some,” he recalls. After nearly four years at LinkedIn, he was ready to leave and work on another startup. “My only criterion was what do I want to spend the next 10 years of my life on,” he says.
While he was pondering what to do next, he stumbled upon Afridi’s profile on LinkedIn—where Afridi had changed his header to “startup founder, pharmacist”—and messaged him cold to talk about healthcare. Soon the two were meeting regularly and brainstorming ideas for a business to start together.
By then, other startup pharmacies, like PillPack, were making inroads with retail customers. Rather than compete in what had become a crowded space vying for retail customers, Afridi and Viswanathan figured they could operate in the background, using technology to build an extremely efficient pharmacy distribution center. “Truepill is what you get when you put together a pharmacist and a software engineer,” Viswanathan says.
“This is the building block of digital health and the future of healthcare,” says Initialized Capital’s Garry Tan.
Their idea coincided with the rise of new direct-to-consumer health brands that needed a distributor that could follow all the pharmacy regulations. To consumers, these Instagrammable health products don’t look like drugs, and often their subscription boxes contain a mix of both prescription and over-the-counter products. But if there’s even one vial of prescription pills going out in the mail, the startup sending it needs a pharmacy to fulfill the order. In talking with Nurx, Viswanathan says, “we came to find out they were literally picking up the phone to mom-and-pop pharmacies in different states.” They gained a customer by offering a better way.
In 2017, Andrew Dudum cofounded Hims, the fast-growing direct-to-consumer therapeutics startup for men, and he, too, signed up with Truepill. “We knew from the beginning we were going to grow very fast,” Dudum says. “We expected 30 to 50 orders per day, and that was the scale we communicated to Umar and Sid that we needed to be prepared for. In the first week, we were getting 500 orders per day.” Today, Hims, which is valued at $1.1 billion, does thousands of orders per day and is one of Truepill’s largest customers. “They figured out a way to scale with us,” Dudum says.
At Truepill’s Hayward distribution center, all orders come in electronically. When Hims sends a prescription for finasteride, the male hair-loss treatment, for example, it goes through electronic vetting and then a robotic machine pulls the 1-milligram tablets from custom-made 1,000-count bottles into a small pill vial that gets labeled with Hims branding. That automation allows Truepill to work more efficiently than a traditional retail pharmacy. So, too, does its focus on a small number of medications: Ten medications, including finasteride and the erectile-dysfunction drug sildenafil, represent 80% of its volume. Its scale in those allows Truepill to turn over its inventory every few days and gives it the power to negotiate prices with drug manufacturers and pharmacy benefit managers on those products.
“Truepill is what you get when you put together a pharmacist and a software engineer,” says cofounder Sid Viswanathan.
For Afridi and Viswanathan, direct-to-consumer medications are just the beginning. They are starting to sign agreements with drugmakers and pharmacy benefit managers, though they won’t name those larger partners yet. This shift comes none too soon, as Hims has announced that it would open its own pharmacy in Ohio to shift a portion of its distribution in-house—a move that Viswanathan says will begin to impact Truepill in 2021. “Hims is a large part of the business in quantity, but not in revenue,” he says, noting that medications reimbursed by insurance are higher cost than lifestyle meds that consumers pay for out of pocket. Truepill currently has two distribution centers and is adding another five.
Afridi and Viswanathan’s next step: building a nationwide network of doctors in every state that will enable their pharmacy startup to play a bigger role in the shift to telemedicine. Those doctors will allow it to work directly with makers of specialty medications, say, so that they can distribute their medications to consumers more easily. Over time, Truepill figures its orders could rise from 5,000 to 10,000 per day to 100,000.
“Lifestyle and ED [erectile dysfunction] medications have allowed us to build the infrastructure to all these other areas,” Afridi says. “There is a lot of innovation that needs to happen in the space.”
I’m a senior editor at Forbes, where I cover manufacturing, industrial innovation and consumer products. I previously spent two years on the Forbes’ Entrepreneurs team. It’s my second stint here: I learned the ropes of business journalism under Forbes legendary editor Jim Michaels in the 1990s. Before rejoining, I was a senior writer or staff writer at BusinessWeek, Money and the New York Daily News. My work has also appeared in Barron’s, Inc., the New York Times and numerous other publications. I’m based in New York, but my family is from Pittsburgh—and I love stories that get me out into the industrial heartland. Ping me with ideas, or follow me on Twitter @amyfeldman.
Hi, I’m Garry Tan, venture capitalist and cofounder at Initialized Capital. We were earliest investors in billion dollar startups like Coinbase and Instacart, and we’re spending time with some of our best founders to learn the secrets of their success and see the future they’re building. Today I sat down with Sid Viswanathan, cofounder of Truepill, an API for all needs for telemedicine. Telemedicine has the potential to bring down costs and make high quality care more accessible for every person on the planet. We’re headed to Hayward, California, their west coast HQ and fulfillment center out of which they provide pharmacy services for dozens of telemedicine startups and practices large and small, shipping to all 50 states. Come learn about how as a founder, you need to choose a problem space that you could want to work on for 10 years or more. Please like this video and subscribe to my channel if you want to see more videos like this with top founders. Find Sid on Twitter at https://twitter.com/sidviswanathan Find Garry on Twitter at https://twitter.com/garrytan Learn more about Truepill at https://truepill.com Learn more about the companies we fund, and how we work with them at https://initialized.com
A few weeks ago, a patient came to me complaining of nausea, muscle weakness and fatigue. Her urine was tea-colored despite drinking loads of water. A middle-aged woman, she seemed worried she had cancer or some deadly disease. Her lab tests revealed significant liver dysfunction. But her symptoms were not due to liver cancer, hepatitis or other disease. It turned out she had liver toxicity from a green tea supplement that she’d heard was a “natural” way to lose weight.
When she stopped taking the supplement at my suggestion, her liver tests gradually normalized and she felt better over the course of a few weeks
I’ve seen the green tea issue in patients before and often witness the real-life pitfalls of eschewing traditional medicine, science and facts in favor of supplements, herbs and cleanses in the name of “natural” healing.
In an effort to be healthy, patients can easily become ensnared in the potential dangers of alternative medicine or homeopathy.
Let’s be clear: Nature has a lot to offer patients.
The Greek physician Hippocrates is said to have reported on the use of St. Johnswort, a flowering plant, for mood disturbances in the 5th century B.C. Digoxin, a well-studied medicine used to treat heart failure, is derived from the foxglove plant. Parkinson’s patients are often commonly treated with the medication L-dopa, which comes from the plant Mucuna pruriens. Moreover, research repeatedly shows that consuming fruits and vegetables, getting adequate sleep and regular exercise, and spending time outdoors have myriad health benefits.
But nature isn’t always so well-intended.
Spoiler alert: Arsenic, cyanide, asbestos and snake venom derive from nature. Refined sugar, a naturally occurring substance and one that lives in most Americans’ pantries, is in large part responsible for our country’s obesity epidemic. Simply because a substance comes from nature does not mean it is good for us.
An important key to health is using nature appropriately.
And in the case of my patient, she was able to lose weight when we made a clear plan to alter her basic human behaviors. Before she started taking the green tea extract, she was skipping breakfast, drinking the equivalent of two Venti coffees before noon, eating takeout meals for lunch, washing down her late-night dinner with two glasses of wine, sleeping restlessly, and spending too much time sitting and indoors.
Green tea extract was never going to be the quick fix that she — and other patients I have seen — had hoped. It may be attractive as a natural cure for extra body fat, but this promise has not been shown in any studies, according to the National Center for Complementary and Integrative Health at the National Institutes of Health. The key to helping my patient was pretty basic: looking at her lifestyle, her stress, and creating some structure and accountability for important lifestyle changes.
While she wasn’t able to eat like Gwyneth Paltrow would recommend (who can eat Pinterest-perfect meals like that as a mere mortal?), my patient took my advice to heart that she begin eating breakfast, packing healthy leftovers for lunch at work, cutting back the wine to weekends only, and getting more exercise on weekends.
As a result, she started sleeping better and feeling more energetic. Eventually, the weight started coming off, too.
Particular patients seem to be more susceptible to the lure of “naturopathic” medicine or homeopathy. Patients who have vague symptoms that do not fit tidily into a box, for example, are often the ones combing the Internet for answers to their health woes and spending hundreds of dollars on unproven and insufficiently regulated supplements and herbs.
Scientific data is often not the reason patients are drawn to herbal or “natural” supplements, Harvard School of Public Health researchers said. Of supplements users surveyed in 2001, 72 percent said they would continue using supplements despite a negative government scientific study. Patients reported getting much information about herbs from family, friends, advertisements and the Internet.
My patients often consider herbal remedies to be free of side effects, but many “natural” products can lead to toxicity and can dangerously interact with prescription medications.
Last year, another patient came in to see me complaining of fatigue, joint pains and abdominal bloating. She had seen a naturopath for these symptoms, who told her she had “chronic Lyme” disease and gave her multiple rounds of antibiotics and a bag full of daily herbal supplements. She said she didn’t feel any better.
When we met, she told me she was certain she had Lyme disease that wasn’t being adequately treated. In fact, the antibiotics she had been given had only worsened her abdominal issues and caused a new problem: an intestinal infection that causes bad diarrhea.
After 10 days of appropriate antibiotic treatment, her diarrhea was gone but she was back to her tired and achy self. At my recommendation, she stopped the supplements, and her fatigue abated somewhat.
When we discussed her situation further, she revealed to me she suffered from a love-hate relationship with sugar.
Like many of my patients, when she was stressed out she binged on sugar. For most people, ingesting sugar provides a quick hit of the pleasure hormone dopamine, and for some people that rush of dopamine and the accompanying instantaneous boost of energy can become addicting.
The problem is that a high sugar load causes a surge in the hormone insulin, which then results in a sudden drop in blood sugar — which can promote fatigue, weakness and irritability, among other symptoms. If consumed in excess over time, such dietary sugar can cause abdominal distress, bloating and joint aches. This is what was probably causing my patient’s symptoms.
So we made a plan for her to not only cut back on sugar but also fill her diet with healthy stuff to get ahead of hunger and avoid binges. I also recommended she work with a therapist to deal with stress-eating. Her joint aches went away and her energy improved after about two weeks, and she continues to see a therapist for stress-eating issues.
Food — and added support to use it properly — was the fix.
Symptoms such as fatigue, headaches, joint pains and irregular bowel movements are some of the most common complaints I see in my office. They can be challenging for physicians to figure out, largely because they require careful and attentive listening by the doctor.
Occasionally, it takes time with the patient, careful attention to the patient’s story, and asking the right questions to get to the bottom of the problem. Often, the solution is right under our nose.
Nature is indeed wonderful, but it doesn’t always come in a pill.
Lucy McBride is an internist based in the District.
John Oliver outlines what, exactly is problematic about Dr. Oz and the nutrition supplement industry. Then he invites George R.R. Martin, Steve Buscemi, the Black and Gold Marching Elite, and some fake real housewives on the show to illustrate how to pander to an audience without hurting anyone. Connect with Last Week Tonight online… Subscribe to the Last Week Tonight YouTube channel for more almost news as it almost happens: http://www.youtube.com/user/LastWeekTonight Find Last Week Tonight on Facebook like your mom would: http://Facebook.com/LastWeekTonight Follow us on Twitter for news about jokes and jokes about news: http://Twitter.com/LastWeekTonight Visit our official site for all that other stuff at once: http://www.hbo.com/last-week-tonight-…
Keith McCarty was two years into his Snoop Dogg-backed cannabis startup when he knew it was time for a change. Eaze, nicknamed the Uber for Weed as it serves as a delivery platform connecting cannabis dispensaries and their customers in legalized areas, was hitting its stride. It was 2014, and the company was on the eve of closing on a $40 million Series B round. What’s more, Eaze’s home state of California had just voted to legalize recreational use of marijuana, serendipitously expanding the company’s services beyond medical use clientele. But connecting clients and dispensaries came with multiplying constraints of the scattered commercial supply chain. So for McCarty, it was time to go.
McCarty, a serial entrepreneur, a founding team member of social media startup Yammer, saw an opportunity in the excruciating pain points between cannabis brands and dispensaries. In August, three years after his departure from Eaze and with $5 million in seed funding, McCarty launched Wayv, a B2B version of Eaze.“With more legalization comes more regulation and causes more friction in the supply chain,” McCarty told Forbes. That’s why he’s doubling down on his bet that tech solutions will help smooth out the logistical kinks through Wayv’s Amazon fulfillment model, in which brands can list their products and retailers can place bulk orders for next day delivery.
Like soda or cigarettes, the cannabis business is emerging with multiple brands, and each has its fans. It’s in the interest of every dispensary to carry the brands its customers prefer, but because of byzantine and contradictory state and federal laws, outlets can’t order multiple brands from a single outlet. Adding to the complication is the fact that nobody in the supply chain, not the growers, processors, distributors or retailers, can use banks to make it all happen as facilitating the sale of cannabis is against federal law.
Each cannabis brand begins with growers, processors and state-mandated laboratory tests before it hits the distributor, which gets the brand product to the warehouse before it’s ready to hit dispensary shelves. Together, cannabis brands bear the operational brunt of marketing, sales and processing transactions, and retailers can’t buy brands in bulk but have to deal with each individually.
“Today, the process retailers have to go through is sending emails, text messages and make calls to 30 to 50 brands to even place the order,” McCarty said. “This is one of the biggest white spaces in the industry and one of the most unsolved aspects.” In California, Wayv is greasing the cannabis distribution track, offering a “seed to sale” e-commerce compliance and distribution platform. For 80% of California’s licensed retailers using Wayv’s services, access to live inventory and brands beyond their geographical market means consistent and diverse product selection for dispensary customers. For a 15% fee, Wayv replaces the door-to-door salesman model for brands to get their products on store shelves and offloads the delivery and payment exchange—which is mainly cash-based.
WAYV founder and CEO Keith McCarty
Beboe, a high-end vape and edibles company, uses Wayv as a marketing tool and credits the platform for an uptick in sales. “Last year there was such a supply and demand issue because there was no data before,” said Kiana Anvaripour, Beboe’s VP of marketing. “Wayv has helped us be nimble and quick—it’s a way for you to be able to show your brand digitally.”
Brands, retailers and the distributor can all track the status of the order through Wayv’s platform and app, which helps avoid unwanted issues such as ordering the wrong product or amount—cannabis products legally come with a nonreturnable policy upon delivery.
Wayv also addresses one of the biggest pain points for brands, the inability to access traditional lines of credit. To alleviate the cash flow part of the supply chain, Wayv offers an initial credit line and takes on delinquency and default for brands to help them keep up with market demand. “We understand that brands don’t want to be a distributor or tech company. Both of those are provided for a 15% fee, and that’s lower than your fully weighted distribution cost,” McCarty said.
McCarty remains the majority shareholder of Eaze, which he launched with his Yammer cofounders, Jim Patterson, Aleksey Klempner and Roie Edery. He spent a year at Microsoft after it purchased Yammer for $1.2 billion in 2012 before moving into cannabis. As research, McCarty interviewed 150 medical marijuana patients at the San Francisco medical dispensary Sparc. The biggest problem with the plant, McCarty cleared, was lack of easy access. Hence, Eaze.
“Eaze was pushing the limits of what’s required by brands to be able to participate, and very quickly you start to realize there’s a supply constraint about to happen,” said McCarty. He reemerged on the cannatech scene last summer with the launch of Wayv and $5 million in seed funding from Yammer cofounder David Sacks, his first investment in a cannabis business.
While there are a handful of cannabis POS startups, one thing Wayv has over one of its competitors is partnerships with a licensed distributor and lab. McCarty says one of the biggest hurdles brands face is getting their product into the dispensaries. The average mom-and-pop brownie business doesn’t have the funds to hire a delivery driver, so Wayv deploys a third-party distributor, Indus, to fulfill pickups for brands and drop-offs for retailers. Wayv also offers the option to offload state-mandated testing requirements by partnering with a licensed lab that conducts product batch testing adjacent to Indus’ warehouse.
Because Wayv is not vertically integrated, it’ll be easy to expand outside of California, but McCarty cautions that scaling is a race against time. “This is a very complex part of the supply chain,” he says. “People could probably do it over time, but the industry doesn’t have time.”
Follow Samar on Twitter at @HellaSamar or email her at smarwan[at]forbes.com.
Samar Marwan is the West Coast-based assistant editor of technology at Forbes. Marwan’s coverage of women run startups and the MENA tech scene has gone into defining
Despite the bad press millennials receive, as a cohort they have committed to sustainability. A full 70% of millennials will pay more for products made sustainably, while 83% consider a product’s environmental or social impact before making a purchase. They are bringing that sense of responsibility for maintaining a livable planet to the cannabis industry which is populated with young, progressive entrepreneurs. But while cannabis is a business based around agriculture, there aren’t clear rules for how to make it more sustainable…..
In late 2012, 60 people died in two cities in Pakistan after drinking cough syrup to get high. Syrups from two separate manufacturers were involved. It was found that both were using an active ingredient — dextromethorphan, a synthetic morphine-like compound — imported from the same manufacturer in India. Indian drug authorities put a halt to production while they investigated. Tests in Pakistan revealed that the medicines seemed to contain the correct amount of active ingredient. But further tests revealed something that was not supposed to be there……..
Healthy Lifestyle
