How Will the COVID Pills Change the Pandemic?

In March, 2020, researchers at Emory University published a paper about a molecule called NHC/EIDD-2801. At the time, there were no treatments available for the coronavirus. But NHC/EIDD-2801, the researchers wrote, possessed “potency against multiple coronaviruses,” and could become “an effective antiviral against SARS-CoV-2.” A few days later, Emory licensed the molecule to Ridgeback Biotherapeutics, a Miami-based biotechnology company which had previously developed a monoclonal antibody for Ebola.

Ridgeback partnered with the pharmaceutical giant Merck to accelerate its development.The Emory researchers named their drug molnupiravir, after Mjölnir—the hammer of Thor. It turns out that this was not hyperbole. Last month, Merck and Ridgeback announced that molnupiravir could reduce by half the chances that a person infected by the coronavirus would need to be hospitalized. The drug was so overwhelmingly effective that an independent committee asked the researchers to stop their Phase III trial early—it would have been unethical to continue giving participants placebos.

None of the nearly four hundred patients who received molnupiravir in the trial went on to die, and the drug had no major side effects. On November 4th, the U.K. became the first country to approve molnupiravir; many observers expect that an emergency-use authorization will come from the U.S. Food and Drug Administration in December.

Oral antivirals like molnupiravir could transform the treatment of COVID-19, and of the pandemic more generally. Currently, treatments aimed at fighting COVID—mainly monoclonal antibodies and antiviral drugs like remdesivir—are given through infusion or injection, usually in clinics or hospitals. By the time people manage to arrange a visit, they are often too sick to receive much benefit. Molnupiravir, however, is a little orange pill.

A person might wake up, feel unwell, get a rapid COVID test, and head to the pharmacy around the corner to pick up a pack. A full course, which needs to start within five days of the appearance of symptoms, consists of forty pills—four capsules taken twice a day, for five days. Merck is now testing whether molnupiravir can prevent not just hospitalization after infection but also infection after exposure.

If that’s the case, then the drug might be taken prophylactically—you could get a prescription when someone in your household tests positive, even if you haven’t.Molnupiravir is—and is likely to remain—effective against all the major coronavirus variants. In fact, at least in the lab, it works against any number of RNA viruses besides SARS-CoV-2, including Ebola, hepatitis C, R.S.V., and norovirus. Instead of targeting the coronavirus’s spike protein, as vaccine-generated antibodies do, molnupiravir attacks the virus’s basic replication machinery. The spike protein mutates over time, but the replication machinery is mostly set in stone, and compromising that would make it hard for the virus to evolve resistance.

Once it’s inside the body, molnupiravir breaks down into a molecule called NHC. As my colleague Matthew Hutson explained, in a piece about antiviral drugs published last year, NHC is similar to cytosine, one of the four “bases” from which viral RNA is constructed; when the coronavirus’s RNA begins to copy itself, it slips into cytosine’s spot, in a kind of “Freaky Friday” swap. The molecule evades the virus’s genetic proofreading mechanisms and wreaks havoc, pairing with other bases, introducing a bevy of errors, and ultimately crashing the system.

A drug that’s so good at messing with viral RNA has led some to ask whether it messes with human DNA, too. (Merck’s trial excluded pregnant and breast-feeding women, and women of childbearing age had to be on contraceptives.) This is a long-standing concern about antiviral drugs that introduce genomic errors. A recent study suggests that molnupiravir, taken at high doses and for extended periods, can, in fact, introduce mutations into DNA. But, as the biochemist Derek Lowe noted, in a blog post for Science, these findings probably don’t apply directly to the real-world use of molnupiravir in COVID patients. The study was conducted in cells, not live animals or humans.

The cells were exposed to the drug for more than a month; even at the highest doses, it caused fewer mutations than were created by a brief exposure to ultraviolet light. Meanwhile, Merck has run a battery of tests—both in the lab and in animal models—and found no evidence that molnupiravir causes problematic mutations at the dose and duration at which it will be prescribed.With winter approaching, America is entering another precarious moment in the pandemic. Coronavirus cases have spiked in many European countries—including some with higher vaccination rates than the U.S.—and some American hospitals are already starting to buckle under the weight of a new wave. Nearly fifty thousand Americans are currently hospitalized with COVID-19.

It seems like molnupiravir is arriving just when we need it.It isn’t the only antiviral COVID pill, either. A day after the U.K. authorized Merck’s drug, Pfizer announced that its antiviral, Paxlovid, was also staggeringly effective at preventing the progression of COVID-19 in high-risk patients. The drug, when taken within three days of the onset of symptoms, reduced the risk of hospitalization by nearly ninety per cent. Only three of the nearly four hundred people who took Paxlovid were hospitalized, and no one died; in the placebo group, there were twenty-seven hospitalizations and seven deaths. Paxlovid is administered along with another antiviral medication called ritonavir, which slows the rate at which the former drug is broken down by the body.

Like Merck, Pfizer is now examining whether Paxlovid can also be used to prevent infections after an exposure. Results are expected early in 2022. (It’s not yet known how much of a difference the drugs will make for vaccinated individuals suffering from breakthrough infections; Merck’s and Pfizer’s trials included only unvaccinated people with risk factors for severe disease, such as obesity, diabetes, or older age. Vaccinated individuals are already much less likely to be hospitalized or die of COVID-19.)

Living in an Age of ExtinctionPaxlovid interrupts the virus’s replication not by messing with its genetic code but by disrupting the way its proteins are constructed. When a virus gets into our cells, its RNA is translated into proteins, which do the virus’s dirty work. But the proteins are first built as long strings called polypeptides; an enzyme called protease then slices them into the fragments from which proteins are assembled.
If you can’t cut the plywood, you can’t build the table, and Paxlovid blunts the blade. Because they employ separate mechanisms to defeat the virus, Paxlovid and molnupiravir could, in theory, be taken together. Some viruses that lead to chronic infections, including H.I.V. and hepatitis C, are treated with drug cocktails to prevent them from evolving resistance against a single line of attack. This approach is less common with respiratory viruses, which don’t generally persist in the body for long periods.
But combination antiviral therapy against the coronavirus could be a subject of study in the coming months, especially among immunocompromised patients, in whom the virus often lingers, allowing it the time and opportunity to generate mutations.

Merck will be producing a lot of molnupiravir. John McGrath, the company’s senior vice-president of manufacturing, told me that Merck began bolstering its manufacturing capacity long before the Phase III trial confirmed how well the drug worked. Normally, a company assesses demand for a product, then brings plants online slowly. For molnupiravir, Merck has already set up seventeen plants in eight countries across three continents. It now has the capacity to produce ten million courses of treatment by the end of this year, and at least another twenty million next year.

It expects molnupiravir to generate five to seven billion dollars in revenue by the end of 2022.How much will all these pills soften the looming winter surge? As has been true throughout the pandemic, the answer depends on many factors beyond their effectiveness. The F.D.A. could authorize molnupiravir within weeks, and Paxlovid soon afterward. But medications only work if they make their way into the body. Timing is critical. The drugs should be taken immediately after symptoms start—ideally, within three to five days. Whether people can benefit from them depends partly on the public-health infrastructure where they live. In Europe, rapid at-home COVID tests are widely available.

Twenty months into the pandemic, this is not the case in much of the U.S., and many Americans also lack ready access to affordable testing labs that can process PCR results quickly.Consider one likely scenario. On Monday, a man feels tired but thinks little of it. On Tuesday, he wakes up with a headache and, in the afternoon, develops a fever. He schedules a COVID test for the following morning. Two days later, he receives an e-mail informing him that he has tested positive. By now, it’s Friday afternoon. He calls his doctor’s office; someone picks up and asks the on-call physician to write a prescription. The man rushes to the pharmacy to get the drug within the five-day symptom-to-pill window.

Envision how the week might have unfolded for someone who’s uninsured, elderly, isolated, homeless, or food insecure, or who doesn’t speak English. Taking full advantage of the new drugs will require vigilance, energy, and access.Antivirals could be especially valuable in places like Africa, where only six per cent of the population is fully vaccinated. As they did with the vaccines, wealthy countries, including the U.S. and the U.K., have already locked in huge contracts for the pills; still, Merck has taken steps to expand access to the developing world.

It recently granted royalty-free licenses to the Medicines Patent Pool, a U.N.-backed nonprofit, which will allow manufacturers to produce generic versions of the drug for more than a hundred low- and middle-income countries. (Pfizer has reached a similar agreement with the Patent Pool; the company also announced that it will forgo royalties for Paxlovid in low-income countries, both during and after the pandemic.) As a result, a full course of molnupiravir could cost as little as twenty dollars in developing countries, compared with around seven hundred in the U.S. “Our goal was to bring this product to high-, middle-, and low-income countries at fundamentally the same time,” Paul Schaper, Merck’s executive director of global pharmaceutical policy, told me.

More than fifty companies around the world have already contacted the Patent Pool to obtain a sublicense to produce the drug, and the Gates Foundation has pledged a hundred and twenty million dollars to support generic-drug makers. Charles Gore, the Patent Pool’s executive director, recently said that, “for large parts of the world that have not got good vaccine coverage, this is really a godsend.” Of course, the same challenges of testing and distribution will apply everywhere.

Last spring, as a doctor caring for COVID patients, I was often dismayed by how little we had to offer. We tried hydroxychloroquine, blood thinners, and various oxygen-delivery devices and ventilator maneuvers; mostly, we watched as patients got better or got worse on their own. In the evenings, as I walked the city’s deserted streets, I often asked myself what kinds of treatment I wished we had. The best thing, I thought, would be a pill that people could take at home, shortly after infection, to halt the cascade of biological processes that sends them to the hospital, the I.C.U., or worse.

We will soon have not one but two such treatments. Outside of the vaccines, the new antiviral drugs are the most important pharmacologic advance of the pandemic. As the coronavirus becomes endemic, we’ll need additional tools to treat the inevitable infections that will continue to strike both vaccinated and unvaccinated people. These drugs will do that, reducing the damage that the coronavirus can inflict and, possibly, cordoning off avenues through which it can spread. Still, insuring that they are meaningfully and equitably used will require strength in the areas in which the U.S. has struggled: early and accessible testing; communication and coördination across health-care providers; fighting misinformation and building trust in rapid scientific advances. Just as vaccines don’t help without shots in arms, antivirals can’t work without pills in people.

 

Source: https://www.newyorker.com/

More on the Coronavirus

JP Morgan Chase Launches Its Own Health Business Unit Three Months After Haven Implodes

https://g.foolcdn.com/image/?url=https%3A%2F%2Fg.foolcdn.com%2Feditorial%2Fimages%2F616249%2Fjpmorgan-branch-courtesy.jpg&w=1200&h=630&op=resize

JPMorgan Chase is staking out its own healthcare venture, after its joint project with Berkshire Hathaway and Amazon failed earlier this year. On Thursday, the financial firm announced the launch of Morgan Health, a business unit focused on improving employer-sponsored healthcare, to be led by Dan Mendelson, founder and former CEO of the Washington, D.C.-based healthcare consultancy Avalere Health.

The move comes a little over three months since the joint venture Haven Health, which also aimed to lower employee healthcare costs and boost quality services, said it would be winding down.

Morgan Health will invest up to $250 million in “promising healthcare solutions” and will also enter into strategic partnerships, the company said. The new division, which will be headquartered in Washington, D.C., will also focus on health equity issues.

“JPMorgan Chase has been focused on improving healthcare for its employees for many years,” Morgan Health CEO Mendelson said in a statement. “We are going to take what we’ve learned and accelerate healthcare innovation in the employer-sponsored healthcare market, partnering with and investing in companies that share our goals, and measuring key health outcomes to show what works.”

Mendelson has a background in both health policy and finance. He was an operating partner at healthtech PE firm Welsh Carson for the past two years and served as the associate director for health in the Office of Management and Budget in the Clinton White House prior to founding Avalere. With 165,000 employees in the United States, JPMorgan Chase provides health insurance to around 285,000 people, including dependents.

Haven was announced with much fanfare in 2018, with billionaire Warren Buffet calling rising employee healthcare costs “a hungry tapeworm on the American economy.” Around half of Americans receive healthcare benefits through their employers, according to the Kaiser Family Foundation. The federal government estimates total national healthcare spending reached $3.8 trillion, or $11,582 per person, in 2019. And health spending continues to outpace inflation, growing 4.6% in 2019.

The implosion of Haven three years later demonstrated how even well-capitalized corporate juggernauts could be thwarted by the complexity of the U.S. healthcare system. “We were fighting a tapeworm in the American economy, and the tapeworm won,” Buffet said at Berkshire’s annual shareholder meeting earlier this month, according to Yahoo Finance.

“Haven was supposed to show how creativity, ingenuity and private sector, entrepreneurship could beat the healthcare sector. And it failed,” David Blumenthal, a physician and president of the healthcare think-tank The Commonwealth Fund, told Forbes in an interview earlier this year.

He said the speculation as to one of the big challenges Haven faced was that each company wanted to make its own choices for its employees, which has been the downfall of many similar coalitions. Amazon has also been making its own big push into the healthcare sector recently with a virtual primary care service called Amazon Care, the launch of its wearable Amazon Halo and its purchase of online pharmacy PillPack for $750 million.

The radical change needed to control healthcare costs requires buy-in on many levels, including some that employees might not be happy about, says Blumenthal. It could mean narrower networks of physicians to choose from or requiring travel for certain surgeries so they take place at top-ranked facilities, as opposed to the comfort of a local community hospital.

But the biggest impediments are structural—the lack of purchasing power for employers and consolidation among health systems, he said. “In the end, controlling costs in almost every other Western country is a responsibility that government assumes,” Blumenthal said. “It’s for precisely this reason that the alternatives are not effective.”

Despite what may be an uphill battle ahead, JPMorgan leadership is giving it another go. “Covid has shed light on both the greatness of our healthcare system and its challenges,” Peter Scher, vice chairman of the company who will be overseeing Morgan Health, said in a statement. “The firm has been investing in developing solutions to address social and economic challenges over the past 10 years. We plan to take what we’ve learned there and apply it to healthcare.”

Follow me on Twitter or LinkedIn. Send me a secure tip.

I am a staff writer at Forbes covering healthcare, with a focus on digital health and new technologies. I was previously a healthcare reporter for POLITICO covering the European Union from Brussels and the New Jersey Statehouse from Trenton. I have also written for the Los Angeles Times and Business Insider. I was a 2019-2020 Knight-Bagehot Fellow in business and economics reporting at Columbia University. Email me at kjennings@forbes.com or find me on Twitter @katiedjennings.

Source: JP Morgan Chase Launches Its Own Health Business Unit Three Months After Haven Implodes

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References

 

“The History of JPMorgan Chase & Co.: 200 Years of Leadership in Banking, company-published booklet, 2008, p. 5. Predecessor to J.P. Morgan & Co. was Drexel, Morgan & Co., est. 1871. Retrieved July 15, 2010. Other predecessors include Dabney, Morgan & Co. and J.S. Morgan & Co” (PDF).

Billionaire Eric Lefkofsky’s Tempus Raises $200 Million To Bring Personalized Medicine To New Diseases

On the surface, Eric Lefkofsky’s Tempus sounds much like every other AI-powered personalized medicine company. “We try to infuse as much data and technology as we can into the diagnosis itself,” Lefkofsky says, which could be said by the founder of any number of new healthcare companies.. But what makes Tempus different is that it is quickly branching out, moving from a focus on cancer to additional programs including mental health, infectious diseases, cardiology and soon diabetes. “We’re focused on those disease areas that are the most deadly,” Lefkofsky says. 

Now, the billionaire founder has an additional $200 million to reach that goal. The Chicago-based company announced the series G-2 round on Thursday, which includes a massive valuation of $8.1 billion. Lefkofsky, the founder of multiple companies including Groupon, also saw his net worth rise from the financing, from an estimated $3.2 billion to an estimated $4.2 billion.

Tempus is “trying to disrupt a very large industry that is very complex,” Lefkofsky says, “we’ve known it was going to cost a lot of money to see our business model to fruition.” 

In addition to investors Baillie Gifford, Franklin Templeton, Novo Holdings, and funds managed by T. Rowe Price, Lefkofsky, who has invested about $100 million of his own money into the company since inception, also contributed an undisclosed amount to the round. Google also participated as an investor, and Tempus says it will now store its deidentified patient data on Google Cloud. 

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“We are particularly attracted to companies that aim to solve fundamental and complex challenges within life sciences,” says Robert Ghenchev, a senior partner at Novo Holdings. “Tempus is, in many respects, the poster child for the kind of companies we like to support.” 

MORE FOR YOUTony Hsieh’s American Tragedy: The Self-Destructive Last Months Of The Zappos VisionaryWhy 40 North Ventures Bought GE Ventures’ Stakes In 11 Industrial StartupsAt-Home Health Testing Company Everlywell Raises $175 Million Series D Round At A $1.3 Billion Valuation

Tempus, founded by Lefkofsky in 2015, is one of a new breed of personalized cancer diagnostic companies like Foundation Medicine and Guardant Health. The company’s main source of revenue comes from sequencing the genome of cancer patients’ tumors in order to help doctors decide which treatments would be most effective. “We generate a lot of molecular data about you as a patient,” Lefkofsky says. He estimates that Tempus has the data of about 1 in 3 cancer patients in the United States. 

But billing insurance companies for sequencing isn’t the only way the company makes money. Tempus also offers a service that matches eligible patients to clinical trials, and it licenses  de-identified patient data to other players in the oncology industry. That patient data, which includes images and clinical information, is “super important and valuable,” says Lefkofsky, who adds that such data sharing only occurs if patients consent. 

At first glance, precision oncology seems like a crowded market, but analysts say there is still plenty of room for companies to grow. “We’re just getting started in this market,” says Puneet Souda, a senior research analyst at SVB Leerink, “[and] what comes next is even larger.” Souda estimates that as the personalized oncology market expands from diagnostics to screening, another $30 billion or more will be available for companies to snatch up. And Tempus is already thinking ahead by moving into new therapeutic areas. 

While it’s not leaving cancer behind, Tempus has branched into other areas of precision medicine over the last year, including cardiology and mental health. The company now offers a service for psychiatrists to use a patient’s genetic information to determine the best treatments for major depressive disorder. 

In May, Lefkofsky also pushed the company to use its expertise to fight the coronavirus pandemic. The company now offers PCR tests for Covid-19, and has run over 1 million so far. The company also sequences other respiratory pathogens, such as the flu and soon pneumonia. As with cancer, Tempus will continue to make patient data accessible for others in the field— for a price. “Because we have one of the largest repositories of data in the world,” says Lefkofsky, “[it is imperative] that we make it available to anyone.” 

Lefkofsky plans to use capital from the latest funding round to continue Tempus’ expansion and grow its team. The company has hired about 700 since the start of the pandemic, he says, and currently has about 1,800 employees. He wouldn’t comment on exact figures, but while the company is not yet profitable he says Tempus has reached “significant scale in terms of revenue.” 

And why is he so sure that his company’s massive valuation isn’t over-inflated? “We benefit from two really exciting financial sector trends,” he says: complex genomic profiling and AI-driven health data. Right now, Lefkofsky estimates, about one-third of cancer patients have their tumors sequenced in three years. Soon, he says, that number will increase to two-thirds of patients getting their tumors sequenced multiple times a year. “The space itself is very exciting,” he says, “we think it will grow dramatically.” Follow me on Twitter. Send me a secure tip

Leah Rosenbaum

Leah Rosenbaum

I am the assistant editor of healthcare and science at Forbes. I graduated from UC Berkeley with a Master’s of Journalism and a Master’s of Public Health, with a specialty in infectious disease. Before that, I was at Johns Hopkins University where I double-majored in writing and public health. I’ve written articles for STAT, Vice, Science News, HealthNewsReview and other publications. At Forbes, I cover all aspects of health, from disease outbreaks to biotech startups.

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Eric Lefkofsky

To impact the nearly 1.7 million Americans who will be newly diagnosed with cancer this year, Eric Lefkofsky, co-founder and CEO of Tempus, discusses with Matter CEO Steven Collens how he is applying his disruptive-technology expertise to create an operating system to battle cancer. (November 29, 2016)

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Expert Pharmacist GEMMA FROMAGE Reveals How To Save £200-a-Year On Everyday Essentials

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

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

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

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

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

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

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

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Tesco Health Chesty Cough Relief

Tesco Health Chesty Cough Relief

Cough syrup

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

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

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:

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Next Billion-Dollar Startups: Online Pharmacy Capsule Leads Healthcare- And Tech-Heavy List

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When Lennie Sliwinski and Matt Pierce founded Trusted Health in 2017, they simply wanted to take what they’d learned about online marketplaces from working at Hired, and apply it to nursing. Their digital platform matches nurses with jobs, giving them more flexibility and control over their careers. Because Sliwinski’s mother worked as a nurse, and Pierce’s brother had suffered a medical error, both of them had a personal passion for the field.

But since the novel coronavirus started to spread across the U.S. this spring, San Francisco-based Trusted’s mission has become even more vital, helping place nurses from around the country in New York City’s hospitals. Last year, Trusted’s revenue reached an estimated $28 million; this year, signups by nurses and job postings on the platform are growing so fast that Pierce, 32, isn’t even estimating year-end revenues yet. “We laid out a rudimentary model at the beginning of the year,” he says. “As you can imagine, that broke.”

Trusted is one of 25 companies that made the cut for this year’s Forbes’ Next Billion-Dollar Startups list. Produced in partnership with TrueBridge Capital Partners, the list highlights the fast-growing, venture-capital-backed companies we think have the best shot of reaching a $1 billion valuation. With millions of Americans at home to fight the spread of coronavirus and unemployment at historic levels, the list reflects the bright spots in a tough economy in the throes of transformation.

Healthcare stands out with five companies, including Lyra Health (mental health benefits), Benchling (biotech R&D software), Weave (software for dentists and other medical professionals) and Capsule (tech-enabled pharmacy), in addition to Trusted Health. Last year, by contrast, there were just two healthcare startups.

Capsule is actually the largest company on this year’s list, racking up some $100 million in revenue last year by helping New Yorkers order their prescription medications by text or app, with home delivery in a two-hour window. Founder Eric Kinariwala, 37, launched the company in 2016 after a bad experience waiting in line at his local Duane Reade drugstore to pick up antibiotics for a sinus infection.

While Capsule was a convenience before the coronavirus crisis, Kinariwala figures it’s now a must-have for those customers who worry about being exposed to the virus at a store and especially for those who are elderly, high-risk or currently in isolation. It plans to expand far beyond New York City, something it should have no trouble doing since it has raised $270 million so far, more funds than any other next-billion-dollar startup on this list. “Everything is working beyond our expectations in New York,” Kinariwala says. “So now it is time to help the 97% of Americans who do not live in New York City.”

Tech companies often dominate the lineup, and all of the companies on this year’s list (including the ones in healthcare) have some technological component to them. Algolia (which powers the corporate search boxes online), Superhuman (a smart email provider) and Tray.io (workflow-automation tools) are among this year’s 25. So, too, are 3 cybersecurity firms: Coalition, Expanse and Signal Sciences.

How Pharmacy Fatigue Put One Company On The Path To A Billion| 32:45

But the list’s diversity reflects how technology is being incorporated into startups across industries, including ones that are helping people through this difficult time like credit card consolidation app Tally and at-home fitness company Mirror.

Whereas previous lists have spotlighted consumer-products companies like shoe manufacturer Rothy’s and now struggling suitcase-maker Away, this year just Mirror made our cut, as the pandemic closed gyms and pushed Americans to work out at home. Retailers? Last year there were two. This year there isn’t even one.

“We’ve seen all the notes about, ‘This is the end of good times,’ and ‘Winter is here,’” says Jason Traff, cofounder of Shipwell, an Austin, Texas-based logistics startup that made the list. “I am very thankful that, compared to a lot of companies I know, we’re going to grow in 2020, and I think in all the right ways.”

Follow me on Twitter. Send me a secure tip.

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.

Source: https://www.forbes.com/

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