Macadamia Nuts vs Brazil Nuts – Which is Healthier?
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Our Verdict
When comparing macadamia nuts to Brazil nuts, we picked the Brazil nuts.
Why?
They’re a lot more nutrient dense! But watch out…
First, to do due diligence in terms of macros: Brazil nuts have twice as much protein and less fat, as well as being a little higher in fiber and slightly lower in carbs.
In terms of vitamins, Brazil nuts are about 10x higher in vitamin E, while macadamias are somewhat higher in several B-vitamins.
The category of minerals is where it gets interesting. Macadamia nuts are a little higher in iron and considerably higher in Manganese. But… Brazil nuts are a lot higher in calcium, copper, magnesium, phosphorus, potassium, selenium, and zinc.
About that selenium… Specifically, it’s more than 5,000x higher, and a cup of Brazil nuts would give nearly 10,000x the recommended daily amount of selenium. Now, selenium is an essential mineral (needed for thyroid hormone production, for example), and at the RDA it’s good for good health. Your hair will be luscious and shiny. However, go much above that, and selenium toxicity becomes a thing, you may get sick, and it can cause your (luscious and shiny) hair to fall out. For this reason, it’s recommended to eat no more than 3–4 Brazil nuts per day.
In short… Brazil nuts are much more nutrient dense in general, and thus come out on top here. But, they’re so nutrient dense in the case of selenium, that careful moderation is advised.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
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How Nature Provides Us With A Surprisingly Powerful Painkiller
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It’s well-known (at least to regular 10almonds-readers) that seeing nature, ideally green leaves and blue sky, improves our mood by stimulating production of serotonin.
See also: Neurotransmitter Cheatsheet
But it does a lot more.
Reducing the actual signals of pain
Researchers at the University of Vienna have discovered that viewing nature scenes (even if just on video) alleviates physical pain—not just in self-reported subjective assessments, but also by a reduction of the neural activity that signals pain:
❝Pain is like a puzzle, made up of different pieces that are processed differently in the brain. Some pieces of the puzzle relate to our emotional response to pain, such as how unpleasant we find it. Other pieces correspond to the physical signals underlying the painful experience, such as its location in the body and its intensity.
Unlike placebos, which usually change our emotional response to pain, viewing nature changed how the brain processed early, raw sensory signals of pain.
Thus, the effect appears to be less influenced by participants’ expectations, and more by changes in the underlying pain signals❞
This was tested against, varyingly, viewing an urban environment or viewing an indoor environment, neither of which gave the same benefits.
The setup of the experiment is relevant, so…
Matching soundscape accompanied each visual stimulus. The three pain runs had a total duration of 9 min each, during which one environment was accompanied by 16 painful and 16 non-painful shocks. Neuroimaging was used for all parts, and participants were exposed to all environments:
- First, a cue indicating the intensity of the next shock (red = painful, yellow = not painful) was presented for 2000 milliseconds (ms).
- Second, a variable interval of 3500 ± 1500 ms was shown.
- Third, a cue indicating the intensity of the shock was presented for 1000 ms, accompanied by an electrical shock with a duration of 500 ms.
- Fourth, a variable interval of 3500 ± 1500 ms followed.
- Fifth, after each third trial, participants rated the shock’s intensity and unpleasantness at 6000 ms each.
- Sixth, each trial ended with an intertrial interval (ITI) presented for 2000 ms.
They found that as well as the self-assessment reports being as expected (nature scenes reduced subjective experience of pain),
❝In summary, the multivoxel and region of interest analyses converged in showing that pain responses when exposed to nature as compared to urban or indoor stimuli were associated with a decrease in neural processes related to lower-level nociception-related features (NPS, thalamus), as well as in regions of descending modulatory circuitry associated with attentional alterations of pain that also encode sensory-discriminative aspects (S2, pINS).❞
In other words—to the extent that pain can be quantified objectively by neural imaging—the pain was also objectively reduced, much like with a chemical painkiller.
You can read the paper in full, here:
Nature exposure induces analgesic effects by acting on nociception-related neural processing
How to benefit from this
Well, first there is the obvious, “view nature“.
However, note the timescales involved in the testing periods: 2000 milliseconds is two seconds, and that was the intertrial interval used—the equivalent of a washout phase in an interventional trial (but a drug/supplement/diet washout is usually a number of weeks).
The fact that the test periods were a matter of seconds, and the intertrial period was also literally two seconds, this means:
It works quickly, and the effect disappears quickly, too.
In other words: if you want pain relief from nature, the good news is you can get it immediately while viewing nature, and the bad news is that you have to keep viewing nature to continue enjoying the painkilling effect.
So that’s a limitation, but it’s still clearly a very worthy option for a little respite from chronic pain now and again, for example.
Want to learn more?
We’ve written quite a bit about pain management, including:
- Before You Reach For That Tylenol…
- How To Stop Pain Spreading
- How To Dial Down Your Pain
- Managing Chronic Pain (Realistically!)
- Get The Right Help For Your Pain
- The 7 Approaches To Pain Management
- Science-Based Alternative Pain Relief (When Painkillers Aren’t Helping, These Things Might)
Take care!
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Zucchini & Oatmeal Koftas
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These vegetarian (and with one tweak, vegan) koftas are delicious as a snack, light lunch, or side to a larger meal. Healthwise, they contain the healthiest kind of fiber, as well as omega-3 fatty acids, and beneficial herbs and spices.
You will need
- ¼ cup oatmeal
- 1 large zucchini, grated
- 1 small carrot, grated
- ¼ cup cheese (your preference; vegan is also fine)
- 2 tbsp ground flaxseed
- 2 tbsp nutritional yeast
- ¼ bulb garlic, minced
- 2 tsp black pepper, coarse ground
- ½ tsp MSG or 1 tsp low-sodium salt
- Small handful fresh parsley, chopped
- Extra virgin olive oil, for frying
Method
(we suggest you read everything at least once before doing anything)
1) Soak the flaxseed in 2 oz hot water for at least 5 minutes
2) Combine all of the ingredients except the olive oil (and including the water that the flax has been soaking in) in a big bowl, mixing thoroughly
3) Shape into small balls, patties, or sausage shapes, and fry until the color is golden and the structural integrity is good. If doing patties, you’ll need to gently flip them to cook both sides; otherwise, rolling them to get all sides is fine.
4) Serve! Traditional is with some kind of yogurt dip, but we’re not the boss of you, so enjoy them how you like:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- The Best Kind Of Fiber For Overall Health? ← it’s β-glucan, as found in oats
- What Omega-3 Fatty Acids Really Do For Us ← as in the flax
- The Many Health Benefits Of Garlic
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk? ← it’s healthier than table salt
Take care!
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The Kitchen Doctor
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Dr. Rupy Aujla: The Kitchen Doctor
This is Dr. Rupy Aujla, and he’s a medical doctor. He didn’t set out to become a “health influencer”.
But then, a significant heart condition changed his life. Having a stronger motivation to learn more about nutritional medicine, he did a deep dive into the scientific literature, because that’s what you do when your life is on the line, especially if you’re a doctor!
Using what he learned, he was able to reverse his condition using a food and lifestyle approach. Now, he devotes himself to sharing what he learned—and what he continues to learn as he goes along.
One important thing he learned because of what happened to him, was that he hadn’t been paying enough attention to what his body was trying to tell him.
He wants us to know about interoception—which isn’t a Chris Nolan movie. Rather, interoception is the sense of what is going on inside one’s own body.
The counterpart of this is exteroception: our ability to perceive the outside world by means of our various senses.
Interoception is still using the senses, but is sensing internal body sensations. Effectively, the brain interprets and integrates what happens in our organs.
When interoception goes wrong, researchers found, it can lead to a greater likelihood of mental health problems. Having an anxiety disorder, depression, mood disorder, or an eating disorder often comes with difficulties in sensing what is going on inside the body.
Improving our awareness of body cues
Those same researchers suggested therapies and strategies aimed at improving awareness of mind-body connections. For example, mindfulness-based stress reduction, yoga, meditation and movement-based treatments. They could improve awareness of body cues by attending to sensations of breathing, cognitions and other body states.
But where Dr. Aujla puts his focus is “the heart of the home”, the kitchen.
The pleasure of food
❝Eating is not simply ingesting a mixture of nutrients. Otherwise, we would all be eating astronaut food. But food is not only a tool for health. It’s also an important pleasure in life, allowing us to connect to others, the present moment and nature.❞
Dr. Rupy Aujla
Dr. Aujla wants to help shift any idea of a separation between health and pleasure, because he believes in food as a positive route to well-being, joy and health. For him, it starts with self-awareness and acceptance of the sensory pleasures of eating and nourishing our bodies, instead of focusing externally on avoiding perceived temptations.
Most importantly:
We can use the pleasure of food as an ally to healthy eating.
Instead of spending our time and energy fighting the urge to eat unhealthy things that may present a “quick fix” to some cravings but aren’t what our body actually wants, needs, Dr. Aujla advises us to pay just a little more attention, to make sure the body’s real needs are met.
His top tips for such are:
- Create an enjoyable relaxing eating environment
To help cultivate positive emotions around food and signal to the nervous system a shift to food-processing time. Try setting the table with nothing else on it beyond what’s relevant to the dinner, putting away distractions, using your favorite plates, tablecloth, etc.
- Take 3 deep abdominal breaths before eating
To help you relax and ground yourself in the present moment, which in turn is to prepare your digestive system to receive and digest food.
- Pay attention to the way you sit
Take some time to sit comfortably with your feet grounded on the floor, not slouching, to give your stomach space to digest the food.
- Appreciate what it took to bring this food to your plate
Who was involved in the growing process and production, the weather and soil it took to grow the food, and where in the world it came from.
- Enjoy the sensations
When you’re cooking, serving, and eating your food, be attentive to color, texture, aroma and even sound. Taste the individual ingredients and seasonings along the way, when safe and convenient to do so.
- Journal
If you like journaling, you can try adding a mindful eating section to that. Ask questions such as: “how did I feel before, during, and after the meal?”
In closing…
Remember that this is a process, not only on an individual level but as a society too.
Oftentimes it’s hard to eat healthily… We can be given to wonder even “what is healthy, after all?”, and we can be limited by what is available, what is affordable, and what we have time to prepare.
But if we make a conscious commitment to make the best choices we reasonably can as we go along, then small changes can soon add up.
Interested in what kind of recipes Dr. Aujla goes for?
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Brown Rice vs Russet Potatoes – Which is Healthier?
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Our Verdict
When comparing brown rice to russet potatoes, we picked the rice.
Why?
First we’ll note: for brevity and to avoid undue repetitiveness, we’re henceforth going to just say “rice” and “potato”, respectively, but values and conclusions are still for brown rice and russet potatoes. Also, we are including the flesh and skin into the metrics for the potato (without the skin, many nutrients are no longer present).
In terms of macros, the rice has more fiber, carbs, and protein. It’s difficult to compare glycemic indices in this case, because they both need cooking before eating, and how one cooks them (and whether one cools them) along with other preparatory methods will change the GI considerably. Thus, we’ll simply go with the more nutritionally dense option, and that’s the rice.
In the category of vitamins, the rice has much more of vitamins B1, B2, B3, B5, B6, B7, B9, E, and choline, while the potato has more of vitamins C and K. A clear win for rice (and by the way, that’s 60x the vitamin E, but as potatoes don’t have much vitamin E, in practical terms, it’s actually the B-vitamins where rice’s strengths really show, as potatoes aren’t a bad source but rice is amazing).
When it comes to minerals, rice has a lot more copper, iron, magnesium, manganese, phosphorus, selenium, and zinc, while potato has more calcium and potassium. Another easy win for rice.
You may be wondering about phytic acid: brown rice contains this by default, and it is something of an antinutrient (i.e., if left as-is, it reduces the bioavailability of other nutrients), and/but the phytic acid content is reduced to negligible by two things: soaking and heating (especially if those two things are combined) ← doing this the way described results in bioavailability of nutrients that’s even better than if there were just no phytic acid, albeit it requires you having the time to soak, and do so at temperature.
All in all, adding up the sections makes for an overall win for brown rice, but by all means enjoy either or both; diversity is good!
Want to learn more?
You might like:
Carb-Strong or Carb-Wrong? Should You Go Light Or Heavy On Carbs?
Enjoy!
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Quit Like a Woman – by Holly Whitaker
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We’ve reviewed “quit drinking” books before, so what makes this one different?
While others focus on the science of addiction and the tips and tricks of habit breaking/forming, this one is more about environmental factors, and that because of society being as it is, we as women often face different challenges when it comes to drinking (or not). Not necessarily easier or harder than men’s in this case, but different. And that sometimes calls for different methods to deal with them. This book explores those.
She also looks at such matters as how to quit alcohol when you’ve never stuck to a diet, and other such very down-to-earth topics, in a well-researched and non-preachy fashion.
Bottom line: if you’ve sometimes tried to quit drinking or even just to cut back, but found the deck stacked against you and things conspire to undermine your efforts, this book will give you a clearer path forward.
Click here to check out Quite Like A Woman, And Take Care Of Yourself!
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Syphilis Is Killing Babies. The U.S. Government Is Failing to Stop the Disease From Spreading.
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ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
Karmin Strohfus, the lead nurse at a South Dakota jail, punched numbers into a phone like lives depended on it. She had in her care a pregnant woman with syphilis, a highly contagious, potentially fatal infection that can pass into the womb. A treatment could cure the woman and protect her fetus, but she couldn’t find it in stock at any pharmacy she called — not in Hughes County, not even anywhere within an hour’s drive.
Most people held at the jail where Strohfus works are released within a few days. “What happens if she gets out before I’m able to treat her?” she worried. Exasperated, Strohfus reached out to the state health department, which came through with one dose. The treatment required three. Officials told Strohfus to contact the federal Centers for Disease Control and Prevention for help, she said. The risks of harm to a developing baby from syphilis are so high that experts urge not to delay treatment, even by a day.
Nearly three weeks passed from when Strohfus started calling pharmacies to when she had the full treatment in hand, she said, and it barely arrived in time. The woman was released just days after she got her last shot.
Last June, Pfizer, the lone U.S. manufacturer of the injections, notified the Food and Drug Administration of an “impending stock out” that it anticipated would last a year. The company blamed “an increase in syphilis infection rates as well as competitive shortages.”
Across the country, physicians, clinic staff and public health experts say that the shortage is preventing them from reining in a surge of syphilis and that the federal government is downplaying the crisis. State and local public health authorities, which by law are responsible for controlling the spread of infectious diseases, report delays getting medicine to pregnant people with syphilis. This emergency was predictable: There have been shortages of this drug in eight of the last 20 years.
Yet federal health authorities have not prevented the drug shortages in the past and aren’t doing much to prevent them in the future.
Syphilis, which is typically spread during sex, can be devastating if it goes untreated in pregnancy: About 40% of babies born to women with untreated syphilis can be stillborn or die as newborns, according to the CDC. Infants that survive can suffer from deformed bones, excruciating pain or brain damage, and some struggle to hear, see or breathe. Since this is entirely preventable, a baby born with syphilis is a shameful sign of a failing public health system.
In 2022, the most recent year for which the CDC has data available, more than 3,700 babies were infected with syphilis, including nearly 300 who were stillborn or died as infants. More than 50% of these cases occurred because, even though the pregnant parent was diagnosed with syphilis, they were never properly treated.
That year, there were 200,000 cases identified in the U.S., a 79% increase from five years before. Infection rates among pregnant people and babies increased by more than 250% in that time; South Dakota, where Strohfus works, had the highest rates — including a more than 400% increase among pregnant women. Statewide, the rate of babies born with the disease, a condition known as congenital syphilis, jumped more than 40-fold in just five years.
And that was before the current shortage of shots.
In Mississippi, the state with the second highest rate of syphilis in pregnant women, Dr. Caroline Weinberg started having trouble this summer finding treatments for her clinic’s patients, most of whom are uninsured, live in poverty or lack transportation. She began spending hours each month scouring medicine suppliers’ websites for available doses of the shots, a form of penicillin sold under the brand name Bicillin L-A.
“The way people do it for Taylor Swift, that’s how I’ve been with the Bicillin shortage,” Weinberg said. “Desperately checking the websites to see what I can snag.”
The shortage is driving up infection rates even further.
In a November survey by the National Coalition of STD Directors, 68% of health departments that responded said the drug shortage will cause syphilis rates in their area to increase, further crushing the nation’s most disadvantaged populations.
“This is the most basic medicine,” said Meghan O’Connell, chief public health officer for the Great Plains Tribal Leaders’ Health Board, which represents 18 tribal communities in South Dakota and three other states. “We allow ourselves to continue to not have enough, and it impacts so many people.”
ProPublica examined what the federal government has done to manage the crisis and the ways in which experts say it has fallen short.
The government could pressure Pfizer to be more transparent.
Twenty years ago, there were at least three manufacturers of the syphilis shot. Then Pfizer, one of the manufacturers, purchased the other two companies and became the lone U.S. supplier.
Pfizer’s supply has fallen short since then. In 2016, the company announced a shortage due to a manufacturing issue; it lasted two years. Even during times when Pfizer had not notified the FDA of an official shortage, clinics across the country told ProPublica, the shots were often hard to get.
Several health officials said they would like to see the government use its power as the largest purchaser of the drug to put pressure on Pfizer to produce adequate supplies and to be more transparent about how much of the drug they have on hand, when it will be widely available and how stable the supply will be going forward.
In response to questions, Pfizer said there are two reasons its supply is falling short. One, the company said, was a surge in use of the pediatric form of the drug after a shortage of a different antibiotic last winter. Pfizer also blamed a 70% increase in demand for the adult shots since last February, which it described as unexpected.
Public health experts say the increase in cases and subsequent rise in demand was easy to see coming. Officials have been raising the alarm about skyrocketing syphilis cases for years. “If Pfizer was truly caught completely off guard, it raises significant questions about the competency of the company to forecast obvious infectious disease trends,” a coalition of organizations wrote to the White House Drug Shortage Task Force in September.
Pfizer said it is consistently communicating with the CDC and FDA about its supply and that it has been transparent with public health groups and policymakers.
The FDA has a group dedicated to addressing drug shortages. But Valerie Jensen, associate director of that staff, said the FDA can’t force manufacturers to make more of a drug. “It is up to manufacturers to decide how to respond to that increased demand.” she said. “What we’re here to do is help with those plans.”
Pfizer said it had a target of increasing production by about 20% in 2023 but faced delays toward the end of the year. The company did not explain the reason for those delays.
The company said it has invested $38 million in the last five years in the Michigan facility where it makes the shots and that it is increasing production capacity. It also said it is adding evening shifts at the facility and actively recruiting and training new workers. Pfizer said it also reduced manufacturing time from 110 to 50 days. By the end of June, the company expects the supply to recover, which it described as having eight weeks of inventory based on its forecast demands with no disruptions in sight.
The government could manufacture the drug itself.
Having only one supplier for a drug, especially one of public health importance, makes the country vulnerable to shortages. With just one manufacturer, any disruption — contamination at a plant, a shortage of raw materials, a severe weather event or a flawed prediction of demand — can put lives at risk. What’s ultimately needed, public health experts say, is another manufacturer.
Congressional Democrats recently introduced a bill that would authorize the U.S. Department of Health and Human Services to manufacture generic drugs in exactly this scenario, when there are few manufacturers and regular shortages. Called the Affordable Drug Manufacturing Act, it would also establish an office of drug manufacturing.
This same bill was introduced in 2018, but it didn’t have bipartisan support and was never taken up for a vote. Sen. Elizabeth Warren, the Massachusetts Democrat who introduced the bill in the Senate, said she’s hopeful this time will be different. Lawmakers from both parties understand the risks created by drug shortages, and COVID-19 helped everyone understand the role the government can play to boost manufacturing.
Still, it’s unlikely to be passed with the current gridlock in Congress.
The government could reserve syphilis drugs for infected patients.
Responding to the shortage of shots to treat the disease, the CDC in July asked health care providers nationwide to preserve the scarce remaining doses for people who are pregnant. The shots are considered the gold standard treatment for anyone with syphilis, faster and with fewer side effects than an alternative pill regimen. And for people who are pregnant, the pills are not an option; the shots are the only safe treatment.
Despite that call, the military is giving shots to new recruits who don’t have syphilis, to prevent outbreaks of severe bacterial respiratory infections. The Army has long administered this treatment at boot camps held at Fort Leonard Wood, Fort Moore and Fort Sill. The Army has been unable to obtain the shots several times in the past few years, according to the U.S. Army Center for Initial Military Training. But the Defense Health Agency’s pharmacy operations center has been working with Pfizer to ensure military sites can get them, a spokesperson for the Defense Health Agency said.
“Until we think about public health the way we think about our military, we’re not going to see a difference,” said Dr. John Vanchiere, chief of pediatric infectious diseases at Louisiana State University Health Shreveport.
Some public health officials, including Alaska’s chief medical officer, Dr. Anne Zink, questioned whether the military should be using scarce shots for prevention.
“We should ask if that’s the best use,” she said.
Using antibiotics to prevent streptococcal outbreaks is a well-established, evidence-based public health practice that’s also used by other branches of the armed services, said Lt. Col. Randy Ready, a public affairs officer with the Army’s Initial Military Training center. “The Army continues to work with the CDC and the entire medical community in regards to public health while also taking into account the unique missions and training environments our Soldiers face,” including basic training, Ready said in a written statement.
The government isn’t stockpiling syphilis drugs.
In rare instances, the federal government has created stockpiles of drugs considered key to public health. In 2018, confronting shortages of various drugs to treat tuberculosis, the CDC created a small stockpile of them. And the federal Administration for Strategic Preparedness and Response keeps a national stockpile of supplies necessary for public health emergencies, including vaccines, medical supplies and antidotes needed in case of a chemical warfare attack.
In November, the Biden administration announced it was creating a new syphilis task force. When asked why the federal government doesn’t stockpile syphilis treatments, Adm. Rachel Levine, the HHS official who leads the task force, said officials don’t routinely stockpile drugs, because they have expiration dates.
In a written statement, an HHS spokesperson said that Bicillin has a shelf life of two years and that the Strategic National Stockpile “does not deploy products that are commercially available.” In general, the spokesperson wrote, stockpiles are most effective before a national shortage begins and can’t overcome the problems of limited suppliers or fragile supply chains. “There is also a risk that stockpiles can exacerbate shortages, particularly when supply is already low, by removing drugs from circulation that would have otherwise been available,” the spokesperson wrote.
Stephanie Pang, a senior director with the coalition of STD directors, said that given the critical role of this drug and the severe access concerns, she thinks a stockpile is necessary. “I don’t have another solution that actually gets drugs to patients,” Pang said.
The government could declare a federal emergency.
Some public health officials say the federal government needs to treat the syphilis crisis the way it did Ebola or monkeypox.
Declare a federal emergency, said Dr. Michael Dube, an infectious disease specialist for more than 30 years. That would free up money for more public health staff and fund more creative approaches that could lead to a long-term solution to the near-constant shortages, he said. “I’d hate to have to wait for some horrible anecdotes to get out there in order to get the public’s and the policymakers’ minds on it,” said Dube, who oversees medical care for AIDS Healthcare Foundation wellness clinics across the country.
Citing an alarming surge in syphilis cases, the Great Plains Tribes wrote to the HHS secretary last week asking that the agency declare a public health emergency in their areas. In the request, they asked HHS to work globally to find adequate syphilis treatment and send the needed medicine to the Great Plains region.
During the 2014 outbreak of Ebola in West Africa, Congress gave hundreds of millions of dollars to HHS to help develop new rapid tests and vaccines. Facing a global outbreak of monkeypox in 2022, a White House task force deployed more than a million vaccines, regularly briefed the public and sent extra resources to Pride parades and other places where people at risk were gathered.
Levine, leader of the federal syphilis task force, countered that declaring an emergency wouldn’t make much of a difference. The government, she said, already has a “dramatic and coordinated response” involving several agencies.
The FDA recently approved an emergency import of a similar syphilis treatment made by a French manufacturer that had plenty on hand. According to the company, Provepharm, the imported shots are enough to cover approximately one or two months of typical use by all people in the U.S. (The FDA would not say how many doses Provepharm sent, and the company said it was not allowed to reveal that number under the federal rules governing such emergency imports.)
Clinics applaud that development. But many of them can’t afford the imported shots.
The government could do more to rein in the cost.
Clinics and hospitals that primarily serve low-income patients often qualify for a federal program that allows them to purchase drugs at steeply discounted prices. Pharmaceutical companies that want Medicaid to cover their outpatient drugs must participate in the program.
One factor in determining the discount price is whether a pharmaceutical company has raised the price of a drug by more than the rate of inflation. Because Pfizer has hiked the price of its Bicillin shots significantly over the years, the government requires that it be sold to qualifying clinics for just pennies a dose. Otherwise, a single Pfizer shot can retail for upwards of $500. The French shots are comparable in retail price and not eligible for the discount program.
Several clinic directors also said they worried that drug distributors were reserving the limited supply of the Pfizer shot for organizations that could pay full price. For several days in January, for example, the website of Henry Schein, a medical supplier, showed doses of the shot available at full price, while doses at the penny pricing were out of stock, according to screenshots shared with ProPublica. When asked whether it was only selling shots at full price, a spokesperson for Henry Schein did not respond to the question.
Local health departments that qualify for the discount program told ProPublica they’ve had to pay full price at other distributors, because it was the only stock available.
The Health Resources and Services Administration, the federal agency that regulates the discount program, said that a drug manufacturer is ultimately responsible for ensuring that when supplies are available, they are available at the discounted price. When asked about this, Pfizer said that it has “one inventory that is distributed to our trade partners” and that hospitals and clinics that qualify for the discount program are “responsible for ensuring compliance with the program and orders through the wholesaler accordingly.” The company added, “Pfizer plays no part in this process.”
In October, on Weinberg’s regular search for shots for her Mississippi clinic, she found doses of Bicillin for sale at the discounted price and purchased 40. “The idea that we’re supposed to be hoarding treatment is a horrific compact,” she said. Word got out that the clinic, called Plan A, has some shots, and other clinics began sending pregnant patients there.
The clinic’s supply is dwindling. Weinberg is happy to get the shots to patients who need them. But she’s not sure how much longer her reserve will last — or if she’ll be able to find more when they’re gone.
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