
The Medicinal Properties Of Bay Leaves
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The humble bay leaf has more uses than just culinary!
How about for hair growth?
Popularly recommended on social media with the promise of long and glowing hair… Guess how many scientific studies back up this claim!
If you guessed zero, you guessed correctly. At least, we were not able to find any. In fact, the only paper on the entirety of PubMed (a large online database of available scientific literature from most, if not all, reputable scientific journals) to return a hit for the search string “bay leaf hair growth” was this one:
You may notice that that has nothing to do with hair growth, and rather returned the hit because the acne bacteria are known to “proliferate within sebum-blocked skin hair follicles”.
So let’s talk about that instead:
Against acne & skin inflammation
Well, for that, it works! The research that we mentioned above concluded that:
❝LNE significantly suppressed the expression of P. acnes-mediated proinflammatory cytokines, such as IL-1β, IL-6, and NLRP3. We also found that LNE inhibited the inflammatory transcription factor NF-κB in response to P. acnes. In addition, eucalyptol, which is the main constituent of LNE, consistently inhibited P. acnes-induced inflammatory signaling pathways. Moreover, LNE significantly ameliorated P. acnes-induced inflammation in a mouse model of acne. We suggest for the first time that LNE hold therapeutic value for the improvement of P. acnes-induced skin inflammation.❞
LNE = Laurus nobilis extract, i.e. bay leaf extract
Now, that’s all about acne-induced skin inflammation, but what about other kinds?
Against inflammation in general
Bay leaves have an abundance of antioxidant polyphenols, and what’s good against oxidation is good against inflammation. For example:
Laurus nobilis leaf extract controls inflammation by suppressing NLRP3 inflammasome activation
That anti-inflammatory action is more than skin-deep though, because…
Against IBD / ulcerative colitis
It’s good for the gut, too, for example in this study (with mice, but the bacteria affected are the same as we have), which found:
❝…bay leaves showed the best treatment effects on gut microbiota compositions; promoting the growth of Bifidobacteria and Lactobacillus in addition to producing high butyric acid levels. Meanwhile, the number of Clostridium and sulfate-reducing bacteria was significantly reduced. Conclusively, consuming bay leaves brought significant colon health benefits other than stimulating appetite for a better taste.❞
Note that all of those gut-related changes are beneficial to us, increasing things that are best increased, and reducing things that are best reduced.
Against diabetes
It’s good for the blood—and for the heart, but more on that later. First, about diabetes:
❝All three levels of bay leaves reduced serum glucose with significant decreases ranging from 21 to 26% after 30 d.
Total cholesterol decreased, 20 to 24%, after 30 days with larger decreases in low density lipoprotein (LDL) cholesterol of 32 to 40%. High density lipoprotein (HDL) cholesterol increased 29 and 20% in the groups receiving 1 and 2 g of bay leaves, respectively. Triglycerides also decreased 34 and 25% in groups consuming 1 and 2 g of bay leaves, respectively, after 30 d. There were no significant changes in the placebo group.
In summary, this study demonstrates that consumption of bay leaves, 1 to 3 g/d for 30 days, decreases risk factors for diabetes and cardiovascular diseases and suggests that bay leaves may be beneficial for people with type 2 diabetes.❞
Again, all those changes are good:
Bay Leaves Improve Glucose and Lipid Profile of People with Type 2 Diabetes
Good for the heart
This one’s quite straight forward. Bay leaf tea is indeed good for the heart,
- Literally: Evaluation of Daily Laurus nobilis Tea Consumption on Lipid Profile Biomarkers in Healthy Volunteers
- Metaphorically: Evaluation of daily Laurus nobilis tea consumption on anxiety and stress biomarkers in healthy volunteers
Of course, even that latter is also good for the heart literally, just, indirectly, by reducing anxiety and stress, thus indirectly benefiting the heart itself.
But even before that, it’s already very directly beneficial to cardiovascular health, per its significant improvements to the lipid profile.
Anything else?
So much else, but there’s only so much we can feature in one day, so if you’d like to learn more, we recommend this very comprehensive paper:
…which discusses many benefits in considerable detail, including…
❝The LN leaves have various biological activities, such as antioxidant, wound healing, antibacterial, analgesic, and anti-inflammatory activities. However, oxidative stress, cancer, diabetes, microbial infections, and inflammatory diseases are closely linked. The objective of this research is to characterize Laurus nobilis (LN) aromatic oil (AO) and evaluate its antioxidant, antidiabetic, antiobesity, antimicrobial, and antimutagenic bioactivities.
The plant AO showed potent antioxidant activity (IC50 = 2.2 ± 1.38) and has moderate anti-amylase (IC50 = 60.25 ± 1.25), anti-glucosidase (IC50 = 131.82 ± 0.1), and antilipase (IC50 = 83.17 ± 0.06) activities.
Moreover, LNAO showed potent antimicrobial activity against Staphylococcus aureus, Escherichia coli, Klebsiella pneumonia, Proteus vulgaris (MICs = 1.56 µg/mL), methicillin-resistant Staphylococcus aureus (MRSA) (MIC = 3.125 µg/mL) and Candida albicans (MIC = 0.195 µg/mL). The cytotoxicity results demonstrated that at a concentration of 1 mg/mL, LNAO has potent breast cancer (MCF-7), and hepatocellular carcinoma (Hep 3B) cancer cells inhibitory activities of 98% and 95%, respectively.
Importantly, we are the first to show that LNAO significantly hinders hepatocellular carcinoma spheroids’ formation capacity in a 3D model.
These results show that LNAO is a promising natural source with powerful antioxidant, antidiabetic, anticancer, and antimicrobial activities that could be exploited in the future to treat a variety of diseases.❞
Want to try some?
We don’t sell it, but you can buy leaves from your local supermarket and make bay leaf tea, or alternatively, if you prefer essential oil form, here for your convenience is an example product on Amazon 😎
Enjoy!
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Neuroaffirming care values the strengths and differences of autistic people, those with ADHD or other profiles. Here’s how
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We’ve come a long way in terms of understanding that everyone thinks, interacts and experiences the world differently. In the past, autistic people, people with attention deficit hyperactive disorder (ADHD) and other profiles were categorised by what they struggled with or couldn’t do.
The concept of neurodiversity, developed by autistic activists in the 1990s, is an emerging area. It promotes the idea that different brains (“neurotypes”) are part of the natural variation of being human – just like “biodiversity” – and they are vital for our survival.
This idea is now being applied to research and to care. At the heart of the National Autism Strategy, currently in development, is neurodiversity-affirming (neuroaffirming) care and practice. But what does this look like?
Unsplash Reframing differences
Neurodiversity challenges the traditional medical model of disability, which views neurological differences solely through a lens of deficits and disorders to be treated or cured.
Instead, it reframes it as a different, and equally valuable, way of experiencing and navigating the world. It emphasises the need for brains that are different from what society considers “neurotypical”, based on averages and expectations. The term “neurodivergent” is applied to Autistic people, those with ADHD, dyslexia and other profiles.
Neuroaffirming care can take many forms depending on each person’s needs and context. It involves accepting and valuing different ways of thinking, learning and experiencing the world. Rather than trying to “fix” or change neurodivergent people to fit into a narrow idea of what’s considered “normal” or “better”, neuroaffirming care takes a person-centered, strengths-based approach. It aims to empower and support unique needs and strengths.
Neuroaffirming care can look different in a school or clinical setting. Shutterstock/Inna Reznik Adaptation and strengths
Drawing on the social model of disability, neuroaffirming care acknowledges there is often disability associated with being different, especially in a world not designed for neurodivergent people. This shift focuses away from the person having to adapt towards improving the person-environment fit.
This can include providing accommodations and adapting environments to make them more accessible. More importantly, it promotes “thriving” through greater participation in society and meaningful activities.
At school, at work, in clinic
In educational settings, this might involve using universal design for learning that benefits all learners.
For example, using systematic synthetic phonics to teach reading and spelling for students with dyslexia can benefit all students. It also could mean incorporating augmentative and alternative communication, such as speech-generating devices, into the classroom.
Teachers might allow extra time for tasks, or allow stimming (repetitive movements or noises) for self-regulation and breaks when needed.
In therapy settings, neuroaffirming care may mean a therapist grows their understanding of autistic culture and learns about how positive social identity can impact self-esteem and wellbeing.
They may make efforts to bridge the gap in communication between different neurotypes, known as the double empathy problem. For example, the therapist may avoid relying on body language or facial expressions (often different in autistic people) to interpret how a client is feeling, instead of listening carefully to what the client says.
Affirming therapy approaches with children involve “tuning into” their preferred way of communicating, playing and engaging. This can bring meaningful connection rather than compliance to “neurotypical” ways of playing and relating.
In workplaces, it can involve flexible working arrangements (hours, patterns and locations), allowing different modes of communication (such as written rather than phone calls) and low-sensory workspaces (for example, low-lighting, low-noise office spaces).
In public spaces, it can look like providing a “sensory space”, such as at large concerts, where neurodivergent people can take a break and self-regulate if needed. And staff can be trained to recognise, better understand and assist with hidden disabilities.
Combining lived experience and good practice
Care is neuroaffirmative when it centres “lived experience” in its design and delivery, and positions people with disability as experts.
As a result of being “different”, people in the neurodivergent community experience high rates of bullying and abuse. So neuroaffirming care should be combined with a trauma-informed approach, which acknowledges the need to understand a person’s life experiences to provide effective care.
Culturally responsive care acknowledges limited access to support for culturally and racially marginalised Autistic people and higher rates of LGBTQIA+ identification in the neurodivergent community.
In the workplace, we can acknowledge how difference can fuel ideas. Unsplash/Jason Goodman Authentic selves
The draft National Autism Strategy promotes awareness that our population is neurodiverse. It hopes to foster a more inclusive and understanding society.
It emphasises the societal and public health responsibilities for supporting neurodivergent people via public education, training, policy and legislation. By providing spaces and places where neurodivergent people can be their authentic, unmasked selves, we are laying the foundations for feeling seen, valued, safe and, ultimately, happy and thriving.
The author would like to acknowledge the assistance of psychologist Victoria Gottliebsen in drafting this article. Victoria is a member of the Oversight Council for the National Autism Strategy.
Josephine Barbaro, Associate Professor, Principal Research Fellow, Psychologist, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Creatine’s Brain Benefits Increase With Age
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Creatine is generally thought of as a body-building supplement, and for most young people, that’s all it is. But with extra years come extra advantages, and creatine starts to confer cognitive benefits. Dr. Brad Stanfield shares the science:
What the science says
Although 95% of creatine is stored in muscles, 5% is found in the brain, where it helps produce energy needed for brain processes (and that’s a lot of energy—about 20% of our body’s metabolic base rate is accounted for by our brain).
In this video, Dr. Stanfield shares studies showing creatine improving memory, especially in older adults—and also in vegetarians/vegans, since creatine is found in meat (just like in our own bodies, which are also made of meat) and not in plants. On the meta-analysis level, a systematic review concluded that creatine supplementation indeed improves memory, with stronger effects observed in older adults.
Dr. Stanfield also addresses the safety concerns about creatine, which, on balance, are not actually supported by the science (of course, always consult your own doctor to be sure, as your case could vary).
As for dosage, 5g/day is recommended. For more on all of this plus links to the studies cited, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Creatine: Very Different For Young & Old People
Take care!
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Aspirin vs Cancer Metastasis
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Aspirin is a bit of a mixed bag.
In the category of things in its favor, it’s a modest analgesic with few side effects from occasional use, so it’s a good option if you have a headache, for example.
Unless you’re already on blood thinners or having a bleeding disorder, in which case, aspirin is not the thing to reach for.
About aspirin and heart disease
This is actually a complicated one, and we covered it at length in a dedicated main feature. If you want a one-line summary, it’s “chronic low-dose aspirin use can lower overall CVD risk, but does not reduce CVD mortality or all-cause mortality, and you may pay for it with gastrointestinal bleeding, and increased risk of ulcers“.
For a more nuanced explanation, see: Aspirin, CVD Risk, & Potential Counter-Risks
On the other hand, if you are having a heart attack and are waiting for the ambulance that you already called, and have aspirin to hand that you don’t have to go looking for, then it can be good to take a dose then.
For more on that, see: How To Survive A Heart Attack When You’re Alone
There are more problems
In the case of chronic use of low-dose aspirin, not only does it increase the risks of bleeding, especially gastrointestinal bleeding, and ulcers, but also it increases the risk of anemia. Given that anemia also gives the symptom “dizziness”, this is also a significant threat for increasing the incidence of falls in the older population, too, which can of course lead to serious complications and ultimately death.
For the science about this, see: Low-Dose Aspirin & Anemia
Now, about aspirin and cancer metastasis
This one’s a point in aspirin’s favor.
Cancer is, in and of itself, obviously a big problem. In terms of when it’s most likely to kill someone, that is usually when the cancer becomes metastatic, that is to say, it has spread.
So, while preventing cancer and, failing that, killing cancer are very important goals, there is a third axis to cancer care, which is preventing metastasis in someone who has cancer.
And that’s what aspirin does. How, you ask?
Scientists found this one out by accident!
They were doing genetic research in mice, to find genes that had an effect on metastasis. In the process, they found a certain gene that instructs the creation of a certain protein, and mice that lacked that gene (and thus its associated protein) had less metastasis.
The protein in question suppresses T-cells, which are programmed to recognize and kill metastatic cancer cells (amongst having other great jobs; they are an important part of the immune system in general, and one that declines with aging; most people in their 60s or older are producing very few T-cells).
About that, see: Focusing On Health In Our Sixties
Tracing the cell signaling, the researchers found that the protein is activated when T-cells are exposed to thromboxane A2 (or TXA2 to its friends).
And TXA2? That’s produced by platelets, and aspirin works by inhibiting TXA2 production, effectively making platelets (and thus the blood as a whole) less sticky.
So, that’s quite a few steps in the process, but ultimately:
- Aspirin inhibits TXA2 production
- Lower TXA2 levels mean ARHGEF1 (that’s the protein) isn’t activated
- ARHGEF1 not being activated means T-cells are free to do their thing
- T-cells are now free to kill metastatic cancer cells
You can read the paper here:
Aspirin prevents metastasis by limiting platelet TXA2 suppression of T cell immunity
Take care!
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The Compass of Pleasure – by Dr. David Linden
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There are a lot of books about addiction, so what sets this one apart?
Mostly, it’s that this one maintains that addiction is neither good nor bad per se—just, some behaviors and circumstances are. Behaviors and circumstances caused, directly or indirectly, by addiction.
But, Dr. Linden argues, not every addiction has to be so. Especially behavioral addictions; the rush of dopamine one gets from a good session at the gym or learning a new language, that’s not a bad thing, even if they can fundamentally be addictions too.
Similarly, we wouldn’t be here as a species without some things that rely on some of the same biochemistry as addictions; orgasms and eating food, for example. Yet, those very same urges can also inconvenience us, and in the case of foods and other substances, can harm our health.
In this book, the case is made for shifting our addictive tendencies to healthier addictions, and enough information is given to help us do so.
Bottom line: if you’d like to understand what is going on when you get waylaid by some temptation, and how to be tempted to better things, this book can give the understanding to do just that.
Click here to check out The Compass of Pleasure, and make yours work in your favor!
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Live Long, Die Short – by Dr. Roger Landry
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First know: “die short” is not about your height—although on average, short people do live longer, partly because insulin-like growth factor (IGF-1) promotes both tallness and accelerated DNA damage (thus, aging and cancer), and partly because if someone is very tall, it can cause circulatory problems, and without a nice easy flow of blood through the brain, bad things happen (such as accumulation of harmful detritus in the brain, and increased stroke risk too).
Next know: “die short” is, in this book, actually about shortening the decline at the end of life. Sometimes people say “I don’t want to live 10 years longer; they’ll be the 10 most miserable years”, but in fact if we look after our health, we will be healthy for perhaps >9.5 of our last 10 years, while an unhealthy person may just get their expected “10 most miserable years” 10 or 20 years earlier (and then die).
So, in short (so to speak), it’s about increasing healthspan.
To enjoy the longest and healthiest healthspan, Dr. Landry offers 10 tips. We’ll not keep them a secret; they are:
- Use it or lose it
- Keep moving
- Challenge your brain
- Stay connected
- Lower your risks
- Never act your age
- Wherever you are, be fully there
- Find your purpose
- Have children in your life
- Laugh to a better life
Each of these has a chapter devoted to them, in section 2 of the book (section 1 is about what we know about healthy aging, and section 3 is about where we go from here).
You’ll notice that one item not generally found on such lists is “have children in your life”; to be clear, they don’t have to be your children, and/but they do have to be actual current children; any now-grown-up progeny aren’t what’s being talked about here (wonderful as they may be, any support role they may play gets filed under “stay connected” instead).
The style is mostly impersonal pop-science with occasional personal anecdotes, and the book’s formatting (many subheadings within chapters) makes it easy to read a bit at a time, if that’s your preference. There’s a modest, but extant, bibliography.
Bottom line: if you’d like to stay younger as you get older, this book goes into a lot of detail about 10 ways to do just that.
Click here to check out Live Long, Die Short, and live long, die short!
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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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