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For most patients, pain is a very distressing symptom.

Pain should be considered the fifth vital sign, according to the American Pain Society, which is working to increase awareness of pain treatment. There have been many attempts within the health care industry to understand pain, but it remains a huge challenge.

 Pain is an indicator to the nervous system that there is a problem, and the unpleasant feeling is an alarm to the body that something must be done to alleviate it. Although pain can assist in diagnosing, it can also reach a point where it may no longer be curable, so it is imperative that immediate steps are taken to identify the underlying issue. Acute pain can transition to chronic pain and have a profound impact on an individual’s quality of life.

High predominance of pain and pain-related disease are leading causes of disability and disease throughout the world, according to results of the Global Burden of Disease Study 2016.

To fully combat pain, its contribution to disability must be understood within the context of biological, physical, psychological, and social factors.

It has been shown that patients are willing to accept pain, particularly postoperatively, given high pain intensity scores, so it is important for pain management to include a collaborative approach.

 A pain assessment is considered a significant first step toward achieving optimal pain management interventions. Pharmacists can play a key role in pain assessments, because they possess unique knowledge and skills to assist the care team with evaluating and recommending ways to manage pain.

 Pain management should focus on the description of the pain, duration, intensity, location, and identification of aggravating or alleviating factors.

 Additionally, it is important for pharmacists engaged in the interviewing process to have an awareness of the pathophysiology of the pain in combination with objective data, such as imaging or laboratory tests, that can help determine the gravity of a patient’s pain.

 For any health care professional, the performance of a comprehensive pain assessment screening to deliver adequate pain management is viewed as a universal requirement.

Pharmacists can begin an assessment by asking patients to rate their pain on a scale from 0 to 10, with 10 being the worst possible pain and 1 being no pain.

 Pharmacists should then ask how long the pain has been felt, whether the pain radiates to other locations, what the associated symptoms are, what events precipitate the pain, what type of pain it is, where the pain is located, and whether the pain is constant or intermittent.

 The more focused and thorough the assessment, the more likely that the pain’s characteristics can be identified and treated.

Pharmacists serve a critical role in pain management for patients, so it is vital that their expertise and training be used to the fullest when it comes to the thorough assessment of pain.

, is a professor of health care administration at Columbia Southern University College of Business in Orange Beach, Alabama.

1. Raffaeli W, Arnaudo E. Pain as a disease: an overview. 

. 2017;10:2003-2008. doi:10.2147/JPR.S138864

2. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. 

. 2019;123(2):e273-e283. doi:10.1016/j.bja.2019.03.023

3. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators

. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. 

2017;390(10100):1211-1259. doi:10.1016/S0140-6736(17)32154-2

4. van Boekel RLM, Vissers KCP, van der Sande R, Bronkhorst E, Lerou JGC, Steegers MAH. Moving beyond pain scores: multidimensional pain assessment is essential for adequate pain management after surgery. 

 2017;12(5):e0177345. doi:10.1371/journal.pone.0177345

5. Halpape K, Jorgenson D, Ahmed A, et al. Pharmacist-led strategy to address the opioid crisis: The Medication Assessment Centre Interprofessional Opioid Pain Service (MAC iOPS). 

 Published online September 21, 2021. doi:10.1177/17151635211045950

6. Fink R. Pain assessment: the cornerstone to optimal pain management. 

. 2000;13(3):236-239. doi:10.1080/08998280.2000.11927681

7. Erickson AK. Navigating the complexities of pain management: pharmacists offer insight, lively debate on controversial pain topics. 

 2012;18(1):7-8. doi:10.1016/S1042-0991(15)32047-8

8. Glowacki D. Effective pain management and improvements in patients’ outcomes and satisfaction. 

 2015;35(3):33-41. doi:10.4037/ccn2015440

9. Patient assessment. Doyle GR, McCutcheon JA, eds. In: 

Articles

Their unique knowledge and skills assist the care team in evaluating and recommending ways to manage pain

News

Pain Management

Pharmacists Play Critical Role in Pain Assessment

Officials with the FDA have approved the QuantiFERON-TB Gold Plus assay for use on DiaSorin’s automated LIAISON XS platform, according to a press release from Qiagen. This assay is an automated blood-based test for detecting latent tuberculosis (TB).

LIASON QuantiFERON-TB Gold Plus is an interferon-gamma release assay designed to offer streamlined laboratory automation for latent TB screening. The test searches for interferon-gamma released from T cells that have encountered TB bacteria, and it has been available on LIAISON XL platforms in the United States since 2019.

“QuantiFERON-TB Gold Plus continues to set new standards in the global fight against TB, a disease that remains a persistent killer and impacts people around the world,” said Thierry Bernard, CEO of Qiagen NV, in a press release. “Our partnership with DiaSorin has enabled customers to absorb the increasing demand for TB detection with access to a proven automation solution on the LIAISON XL platform, especially in larger reference labs and hospitals. The addition of the LIAISON XS platform will open up new joint opportunities for us to reach new customer segments requiring lower-throughput options.”

According to the World Health Organization, approximately 2.5 billion people carry TB infection in its latent form, accounting for nearly one-third of the global population. If left untreated, up to 10% of individuals with latent TB eventually become patients with active TB. The infection is primarily spread through coughing by patients with the active, lung-based form of the disease, though it can also cause infection without disease symptoms. Approximately 1.7 million individuals die from TB each year.

“Today we announce the approval of our first PMA assay available on the LIAISON XS platform,” said Carlo Rosa, CEO of DiaSorin Group, in the release. “This solution is a key milestone of our LIAISON XS strategy in the US, where the test was already successfully launched in 2019 on our LIAISON XL platform. Making this test available with our partner QIAGEN for use on the LIAISON XS benchtop solution is part of our plan to increase adoption of this highly automated solution on a platform that is suitable for smaller-size laboratories.”

QIAGEN and DiaSorin widen access to latent TB testing in the U.S. with FDA approval of QuantiFERON®-TB Gold Plus assay on LIAISON® XS [news release]. Business Wire; November 29, 2021. Accessed November 29, 2021. 

https://www.businesswire.com/news/home/20211128005225/en

Officials with the FDA have approved the QuantiFERON-TB Gold Plus assay for use on DiaSorin’s automated LIAISON XS platform.

Retail

Infectious Disease

Immunization

Hospital

FDA Approves Wider Access to Automated Blood Test for Latent Tuberculosis

Community pharmacies are filled with meaningful data nearly every day. Data can be organized to tell stories when partnering with physicians, other health care professionals, and payers to expand community-based patient care. The COVID-19 pandemic is an example of how useful pharmacy data can be in identifying, sharing, and responding to the testing and vaccination needs of local communities and large populations.

While pharmacists can qualitatively describe the needs of their communities by reflecting on the prescriptions they receive and dispense, the medication dispensing process quantitatively collects large amounts of data that can be used to further understand the unique needs of these populations. Here, we share 3 tips to help community-based pharmacists use the data at their fingertips to better market and provide the enhanced pharmacy services that drive practice transformation.


First, collect your data. Consider what data sources are available in your pharmacy every day. One large source of data is the pharmacy management (dispensing) system. Data describing your patient population will support your qualitative patient care stories with quantitative numbers.

Data can be extracted from most dispensing systems and shared to boost your collaborations and referrals with other health care professionals. For example, a pharmacy in rural Pennsylvania downloaded prescription reports prior to a “get to know each other” visit with a local physician office.

This allowed the pharmacist to learn more about the physician’s patient population and to tailor the discussion to the enhanced pharmacy services that could best meet the needs of their mutual patients.

Another source of data is the clinical documentation (electronic health record) software. Consider using data from 

 to describe success caring for individual patients over time (e.g., reduced blood pressures, improved PHQ9 scores, or optimized lipid profiles).

Try downloading reports that characterize the number of patients you serve by prescriber. For example, 200 of Dr. Smith’s patients were vaccinated for herpes zoster at your pharmacy; 100 of Dr. Johnson’s patients received a comprehensive medication review in 2021 and 30 major medication-related problems were resolved by the pharmacy team; 10 of Dr. Patel’s patients received medication adherence packaging services so they could continue to live independently at home).

Contact your software provider for help extracting data and downloading reports.


Second, create a visualization of your data. Visualizations are pictorial representations of data and should appeal to your intended audience. Is your audience a physician, nurse practitioner, or audiologist down the street? Or perhaps a local, state, or US legislator.

It is important to know your audience and to tailor your message accordingly. In general, keep data visualizations simple and easy-to-understand. Present data that actually matter.

For example, therapeutic gaps-in-care that affect quality measures will be important to highlight to a primary care physician. The number of patients who received a COVID-19 vaccine in your municipality will be influential to a local or state legislator.

Infographics—a specific type of data visualization—can capture the breadth of services provided by your pharmacy team in pictures rather than in words. There are several infographic creators (e.g., 

) available online. Consider asking a student pharmacist for help displaying your data in a visually compelling way.

Visually connect your data with the pharmacy services that you offer. For example, you might identify 35 patients from a single prescriber who use more than 10 chronic medications. Use this opportunity to highlight to the prescriber with visualizations how your medication synchronization or adherence packaging services could benefit these patients.

Maps can also be a useful tool for connecting data with stories.

 Consider a map to show the local and surrounding communities you serve. Pinpoint special populations, such as senior community centers or elementary schools. Highlight the neighborhoods and surrounding areas you serve that are in food deserts, underserved, or designated as health care professional shortage areas.


Finally, share your data. You may consider sharing your data visualizations via social media, visits with local prescribers and care teams, or meetings with local employers, health plans, or other payers.

Patient care stories supported with concrete data will help you speak to your audience about the patients you serve. Data presented visually may also help you to collaborate with others for payment of services that further improve patient care outcomes.

Print and leave behind your data visualizations for those with whom you meet and collaborate.

Partner with a nearby college or school of pharmacy to create policy briefings for local, state, and federal legislators using your data.


Pharmacists with individual and population-scale data can use these powerful tools to better the health of the communities they serve. When stories are supported by data, the outcomes can be powerful and sustain practice transformation.

Carroll JC, Renner HM, McGivney MS, et al. Using prescription dispensing data infographics to facilitate collaborative pharmacist-prescriber discussions on mutual patients. J Am Pharm Assoc. 2019 Mar-Apr;59(2):232-237.e1.

Berenbrok LA, Tang S, Coley KC, et al. Access to potential COVID-19 vaccine administration facilities: A geographic information systems analysis. February 2, 2021. 

https://s8637.pcdn.co/wp-content/uploads/2021/02/Access-to-Potential-COVID-19-Vaccine-Administration-Facilities-2-2-2021.pdf

Tips to help community-based pharmacists use the data at their fingertips to better market and provide the enhanced pharmacy services that drive practice transformation.

How to Use Data to Transform Pharmacy Practice 

Investigators have developed an antibody-based treatment for Alzheimer disease, as well as a protein-based vaccine, according to a study published in 

. These 2 treatments were shown to reduce symptoms of Alzheimer disease in mouse models.

“In clinical trials, none of the potential treatments which dissolve amyloid plaques in the brain have shown much success in terms of reducing Alzheimer's symptoms,” said Thomas Bayer, MD, in a press release. “Some have even shown negative side effects. So, we decided on a different approach. We identified an antibody in mice that would neutralize the truncated forms of soluble amyloid beta but would not bind either to normal forms of the protein or to the plaques.”

Amyloid beta protein naturally exists as highly flexible, string-like molecules in solution, which can join together to form fibers and plaques. In Alzheimer disease, a high proportion of these string-like molecules become shortened or 'truncated,' which investigators suspect could be key to the development and progression of the disease. Both the antibody and the vaccine target this soluble form of the protein, which is thought to be highly toxic. When observing how and where the adapted antibody binds to the truncated form of amyloid beta, they found that the amyloid beta protein was folded back on itself in a hairpin-shaped structure.

“This structure had never been seen before in amyloid beta,” said Mark Carr, PhD, in the release. “However, discovering such a definite structure allowed the team to engineer this region of the protein to stabilize the hairpin shape and bind to the antibody in the same way. Our idea was that this engineered form of amyloid beta could potentially be used as a vaccine, to trigger someone's immune system to make TAP01_04 type antibodies.”

The investigators tested both the antibody and the engineered amyloid beta vaccine TAPAS in 2 different mouse models of Alzheimer disease. According to the results, both the antibody and the vaccine helped to restore neuron function, increase the brain’s glucose metabolism, and restore memory loss. Additionally, although neither treatment targeted amyloid beta plaques directly, both treatments reduced amyloid beta plaque formation.

“The TAP01_04 humanized antibody and the TAPAS vaccine are very different to previous antibodies or vaccines for Alzheimer disease that have been tested in clinical trials, because they target a different form of the protein,” said Preeti Bakrania, PhD, in the press release. “This makes them really promising as a potential treatment for the disease either as a therapeutic antibody or a vaccine. The results so far are very exciting and testament to the scientific expertise of the team. If the treatment does prove successful, it could transform the lives of many patients.”

New approach provides potential vaccine and treatment for Alzheimer’s [news release]. Science Daily; November 14, 2021. Accessed November 24, 2021. 

https://www.sciencedaily.com/releases/2021/11/211114201756.htm

Investigators have developed an antibody-based treatment for Alzheimer disease, as well as a protein-based vaccine.

Neurology

Investigators Develop Potential Vaccine, Treatment for Alzheimer Disease Using Novel Drug Target

Results from the phase 2 AXIOMATIC-TKR study showed the investigational oral drug milvexian reduced the risk of postoperative venous thromboembolism (VTE) in a dose-dependent manner without increasing the risk of bleeding compared with enoxaparin in patients undergoing total knee replacement surgery (TKR), according to a Johnson & Johnson press release.

“This study establishes proof-of-principle for milvexian as a differentiated antithrombotic agent,” said Jeffrey Weitz, MD, professor of Medicine & Biochemistry and Biomedical Sciences at McMaster University, in the press release. “Furthermore, the consistently low rates of bleeding across a 16-fold range of milvexian doses suggest that it has a wide therapeutic window, which opens the opportunity to explore milvexian across a broad range of patients including those for whom factor Xa inhibitors are underutilized or not indicated.”

The trial met both of its requirements, with the dose response for efficacy with twice-daily milvexian found to be significant and the 12% rate of VTE with combined twice-daily doses of milvexian being significantly lower than the prespecified benchmark rate of 30%. Further, at daily doses of at least 100 mg, the rates of VTE with milvexian were significantly lower than with enoxaparin, according to the study authors.

The study also found no major bleeds with milvexian and 1 with enoxaparin. The rates of major plus clinically relevant nonmajor bleeds with milvexian and enoxaparin were 0.8% and 1.4%, respectively. Additionally, across a 16-fold range of doses, milvexian demonstrated a low risk of major plus CRNM bleeding with no major bleeds and no dose-response on this composite outcome.

“These promising phase 2 data support a profile that is consistent with better efficacy and safety than enoxaparin and reinforce our confidence in milvexian,” said James List, MD, PhD, Global Therapeutic Area Head, Cardiovascular, Metabolism, & Retina, Janssen Research & Development, LLC, in the press release. “We’re optimistic about the milvexian program and its potential impact for patients.”

This study is the first of 2 from the phase 2 milvexian program, with results from the ongoing phase 2 study of milvexian for secondary stroke prevention expected in the beginning of 2022.

Late-Breaking Phase 2 Data for Investigational Oral Factor XIa Inhibitor Milvexian Suggest Favorable Antithrombotic Profile Across a Wide Range of Doses. Johnson and Johnson. November 15, 2021. Accessed November 16, 2021. 

https://www.jnj.com/late-breaking-phase-2-data-for-investigational-oral-factor-xia-inhibitor-milvexian-suggest-favorable-antithrombotic-profile-across-a-wide-range-of-doses

Further, at daily doses of at least 100 mg, the rates of VTE with milvexian were significantly lower than with enoxaparin, according to the study authors.

Hematology

Milvexian Shows Favorable Antithrombotic Profile in Postoperative Venous Thromboembolism

A recent study has found that exposure in utero to a drug used to prevent miscarriage in mothers can lead to an increased risk of developing cancer in their offspring, according to a research team at The University of Texas Health Science Center at Houston.

The drug, 17α-hydroxyprogesterone caproate (17-OHPC), is a synthetic progestogen that was frequently used by women in the 1950s and 1960s. It is still currently prescribed to women to help prevent preterm birth and can help the womb grow during pregnancy while preventing a woman from having early contractions that may lead to miscarriage.

“Children who were born to women who received the drug during pregnancy have double the rate of cancer across their lifetime compared to children born to women who did not take this drug,” said lead study author Caitlin C. Murphy, PhD, MPH, in the press release. “We have seen cancers like colorectal cancer, pancreatic cancer, thyroid cancer, and many others increasing in people born in and after the 1960s, and no one really knows why.”

The researchers reviewed data from the Kaiser Foundation Health Plan on women who received prenatal care between June 1959 and June 1967 and the California Cancer Registry, which traced cancer in offspring through 2019, according to the study authors.

The team found that out of more than 18,751 live births, 1008 cancer diagnoses were made in offspring 0 to 58 years of age. In addition, a total of 234 offspring were exposed to 17-OHPC during pregnancy. Offspring who were exposed in the womb had cancer detected in adulthood more than twice as often as offspring not exposed to the drug, with 65% of cancers occurring in adults younger than 50 years of age, according to the study.

“Our findings suggest taking this drug during pregnancy can disrupt early development, which may increase risk of cancer decades later,” Murphy said in the press release. “With this drug, we are seeing the effects of a synthetic hormone. Things that happened to us in the womb, or exposures in utero, are important risk factors for developing cancer many decades after we’re born.”

In a new randomized trial, there was no benefit shown in taking 17-OHPC and it did not reduce the risk of preterm birth, according to Murphy. In October 2020, the FDA proposed that this drug should be withdrawn from the market.

Drug used to prevent miscarriage increases risk of cancer in offspring. UT Health News. November 9, 2021. Accessed November 10, 2021. 

https://www.uth.edu/news/story.htm?id=9f15d85c-254d-499b-af44-31fb94f9d4bc

The team found that out of more than 18,751 live births, 1008 cancer diagnoses were made in offspring 0 to 58 years of age.

Women's Health

Oncology

Study Shows Drug Used to Prevent Miscarriage Increases Risk of Cancer in Offspring

When you call a doctor’s office and ask for clarification on a script, and the nurse just reads the directions.

When patients ask you to transfer medications and give you the name of the wrong pharmacy.

When you do all the work for a prior authorization that a patient wants filled elsewhere.

Bossy patients, abandoned prescriptions, drive-through demands? We want to know! Send your pet peeves to 

Pet Peeves: November 2021

 I want to transition into our second section, which is understanding 

–associated diarrhea. Carl, I’ll turn to you. What is 

 is a gram-positive spore-forming anaerobic rod that’s capable of causing disease by the elaboration of 1 or 2 toxins that inflame the lining of the colon. It’s very specific to the colon. Once that happens, you lose the ability to regulate fluids and electrolytes across the wall of the colon and it ends up giving people diarrhea. That diarrhea in the context of 

 defined by clinicians is having 3 or more unformed or watery stools within a 24-hour period for at least 2 consecutive days. Once you have that clinical diagnosis, the question is: is that individual’s diarrhea being caused by this particular organism, because that would make it the 

One of the things we do as clinicians is identify: does this patient meet the criteria of diarrhea. The second part to this is, are there any alternative explanations for this diarrhea? Is the person on a laxative? Is this person on a chemotherapeutic agent that can cause diarrhea? Once you’ve excluded all those things, the next step is to confirm that 

 is causing this individual’s diarrhea. We do that by testing for the presence of the toxin itself because that’s causing the disruption in the wall of the colon. There are tests that are commercially available for us at most hospitals where you can detect this toxin, which is great because once you have that patient with the diarrhea, you’ve ruled out other things. You have this positive toxin, you have your diagnosis, and you can begin treatment.

Sometimes the difficulty comes when we don’t have the availability to confirm that toxin, and we have other tests that are extremely sensitive to detect the presence of a 

 species that harbors a gene that can make this toxin. We may detect it and see that it’s present inside an individual, but it doesn’t tell us whether that organism is making the toxin. It tells us only that there’s an organism in there that has the potential to make that toxin. Sometimes that can lead to overtreatment in some individuals.

In that case where we can pick up the presence of 

 in an individual, but it’s not producing a toxin and it’s not causing that patient’s diarrhea, we call that colonization. That’s an important distinction between being colonized with the organism, meaning that it’s just sitting inside our gastrointestinal tract—I’m sure we’re harboring this organism, and the organism causing a patient to have diarrhea or be hospitalized, which is the true infection. With the true infection, you must treat just being colonized. You don’t treat, and that’s the important distinction between the 2.

 That’s an important concept: what’s colonization and what’s true infection? When you’re talking about somebody who has true infection with 

, are we talking about mild diarrhea or can this be much more severe? For an individual patient, how big of a problem can 

It’s very interesting because there’s a whole spectrum of disease that this particular organism can cause, and it can vary anywhere between mild diarrhea—a patient may have a couple of bowel movements a day that are loose or watery—and severe diarrhea, which results in dehydration that requires hospitalization. It can get even worse than that, or it can cause severe colitis—which we call fulminant colitis or pseudomembranous colitis—and can land individuals in an intensive care unit [ICU] and has the potential for sepsis and even require surgery to prevent death. This is an organism that has a high degree of morbidity and mortality. Over the last several decades, we started to see the evolution or the appearance of an epidemic strain or a hypervirulent strain that would lead to this particular increase in morbidity and mortality, and we call that the NAP1/B1/027 strain.

In terms of sort of speed of presentation, how fast does this come on?

It’s very interesting. That’s a variable after the risk factor exposure. If I take a patient and ask them their history, they could have taken the antibiotic, which is the most common risk factor for getting 

 in the last week to the last 3 months. The presence of the antibiotic as a risk factor can be traced back several months at times. It’s a double whammy. You get the antibiotic as a risk factor, and then the second part of it is exposure to the 

 organism in the spore form or the vegetative form from the environment.

After that, some people have an indolent course, where they get slowly sick and get a couple of loose tools, and then it progresses very fast. If you have other risk factors that put you at risk for getting bad illnesses—older people, immunocompromised people, multiple antibiotics—then you can see a very rapid turn to the worst, in which people get very sick very quickly. I’ve seen people who present to the emergency department and are sent home with a prescription because they have mild disease. At the same time, another patient who comes to the emergency department could be in the ICU in 12 hours and be intubated. It’s a wide spectrum that we see in terms of how fast people get sick and how sick people get.

From an epidemiological perspective, Kelly, how big of an issue is 

 in the United States? Is this a big deal? Is this a minor deal?

It’s a big deal in the United States and worldwide. The Centers for Disease Control and Prevention classifies 

 as 1 of only 5 urgent threats to public health in the United States. There was a great article published [

] by [Wenpeng] Gu and colleagues last year that captured the epidemiology of 

 from the emerging infections program, but also extrapolating to national estimates. They estimate that we have close to half a million cases of 

Now, they did some adjustments for potential overestimation for certain diagnostic tests. We’re talking at least 365,000 true infections every year so common. Of course, patients can have severe disease, which ultimately leads to potentially death. Many studies have characterized mortality associated with 

. Some have been able to calculate attributable mortality, which tends to be 5% to 10% or so. We’ve done some epidemiology studies in the national veteran population. If you look out 30 to 60 days for all-cause mortality, and we’re talking 20% to 30%. This is an important infection that can lead to really poor outcomes among patients.

One of the other things the Gu study characterized was community associated vs health care associated. Our health care–associated 

 is among patients who develop the infection within the hospital— hospital onset is after 72 hours of admission or patients who present from the community but who have had recent health care exposure within the past 12 weeks or so. Then we have our community-associated cases: patients who haven’t had health care exposures recently. Right now, the epidemiology is about split: 50% of our cases are health care associated, and 50% are community associated. That’s a change because we’ve typically thought of 

 as a health care–associated infection, but rates of health care–associated infections have gone down substantially over the past decade or so, whereas community-associated cases are increasing or have remained steady.

I was going to raise a topic later that’s near to your heart, which is antimicrobial stewardship in the outpatient setting is clearly a next need.

. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming 

 and other great content right in your in-box.

Videos

Comprehensive discussion on the identification of Clostridioides difficile infection, the spectrum of disease, and overall epidemiology. 

C. difficile

Identifying CDI: Presentation, Prevalence, and Spectrum of Disease

As the app TikTok has exploded over the past 2 years, influencers have identified new ways to gain followers and expand their influence using the app’s short-video format. Among these influencers are a growing number of pharmacists and pharmacy students who are educating young viewers and advocating for the profession.

Monthly users of the app have grown nearly 800% since January 2018, according to data released in August 2020 and reported by CNBC.

 Over 100 million Americans are considered active monthly users, and over 50 million are daily users.

 The pandemic played a major role in this growth, with users in the United States skyrocketing from almost 39.9 million in October 2019 to almost 92 million in June 2020.

According to a paper published by the Society for Academic Emergency Medicine, TikTok has been a major source of information during the pandemic, especially for younger viewers. Investigators searched the hashtag coronavirus on the app and found 90 billion views, whereas the hashtags medicine and doctor received 1.4 billion and 6.7 billion views, respectively. Pharmacists on the app are also finding niches in which to educate the audience, including the 3 pharmacists profiled below.

Like many TikTok users, pharmacist Savannah Malm, PharmD, IBCLC, downloaded the app out of boredom at the beginning of the pandemic. At the time, she was stuck in South Carolina while her husband was in Idaho, and her International Board of Lactation Consultant Examiners exam was canceled.

“I downloaded the app just to pass the time,” Malm said. “At that point, there was no indication that I was going to do anything beneficial on it.”

Now with 705.8 thousand followers around the world and 23.1 million likes, Malm (with the username @rx0rcist) has garnered one of the largest followings among pharmacists on TikTok. Malm’s interests include lactation counseling and COVID-19 vaccine advocacy, so she aims to educate viewers on both issues. In the interview, Malm said she is the first person in the country to have both a PharmD and IBCLC certification.

She now posts a combination of educational content as well as what she termed “accountability content,” which involves calling out those who post misinformation on the app.

“I find people doing illegal things [or] posting misinformation in very egregious ways,” Malm said. “It’s a mix between [those].”

However, Malm’s popularity has come with a price. In addition to the millions of likes and positive comments, she and her family have been attacked and threatened online by antivaccine groups and others who disagree with her content. In 2020, she posted a video discussing pharmacists’ right of refusal to fill a prescription and was attacked online by a chronic pain advocacy group.

“That was the first experience I had with people who didn’t like to hear the truth, so they responded with very violent attacks,” Malm said.

She also began calling out videos with fake COVID-19 vaccine cards in the spring of 2021 and was quickly attacked for that as well. One video received almost 11 million views, after which her address was posted online. Malm then had to work with the Federal Bureau Investigation, although she said there is no way to know who posted her address, and it is still posted to this day.

“I’ve learned there are people who want to avoid accountability so badly that they will respond in such a way that they escalate it to very violent, angry threats,” Malm said.

When asked why she continues to use the app despite these attacks, Malm said she quit social media for 3 weeks and debated whether to return. Some viewers said she was endangering her young daughter by returning, but she decided that she wanted to use the platform to advocate for underrepresented groups and marginalized communities.

“Being a White person in America with the privilege I’ve been born into, [and] being able to just walk away from it, is a privilege that many marginalized communities do not have,” Malm said. “I don’t get to hide because they don’t get to hide. I want to be a true ally to these communities that I’m trying to serve and amplify their voices.” This chance to amplify marginalized voices is one of the major places Malm said she sees potential for TikTok as an educational tool. She added it is also a great way for her to talk about issues that interest her and to connect with like-minded people who also want to fight misinformation.

Peter Ginn, PharmD, has also used TikTok as a tool to advocate for the profession—in particular, for provider status. Ginn graduated from Campbell University and now works in the intensive care unit (ICU) at a large community teaching hospital in North Carolina.

Like Malm, Ginn said he downloaded TikTok for entertainment during the first few weeks of the COVID-19 pandemic. He quickly found some medical creators and decided to post about pharmacy, because he said he did not see many pharmacists utilizing the app. Now he has 3227 followers and 42 thousand likes, under the username @pgpharmd. As the pandemic escalated, Ginn said he started tackling misinformation.

“I’m really interested in trying to create...factual COVID-19 information that is somewhat relatable [and] that combats some of the vaccine hesitancy that’s out there,” Ginn said.

Ginn explained that, at this point, almost every patient with COVID-19 he sees in the ICU is unvaccinated, so he hopes his content will reach those people. He also said the app has potential beyond the pandemic and suggested that short educational videos about commonly prescribed drugs could be especially successful.

“Everyone always [asks], ‘Do you have any questions for the pharmacist?’ And everyone always says, ‘No,’” Ginn said. Because of this, he said many patients might not know basic information about their medications, such as whether it is acceptable to take a certain prescription at night or whether it should be taken with food.

Ginn has also used the app to network with other content creators, including Malm, who he said has been an inspiration in pushing the issue of COVID-19 vaccines. Although Ginn said he does not feature his responses to misinformation as frequently as Malm does, he will often respond to misinformed comments or might make a video to explain the topic further.

In addition to working on COVID-19 content, Ginn said he is passionate about advocating for pharmacist provider status. With such a large potential audience on the app and with so much new recognition for the role of the pharmacist during the pandemic, Ginn said he sees a chance to accomplish this goal.

“TikTok can be used to advocate for provider status—both by current pharmacy students and practicing pharmacists,” Ginn said. “Pharmacists are some of the most accessible health care professionals, yet [the Centers for Medicare and Medicaid Services] does not recognize pharmacists as health care providers. When the COVID-19 pandemic dust settles in the future, I imagine I’ll try to advocate for pharmacists to be recognized as health care providers.”

Unlike Malm and Ginn, who downloaded TikTok in early 2020, Sagar Parekh, PharmD, said he got started on the app during his third year of pharmacy school at the end of 2019. He initially started by posting humorous videos based on his experiences in retail pharmacy, but also included videos on his South Asian heritage and what it was like growing up as an Indian American.

“I just started creating these funny clips about being asked weird questions like ‘Hey, do you know where the bathroom is?’ while you’re a pharmacist,” Parekh said.

In addition to his first 2 topics, Parekh said he now creates content about working in a corporate environment. Since graduating from Rutgers University Ernest Mario School of Pharmacy in the spring with his doctor of pharmacy degree, Parekh said he works in the pharmaceutical industry and is participating in an oncology brand marketing fellowship through the Rutgers Institute for Pharmaceutical Industry Fellowships.

He has also uploaded some videos about the importance of COVID-19 vaccines, although he said this is not a major focus of his platform. Parekh said he likes to create funny content and entertain viewers, as there are many professionals who use the app as an educational tool.

“I view my platform as a place people can go for humorous jokes, for something that’s lighthearted, something that they can relate to, and just provide them a good laugh,” Parekh said.

He added that he sees boundless potential for the app both as an educational tool and as a network-building opportunity.

“There’s no roof to where it can go,” he said. “It can be a huge educational tool...with some of the fast facts you can provide, such as what different medications do. It can be a cool way for pharmacy students to stay engaged and stay in the loop while using a social platform that is really fun to be on.”

Sherman, A. TikTok reveals detailed user numbers for the first time. CNBC. Updated August 24, 2020. Accessed September 13, 2021. 

https://www.cnbc.com/2020/08/24/tiktok-reveals-us-global-user-growth-numbers-for-first-time.html

Comp G, Dyer S, Gottlieb M. Is TikTok the next social media frontier for medicine? 

. 2020;5(3)10.1002/aet2.10532. doi:10.1002/aet2.10532

Cortney tried. TikTok. August 14, 2021. Accessed September 13, 2021. 

Student

Pharmacists See Opportunities in TikTok to Educate, Advocate

 We now have 2 BTK [Bruton tyrosine kinase] inhibitors in this area. Obviously, there are more than 2 BTK inhibitors, but we have at least 2 approved in this setting. Javier, thinking about the differences in the BTK inhibitors and adverse effect profiles, how do you choose which BTK inhibitor to use from your perspective?

 Excellent question. My experience has been positive with BTK inhibitors in general. Regarding marginal zone lymphoma, there was a phase 2 study addressing single-agent ibrutinib 560 mg per day. It was a small study of only 63 patients with relapsed/refractory marginal zone lymphoma. The overall response rate was 58%, which is attractive. The median duration of response was 27.6 months, which is very attractive. The safety profile was consistent with prior reports. The most common grade 3 or higher event was anemia in that particular trial.

When it comes to zanubrutinib, which was recently FDA approved for marginal zone lymphoma, we have the results from the MAGNOLIA trial. Amit is going to comment a little more about that study in a second. The overall response rate was 60%, and responses were seen in all subtypes of marginal zone lymphoma. The median duration of response wasn’t reached. Was zanubrutinib stopped? Yes. The treatment discontinuation was mainly due to disease progression. The adverse effects were similar to what we have seen with other BTK inhibitors: diarrhea, easy bruising, and upper respiratory tract infections. Of note, atrial flutter was only seen in the single digits—1.5% in the MAGNOLIA trial—at least during the last data cutoff, the last rendition reported during ASH [American Society of Hematology annual meeting] 2020. Until then, no major bleeding events had been reported.

What comes to mind when you think about a BTK inhibitor is bleeding, atrial flutter or atrial fibrillation, and hypertension. It seems like these novel BTK inhibitors retain efficacy with a more favorable toxicity profile. We’re starting to get results, including randomized data from several lymphoproliferative disorders, like Waldenstrom macroglobulinemia and chronic lymphocytic leukemia. It’s tempting to extrapolate. I don’t think the novel BTK inhibitors are necessarily more efficacious, but they probably have a safer toxicity profile.

 It’s amazing. We continue to expand on what we have in terms of more selective higher BTK occupancy in the lymph nodes and the PBMCs [peripheral blood mononuclear cells]. We haven’t seen a clinical difference in responses, but we’re seeing differences in adverse effects. It’s amazing how we continue to evolve, making these treatments even better.

A broad review of BTK inhibition as a novel therapeutic approach toward the treatment of marginal zone lymphoma.

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