Latest / Morning Medical with Dr. Chow / FDA Approves Onapgo for Parkinson's, GLP-1 Medications, and U.S.-Canada Trade Tensions

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FDA Approves Onapgo for Parkinson's, GLP-1 Medications, and U.S.-Canada Trade Tensions · Morning Medical with Dr. Chow

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  Welcome to Morning Medical with Doctor Chi-Ming Chow.
• 0:04
  I'm Doctor Chi-Ming Chow, a cardiologist based in Toronto, Canada.
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  Each day, we delve into the latest medical and health news from around the world, utilizing
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  the power of artificial intelligence to keep you informed and engaged.
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  Today, we're kicking things off with a significant development on the international
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  stage that intersects with health policy and diplomacy.
• 0:32
  In recent news, the concept of appointing a 'fentanyl czar' has emerged as a crucial move
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  in the ongoing battle against the opioid crisis, particularly concerning the trafficking
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  of fentanyl across the Canada-United States border.
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  This decision comes in the wake of a heated trade dispute between the two countries, with
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  United States President Donald Trump imposing broad tariffs on Canada and Mexico, citing the
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  flow of illegal fentanyl into the United States as a primary concern.
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  Canada's Prime Minister, Justin Trudeau, has responded by agreeing to several measures to
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  strengthen border security, including the appointment of a 'fentanyl czar.' This position
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  is intended to be the main liaison between the Canadian and United States governments,
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  enhancing collaboration in combating fentanyl trafficking.
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  The Canadian government has committed to a two hundred million dollar investment to back this
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  initiative, reflecting its seriousness in addressing the issue.
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  The idea of a 'czar' is not new.
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  In the United States, the term has been used since the twentieth century to denote positions
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  created to tackle specific issues, such as the 'homeless czar' appointed by President George
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  W.
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  Bush.
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  However, these roles often lack formal powers and may serve more as symbolic or political
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  gestures rather than positions with significant authority.
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  Despite the symbolic nature of the title, the appointment of a fentanyl czar could represent
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  a strategic diplomatic move by Canada.
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  It aims to placate the United States administration and ease the tensions resulting
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  from the threatened tariffs.
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  However, the actual impact of this role on policy changes remains to be seen.
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  As it stands, the position is likely to focus on overseeing and coordinating actions related
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  to fentanyl, including policy and legislation.
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  Yet, it will not override the authorities of existing ministers such as the Public Safety
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  Minister, who oversees the Canada Border Services Agency and the Royal Canadian Mounted
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  Police.
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  This development underscores the complex interplay between health policy and
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  international diplomacy.
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  While the creation of a fentanyl czar might be seen as a political maneuver, it highlights the
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  urgency of addressing the opioid crisis and the need for cross-border cooperation.
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  We'll keep a close eye on how this unfolds and what implications it might have for health
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  policies in both Canada and the United States.
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  Let's dive into an exciting development for those living with Parkinson's disease.
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  The United States Food and Drug Administration has recently approved a new wearable treatment
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  for managing motor fluctuations in adults with advanced Parkinson's disease.
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  This device, known as Onapgo, is a subcutaneous apomorphine infusion system developed by
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  Supernus Pharmaceuticals.
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  It's designed to provide continuous treatment throughout the day.
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  As Parkinson's disease progresses, traditional treatments like levodopa can become less
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  effective, primarily due to gastrointestinal issues that affect the absorption of oral
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  medications.
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  This can lead to inconsistent motor control.
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  Stuart Isaacson, a doctor from the Parkinson's Disease and Movement Disorders Center of Boca
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  Raton in Florida, highlighted that Onapgo offers a direct stimulation of dopamine
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  receptors in the brain without the need for metabolic conversion.
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  This is achieved by bypassing the gastrointestinal tract, potentially leading to
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  more predictable improvements in symptoms.
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  The approval of Onapgo comes after a rigorous process, including a resubmission of the new
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  drug application by Supernus Pharmaceuticals after an initial rejection.
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  The decision was heavily supported by findings from the phase three TOLEDO trial.
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  This trial involved one hundred and seven Parkinson's patients in Europe who experienced
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  persistent motor fluctuations.
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  The results showed that apomorphine infusion significantly reduced 'off' time, meaning the
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  periods when medication is not working well to control symptoms.
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  Specifically, patients on apomorphine had a reduction of about two and a half hours per day
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  compared to those on a placebo.
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  Moreover, the treatment increased 'on' time without troublesome dyskinesia, which refers to
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  involuntary movements that can be a side effect of Parkinson's treatment.
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  It's worth noting that the apomorphine infusion was generally well tolerated.
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  However, some patients did experience adverse events.
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  Six participants in the apomorphine group withdrew from the study due to adverse events,
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  including severe hypotension and myocardial infarction.
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  Despite these concerns, the most common side effects were relatively manageable, such as
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  infusion-site nodules and nausea.
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  Supernus Pharmaceuticals plans to make this innovative treatment available by the second
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  quarter of 2025.
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  This development marks a significant step forward in providing more effective management
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  options for those dealing with the challenges of advanced Parkinson's disease.
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  We'll be following how this new treatment impacts the lives of patients and continues to
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  shape the landscape of Parkinson's disease management.
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  The recent trade tensions between Canada and the United States have brought to light
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  significant economic vulnerabilities that could impact Canadians' wallets in various ways.
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  While there's currently a 30-day pause in the trade war, the specter of tariffs and
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  counter-tariffs looms large.
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  This has led to a surge in "Buy Canadian" campaigns across social media, with many
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  Canadians boycotting American products.
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  Several provinces have even pulled U.S.
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  liquor from their shelves, showcasing the immediate reactions to the trade tensions.
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  The United States President, Donald Trump, announced a 25 percent tariff on nearly all
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  Canadian goods and a 10 percent tariff on Canadian energy.
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  In response, Canada declared a 25 percent tariff on thirty billion dollars' worth of
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  American goods, with plans to expand this to one hundred and twenty-five billion dollars in
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  three weeks.
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  While the trade war is temporarily on hold, analysts warn that this could escalate, leading
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  to increased prices for consumers on both sides of the border.
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  Fen Osler Hampson, a professor of international affairs at Carleton University, pointed out
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  that a full-blown tariff war would generally make everything more expensive, affecting
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  everyone.
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  The threats have already highlighted the complexities of the intertwined Canadian and
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  American economies.
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  Canada is the largest export destination for U.S.
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  goods, and any disruption in trade could have widespread repercussions.
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  The Canadian Chamber of Commerce estimated that Trump's tariffs could cost Canadians about one
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  thousand nine hundred dollars per person annually.
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  The most heavily impacted sectors would include energy, autos, mining, pharmaceuticals,
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  chemical, and forestry products.
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  The Public Policy Forum also estimated that retaliatory tariffs could cause consumer prices
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  to rise by 4.1 percent.
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  The retail sector, particularly grocery items, is especially vulnerable.
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  Fresh produce, such as tomatoes, cucumbers, citrus fruits, and berries, are primarily
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  imported from the southern United States during the winter months.
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  With Canada proposing counter-tariffs on these items, consumers could see immediate price
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  hikes due to the lack of Canadian alternatives and the perishability of these goods.
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  Juice and cereal are also likely to become more expensive.
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  Canada imports a significant amount of fruit juice from the U.S., particularly orange juice
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  from Florida.
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  The proposed tariffs could lead to price increases on these products, impacting
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  consumers who rely on them.
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  Similarly, grains used in breakfast cereals, pasta, and baked goods could see price hikes as
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  tariffs affect imports of wheat, rye, barley, oats, and rice.
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  Alcohol has been another focal point in the tariff discussions.
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  Canada's counter-tariffs targeted American-made beer, wine, and spirits, prompting some
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  provinces to remove these products from store shelves.
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  With Canada being a major market for U.S.
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  wine and spirits, any tariffs could lead to higher prices for both American and Canadian
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  consumers.
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  Canadian booze could also become more expensive as demand shifts from American products.
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  Beyond food and drink, other consumer goods like cosmetics, toiletries, and clothing are
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  also at risk.
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  The U.S.
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  is a major supplier of these items to Canada, and any increase in tariffs could raise prices
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  due to higher production and transportation costs.
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  This highlights the broader economic impact of the trade tensions and the challenge of
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  increasing domestic production to meet demand.
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  Today, we're exploring why people discontinue weight loss and diabetes medications known as
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  glucagon-like peptide 1 receptor agonists, or GLP-1s, within a year of starting them.
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  These drugs, including Wegovy, Ozempic, and Mounjaro, have gained popularity but come with
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  a hefty price tag of about one thousand dollars per month before insurance.
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  While many insurance plans cover these drugs for diabetes, coverage for obesity treatment is
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  less common, which significantly impacts patient adherence.
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  According to a recent study published in the Journal of the American Medical Association
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  Network Open, approximately sixty-five percent of patients without diabetes stopped taking
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  GLP-1s in less than a year.
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  This rate drops to about forty-six percent for those with Type 2 diabetes.
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  Over a two-year period, the discontinuation rates were around eighty-four percent for
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  non-diabetics and sixty-four percent for diabetics.
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  The study highlights that adverse side effects and cost are the primary reasons for
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  discontinuation.
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  GLP-1s are associated with moderate to severe gastrointestinal side effects, such as nausea
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  and vomiting.
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  Patients experiencing fewer side effects were less likely to stop treatment, aligning with
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  previous research findings.
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  Moreover, higher income levels were linked to a lower rate of discontinuation, especially among
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  those with diabetes, suggesting financial capability plays a role in continued usage.
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  Interestingly, the study also found that the effectiveness of the drugs in achieving weight
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  loss influenced patient decisions.
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  Those who lost more weight were more likely to continue the medication.
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  Conversely, patients who regained weight after stopping GLP-1s were often inclined to resume
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  treatment.
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  This indicates that weight management outcomes are crucial for patients, irrespective of their
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  diabetes status.
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  The research analyzed electronic health records of over one hundred twenty-five thousand adults
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  who started GLP-1 medications between January 2018 and December 2023.
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  These medications include liraglutide, semaglutide, and tirzepatide.
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  Semaglutide is the active ingredient in Novo Nordisk’s Wegovy and Ozempic, while tirzepatide
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  is found in Eli Lilly’s Zepbound and Mounjaro.
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  Today, we're diving into a significant topic concerning the United States healthcare system.
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  Recently, Forbes Senior Editor Alex Knapp discussed what he believes to be President
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  Donald Trump's most substantial impact on U.S.
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  healthcare since taking office.
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  This assessment comes from a detailed analysis of Trump's early decisions and their ripple
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  effects on both domestic and global healthcare landscapes.
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  According to Knapp, one of the standout aspects of Trump's healthcare policy has been the
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  emphasis on deregulation.
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  This approach has been characterized by a series of executive orders aimed at reducing
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  the regulatory burden on healthcare providers and insurers.
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  Trump's administration argued that by cutting red tape, healthcare costs would decrease, and
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  innovation would be spurred.
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  This deregulatory push has been a double-edged sword, garnering both praise and criticism from
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  various stakeholders in the healthcare sector.
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  Supporters of Trump's policies claim that deregulation has led to increased competition
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  among insurers and providers, potentially lowering costs for consumers.
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  They argue that the reduction in regulations has allowed for more flexibility in designing
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  health plans, which could cater to a wider range of consumer needs.
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  This, in turn, might foster a more dynamic healthcare market, encouraging providers to
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  offer more personalized and efficient care.
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  On the flip side, critics warn that the deregulatory measures might undermine patient
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  protections and healthcare quality.
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  They express concerns that less oversight could lead to disparities in healthcare access,
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  particularly for vulnerable populations who might find themselves with fewer options or
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  facing higher out-of-pocket costs.
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  The debate continues as to whether the benefits of deregulation outweigh the potential risks,
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  with experts divided on the long-term implications for the U.S.
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  healthcare system.
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  Another significant impact noted by Knapp is Trump's focus on drug pricing.
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  The administration has attempted to address the high cost of prescription drugs, which has been
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  a pressing issue for many Americans.
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  Initiatives have included efforts to increase transparency in drug pricing and to promote the
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  importation of cheaper drugs from abroad.
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  While these measures have been met with varying degrees of success, they highlight the
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  administration's recognition of the burden of drug costs on consumers.
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  In the global arena, Trump's healthcare policies have also had ramifications.
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  The administration's stance on international health aid and its approach to multinational
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  health agreements have influenced global health diplomacy.
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  These moves have sparked discussions about the role of the U.S.
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  in global health initiatives, especially in terms of funding and leadership.
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  As we reflect on these developments, it's clear that Trump's healthcare policies have left a
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  lasting mark.
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  Whether viewed positively or negatively, these actions have prompted a reevaluation of how
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  healthcare is delivered and financed in the U.S.
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  As we continue to monitor these changes, it's crucial to consider their broader implications
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  on both national and international health landscapes.
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  That's all for today's episode of Morning Medical with Doctor Chi-Ming Chow.
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  Thank you for joining us as we explored these impactful topics in the world of healthcare.
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  Stay tuned for more updates and insights in future episodes.
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  Until next time, take care and stay healthy.