Stan, Clarence, Barry, and the Health Chatter team chat with Dr. Ronda Marie Chakolis-Hassan, President of the Minnesota Board of Pharmacy, and Dr. Ai-Ja Jackson, pharmacist, about Medication Management—and explore the central question: “Should we just medicate?”Dr. Ronda Marie Chakolis-Hassan, PharmD, MPH, exemplifies the intersection of clinical expertise and public health advocacy in pharmacy practice. An alum of the University of Minnesota College of Pharmacy and School of Public Health, her diverse career spans 15 years in Pharmacy Benefit Management and over 5 years as a Medication Therapy Management pharmacist in community practice. Her commitment to healthcare equity shines through her work addressing infant mortality, opioid abuse prevention, and her service on the Minnesota Department of Human Services Drug Formulary Committee, where she helps shape medication access policies across the state.Join us for an enlightening discussion about when medication is the right solution—and when it might not be.Join the conversation at healthchatterpodcast.comBrought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships.More about their work can be found at https://www.huemanpartnershipalliance.org/
Chapter 1: What is the main topic discussed in this episode?
Hello, everybody. Welcome to today's show on Health Chatter. It's a real heavy-duty topic. We're going to be looking at medication management, and we're also going to be addressing the question, should we just medicate? In other words, with all the ailments that we have, is it just easier to take a pill and forget everything else?
So we'll get into all these logistics with two wonderful guests, which I'll introduce in a couple minutes. We have a great staff that I like to introduce all the time on all our shows. Maddie Levine-Wolfe, Matthew Campbell, Sharon Nygaard, and Deondra Howard, Erin Collins. They've all been with us since day one doing Health Chatter.
They're our background crew that does our background research, our production, transcription of all of our shows on our website. They are a crew that's second to none. And even though some of them live in different cities, they still are connected with us. So thank you to all of you. You're really great. Clarence Jones is my co-host on Health Chatter.
And we've been chatting a lot over the years and we keep doing it. And Dr. Barry Baines is with us. He's our medical advisor for our show. And he brings in the medical perspective on some of these shows that, frankly, we really need some insight on. So thanks to everybody. Human Partnership is our sponsor for these shows. You can check them out.
They're a great community health organization at humanpartnershipalliance.org. Humanpartnership.
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Chapter 2: How do medication costs impact patient access?
Alliance.org. Check them out. They do some really creative things and continue to do them. You can check us out at healthchatterpodcast.com for all the research. We attach the research that we do, our background research for all these shows. The shows are transcribed, so if you don't want to listen to them, you can read them.
So check us out and also provide us with questions if you have any that we could follow up with you. So Thanks to everybody. Today, we have Dr. Rhonda Chakoulis. She's actually a nationally respected pharmacist, has actually been on our show before. 16 years of experience across clinical practice, pharmacy regulation, community innovation. She has her hands in a variety of different things.
And with a really creative bend to it all. And she's a really good community health strategist. And it's really great having you again on Health Chatter. Dr. Aja Jackson is a licensed pharmacist with over five years of experience in hospital and specialty pharmacy settings. beginning her career in acute care in Baton Rouge, Louisiana, even though where she is today is in Sarasota, Florida.
So I think she's linked to warm weather. I think that's the key here. A variety of different initiatives that she's involved with, including pharmacogenetics,
genomics excuse me um and also patient outcomes as it relates to um to drugs and medications so you guys are second to none i i could frankly you know hand off the show and just we could the rest of us could just be quiet because i'm sure you have great insights so thanks for being with us on health chatter so all right so let me start this thing out um Yeah.
Frankly in the news, in the news, in today's paper, nationally, right. And is makers of obesity drugs are to cut prices so that they can widen coverage and provide obesity drugs easier for patients.
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Chapter 3: What are the implications of GLP-1 medications for weight management?
Okay. So my question is, um, You know, first and foremost, they might have been too expensive to begin with, but that's another issue altogether. But what are we dealing with here? Are we dealing with medications that are just easy peasy? Let's just take the drugs and we don't have to worry about anything. And obesity, these obesity drugs are certainly one angle on this. So
Asia and Rhonda, give me your perspective on should we just medicate? When in doubt, just medicate. Forget exercise. Forget eating properly. Just take the drug. And thank you very much.
I think I'll start, Stan. First of all, thank you for that wonderful introduction. And then because I have my hands in so many things, I have to do my usual disclaimer that none of the things I'm going to talk about represent any of the entities that I either am employed by or affiliated with. And then also, since we were here last time, I got a lot of alphabet on the last part of my name.
So it's now chacolas hassan um that's kind of been new in the last year so i got remarried and um yeah i i think uh i think you bring out uh interesting points so one let's talk about obesity in general um we know the rates are generally going up we're actually seeing them in children african-american women also are very um increasingly susceptible to obesity, right?
And so let's just go with the elephant in the room and talk about those medications you're talking about, the GLP-1s. for a long time, if you think about the history of medicine and how we treat conditions, right, we've been thinking about let's have the magic bullet. So for a while, antibiotics, penicillins, those kinds of things, those were our magic bullets.
And here we are now with this GLP run products that have the magic bullets.
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Chapter 4: How does pharmacogenomics influence medication effectiveness?
First of all, we are forgetting that sometimes medications are intended to treat one thing and have this lovely side effect. And so the GLP ones are kind of one of those things that really kind of started out as mostly to treat diabetes, but magically, had a side effect of weight loss. We have medications like that.
Your Viagra and whatever initially started out as blood pressure medicines and in clinical trials didn't do so well. And they found that they also had a side effect. So here we are. And I think medication is just one small portion of what we're doing. So what we see now, even with the GLP-1s, yes, you will lose weight.
However, if you don't look at the behaviors, if you look at the data, people rebound very quickly. It's the same thing that people have had when we initially thought in terms of weight loss that gastric sleeves and gastric bypasses are also the magic bullet.
Five to 10 years out, a lot of patients, if they don't get those behaviors, they've not only gained back the weight that they've lost, but they've even gone back to their baseline. So hopefully that's a good start. I'm interested in what my colleague kind of thinks about GLP-1s, Dr. Jackson.
Yes, I do want to piggyback off of what Dr. Takolis Hassan said and just say thank you for having me on the show. With regard to GLP-1s, I do think they are more so of a quick start. But if you don't address the underlying causes of, you know, eating habits, exercising habits, moving daily, like she mentioned, once you kind of complete that medication, you
are likely to rebound because if you haven't changed those habits prior to or while you're on the medication you're not going to change them once you stop so let me ask you is it a fad drug are you as pharmacists are you concerned that this is a fad
Me personally, I am a little bit concerned that it's a fad because I've seen patients that actually need the medication for a diabetic diagnosis and they aren't able to get the medication because it's either out of stock, low inventory, things like that.
I think once you have one person, be it celebrity, someone you know that has taken a GLP-1, lost all this weight, people are going to their providers and saying, hey, my so-and-so is on this. I want to get on it too to lose the weight. So I do think it's a fad. I wish there was more education from providers, from pharmacists, just about that.
the GLP ones in general, to really give patients and people, whether they'll listen or not, really good insight on what they're getting themselves into.
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Chapter 5: What role do pharmacists play in patient education?
So I'm concerned, this is Clarence, I'm concerned about the whole issue around polypharmaceuticals. I mean, here we go, we keep adding and adding and adding. What kind of conversation should we be having about this drug and how it might impact, as Dr. Ronald was talking about, how this might impact the real health of people, either now or in the future? What should we be thinking about?
I think that's a great question, Clarence. First of all, I kind of hinted at it as side effects, right? And now you're starting to hear and see terms like ozempic face. You're starting to see things, other side effects in terms of even how it's affecting female reproductive anatomy. You're hearing things about vision. You're hearing things about possible thyroid cancer.
I think the conversation is what is health? What is medication? Medication is a tool, as Dr. Jackson said, but when it's not paired with other things, that's where we get into problems. The other thing is there is nothing that is out there that is without risk. And so a lot of times we're not even having that conversation about what is the risk and the benefits of taking something.
There's risk and benefits with anything. And I think because people have this desire to want the quick fix. And again, we all are very aware that TikTok and other platforms have made this be where people are like, oh my gosh, this is the best thing ever. But what we're not hearing about is the people who are being hospitalized because their gastrointestinal system
can't handle this medication or they're having issues with their pancreas or they're having issues with their vision, we're only looking at the quick fix. And so when we're adding that additional medication, we also need to think about what's being taken away.
And so when we talk about weight loss, when I talk to people who are starting this drug, be it for weight loss or diabetes, it's indiscriminate. So we think about the scale, but are we looking at muscle mass?
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Chapter 6: How can patients advocate for themselves regarding medication?
Are we looking at how loose your skin is? Are we looking at how fast this is? And so The conversation I often have is, yeah, when you're losing weight, your body doesn't know what's fat or muscle. So you got to eat protein. You have to exercise. You have to drink water. You have to incorporate fiber.
And so those are the conversations we need to be having, not just about this class of medication, but with any medication.
You know, it's interesting. I was just out east and I was visiting my son and daughter-in-law and grandkids. And I was talking to my... my daughter-in-law and she, we were talking about these drugs. Okay. And she said a lot of her friends are on it. And you know what? That really struck me. It's just like, okay, wait a minute. Why are all your friends on it? Okay. And what is it?
It seems to me that there's a communication breakdown. Why would physicians put a lot of these people on these drugs? And it's just like, you know, there's a, there's a concern that I have from a, from a public health standpoint, um, just about this drug and then, you know, um, Rhonda, you brought up the idea.
Chapter 7: What are the risks associated with polypharmacy?
Okay, well, it's one thing if you take a drug like this. What about all the other drugs that you might be taking? And what might be the interaction with some of these drugs? I'm hoping that certainly their physicians are aware of that. But going forward, I have a feeling, I might be wrong, but no matter what
kind of ailment that we might be dealing with as humans, I have a feeling that we might be headed towards quick fix drugs.
I agree. But I think one thing that we forget is in terms of physician, and I'm talking to a couple of them right here as we're sitting on this show, is those clinical guidelines and FDA indications, right? Yeah. And so physicians have been... Like right now, I'm a candidate. I have a BMI over 27. I have a family history of, you know, cardiovascular disease.
I guarantee you, you probably don't want to be in the room with me when I'm sleeping because I snore and have some sleep apnea. So even based on clinical guidelines, right, I could walk in and very much be a candidate for these medicines. Here's the thing. Is this the best thing? Is this first-line therapy? Sleep apnea? Yeah, maybe I get a CPAP machine and actually use it.
You know, those cardiovascular risk factors that I have in my family, continue to exercise and do – do different things. And then let's get to the bigger thing, BMI. I have a strong suspicion that we need to really revisit how that's calculated. My waist is under 30, but when I go in to the doctor, like I'm on the obese side, right?
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Chapter 8: How can community efforts improve medication management?
And again, we're not looking at those whole things because they're looking at just my height. in my weight, not even my muscle mass content or any of those other things. So again, you know, I don't want to put doctors in a bad place, but they're only going on like, oh my goodness, this has potential for this. And we've seen this all the time in the pharmaceutical industry.
We've seen it with even some of the medications that are used for cholesterol. Well, they've They have other indications, some of the medications that are used for mental health. They have other FDA indications. I think the bigger conversation is kind of back to what this show is about. Let's chatter about health. Let's talk about what health actually means.
Yeah. So, Barry, okay, I know you have some insight here or some questions. So, all right, so let's go.
I'm getting a lot of tears here. I better say something. But I mean, I think everything here that we're saying is true. And one of the overlaying issues, from my perspective, is because obesity is so epidemic in our society, and it's multifactorial, as we've covered
on shows in particular for some of our people of color populations that live in areas where there's no nutritious food available, the food deserts, we kind of talked about that. So then you wind up getting more empty calories, not the protein, not the fiber, not all those good things. But I think you can't get away from this issue that you have an epidemic of obesity
And it's even worse with younger people today and some of the older populations. I think there's been a very slight decrease over the past few years in obesity rates. And then you have a disease that's also very prevalent in terms of type 2 diabetes. And then as Dr. Chaklis Hassan has talked about, the indications for use of GLP-1s has been expanding.
And, you know, so you wind up getting in a really tough situation where, you know, when I was in an active practice working with, you know, patients, you know, doing exercise and eating right is, you know, it sounds, you know, easy, but behaviorally, it's very difficult.
And part of it is actually genetic, not from the standpoint that obesity is genetic, but the human species was always driven that you're always on the edge of starvation. you know, in caveman and cavewoman times. And if food was available, you just eat as much as you can and build up your fat reserves because you know it's going to happen. And our genetics haven't changed with that.
So we're sort of at a very deep level. The idea of exercise and good nutrition is not easy to follow. And so this idea of the magic pill, the blockbuster, you know, medications that come out, this has had a significant impact. But I kind of, in Dr. Jackson's corner here, because as soon as you go off the medication, if you don't do these other things, the weight will just come back.
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