A fight is brewing between drug giants and compounding pharmacies that have seized on surging demand for obesity drugs.

Why it matters: The clash is testing the boundaries of a Food and Drug Administration policy that allows pharmacies to make versions of patented drugs like Eli Lilly's Zepbound and Novo Nordisk's Wegovy when there are shortages.

The big picture: Both regulated and unregulated compounders have raced to fill gaps in the supply chain with copies of GLP-1 drugs' active ingredients — semaglutide and tirzepatide — at a much lower price than the branded drugs.

• The compounders say they're improving access for people who have been prescribed GLP-1s for diabetes and obesity but are still scrambling to find the drugs.
• But it's created headaches for states that oversee compounding pharmacies, prompted consumer warnings from the Food and Drug Administration, and sparked multiple lawsuits from Lilly and Novo Nordisk seeking to protect their market share.
• One recent study found that nearly half of the online pharmacies selling anti-obesity drugs were doing so without a license from their state board of pharmacy.

Zoom in: Lilly announced last month its drugs were "commercially available" and pushed for compounders to stop producing and marketing their own versions of the active ingredient of its diabetes drug Mounjaro, as well as Zepbound.

• Lilly also recently announced a move to offer a cheaper version of Zepbound.

Yes, but: The drugs from Lilly and Novo are still on the FDA shortage list so compounders have continued producing GLP-1s.

• Even after the shortages get resolved, another regulatory pathway would allow compounders to continue making versions of GLP-1s.
• In such scenarios, a doctor can prescribe a compounded drug with a tweak — such as a different dosage, and added or subtracted ingredient — that they say would help a patient who'd otherwise suffer side effects like nausea.

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Mammography reports starting today will be required to include an assessment of breast density, and how dense tissue can make it harder to detect tumors and raises cancer risk.

Why it matters: About half of women over the age of 40 in the U.S. have dense breast tissue. The FDA directive is aimed at better communicating the need for further evaluation, or a repeat mammogram when appropriate.

State of play: 39 states and the District of Columbia already require some notification about breast density, but there's no standard for what mammography providers should communicate, per Dense Breast-Info, an educational website.

• The FDA first proposed updating federal standards last year, outlining four categories for assessing breast density. The update also calls for giving patients a "lay summary" that urges those with dense tissue to talk with their health providers and to seek follow-up imaging.
• Dense tissue not only makes it harder to detect a tumor, because they both appear white on a mammogram, but is strongly associated with higher breast cancer risk.

Yes, but: There are concerns that while follow-up tests may be able to find cancers that are missed on a mammogram, they could show false positive results.

• The demand for more tests and screenings could also drive up health spending.

The Affordable Care Act requires health plans to pay for an annual mammogram at no cost for women 40 and older.

About one in five U.S. COVID deaths during the Delta wave were because of overwhelmed hospital capacity, an analysis of data from 620 facilities showed.

Why it matters: The findings in Annals of Internal Medicine reinforce the need to minimize surges of patients during future health emergencies or staffing crises.

The big picture: Many hospitals across the country reported running out of intensive care unit beds as the Delta variant surged in the second half of 2021.

• Patients' odds of survival were reduced across all varieties of hospitals struggling with caseloads, regardless of the equipment available and even after adjustments for vaccination rates and other factors.
• Delta caused more than twice as many infections as previous variants and caused more severe disease than other variants in people who weren't vaccinated.

Between the lines: Policies to transfer more patients between nearby facilities when one gets overwhelmed can help avoid the pitfalls of surges, the researchers said.

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Blinking every 20 minutes and then looking at a point 20 feet away for 20 seconds can protect your eyes during long periods of screen time.

Why it matters: Data suggests we're spending more than 18 years of our adult lives online — and that's not great news for our eyeballs.

How it works: When we stare at a screen, we forget to blink and our eyes dry out. The 20-20-20 rule relaxes eye muscles and encourages hydrating blinks.

• "It affects us every decade of our life that we age more because the amount of tears we produce decreases," says Raj Maturi, spokesperson for the American Academy of Ophthalmology and ophthalmologist at Midwest Eye Institute in Indianapolis.

Caveat: There isn't extensive data to back up its benefits, but doctors endorse it as a good rule of thumb.

Blue light-blocking glasses, while popular, don't help with dry eyes, and doctors aren't impressed with them.

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