It’s often reported that underfunded public employee pension systems
create barriers to state and local governments’ ability to provide ample
public services like education, parks, and libraries. Too often
overlooked, however, is another looming fiscal challenge: the rising
costs of paying for health insurance for America’s retired public
employees.
The Federal Reserve estimates that the long-term liability for
providing medical coverage (technically called Other Post-Employment
Benefits, or OPEB) for retired public workers is over $1 trillion. These
retirement benefits vary widely across the country but can cover early
retirees who are ineligible for Medicare as well as older retirees on
Medicare. The costs of this coverage constrain what governments can do
to address pressing problems and have even contributed to a few cities
filing for bankruptcy.
The good news is that a few states have tackled the OPEB problem—and they provide lessons for others. Consider North Carolina.
The state had run up a staggering OPEB liability of $34.4 billion—or
$3,200 per resident. In 2017, the State Treasurer’s office found that
pensions and retiree health care were approaching 20% of the state’s
general fund budget—effectively “crowding out” other critical services.
Since the General Accounting Standards Board (GASB) now requires state
and local governments to report these liabilities in their annual
financial reports, officials were worried about the impression this gave
about the state’s fiscal health.
Rather than wait for a crisis, North Carolina took steps to phase out
its retiree medical costs in an orderly and predictable fashion. First,
in 2006, it raised the required years of service to qualify for retiree
health care from five to 20 years. Second, in 2017, the state
eliminated health insurance benefits for retirees hired after Jan. 1,
2021.
The result will be a steady decline in the number of workers
qualifying for OPEB over the next two decades until it reaches zero in
2041. The state will begin to realize budget savings over the next
decade and can then either spend those savings productively or return
them to taxpayers. Either bodes well for North Carolina’s fiscal
sustainability and economic climate.
North Carolina demonstrates that the politics of reforming retiree
medical coverage can be overcome. The problem is that to reform OPEB and
the fiscal drain it represents, governments or workers must make
greater financial contributions to the plans, or benefits must be cut.
Yet neither governments nor workers want to pay more—and of course
workers don’t want their benefits cut. Reform has thus proved
intractable in many states.
North Carolina’s approach was especially effective because it
eliminated benefits only for new hires. Current workers are not losing
anything that was promised to them when they were hired, which helped
the state avoid a confrontation with public employee unions.
Furthermore, cutting retiree health benefits is hardly as draconian
as it sounds. First, few workers actually stay on the job long enough to
qualify for these benefits. In other words, retiree health care is a
promised benefit that few workers ever enjoy. Second, many employees who
retire before they are eligible for Medicare now have alternatives
through the Obamacare exchanges—and some may be able to secure coverage
through their spouse or new employment in the private sector.
Third, alternatives to government health care plans exist to allow
employees to keep their benefits. Public employees or their unions could
create Retiree Medical Trusts (RMTs), which are defined-contribution
plans for medical benefits. These trusts would be run by and for their
beneficiaries, thus offering greater autonomy and control. Police and
firefighters in several West Coast states have already initiated such
programs.
North Carolina’s experiment can serve as a model for other states in
similar fiscal and political circumstances. States that are home to high
retiree medical liabilities and relatively weak public sector unions
are especially well-positioned to emulate North Carolina’s OPEB reforms.
These include Alabama, Georgia, South Carolina, and Texas.
State and local governments should consider the trade-off of retiree
health care. Only a small slice of employees spend their entire careers
in public service in the same state to qualify for benefits, and there
is limited evidence that these benefits help governments attract and
retain a high-quality workforce. Meanwhile, by reducing and ultimately
eliminating these benefits, states and localities will be able to
provide better services to their residents, improve their bond ratings,
and enhance their business climate. The benefits of OPEB are clearly
outweighed by its outsize cost. Other states should look to North
Carolina and stop putting off this critical reform.
Daniel DiSalvo is a senior fellow at the Manhattan Institute,
a conservative think tank, and a professor of political science at the
City College of New York-CUNY. He is the author of the recent report
“North Carolina’s OPEB Experiment: Defusing the State Debt Bomb.”
https://www.marketwatch.com/story/want-a-relatively-painless-way-to-curb-retiree-health-care-costs-look-to-north-carolina-2020-02-06
Sunday, February 9, 2020
January price increases confirm slowing drug inflation
- Big pharmaceutical companies raised list prices an average of 5% in their annual January adjustments, the smallest increase since at least 2014, according to analysts from the investment bank Raymond James. The analysis comes ahead of President Donald Trump’s State of the Union address, where he is expected to announce a new drug-price control initiative.
- The bank’s analysis, based on data from IQVIA and Wolters Kluwers, found big pharma is raising prices of more drugs than they were in the era of double-digit price hikes, with 2,227 having gone up in January.
- The U.S. government’s measures show drug prices overall have been flat or even in decline. While the bank’s analysis doesn’t back up that finding, it does confirm a picture of moderating price inflation, likely due to payer and public pressure.
However, it is a useful indicator of the expected level of net price increases. While drugmakers increase prices throughout the year, a declining number are being announced after January, making the early-year hikes the key barometer.
Since 2014, January price increases from 25 big companies have declined steadily from 12% to 5.2% in 2019. The declining trend has coincided with a rising concern about drug prices first triggered by the launch of hepatitis C cures at $1,000 per pill. It has been carried on by expensive life-extending cancer cell therapies and gene therapies whose price tags exceed $1 million.
“Given the transparency the public and the government is continually seeking from the industry, combined with administration initiatives to slow the rate of list price increase levels, WAC list price increases should continue to trend toward the low to mid-single digits with longer-term potential to reach levels consistent with changes in overall inflation metrics,” Wilbur wrote.
Big pharma January price increases by year.
| Year | Mean price increase | Total number of price increases |
|---|---|---|
| 2014 | 12% | 1,579 |
| 2015 | 11% | 1,872 |
| 2016 | 9% | 2,025 |
| 2017 | 8% | 2,132 |
| 2018 | 8% | 2,383 |
| 2019 | 6% | 2,103 |
| 2020 | 5% | 2,227 |
SOURCE: Raymond James, IQVIA, Wolters Kluwers
In January, the company with the biggest average price increase was, surprisingly, generics giant Teva Pharmaceuticals, at 6.4% over 36 products. The smallest was AstraZeneca at 2.8% over 31 drugs.
Pfizer raised prices on the most drugs, 226, yielding a mean increase of 5.1%. Subsidiary Hospira was counted as a separate line item in this analysis — it raised prices on 26 products. Spanish blood-products specialist Grifols raised on the least, with a 3.4% increase.
The Trump administration has promised to bring drug price inflation down even more, although it has struggled to implement initiatives like banning drug price rebates in Medicare and Medicaid and forcing pharmaceutical manufacturers to show list prices in direct-to-consumer advertisements.
In Tuesday night’s State of the Union address, Trump is expected to announce a regulation to bring physician-administered injectable drugs more in line with international prices through a Medicare competitive bidding program.
https://www.biopharmadive.com/news/january-drug-price-increase-trump-state-union/571676/
Bright idea in dentist’s office leads to innovative smoking cessation project
While sitting in the dentist’s office, Hollings Cancer Center
researcher Matthew Carpenter, Ph.D., of the Medical University of South
Carolina, had a bright idea.
As he received his goody bag with dental hygiene products, he wondered why not conduct a study and have primary care providers do the same thing for their patients who use tobacco. The bags would contain educational material, free lozenges and tobacco cessation medications to encourage people to stop smoking.
Results from the study, recently published online in Addiction, weren’t surprising to Carpenter. He and colleagues found providing smokers with a free, two?week starter kit of nicotine replacement therapy (NRT) increased quit attempts, use of stop smoking medications, and smoking abstinence as compared with standard care in a primary care setting.
“Not a day went by in this study when I was not excited by it because I knew that we were having an impact on real patients in the real world with their doctors,” Carpenter said. “This gets the patients to know that their doctor cares, and they have something they can use right now.”
Carpenter believes a smoker’s annual visit to the doctor creates the perfect window of opportunity for a physician to provide a quick intervention, while providing tools to help smokers begin the process of quitting. Along with advice on why and how a patient should stop smoking, a person should be able to walk away with a product they can use immediately to try and stop their dependence on nicotine.
“About 70 percent of smokers will see their primary care providers on a yearly basis,” Carpenter said. “It’s a clinical encounter to do something, but I think we can offer them tools other than words.”
In the U.S., 34 million adults currently smoke cigarettes and nearly 70 percent of U.S. adults who smoke say they want to quit, according to the 2020 Surgeon General’s Report.
The $2 million study, Tobacco Intervention in Primary Care: Treatment Opportunities for Providers, also known as Tip Top, included 22 clinics throughout South Carolina and was conducted in collaboration with the National Institute of Drug Abuse (NIDA). A total of 1,245 patients participated in the study.
The study included 652 patients from 12 of the clinics who only received advice on the importance of quitting smoking. The remaining 593 patients at 10 clinics were provided with samples of medication to use including nicotine patches and lozenges. During the study, all smokers were advised to quit through a regular conversation with their physician.
They also received information and resources to help them quit smoking and information about Quitline, a tobacco cessation service available through a toll-free telephone number.
Carpenter said that the study was well-received by primary care providers, who welcomed the goody bag as a conversation starter. “The doctors are giving something that is concrete and immediately actionable,” Carpenter said. “The patient can go home and use the products that day.”
During this study, 26 percent of patients who received the NRT samples achieved at least one week without smoking. “If you can achieve seven days in a row of not smoking, I’m going to call that success,” Carpenter said.
The study also found that 12 percent of patients were quit at final follow-up (six months). While this may seem a modest amount, it’s more than 150 patients who potentially will save thousands in medical costs if they are able to quit smoking, all for just the cost of a $70 intervention. “That has to be cost-effective no matter you slice it,” says Carpenter.
On average, it takes a patient seven to 10 attempts of trying to quit smoking before becoming successful, so interventions such as this can be helpful in the process. Even for the smokers who didn’t use the products, it planted a seed, he said.
An interesting finding during this study showed that the smoking cessation bags with information and medication were more beneficial to patients who had a lower income, lower education or if they were in the more rural areas of the state. The finding on income, education, and rurality is an area Carpenter would like to study more in the future.
“It’s about access,” Carpenter said. “We’re helping people who are struggling out there to find and succeed in treatment.”
Given the toll of smoking-related health conditions, Carpenter said he hopes insurance companies will see the value and provide funding in the future so that primary care physicians could offer this to their patients. The concept also could be used for smokers who are leaving the hospital, or even those who have been incarcerated.
“These samples can be given out almost universally – even to smokers who may not want to quit and who may not yet be ready to try medications,” Carpenter said. “It’s a pragmatic and brief intervention that takes minutes to deliver and is scalable as an intervention to be used a variety of settings.”
Smoking cessation reduces the risk of twelve cancers, including cancers of the lung; larynx; oral cavity and pharynx; esophagus; pancreas; bladder; stomach; colon and rectum; liver; cervix; kidney; and acute myeloid leukemia.
Carpenter said the intervention provides patients a starting point to their journey of becoming smoke-free and it’s simple to use for primary care providers, who don’t feel pressured to have a long lecture. They can just offer their patients support.
“This is about cancer prevention. Smoking cessation is cancer prevention,” Carpenter said.
https://www.eurekalert.org/pub_releases/2020-02/muos-bii020720.php
As he received his goody bag with dental hygiene products, he wondered why not conduct a study and have primary care providers do the same thing for their patients who use tobacco. The bags would contain educational material, free lozenges and tobacco cessation medications to encourage people to stop smoking.
Results from the study, recently published online in Addiction, weren’t surprising to Carpenter. He and colleagues found providing smokers with a free, two?week starter kit of nicotine replacement therapy (NRT) increased quit attempts, use of stop smoking medications, and smoking abstinence as compared with standard care in a primary care setting.
“Not a day went by in this study when I was not excited by it because I knew that we were having an impact on real patients in the real world with their doctors,” Carpenter said. “This gets the patients to know that their doctor cares, and they have something they can use right now.”
Carpenter believes a smoker’s annual visit to the doctor creates the perfect window of opportunity for a physician to provide a quick intervention, while providing tools to help smokers begin the process of quitting. Along with advice on why and how a patient should stop smoking, a person should be able to walk away with a product they can use immediately to try and stop their dependence on nicotine.
“About 70 percent of smokers will see their primary care providers on a yearly basis,” Carpenter said. “It’s a clinical encounter to do something, but I think we can offer them tools other than words.”
In the U.S., 34 million adults currently smoke cigarettes and nearly 70 percent of U.S. adults who smoke say they want to quit, according to the 2020 Surgeon General’s Report.
The $2 million study, Tobacco Intervention in Primary Care: Treatment Opportunities for Providers, also known as Tip Top, included 22 clinics throughout South Carolina and was conducted in collaboration with the National Institute of Drug Abuse (NIDA). A total of 1,245 patients participated in the study.
The study included 652 patients from 12 of the clinics who only received advice on the importance of quitting smoking. The remaining 593 patients at 10 clinics were provided with samples of medication to use including nicotine patches and lozenges. During the study, all smokers were advised to quit through a regular conversation with their physician.
They also received information and resources to help them quit smoking and information about Quitline, a tobacco cessation service available through a toll-free telephone number.
Carpenter said that the study was well-received by primary care providers, who welcomed the goody bag as a conversation starter. “The doctors are giving something that is concrete and immediately actionable,” Carpenter said. “The patient can go home and use the products that day.”
During this study, 26 percent of patients who received the NRT samples achieved at least one week without smoking. “If you can achieve seven days in a row of not smoking, I’m going to call that success,” Carpenter said.
The study also found that 12 percent of patients were quit at final follow-up (six months). While this may seem a modest amount, it’s more than 150 patients who potentially will save thousands in medical costs if they are able to quit smoking, all for just the cost of a $70 intervention. “That has to be cost-effective no matter you slice it,” says Carpenter.
On average, it takes a patient seven to 10 attempts of trying to quit smoking before becoming successful, so interventions such as this can be helpful in the process. Even for the smokers who didn’t use the products, it planted a seed, he said.
An interesting finding during this study showed that the smoking cessation bags with information and medication were more beneficial to patients who had a lower income, lower education or if they were in the more rural areas of the state. The finding on income, education, and rurality is an area Carpenter would like to study more in the future.
“It’s about access,” Carpenter said. “We’re helping people who are struggling out there to find and succeed in treatment.”
Given the toll of smoking-related health conditions, Carpenter said he hopes insurance companies will see the value and provide funding in the future so that primary care physicians could offer this to their patients. The concept also could be used for smokers who are leaving the hospital, or even those who have been incarcerated.
“These samples can be given out almost universally – even to smokers who may not want to quit and who may not yet be ready to try medications,” Carpenter said. “It’s a pragmatic and brief intervention that takes minutes to deliver and is scalable as an intervention to be used a variety of settings.”
Smoking cessation reduces the risk of twelve cancers, including cancers of the lung; larynx; oral cavity and pharynx; esophagus; pancreas; bladder; stomach; colon and rectum; liver; cervix; kidney; and acute myeloid leukemia.
Carpenter said the intervention provides patients a starting point to their journey of becoming smoke-free and it’s simple to use for primary care providers, who don’t feel pressured to have a long lecture. They can just offer their patients support.
“This is about cancer prevention. Smoking cessation is cancer prevention,” Carpenter said.
https://www.eurekalert.org/pub_releases/2020-02/muos-bii020720.php
First-of-kind hydrogel platform allows on-demand production of meds, chemicals
A team of chemical engineers has developed a new way to produce
medicines and chemicals on demand and preserve them using portable
“biofactories” embedded in water-based gels called hydrogels. The
approach could help people in remote villages or on military missions,
where the absence of pharmacies, doctor’s offices or even basic
refrigeration makes it hard to access critical medicines, daily use
chemicals and other small-molecule compounds.
Led by Hal Alper, professor at The University of Texas at Austin’s Cockrell School of Engineering, in collaboration with chemist Alshakim Nelson and his research group at the University of Washington, this first-of-its-kind system effectively embeds microbial biofactories — cells bioengineered to overproduce a product — into the solid support of a hydrogel, allowing for portability and optimized production. It is the first hydrogel-based system to organize both individual microbes and consortia for in-the-moment production of high-value chemical feedstocks, used for processes such as fuel production, and pharmaceuticals. Products can be produced within a couple of hours to a couple of days.
The team describes their new approach in the Feb. 4 issue of Nature Communications.
“We have taken a completely different angle for fermentation by utilizing hydrogels,” said Alper, whose research expertise is focused in biotechnology and cellular engineering. “Many of the chemicals, fuels, nutraceuticals and pharmaceuticals we use rely on traditional fermentation technology. Our technology addresses a strong limitation in the fields of synthetic biology and bioprocessing, namely the ability to provide a means for both on-demand and repeated-use production of chemicals and antibiotics from both mono- and co-cultures.”
As a crosslinked polymer, the hydrogel used in this work can be 3D printed or manually extruded. The gel material, along with the cells inside, can flow like a liquid and then harden upon exposure to UV light. Molecularly, the resulting polymer network is large enough for molecules and proteins to move through it, but the space is too small for cells to leak out.
The team also found that by lyophilizing, or freeze-drying, the hydrogel system, it can effectively preserve the fermentation capacity of the biofactories until needed in the future. The result of the freeze-drying somewhat resembles an ancient mummy, shriveled up but well-preserved. To revive the hydrogel and enable the production of the chemical or pharmaceutical, one would simply add water, sugar and/or some other basic nutrients, and the cells will then convert into the product just as effectively as before the preservation process.
One of the novel aspects enabled by this platform is the ability to combine multiple different organisms, called consortia, together in a way that outperforms traditional, large-scale bioreactors. In particular, this system enables a plug-and-play approach to combining and optimizing chemical production. For example, if one set of enzymes works best in the bacteria E. coli, while the other works best in the yeast S. cerevisiae, the two organisms can work together to more efficiently go straight to the product. The research team tested both of these organisms.
This platform has the added benefit of multitasking, keeping different types of cells separated while they grow, preventing one from taking over and killing off the others. Likewise, by testing a range of temperatures, the team was able to control the dynamics of the system, keeping the growth of multiple cell types balanced.
Finally, the team was able to show continuous, repeated use of the system (with yeast cells) over the course of an entire year without a decrease in yields, indicating the sustainability of the process over time.
Medicines such as antibiotics have a certain shelf life and require particular storage conditions. The portability of the biofactory to make these molecules makes the hydrogel system especially useful in remote places, without access to refrigeration to store medications. It would also be a small and compact way to maintain access to several medications and other essential chemicals when there is no access to a pharmacy or a store, like during a military mission or a mission to Mars. Although not quite there yet, the possibilities are promising.
“This technology can be applied to a wide range of products and cell types. We see engineers and scientists being able to plug and play with different consortia of cells to produce diverse products that are needed for a specific scenario,” Alper said. “That’s part of what makes this technology so exciting.”
https://www.eurekalert.org/pub_releases/2020-02/uota-fhp020320.php
Led by Hal Alper, professor at The University of Texas at Austin’s Cockrell School of Engineering, in collaboration with chemist Alshakim Nelson and his research group at the University of Washington, this first-of-its-kind system effectively embeds microbial biofactories — cells bioengineered to overproduce a product — into the solid support of a hydrogel, allowing for portability and optimized production. It is the first hydrogel-based system to organize both individual microbes and consortia for in-the-moment production of high-value chemical feedstocks, used for processes such as fuel production, and pharmaceuticals. Products can be produced within a couple of hours to a couple of days.
The team describes their new approach in the Feb. 4 issue of Nature Communications.
“We have taken a completely different angle for fermentation by utilizing hydrogels,” said Alper, whose research expertise is focused in biotechnology and cellular engineering. “Many of the chemicals, fuels, nutraceuticals and pharmaceuticals we use rely on traditional fermentation technology. Our technology addresses a strong limitation in the fields of synthetic biology and bioprocessing, namely the ability to provide a means for both on-demand and repeated-use production of chemicals and antibiotics from both mono- and co-cultures.”
As a crosslinked polymer, the hydrogel used in this work can be 3D printed or manually extruded. The gel material, along with the cells inside, can flow like a liquid and then harden upon exposure to UV light. Molecularly, the resulting polymer network is large enough for molecules and proteins to move through it, but the space is too small for cells to leak out.
The team also found that by lyophilizing, or freeze-drying, the hydrogel system, it can effectively preserve the fermentation capacity of the biofactories until needed in the future. The result of the freeze-drying somewhat resembles an ancient mummy, shriveled up but well-preserved. To revive the hydrogel and enable the production of the chemical or pharmaceutical, one would simply add water, sugar and/or some other basic nutrients, and the cells will then convert into the product just as effectively as before the preservation process.
One of the novel aspects enabled by this platform is the ability to combine multiple different organisms, called consortia, together in a way that outperforms traditional, large-scale bioreactors. In particular, this system enables a plug-and-play approach to combining and optimizing chemical production. For example, if one set of enzymes works best in the bacteria E. coli, while the other works best in the yeast S. cerevisiae, the two organisms can work together to more efficiently go straight to the product. The research team tested both of these organisms.
This platform has the added benefit of multitasking, keeping different types of cells separated while they grow, preventing one from taking over and killing off the others. Likewise, by testing a range of temperatures, the team was able to control the dynamics of the system, keeping the growth of multiple cell types balanced.
Finally, the team was able to show continuous, repeated use of the system (with yeast cells) over the course of an entire year without a decrease in yields, indicating the sustainability of the process over time.
Medicines such as antibiotics have a certain shelf life and require particular storage conditions. The portability of the biofactory to make these molecules makes the hydrogel system especially useful in remote places, without access to refrigeration to store medications. It would also be a small and compact way to maintain access to several medications and other essential chemicals when there is no access to a pharmacy or a store, like during a military mission or a mission to Mars. Although not quite there yet, the possibilities are promising.
“This technology can be applied to a wide range of products and cell types. We see engineers and scientists being able to plug and play with different consortia of cells to produce diverse products that are needed for a specific scenario,” Alper said. “That’s part of what makes this technology so exciting.”
###
The research was funded by the Camille and Henry Dreyfus Foundation,
University of Washington CoMotion and the Royalty Research Fund.https://www.eurekalert.org/pub_releases/2020-02/uota-fhp020320.php
Portable lab you plug into your phone can diagnose illnesses like coronavirus
Engineers with the University of Cincinnati have created a tiny
portable lab that plugs into your phone, connecting it automatically to a
doctor’s office through a custom app UC developed.
The lab the size of a credit card can diagnose infectious diseases such as coronavirus, malaria, HIV or Lyme disease or countless other health conditions like depression and anxiety.
The patient simply puts a single-use plastic lab chip into his or her mouth then plugs that into a slot in the box to test the saliva.
The device automatically transmits results to the patient’s doctor through a custom app UC created for nearly instant results.
UC professor Chong Ahn and his research team used the smartphone device to test for malaria. But the device could be used for smart point of care testing for countless chronic or infectious diseases or to measure hormones related to stress.
“Right now it takes several hours or even days to diagnose in a lab, even when people are showing symptoms. The disease can spread,” Ahn said.
The study was published in the Nature journal Microsystems & Nanoengineering.
His research team created a novel lab chip that uses natural capillary action, the tendency for a liquid to adhere to a surface, to draw a sample down two channels called a “microchannel capillary flow assay.” One channel mixes the sample with freeze-dried detection antibodies. The other contains a freeze-dried luminescent material to read the results when the split samples combine again on three sensors.
Ahn said the device is accurate, simple to use and inexpensive.
“The performance is comparable to laboratory tests. The cost is cheaper. And it’s user-friendly,” Ahn said. “We wanted to make it simple so anyone could use it without training or support.”
UC doctoral student Sthitodhi Ghosh, the study’s lead author, said the biggest advancement in the device is in the novel design of its tiny channels that naturally draw the sample through the sensor arrays using capillary flow. Ahn is Ghosh’s Ph.D. advisor.
“The entire test takes place on the chip automatically. You don’t have to do anything. This is the future of personal healthcare,” Ghosh said.
While the device has applications for diagnosing or monitoring viruses or other diseases, Ahn said he sees potential in the field of mental health, where doctors already utilize smartphones to help track the wellness of patients.
https://www.eurekalert.org/pub_releases/2020-02/uoc-ply020620.php
The lab the size of a credit card can diagnose infectious diseases such as coronavirus, malaria, HIV or Lyme disease or countless other health conditions like depression and anxiety.
The patient simply puts a single-use plastic lab chip into his or her mouth then plugs that into a slot in the box to test the saliva.
The device automatically transmits results to the patient’s doctor through a custom app UC created for nearly instant results.
UC professor Chong Ahn and his research team used the smartphone device to test for malaria. But the device could be used for smart point of care testing for countless chronic or infectious diseases or to measure hormones related to stress.
“Right now it takes several hours or even days to diagnose in a lab, even when people are showing symptoms. The disease can spread,” Ahn said.
The study was published in the Nature journal Microsystems & Nanoengineering.
His research team created a novel lab chip that uses natural capillary action, the tendency for a liquid to adhere to a surface, to draw a sample down two channels called a “microchannel capillary flow assay.” One channel mixes the sample with freeze-dried detection antibodies. The other contains a freeze-dried luminescent material to read the results when the split samples combine again on three sensors.
Ahn said the device is accurate, simple to use and inexpensive.
“The performance is comparable to laboratory tests. The cost is cheaper. And it’s user-friendly,” Ahn said. “We wanted to make it simple so anyone could use it without training or support.”
UC doctoral student Sthitodhi Ghosh, the study’s lead author, said the biggest advancement in the device is in the novel design of its tiny channels that naturally draw the sample through the sensor arrays using capillary flow. Ahn is Ghosh’s Ph.D. advisor.
“The entire test takes place on the chip automatically. You don’t have to do anything. This is the future of personal healthcare,” Ghosh said.
While the device has applications for diagnosing or monitoring viruses or other diseases, Ahn said he sees potential in the field of mental health, where doctors already utilize smartphones to help track the wellness of patients.
https://www.eurekalert.org/pub_releases/2020-02/uoc-ply020620.php
I was lucky to get post-23andMe genetic counseling. All should have that option
A year
ago, I was shivering in the pre-op room at Cedars-Sinai Medical Center
waiting to be wheeled into surgery for a mastectomy. What led me there
was my spitting into a tube, like millions of others have done, and sending off my DNA to be analyzed.
The results shocked and devastated me. They showed I have a mutation in the BRCA1 gene that puts me at an incredibly high risk of developing breast and ovarian cancer. The mastectomy would reduce my chance of developing breast cancer from as high as 72% to almost nothing. A few months earlier, I had surgery to remove my ovaries.
As terrified as I was at that moment, I also felt incredibly lucky.
I was lucky that I had opted to take the test. I was lucky that the
mutation I have, which is one of roughly 1,000 possible BRCA mutations,
is one of the three that 23andMe tests for. Otherwise I might not have
known about that mutation for years, possibly until after I had been
diagnosed with cancer. And I was very lucky that once I got my results, I
was able to quickly get genetic counseling from a professional.
Genetic tests are becoming increasingly routine. While their market growth has slowed recently (23andMe laid off 14% of its workforce in January), more than 26 million people have already taken such at-home tests. Like me, many of those people will get scary results.
Results like what I received from 23andMe can be difficult to understand. Although the online service offers plenty of tutorials and explainer videos, those don’t feel like enough when faced with a serious health situation. I still had many questions. Did the results mean I would definitely get cancer? Were there other parts of my DNA that were keeping me safe? What was my next step? Was surgery inevitable?
To answer these questions, I needed more than a tutorial. I needed a genetic counselor — a human being to hear my questions and give me guidance based on deep knowledge.
Fortunately, I was able to connect with a counselor just a few days after I received my 23andMe results. The first thing she told me was that I needed to take a second test to confirm the results, though she also gently let me know that the 23andMe test was FDA approved and the second test would most likely confirm its results.
While my doctors gave me medical advice about my options for surgery versus surveillance, my genetic counselor gave me much-needed support. She explained the science behind my mutation. (BRCA genes, I learned, actually repress tumors. When they mutate, tumors can grow more easily.) She walked me through what I could expect to hear from my different doctors and, maybe most importantly, she offered a sympathetic ear.
For most people, there’s a large gap between access to at-home genetic tests and access to genetic counseling. Anyone with a few extra dollars can order a test online and get their results fairly quickly. But finding someone to help interpret those results can be expensive when insurance doesn’t cover counseling. It can also take weeks to get an appointment and, in some communities, it may be impossible. There are only 5,000 certified genetic counselors in the U.S. That’s one for every 65,440 people. Many states, including Wyoming, Mississippi, and Vermont, have fewer than five genetic counselors for the entire state.
If the Bureau of Labor Statistics is right, that should start to change. It anticipates a growth rate of 27% for genetic counselors between 2018 and 2028, a faster rate than most industries. Some in the genetic counseling field put the growth rate closer to 80%.
But more genetic counselors won’t necessarily guarantee more access. Right now, Medicaid and Medicare pay for genetic testing and genetic counseling only when it is initially recommended by a physician currently caring for the patient.
That means if a physician recommends a genetic test and works with a genetic counselor to help interpret the results, Medicaid and Medicare will cover the cost. But if you take the 23andMe, Ancestry.com, or other direct-to-consumer test and then seek genetic counseling, you will be on the hook for the cost, which will likely amount to more than you paid for the test.
You could, of course, take the results to your doctor, who could then recommend further testing in order to get the genetic counseling part covered. But many doctors today feel unprepared to work with patients at high risk of genetic conditions and are not confident in their ability to interpret results of genetic testing. So as at-home genetic tests proliferate, patients are dropping into a deep knowledge chasm that could affect their physical and mental health as they struggle to understand how to deal with the results.
A bill currently making its way through Congress, the Access to Genetic Counselor Services Act of 2019 (H.R. 3235), could change that. If passed, the bill would pay for people who have concerns to see a genetic counselor without needing to wait for a referral from a doctor. That means someone who had questions about an at-home test result could reach out to a knowledgeable expert with the reassurance that the visit would be covered by insurance.
While some insurers already cover genetic counseling in certain circumstances, this bill (which would apply only to people on Medicare) would go a long way toward encouraging all insurers to cover it. In the long run, this can save insurance companies money. Having surgery last year meant that I don’t need an annual breast MRI, which is standard (and expensive) practice for people with BRCA1 mutations. I’m also now unlikely to get breast or ovarian cancer, which will save my insurance company hundreds of thousands of dollars down the road.
It’s time to close the gap between the genetic information that’s easily available to people and the genetic information that they really need. Genetic counselors are the key.
Dorothy Pomerantz, is the managing editor at FitchInk, a boutique content firm, and the former Los Angeles bureau chief for Forbes.
The results shocked and devastated me. They showed I have a mutation in the BRCA1 gene that puts me at an incredibly high risk of developing breast and ovarian cancer. The mastectomy would reduce my chance of developing breast cancer from as high as 72% to almost nothing. A few months earlier, I had surgery to remove my ovaries.
As terrified as I was at that moment, I also felt incredibly lucky.
Genetic tests are becoming increasingly routine. While their market growth has slowed recently (23andMe laid off 14% of its workforce in January), more than 26 million people have already taken such at-home tests. Like me, many of those people will get scary results.
Results like what I received from 23andMe can be difficult to understand. Although the online service offers plenty of tutorials and explainer videos, those don’t feel like enough when faced with a serious health situation. I still had many questions. Did the results mean I would definitely get cancer? Were there other parts of my DNA that were keeping me safe? What was my next step? Was surgery inevitable?
To answer these questions, I needed more than a tutorial. I needed a genetic counselor — a human being to hear my questions and give me guidance based on deep knowledge.
Fortunately, I was able to connect with a counselor just a few days after I received my 23andMe results. The first thing she told me was that I needed to take a second test to confirm the results, though she also gently let me know that the 23andMe test was FDA approved and the second test would most likely confirm its results.
While my doctors gave me medical advice about my options for surgery versus surveillance, my genetic counselor gave me much-needed support. She explained the science behind my mutation. (BRCA genes, I learned, actually repress tumors. When they mutate, tumors can grow more easily.) She walked me through what I could expect to hear from my different doctors and, maybe most importantly, she offered a sympathetic ear.
For most people, there’s a large gap between access to at-home genetic tests and access to genetic counseling. Anyone with a few extra dollars can order a test online and get their results fairly quickly. But finding someone to help interpret those results can be expensive when insurance doesn’t cover counseling. It can also take weeks to get an appointment and, in some communities, it may be impossible. There are only 5,000 certified genetic counselors in the U.S. That’s one for every 65,440 people. Many states, including Wyoming, Mississippi, and Vermont, have fewer than five genetic counselors for the entire state.
If the Bureau of Labor Statistics is right, that should start to change. It anticipates a growth rate of 27% for genetic counselors between 2018 and 2028, a faster rate than most industries. Some in the genetic counseling field put the growth rate closer to 80%.
But more genetic counselors won’t necessarily guarantee more access. Right now, Medicaid and Medicare pay for genetic testing and genetic counseling only when it is initially recommended by a physician currently caring for the patient.
That means if a physician recommends a genetic test and works with a genetic counselor to help interpret the results, Medicaid and Medicare will cover the cost. But if you take the 23andMe, Ancestry.com, or other direct-to-consumer test and then seek genetic counseling, you will be on the hook for the cost, which will likely amount to more than you paid for the test.
You could, of course, take the results to your doctor, who could then recommend further testing in order to get the genetic counseling part covered. But many doctors today feel unprepared to work with patients at high risk of genetic conditions and are not confident in their ability to interpret results of genetic testing. So as at-home genetic tests proliferate, patients are dropping into a deep knowledge chasm that could affect their physical and mental health as they struggle to understand how to deal with the results.
A bill currently making its way through Congress, the Access to Genetic Counselor Services Act of 2019 (H.R. 3235), could change that. If passed, the bill would pay for people who have concerns to see a genetic counselor without needing to wait for a referral from a doctor. That means someone who had questions about an at-home test result could reach out to a knowledgeable expert with the reassurance that the visit would be covered by insurance.
While some insurers already cover genetic counseling in certain circumstances, this bill (which would apply only to people on Medicare) would go a long way toward encouraging all insurers to cover it. In the long run, this can save insurance companies money. Having surgery last year meant that I don’t need an annual breast MRI, which is standard (and expensive) practice for people with BRCA1 mutations. I’m also now unlikely to get breast or ovarian cancer, which will save my insurance company hundreds of thousands of dollars down the road.
It’s time to close the gap between the genetic information that’s easily available to people and the genetic information that they really need. Genetic counselors are the key.
Dorothy Pomerantz, is the managing editor at FitchInk, a boutique content firm, and the former Los Angeles bureau chief for Forbes.
I was fortunate to get post-23andMe genetic counseling. Everyone should have that option
Renowned HIV Researcher Frank Plummer Dies Suddenly at 67
The University of Manitoba (UM) community and fellow clinicians and
colleagues around the world are mourning the death of Francis (Frank)
Plummer, MD, a widely known scientist, academic, and trailblazing HIV/AIDS researcher.
Plummer, 67, died in Nairobi, Kenya, on Tuesday, where he was celebrating the 40th anniversary of the Manitoba/Kenya research collaboration, according to the university. The BBC reports that he died of a heart attack.
The Canadian Broadcasting Corporation (CBC) reported that Plummer was a keynote speaker at the annual meeting of the University of Nairobi’s collaborative center for research and training in HIV/AIDS/STIs. The news organization reported that Plummer collapsed at the meeting and was pronounced dead at a hospital in Nairobi.
The University of Manitoba said that Plummer, an UM alumnus, was senior scientific advisor of the Public Health Agency of Canada, director general of the Centre for Infectious Disease Prevention and Control in Ottawa, and scientific director general of the National Microbiology Laboratory in Winnipeg.
“He was admired and regarded highly by academics and researchers around the world, and his legacy of seeking to develop an HIV vaccine remains one of the landmarks of infectious disease prevention,” David Barnard, UM president and vice-chancellor, said in a news release.
The BBC reported that Plummer was also recognized for his leadership during the Severe Acute Respiratory Syndrome (SARS), H1N1 flu, and Ebola epidemics.
“When I trained as an aspiring HIV epidemiologist in Canada, Frank Plummer was one of about four infectious disease epidemiologists who were experts on HIV. His work was an inspiration to me as I decided to specialize as an HIV epidemiologist. Frank was known for his inventive out-of-the-box thinking that inspired novel HIV prevention research, which included the hypothesis that there was a subset of female sex workers who remained uninfected despite being continuously exposed.”
According to the UM release, the research involving that group of women in Kenya was perhaps his most widely known scientific contribution.
“(Plummer) focused on their immune systems and genetics to identify the basis for this resistance, and the project provided vital new information for HIV vaccine and drug development. Today, global interventions and campaigns have been built on his work,” the university noted.
“As an epidemiologist, he never forgot that behind each data point, there was a person who had a story, and he was one of the few that took the time to listen,” Strathdee said.
The BBC also reported that Plummer “had recently spoken publicly
about undergoing experimental brain surgery to treat alcoholism.”
Plummer praised the positive results of the procedure, deep brain stimulation.
“Dr Plummer said the surgery had given him a new lease on life after a series of health problems had forced him to confront his battle with alcohol addiction,” the BBC reported.
A former student and then colleague, Keith Fowke, PhD, head of medical microbiology and infectious diseases at UM, said in a statement to the university, “Frank’s work was highly innovative and saved hundreds of thousands of lives. He was an outstanding and world-class researcher who was a dear colleague, mentor and friend to many of us lucky enough to work with him, and beside him.”
Fowke told the CBC that the research partnership between the University of Manitoba and the University of Nairobi was established when there was little global awareness of HIV/AIDS. Through the partnership, Plummer’s team discovered that HIV could be passed on to women or to babies through breast milk.
“He helped to identify a lot of the key factors that are involved in HIV transmission in the early days,” Fowke said.
Among Plummer’s awards were the Order of Canada, one of the country’s highest honors, and the Canada Gairdner Wightman Award, which recognizes work that has had a significant impact on health outcomes in the developing world.
https://www.medscape.com/viewarticle/924966
Plummer, 67, died in Nairobi, Kenya, on Tuesday, where he was celebrating the 40th anniversary of the Manitoba/Kenya research collaboration, according to the university. The BBC reports that he died of a heart attack.
The Canadian Broadcasting Corporation (CBC) reported that Plummer was a keynote speaker at the annual meeting of the University of Nairobi’s collaborative center for research and training in HIV/AIDS/STIs. The news organization reported that Plummer collapsed at the meeting and was pronounced dead at a hospital in Nairobi.
The University of Manitoba said that Plummer, an UM alumnus, was senior scientific advisor of the Public Health Agency of Canada, director general of the Centre for Infectious Disease Prevention and Control in Ottawa, and scientific director general of the National Microbiology Laboratory in Winnipeg.
The BBC reported that Plummer was also recognized for his leadership during the Severe Acute Respiratory Syndrome (SARS), H1N1 flu, and Ebola epidemics.
“Out-of-the-Box Thinking”
Steffanie Strathdee, PhD, associate dean of Global Health Sciences in the department of medicine at the University of California San Diego, told Medscape Medical News he had a strong influence on her life.“When I trained as an aspiring HIV epidemiologist in Canada, Frank Plummer was one of about four infectious disease epidemiologists who were experts on HIV. His work was an inspiration to me as I decided to specialize as an HIV epidemiologist. Frank was known for his inventive out-of-the-box thinking that inspired novel HIV prevention research, which included the hypothesis that there was a subset of female sex workers who remained uninfected despite being continuously exposed.”
According to the UM release, the research involving that group of women in Kenya was perhaps his most widely known scientific contribution.
“(Plummer) focused on their immune systems and genetics to identify the basis for this resistance, and the project provided vital new information for HIV vaccine and drug development. Today, global interventions and campaigns have been built on his work,” the university noted.
“As an epidemiologist, he never forgot that behind each data point, there was a person who had a story, and he was one of the few that took the time to listen,” Strathdee said.
Plummer praised the positive results of the procedure, deep brain stimulation.
“Dr Plummer said the surgery had given him a new lease on life after a series of health problems had forced him to confront his battle with alcohol addiction,” the BBC reported.
A former student and then colleague, Keith Fowke, PhD, head of medical microbiology and infectious diseases at UM, said in a statement to the university, “Frank’s work was highly innovative and saved hundreds of thousands of lives. He was an outstanding and world-class researcher who was a dear colleague, mentor and friend to many of us lucky enough to work with him, and beside him.”
Fowke told the CBC that the research partnership between the University of Manitoba and the University of Nairobi was established when there was little global awareness of HIV/AIDS. Through the partnership, Plummer’s team discovered that HIV could be passed on to women or to babies through breast milk.
“He helped to identify a lot of the key factors that are involved in HIV transmission in the early days,” Fowke said.
Among Plummer’s awards were the Order of Canada, one of the country’s highest honors, and the Canada Gairdner Wightman Award, which recognizes work that has had a significant impact on health outcomes in the developing world.
https://www.medscape.com/viewarticle/924966
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