Friday, March 03, 2023

Study: More paid sick leave results in more cancer screenings

The findings highlight the benefits of paid leave mandates as a way to increase healthcare access and potentially improve healthcare equity in the U.S., where 1 in 4 people have no paid sick leave

Peer-Reviewed Publication

TULANE UNIVERSITY

For most Americans, the two major obstacles to proper medical care are time and money. And while insurance can sometimes reduce healthcare costs, having time to visit the doctor is just as important.

Now, a new Tulane University study published in the New England Journal of Medicine has found that more people get screened for cancer when employers are mandated to provide paid sick leave. During a 7-year period covered by the study, breast cancer screening rates increased up to 4% and colorectal cancer screenings increased between 6-8% in areas exposed to policy-driven paid sick leave mandates.

“These non-monetary barriers to healthcare access matter,” said Kevin Callison, lead author and assistant professor of health policy and management at Tulane’s School of Public Health and Tropical Medicine and The Murphy Institute. “Improving or reducing these barriers can have meaningful impacts on people’s health.”

The U.S. is the only wealthy nation in the world to not federally mandate paid time off for being sick, according to the Center for Economic Policy and Research. According to the U.S. Bureau of Labor Statistics, about 1 in 4 American workers can’t take a single paid sick day.

The study, which was co-authored by researchers from Georgia State University and the University of California San Francisco, examined changes in breast cancer and colorectal cancer screening rates among 2 million private sector employees from 2012-2019, a time in which several states and cities adopted policies mandating paid sick leave. The workers were spread among 300 metropolitan statistical areas, 61 of which were exposed to a paid sick leave mandate during that timeframe.

Though the increases in screening rates may seem small, these results include workers who already had paid sick leave, meaning they were unlikely to decrease or increase cancer screening habits. If the results were scaled to focus only on workers gaining sick leave for the first time via mandates, Callison estimated that breast cancers screening rates increase 9-12% and colorectal screening rates increase 21-29%.

“Our effects become much larger if we're willing to assume that only the workers who are gaining paid sick leave coverage are the ones who are changing their screening behaviors,” Callison said.

Past studies have examined the relationship between sick days and cancer screening rates by comparing rates among those with leave to those without. But some workers are more health-conscious than others and may exclusively seek jobs that offer paid sick leave. By focusing on the change in screening rates brought by policy-driven mandates, this study removed some of the potential behavior-based biases.

“Because we focused on these policies that drive changes in coverage rather than people self-selecting into coverage, our argument is that we have a more accurate estimate of the relationship between paid sick leave and cancer screening,” Callison said.

The results underscore the value of sick days. Callison said it’s “reasonable to assume that more cancer screenings lead to earlier detection and better outcomes,” but more research is needed to determine if paid sick leave means cancers are caught earlier and if mortality rates decline.

To Callison, these results also represent one potential way of increasing healthcare equity in the United States.

The majority of those without paid sick leave are people of color and those with less wealth and less education. And though 17 states and 18 cities have adopted paid sick leave, 18 states have passed laws prohibiting cities from passing similar mandates.

“We know that racial and ethnic minorities tend to have higher mortality rates for certain cancers,” Callison said. “So are things like this going to improve those gaps? That’s really the next step where we want to go.”

JOURNAL

New England Journal of Medicine

DOI

10.1056/NEJMsa2209197

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Cancer Screening after the Adoption of Paid-Sick-Leave Mandates

ARTICLE PUBLICATION DATE

2-Mar-2023

THANK JOE

Endocrine Society applauds Eli Lilly’s

efforts to lower insulin costs

Monthly price caps should be available to everyone who depends on insulin

Business Announcement

THE ENDOCRINE SOCIETY

The Endocrine Society commends Eli Lilly and Company for taking steps to reduce insulin prices and make insulin affordable for more people with diabetes.

Eli Lilly's announcement to cut insulin prices by 70% and extend the $35 per month insulin cap to people with private insurance is a positive step towards making insulin affordable for the more than 7 million Americans that rely on the medication.

“Lilly’s move to apply a $35/month cap for people with private insurance will be a significant improvement for adults and children with diabetes who use Lilly’s products,” said Endocrine Society Chief Medical Officer Robert Lash, M.D. “We encourage all insulin manufacturers to join in the effort to reduce out-of-pocket costs for people who need insulin.”

The Endocrine Society has championed measures to improve insulin access for years. Last year, we were pleased that a $35/month cap on insulin for people with Medicare was included in the Inflation Reduction Act and implemented this January 1. The Endocrine Society continues to call on Congress to pass an insulin price cap for all people with private insurance.

More than 7 million people nationwide rely on insulin to manage their diabetes. According to the U.S. Center for Disease Control and Prevention, 37.3 million people nationwide—about 11 percent of Americans—have diabetes.

While insulin was discovered more than 100 years ago, the price of insulin nearly tripled between 2002 and 2013, and the trend upward has continued over the past decade. In 2021 alone, nearly one in five American adults with diabetes—about 1.3 million people—rationed their insulin to save money, according to a study.

The Society will continue to work to improve insulin access for all who need it.

“Our patients who rely on insulin have waited long enough. The time to act is now,” Lash added.

# # #

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

Pressure mounts on the other two major

insulin makers to slash prices

Analysis by Rachel Roubein
with research by McKenzie Beard
March 2, 2023

Eli Lilly announces it will cut insulin list prices. Novo Nordisk and Sanofi haven’t said they’ll do the same.

Drugmaker Eli Lilly announced it was slashing list prices of older insulin products and expanding its program capping how much patients pay for the lifesaving drug to $35 per month.

It didn’t take long for pressure to mount on the other two main insulin makers to follow suit.

Sen. Bernie Sanders (I-Vt), the chair of the chamber’s sweeping health panel, quickly sent letters to Sanofi and Novo Nordisk urging the manufacturers to join Eli Lilly in lowering costs. President Biden called on “other manufacturers to follow.” And Eli Lilly has said its competitors should reduce their prices as well.

Neither Sanofi nor Novo Nordisk indicated plans to immediately copy Eli Lilly’s move, while pointing to other programs they have in place that substantially decrease costs for many patients.

The public pressure yesterday is a prime example of the intense scrutiny the three companies have been under for years to clamp down on the soaring costs of their insulin products. The drug is used daily by roughly 7 million Americans with diabetes to manage their blood sugar levels, and the list prices of the medications have doubled — and in some cases tripled — over the past decade, bipartisan Senate investigators said in a 2021 report.

“I think you can safely say that, like many followed price increases, expect these guys to follow price decreases, too,” said one Democratic pharmaceutical lobbyist who spoke on the condition of anonymity to be candid.

More from Biden:

The details

The move comes after congressional Democrats passed legislation last year imposing a $35 cap on how much Medicare patients pay for insulin. Republicans successfully jettisoned the part of the proposal that would have applied to privately insured patients, arguing it didn’t conform with certain budgetary rules.

Democratic lawmakers, advocates and experts welcomed Eli Lilly’s announcement, though it appears to be not as sweeping as originally meets the eye. Experts say it could particularly help uninsured patients who pay cash and those with private insurance who weren’t part of the company’s already existing program to cap monthly costs at $35 per month.

That program will be improved for patients with private insurance. That’s because the price will be automatically adjusted by pharmacies participating in the program, which amounts to roughly 85 percent of local and national retail pharmacies. Those without insurance will need to continue to download a savings card online so they can get the price cap.

The company also said it would reduce the list price of certain insulins.
For instance: Lilly’s most affordable insulin — its non-branded lispro injection — will run about $25 per vial starting May 1, compared with the current price of $82.41. The list price for Humalog, its most commonly prescribed insulin, and Humulin will drop 70 percent effective in the last three months of the year.
The company also plans to launch a new longer-acting insulin, which it says is interchangeable with a product from competitor Sanofi, but cheaper.

The money trail

One question is whether the change will impact the company’s bottom line.

Some experts said they thought it probably wouldn’t, at least not much, and pointed to the company’s stock price ticking up slightly yesterday.

“Lilly may actually not be losing much in the way of revenue by cutting the list price this way,” Stacie Dusetzina, a professor of health policy at Vanderbilt University School of Medicine. It might be a small change in the amount of money they get for these products, but they could make up for it with additional volume, she said.

The fact that it might not hurt the company’s profits doesn’t mean the move is “a bad thing,” said Craig Garthwaite, a health economist at Northwestern University’s Kellogg School of Management. “We wanted list prices to go down, we have now gotten those prices to go down. That is a good thing.”

Emerging field of evolutionary medicine could address range of health conditions

UCLA researchers say the approach could help tackle cancer, antibiotic resistance, food-related disorders

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - LOS ANGELES

Evolution has helped many members of the animal kingdom adapt to overcome or resist a range of medical issues that scientists are trying to solve in humans.

The giraffe, for example, has a gene that protects the heart from being damaged by blood pressure that would be high enough to ruin a human heart. Elephants possess multiple copies of a gene, one that’s common in mammals, that makes them highly resistant to cancer. And naked mole rats seem almost immune to aging.

Now, scientists in an emerging field of study are studying the evolution of those and other traits to better understand the origins of human diseases — and to pursue cures for conditions that seem intractable.

In a paper published Feb. 28 in Frontiers in Science, an international team of scientists led by two UCLA evolutionary biologists lays out a research plan for “evolutionary medicine.”

Evolutionary medicine applies insights from ecology and evolution to inform, direct and improve biomedical research, public health measures and clinical care. Observing that there are likely countless disease-resistance mechanisms among the vast diversity of life on Earth, the authors argue for the need to systematically search out those mechanisms, uncover their physiological bases and use those findings as the foundation for new clinical treatments and improved public health policy.

“Our bodies and minds evolved in one environment but are living in another — and that mismatch causes disease,” said Dr. Barbara Natterson-Horowitz, the paper’s first author, a cardiologist and evolutionary biologist at UCLA and Harvard University. “Evolutionary mismatch underlies many forms of heart disease, cancer, reproductive disorders and even mental health challenges.”

Conditions like those often are treated as lifestyle diseases; current interventions tend to place the responsibility for treatment on the patient — calling for exercise and dietary changes, for example. However, changing health behaviors doesn’t always work.

“It’s not about treating diabetes when a person gets it at 40, but about making the investment during childhood,” said Daniel Blumstein, a UCLA professor of ecology and evolutionary biology and a co-author of the paper. “Policies that promote interventions early in life can have an immensely positive effect on future health and welfare.”

The paper presents four broad areas in which insights from evolution and ecology could bring the biggest benefits to human health.

Identifying evolutionary and developmental mismatches with human behaviors could lead to new interventions for obesity, Type 2 diabetes, cardiovascular disease, allergies, conditions related to gut health and mental illness.
Studying infectious disease epidemiology, such as the evolution in virulence and transmissibility of viruses, could help prevent or stop future pandemics.
Improving understanding of human development in an evolutionary perspective, could help solve problems in growth, reproduction and aging.
Learning more about the evolutionary tradeoffs that influence human behavior could inform efforts to promote habits that improve health and longevity.

“Understanding our collective human evolutionary history can help us forecast future public health burdens,” said Molly Fox, a co-author of the paper and a UCLA assistant professor of anthropology and of psychiatry. “Across the animal kingdom and the fossil record, we can draw from a vastly larger pool of information than traditional epidemiology to understand how environments and lifestyles shape the basic processes underlying disease.”

An evolutionary approach could also help guide the development of drugs that don’t induce bacteria to become antibiotic-resistant — interfering with bacteria’s ability to evolve, for example, or using viruses called phages that could infect bacteria and cause them to become more susceptible, rather than more resistant, to treatment.

The authors also describe a possible evolution-inspired approach to overcoming chemotherapy resistance in people with cancer: treating the cancer like an organism undergoing extinction.

“The idea is that an effective way to eradicate a population is to first critically reduce its size with an ecological catastrophe — like the meteor strike for the dinosaurs,” Blumstein said. “And then kill remaining individuals with a second disaster — like the famine that followed the meteor.”

“Extinction therapy” would translate that principle into a clinical strategy. Patients would receive a high dose of one cancer drug to reduce a tumor’s size, as in current protocols. But before drug resistance has a chance to arise, the first treatment would be replaced by another to kill off the remaining cancer cells.

“Knowledge from the wild can inform our understanding of human health,” said Natterson-Horowitz, adding that her own thinking on the subject changed during her time as a medical consultant to the Los Angeles Zoo. “Biodiversity in the natural world can be a powerful source of insights that can accelerate biomedical innovation.”