Health
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- Written by: Robert Sanders
BERKELEY, Calif. – With the help of sponges inserted in the bloodstream to absorb excess drugs, doctors are hoping to prevent the dangerous side effects of toxic chemotherapy agents or even deliver higher doses to knock back tumors, like liver cancer, that don’t respond to more benign treatments.
The “drug sponge” is an absorbent polymer coating a cylinder that is 3D printed to fit precisely in a vein that carries the blood flowing out of the target organ – the liver in liver cancer, for example. There, it would sop up any drug not absorbed by the tumor, preventing it from reaching and potentially poisoning other organs.
In early tests in pigs, the polymer-coated drug absorber took up, on average, 64 percent of a liver cancer drug – the chemotherapy agent doxorubicin – injected upstream.
“Surgeons snake a wire into the bloodstream and place the sponge like a stent, and just leave it in for the amount of time you give chemotherapy, perhaps a few hours,” said Nitash Balsara, a professor of chemical and biomolecular engineering at the University of California, Berkeley, and a faculty scientist at Lawrence Berkeley National Laboratory.
“Because it is a temporary device, there is a lower bar in terms of approval by the FDA,” said Steven Hetts, an interventional radiologist at UC San Francisco who first approached Balsara in search of a way to remove drugs from the bloodstream. “I think this type of chemofilter is one of the shortest pathways to patients.”
Most anticancer drugs are poisonous, so doctors walk a delicate line when administering chemotherapy. A dose must be sufficient to kill or stop the growth of cancer cells, but not high enough to irreparably damage the patient’s other organs. Even so, chemotherapy is typically accompanied by major side effects, including nausea, vomiting, diarrhea and suppression of the immune system, not to mention hair loss and ulcers.
“We are developing this around liver cancer because it is a big public health threat – there are tens of thousands of new cases every year – and we already treat liver cancer using intra-arterial chemotherapy,” Hetts said. “But if you think about it, you could use this sort of approach for any tumor or any disease that is confined to an organ, and you want to absorb the drug on the venous side before it can distribute and cause side effects elsewhere in the body. Ultimately we would like to use this technology in other organs to treat kidney tumors and brain tumors.”
Hetts, Balsara and their colleagues at UC Berkeley, UCSF and the University of North Carolina, Chapel Hill, will publish their results today in the journal ACS Central Science, an open-access publication of the American Chemical Society.
Gentler treatments
Hetts, the chief of interventional neuroradiology at the UCSF Mission Bay Hospitals, treats tumors of the eye and brain by threading catheters through the bloodstream to deliver chemotherapy drugs directly to the site of the tumor. This delivers the maximum dose to the tumor and the least dose to the rest of the body, minimizing side effects. It is a vast improvement over injecting chemotherapy drugs straight into the bloodstream, which allows the drugs to reach and poison every part of the body and gambles on the tumor succumbing before the patient. Nevertheless, typically more than half of the dose injected into the body escapes the target organ.
Several years ago, he started thinking about a major improvement: filtering the blood coming out of the targeted organ to remove excess chemo so that much less of the drug reaches the body as a whole.
Balsara, a chemical engineer who specializes in ionic polymers for batteries and fuel cells, is one of the people Hetts approached to find a suitable absorber to put in the bloodstream. In 2016, former UC Berkeley and Berkeley Lab postdoctoral fellow Chelea Chen identified an ionic polymer, not unlike polymers used in fuel cells, that efficiently absorbed doxorubicin,
“An absorber is a standard chemical engineering concept,” Balsara said. “Absorbers are used in petroleum refining to remove unwanted chemicals such as sulfur. Literally, we’ve taken the concept out of petroleum refining and applied it to chemotherapy.”
That polymer led Balsara’s team to a commercial version of the absorbent polymer that was easier to obtain in large quantities, and Berkeley postdoc Hee Jeung Oh spent more than a year perfecting a way to adhere the polymer to a 3D-printed cylinder with crisscrossing struts that could be placed inside a person’s vein.
“Fitting the cylinder in the vein is important; if the fit is poor, then the blood with the dissolved drug will flow past the cylinder without interacting with the absorbent,” Balsara said. Recognizing the need for customizing the device for individual patients, Balsara solicited the help of a long-time collaborator, Joseph DeSimone, the CEO of Carbon, Inc., a 3D-printing company in Redwood City.
In the experiments reported in ACS Central Science, Hetts implanted the 3D-printed device into the vein of a pig and measured how much of the doxorubicin injected upstream remained downstream of the absorber. In a healthy pig, about 64 percent of the drug was removed.
They are currently in the midst of experiments to determine how much drug is absorbed when the device is implemented at the exit of a healthy pig liver, though the true test will be in humans, perhaps in a couple of years, Hetts said.
“This is a first level in vivo validation that yes, this device will bind up drug in the bloodstream,” he said. “But extensive animal testing is not the next path; the next path is getting conditional approval from FDA to do first-in-human studies, because it is much more realistic to test these in people who have cancer as opposed to continuing to test in young pigs who have otherwise healthy livers.”
Hetts says that the technique is superior to another liver cancer treatment now undergoing testing, which requires major endovascular surgery to completely block the outputs from the liver with balloons and divert the outflowing blood to an external dialysis machine, where the drug is removed and the blood returned to the body.
“There is a lot of opportunity to develop less-invasive devices that will bind up the drug in a gentler manner,” he said.
Drug sponges could be applied to many types of tumors and chemotherapy drugs, Hetts said, and could potentially be used to sop up other dangerous drugs, such as high-powered antibiotics that are toxic to the kidneys but required to kill a pathogen.
“We think this is a generally applicable concept,” he said.
The work was supported by a grant from the National Institutes of Health. Other coauthors are Mariam Aboian, Mark Wilson, Terilyn Moore and Colin Yee of UCSF; Michael Yi, Jacqueline Maslyn and Whitney Loo of UC Berkeley; Xi Jiang and Dilworth Parkinson of Berkeley Lab; and DeSimone, Gregory Robbins and Florian Barth of Carbon.
Robert Sanders writes for the UC Berkeley News Center.
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- Written by: COVERED CALIFORNIA
“Covered California is in the final two days of open enrollment. That means if you are without health insurance, you need to sign up by Tuesday, Jan. 15, to secure health coverage,” Newsom said.
Newsom’s statement came one week after he unveiled a new health care agenda aimed at enhancing affordability in the years ahead and building on the Patient Protection and Affordable Care Act as a pathway to universal coverage.
Covered California Executive Director Peter V. Lee, who was in Los Angeles Monday to promote open enrollment, said time is of the essence.
“The clock is ticking for consumers who need quality health care coverage because this year’s deadline is earlier than it has been in the past,” Lee said. “You must take action today or tomorrow to start an application for health coverage.”
Lee praised the governor’s proposals to enhance affordability by increasing subsidies in the future for middle-income Californians.
“The governor is to be applauded for his agenda to make health insurance more affordable in the years ahead,” Lee said. “The changes he seeks would make a big difference in the support provided to existing Covered California enrollees as well as a new group of individuals who would get financial help to buy health insurance for the first time.”
Gov. Newsom urged Californians to visit www.CoveredCA.com for more information.
“Covered California is the only place you can go to see if you qualify for financial help that can take hundreds of dollars off the price of your insurance premium,” he said. “An estimated 1.1 million Californians are eligible for quality health care coverage, either through Covered California or Medi-Cal, so do not miss this chance to get coverage that will protect you and your family,” he said.
Open enrollment is the one time of the year when consumers can sign up for coverage without needing to meet any conditions. California’s previous open-enrollment period ran through January, but a state law established that open enrollment would run from Oct. 15 through Jan. 15 each year.
Covered California made a stop in Los Angeles on Monday to promote enrollment with longtime partner Asian Americans Advancing Justice. The event culminated a bus tour that traveled more than 2,000 miles, with stops in cities across the state.
The tour will feature individuals who have been enrolled through Covered California since the exchange first opened its doors. Local dance crews will also be depicting the idea that life can change in an instant, which ties to Covered California’s award-winning advertising campaign that features ads showing individuals slipping down stairs, falling off a ladder, getting in a bicycle accident and cutting their hand in the kitchen.
Watch and download time-lapse video of the Covered California bus being wrapped.
“Dance transcends culture, language and age,” Lee said. “These performances from around the state will help Covered California encourage enrollment using a medium that resonates with Californians.”
There will be two performances in Los Angeles, at the headquarters of Asian Americans Advancing Justice. Both dances will be performed by the world-famous GRV dance crew. The crew and the choreographers, Eileen Kim and David Lim, are all based in Los Angeles. Both Kim and Lim have spent years dancing, teaching and touring the world with their performances.
In addition to the live performances during the bus tour, the dances will be captured on video and shared through social media and on Covered California’s website.
“Californians will be able to share these dramatic performances with their family and friends,” Lee said. “We hope the videos spark conversations and get people interested in seeing how affordable it can be to get quality coverage.”
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- Written by: Elizabeth Larson
Currently, if a patient receives treatment through Medi-Cal at a community health center from both a medical provider and a mental health specialist on the same day, the Department of Health Care Services will reimburse the center for only one visit.
A patient must seek mental-health treatment on a subsequent day in order for that treatment to be reimbursed as a second visit.
“A substantial number of patients seen in a primary care setting have an active psychiatric condition,” Atkins said. “Seamlessly transitioning patients from primary care to an onsite mental health specialist on the same day is a proven way to ensure that patient receives needed care and follows through with treatment. This efficient transition is even more important for disadvantaged patients for whom taking time off work and arranging transportation to and from a health center can be extraordinarily difficult.”
The existing financial deterrent for integrated care for mental health patients in California community clinics does not exist for similar health services.
For instance, California allows clinics to bill for two separate Medi-Cal visits if a patient sees both a primary care provider and a dental care provider on the same day.
In addition, the federal Medicare program already allows for same-day billing of mental health and primary care services, and more than 35 state Medicaid programs already make use of this reimbursement mechanism.
“Thousands of rural Californians utilize community health centers as their primary health care home, and this bill will ensure all residents are able to access critical mental health care services on the same day they receive other medical services, which is exactly the way integrated health care should work,” said McGuire, joint author of the SB 66. “Pro Tem Atkins has been a statewide leader on increasing access to health care services, and I’m grateful to partner with her on this critical legislation.”
“California should be a national leader when it comes to promoting a fully integrated approach to health care, encompassing both brain and body,” said Maggie Merritt, executive director of the Steinberg Institute, a Sacramento-based nonprofit dedicated to advancing sound policy on issues of brain health. “And a key aspect of promoting integrated care is knocking down financial barriers for providers. This legislation does exactly that. It’s good for patients and good for California.”
“Senate Bill 66 will improve access to care for all Californians,” said Carmela Castellano Garcia, president and CEO of CaliforniaHealth+ Advocates. “California’s community health centers, which serve nearly 7 million people, provide a full spectrum of care to California’s most vulnerable communities. Right now, California is one of only a handful of states that does not allow health centers to provide and bill for mental and physical health visits on the same day. We are grateful for Senate President pro Tem Toni Atkins’ strong leadership and dedication to providing timely access to behavioral health services for all of our communities.”
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- Written by: Covered California
For those interested in enrolling in a quality health insurance plan, next week’s deadline will mark the last opportunity for many to get coverage for all of 2019.
This year’s deadline is shorter than in previous years, when open enrollment ran through the end of January.
“Covered California knows that many consumers are deadline driven and often wait until the final few days to sign up for health insurance,” said Covered California Executive Director Peter V. Lee. “We want to make sure they know that this year’s deadline is earlier than it has been in the past, and they must take action in the next week in order to get the peace of mind and protection they deserve in 2019.”
California is one of six marketplaces across the nation still enrolling consumers through open enrollment, accounting for a quarter of the United States population.
California’s Jan. 15 deadline is due to a state law that established that open enrollment would run from Oct. 15 through Jan. 15 each year.
Open enrollment is the one time of the year when consumers can sign up for coverage without needing to meet any conditions.
“Do not wait until the last minute, or let this deadline go past, without checking your options,” Lee said. “In only a few minutes at coveredca.com, you can see which plans are available in your area and whether you qualify for financial help to bring the price of coverage within reach.”
Covered California’s announcement comes one day after Gov. Gavin Newsom announced, as his first official act, that he will focus on making health care more affordable.
“We applaud Gov. Newsom for building on the strong foundation of the Affordable Care Act in his first official action,” Lee said. “At a time of ongoing uncertainty in Washington, the governor is not only embracing policies that will lower the cost of coverage for millions in the individual market, but he is also offering increased help to those who are struggling with rising costs.”
The governor proposes to make health care more affordable and restore the individual shared responsibility provision, which was repealed by the federal government in 2019, as part of his goal to continue toward universal coverage.
“Gov. Newsom’s proposals mark concrete and meaningful steps to lower health care costs for millions and increase enrollment,” Lee said. “We look forward to action from Sacramento in the weeks and months ahead, but today the action is happening in local communities across California where individuals can embrace this reminder from the governor of the importance of coverage and sign up through Jan. 15.”
The majority of uninsured Californians who are eligible for financial help either do not know or mistakenly think they do not qualify.
Nearly nine out of 10 Covered California consumers receive financial help. The average Covered California enrollee pays about $5 per day for coverage, but many pay far less.
One out of every three Covered California consumers who receive financial help can purchase a Silver plan — which provides the best overall value — for $50 or less per month. Nearly three out of five of these consumers can get a Silver plan for $100 or less per month.
Consumers can easily find out if they are eligible for financial help and see which plans are available in their area by entering their ZIP code, household income and the ages of those who need coverage into Covered California’s Shop and Compare Tool.
As of Dec. 31, more than 238,000 consumers had signed up and selected a plan during the current open-enrollment period, which remains in line with projections that there would be decline in enrollment due to recent federal policies and ongoing confusion sowed at the national level. In addition, Covered California previously announced that roughly 1.2 million existing consumers had renewed their coverage for 2019.
Those interested in learning more about their coverage options should go to www.CoveredCA.com, where they can get help to enroll.
They can explore their options and find out if they qualify for financial help by using the Shop and Compare Tool.
They can also get free and confidential enrollment assistance by visiting www.coveredca.com/find-help/ and searching among 700 storefronts statewide or 16,000 certified enrollers who can assist consumers in understanding their choices and enrolling, including individuals who can assist in other languages.
In addition, consumers can reach the Covered California service center by calling 800-300-1506.
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