Immigrants play big role in caring for elderly and disabled in U.S

Even as a shortage of U.S. workers who care for the elderly and disabled grows, proposed limits on immigration may worsen the situation, researchers say.

As of 2017, immigrants accounted for more than 18% of U.S. healthcare workers, researchers report in the journal Health Affairs. In nursing homes, nearly one in four workers who directly care for patients are immigrants, as are nearly one in three housekeeping and maintenance workers.

“We rely heavily on immigrants to care for the elderly and disabled, particularly in their everyday care,” said the study’s lead author, Dr. Leah Zallman, an assistant professor of medicine at the Harvard Medical School and director of research for the Institute for Community Health at the Cambridge Health Alliance. “Therefore, any policies trying to reduce immigration are likely to make what is already a workforce shortage worse.”

Currently, Zallman said, “there are not enough people willing to do these jobs and we are going to need a lot more people in the future. This is an industry that needs people round the clock. And immigrants disproportionately take the night shifts. They are really filling the gaps.”

The issue becomes increasingly important as the elderly population grows, with experts predicting it will double by 2050, Zallman and her colleagues noted.

To take a closer look at the role of immigrants in healthcare, the researchers turned to the Annual Social and Economic Supplement of the 2018 Current Population Survey, a nationally representative survey conducted by the Census Bureau and the Bureau of Labor Statistics, which collected data on 180,084 people in March of 2017.

Compared to U.S born healthcare workers immigrant workers were older; 51.6% were older than 44, compared to 43.8% of U.S. born healthcare workers. Immigrant workers were also more likely to have completed a four year college degree and more likely to be Hispanic, non-Hispanic Asian or non-Hispanic Black.

Nearly one in three immigrant healthcare workers – 30.4% – were employed in long term care settings, compared to 22% of U.S. born workers. Overall, 1 million workers, or 23.5%, in the formal and non-formal long term care sector were immigrants.

Among unauthorized immigrant healthcare workers, 43.2% were employed in these types of settings.

Immigrant workers were also more likely than those born in the U.S. to be employed with home health agencies (13.1% versus 7.9%) – and in the non-formal sector (6.8% versus 4.6%).

The new study is “very important and timely,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins School of Public Health. “I hope it will encourage us to be more thoughtful about political decisions as they have an impact on all of us. The current proposal to restrict immigration to more skilled or professional applicants runs directly counter to the need for this category of worker.”

Those proposals are coming at a time when the U.S. birthrate is falling, Wu said. “Looking 10 years ahead, there’s a huge projected shortfall in people who do hands-on face-to-face caregiving for older and disabled adults.”

That’s exactly what’s already happening in Japan, said Dr. John W. Rowe, a professor in the Mailman School of Public Health at Columbia University. “Immigration has been limited by Japan’s preference for an ethnically homogeneous society,” Rowe said in an email. “With the rapid aging of the Japanese, who have the longest life expectancy in the world, this shrinking population has yielded major shortages in the elder care workforce and in manufacturing.”

In response, “the Japanese government in December 2018 relaxed the long-standing immigration restriction and established a program of five-year visas for several hundred thousand workers, Rowe said. “This was seen as a major social change in traditionally xenophobic Japan.”

SOURCE: bit.ly/31ach9O Health Affairs, online June 3, 2019.

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Snapshot of chikungunya could lead to drugs, vaccines for viral arthritis

A team has snapped high-resolution pictures of chikungunya virus latched onto a protein found on the surface of cells in the joints. The structures shows in atomic-level detail how the virus and cell-surface protein fit together — data that promises to accelerate efforts to design drugs and vaccines to prevent or treat arthritis caused by chikungunya or related viruses.
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Churches Wipe Out Millions In Medical Debt For Others

The leaders of Pathway Church on the outskirts of Wichita, Kan., had no clue that the $22,000 they already had on hand for Easter would have such impact.

The nondenominational suburban congregation of about 3,800 had set out only to help people nearby pay off some medical debt, recalled Larry Wren, Pathway’s executive pastor. After all, the core membership at Pathway’s three sites consists of middle-income families with school-age kids, not high-dollar philanthropists.

But then they learned that, like a modern-day loaves-and-fishes story, that smaller amount could wipe out $2.2 million in debt not only for the Wichita area but all available debt for every Kansan facing imminent insolvency because of medical expenses they couldn’t afford to pay — 1,600 people in all.

As Wren thought about the message of Easter, things clicked. “Being able to do this provides an opportunity to illustrate what it means to have a debt paid that they could never pay themselves,” he said. “It just was a great fit.”

Churches in Maryland, Illinois, Virginia, Texas and elsewhere have been reaching the same conclusion. RIP Medical Debt, a nonprofit organization based in Rye, N.Y., that arranges such debt payoffs, reports a recent surge in participation from primarily Christian places of worship. Eighteen have worked with RIP in the past year and a half, said Scott Patton, the nonprofit’s director of development. More churches are joining in as word spreads.

The mountain of bills they are trying to clear is high. Medical debt contributes to two-thirds of bankruptcies, according to the American Journal of Public Health. And a 2018 Kaiser Family Foundation/New York Times poll showed that of the 26% of people who reported problems paying medical bills, 59% reported a major life impact, such as taking an extra job, cutting other household spending or using up savings. (Kaiser Health News is an editorially independent program of the foundation.)

The federal Consumer Financial Protection Bureau proposed a rule this month to curb debt collectors’ ability to bug those with outstanding bills, and some states have tried various measures, such as limiting the interest rates collectors may charge. But until a comprehensive solution emerges, churches and others are trying to ease some of the load by jumping into the debt market.

A big part of RIP’s appeal comes from the impact even a small donation can have, say participating church leaders. When a person can’t pay a bill, that debt is often packaged with other people’s debt and sold to bill collectors for some fraction of the total amount of the bill. Those debts usually come from low-income people and are more difficult to collect.

RIP Medical Debt buys debt portfolios on this secondary market for pennies on the dollar with money from its donors. But instead of collecting the debt, RIP forgives it.

To be eligible for repayment from RIP, the debtor must be earning less than twice the federal poverty level (about $25,000 a year for an individual), have debts that are 5% or more of their annual income and have more debt than assets.

Because hospitals and doctors are eager to get those hard-to-collect debts off their books, they sell them cheap. That’s how, Patton said, those 18 churches have been able to abolish $34.4 million of debt since the start of 2018.

Working this way puts a high-dollar project within reach of even small churches. Revolution Annapolis, a nondenominational Maryland church with Sunday attendance of around 200 and without a permanent building, wiped out $1.9 million in debt for 900 families in March. Total amount raised: $15,000.

Revolution leaders heard about RIP Medical Debt on a segment of John Oliver’s “Last Week Tonight” in 2016, said Kenny Camacho, lead pastor. But at the time, they didn’t think they had the resources to make much of a splash.

After hearing about another church that paid off millions last year, Revolution leaders decided to try it. At most, they hoped to have an impact in their area, Camacho said. But the money went much further, eventually covering 14 counties in eastern and central Maryland.

Emmanuel Memorial Episcopal Church, a congregation of about 175 families in Champaign, Ill., had a similar experience. The original idea was to try to have an impact just in Champaign County, said the Rev. Christine Hopkins. But their $15,000 abolished $4 million of debt for the entire diocese, which stretches across the southern half of the state.

“We were bowled over, actually,” Hopkins said. “It was to the point of tears.”

In many cases, churches have not had to do a fundraising campaign because their contribution came from money already on hand. Emmanuel Episcopal, for instance, had leftovers from a campaign set up a year ago to celebrate the centennial of its church building.

The Fincastle Baptist Church, with 1,600 members in the Roanoke, Va., area used money it had budgeted for an annual “Freedom Fest” event to honor first responders, and then partnered with local television station WSLS in a telethon to raise more. That effort abolished over $2.7 million in medical debt targeted at veterans.

The RIP nonprofit allows donors to choose geographic areas they want to reach and can pinpoint veterans as recipients. But beyond that, no restrictions are allowed, Patton said. A church can’t specify which types of medical procedures could be paid for or anything about the background of the recipients.

That didn’t bother church leaders contacted for this story. But it is a subject that’s been broached by donors of all types in the past, Patton said.

For instance, some potential donors have asked to exclude people from different faiths or certain political parties, he said. “It’s just absurd. This is not a revenge tactic,” Patton said. “People who are requesting those things really don’t understand philanthropy.”

Churches don’t necessarily experience a direct return in the way of new members. All the processing goes through RIP Medical Debt, which sends letters notifying the beneficiaries their debts have been forgiven. Donors can have their names listed on those letters, but not everyone opts to do so.

New membership wasn’t the point for Pathway Church in Kansas, Wren said. “Sometimes the more powerful spiritual message is when you’re able to do something for somebody that you’ll never meet.”

The Revolution Church decided against putting its name on the notification letters, Camacho said, because it didn’t want beneficiaries to feel obligated. “When a person has their debt forgiven, we want them to experience that as a kind of no-strings-attached gift,” he said. “We don’t want there to be any sense that because we did this now they should visit our church or something.”

Besides, he said, the gift covered an area large enough that some beneficiaries live a couple of hours away. “I would much rather them think more positively about the church down the street from where they live.”

Donors sometimes hear back from the people whose debts they’ve paid, but not often. Many don’t expect it. “I guess that’s a biblical story, too. Jesus forgave 10, and only one said thank you,” Hopkins said.

Churches have a lot of choices when it comes to charity, but medical debt and affordability issues often resonate with parishioners. Some churches are worried enough about medical costs for their members that they subscribe to cost-sharing nonprofits, in which members pay each other’s medical bills.

Medical mission work has long been an important form of outreach for Fincastle Baptist Church in Virginia, said associate pastor Warren King. The church runs a free clinic, and mission trips to other countries usually include a medical component.

Paying off medical debt is an extension of that line of thinking. “We need to do not just this thing but many things that practically show the love of God,” King said. “It’s hard to tell somebody God loves you if they’re starving and you don’t try to deal with the problem.”

Hopkins said the debt outreach was a satisfying project for her Illinois congregation because it could resolve a problem for the beneficiaries. “We do a lot of outreach that’s food-related and housing-related. This was something different,” Hopkins said. “You help feed somebody, and you’re feeding them again the next day. This was something that could make an impact.”

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Brazil suspends beef exports to China due to mad cow case: exporter

SAO PAULO (Reuters) – Brazilian exporters selling beef to China face a temporary ban on shipments as Brazil deals with an atypical case of mad cow disease in Mato Grosso state, a representative of a leading exporter told Reuters on Monday on condition of anonymity.

Beef exporters were formally told by the government that, as of Monday morning, issuance of international health certificates was suspended to comply with provisions of a bilateral health protocol signed by Brazil and China.

Listed Brazilian meatpackers including Minerva SA fell by almost 5% in late afternoon trading. JBS SA , and Marfrig Global Foods each dropped by about 3%.

The source said the bilateral protocol foresees preemptive measures in cases such as occurrence of bovine spongiform encephalopathy (BSE), as mad cow disease in known, whether or not it manifests itself in classic form.

After the atypical case was reported in Brazil last week, the agriculture ministry banned exports and communicated with China, which will now assess the situation and give feedback to Brazilian authorities, the source said.

The suspension affects all Brazilian beef exporters to China as per provisions in the bilateral protocol, the source said, adding that the fact it is an isolated case means the ban will likely be short-lived.

Newspaper Valor Econômico reported earlier on Monday that Brazil’s Agriculture Ministry has preemptively suspended beef exports to China after authorities found an atypical case of mad cow disease in Mato Grosso, Brazil’s leading agriculture state.

The ministry did not have an immediate comment.

On Friday, the Brazilian government reported a case of atypical mad cow disease in an animal in Mato Grosso.

Reporting by Ana Mano; Editing by Cynthia Osterman and Tom Brown

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Merck wins U.S. FDA approval for expanded use of antibiotic

FILE PHOTO: The Merck logo is seen at a gate to the Merck & Co campus in Linden, New Jersey, U.S., July 12, 2018. REUTERS/Brendan McDermid

(Reuters) – The U.S. Food and Drug Administration on Monday approved expanded use of Merck & Co Inc’s antibiotic to treat hospital-acquired pneumonia in patients 18 years and older.

The approval is based on late-stage trial results of the treatment, Zerbaxa, which showed that Merck’s drug was as effective as the antibiotic meropenem.

Hospital-acquired pneumonia occurs in patients at least two-three days after being admitted or in those who are on mechanical breathing machines and have life-threatening lung infections with high mortality rates.

Reporting by Saumya Sibi Joseph and Manojna Maddipatla in Bengaluru; Editing by Maju Samuel

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Time to man up and get screened

Are you the type of guy who puts off doing a task or getting a test and later wished you’d just gotten it over with? If you’re a man with Medicare, now’s the time to talk with your doctor about whether you should get screened for prostate cancer, colorectal cancer, or both. Screening tests can find cancer early, when treatment works best.

Don’t let the cost become your excuse to put off screenings—Medicare covers a digital rectal exam and a prostate specific antigen (PSA) test once every 12 months for men 50 or over. Also, Medicare covers a variety of colorectal cancer screenings—like the fecal occult blood test, flexible sigmoidoscopy, or colonoscopy—and you pay nothing for most tests.

Prostate cancer is the most common cancer in men, second only to lung cancer in the number of cancer deaths. About 1 out of  9 men will be diagnosed with prostate cancer during his lifetime. Not sure if you should get screened? You’re at a higher risk for getting prostate cancer if you’re a man 50 or older, are African-American, or have a father, brother, or son who has had prostate cancer.

Colorectal cancer is also common among men—in fact, it’s the second leading cause of cancer-related deaths in the United States among cancers that affect both men and women. If everyone 50 to 75 got screened regularly, we could avoid as many as 60% of deaths from this cancer.

In most cases, colorectal cancer develops from precancerous polyps (abnormal growths) in the colon or rectum. Fortunately, screening tests can find these polyps, so you can get them removed before they turn into cancer. If you’re 50 or older, or have a personal or family history of colorectal issues, make sure you get screened regularly for colorectal cancer.

June is Men’s Health Month, the perfect time for you to take steps to live a safer, healthier life. Visit the Men’s Health Month website for more information.

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Lynparza stalls pancreatic cancer in patients with BRCA mutations: study

CHICAGO (Reuters) – AstraZeneca and Merck & Co’s Lynparza helped patients with advanced pancreatic cancer who carry BRCA gene mutations go nearly twice as long without their disease worsening than those who received a placebo, according to data from a late-stage clinical trial presented on Sunday.

BRCA mutations are typically linked with breast and ovarian cancers, but occur in other cancers as well.

Lynparza was tested against a placebo as a maintenance therapy in 154 patients with metastatic pancreatic cancer whose tumors had not progressed after chemotherapy.

Those who received the Merck and AstraZeneca drug on average went 7.4 months before their disease began to worsen, a measure known as progression-free survival (PFS). That compared with a median PFS of 3.8 months for placebo, according to data presented at the American Society of Clinical Oncology meeting in Chicago.

For the 6-7% of pancreatic cancer patients who carry these inherited mutations, the finding is significant.

“This was clearly positive,” said Dr. Eileen O’Reilly, a pancreatic cancer expert at Memorial Sloan Kettering Cancer Center in New York, who helped lead the study.

O’Reilly said the findings reinforce new guidelines from the National Comprehensive Cancer Network recommending universal BRCA testing for all patients with pancreatic cancer.

Mutations in BRCA genes impair the ability to repair DNA damage, which can drive cancer growth. Lynparza and other drugs in the class known as PARP inhibitors keep cancer cells damaged by chemotherapy from repairing themselves. Lynparza became the first PARP drug to reach the market with a U.S. approval for ovarian cancer in late 2014.

“In pancreatic cancer, progress has been really slow so this is really quite exciting data for patients who have the BRCA mutation,” said Dr. Baynes, Merck’s chief medical officer.

An interim analysis, however, showed the drug made no significant difference in overall survival.

“We typically see about 10 to 12 months” for overall survival in these patients, O’Reilly said. Patients in both arms of the Lynparza study lived about 18 to 19 months.

The companies expect results in the second half of the year for Lynparza in prostate cancer patients with BRCA mutations, and have ongoing studies in endometrial and lung cancer.

“We are now talking about a medicine that actually may have the opportunity to improve outcomes for patients across a multitude of cancer types if they are harboring the BRCA mutation,” Dave Fredrickson, AstraZeneca’s global head of oncology, said in an interview.

Lynparza is an important growth driver for AstraZeneca, generating $647 million in sales last year. Analysts have forecast $2.5 billion in revenue from the drug in 2023, according to Refinitiv data. Use in pancreatic cancer in addition to breast and ovarian cancer would boost Lynparza sales and cement its lead over rival PARP inhibitors Rubraca from Clovis Oncology, GSK’s Zejula and Pfizer’s talazoparib.

Reporting by Julie Steenhuysen; additional reporting by Ludwig Burger in Frankfurt; editing by Bill Berkrot

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Novartis hopes Kisqali data will help narrow gap to blockbuster rival

ZURICH (Reuters) – Novartis has released data showing sharply improved overall survival rates for its breast cancer drug Kisqali, which the Swiss drugmaker hopes will help it chip away at the dominance of Pfizer’s blockbuster Ibrance.

FILE PHOTO: The logo of Swiss drugmaker Novartis is seen at its headquarters in Basel, Jan. 25, 2017. REUTERS/Arnd Wiegmann/File Photo

Novartis’s Kisqali had $235 million in sales in 2018, well behind the $4.1 billion for Ibrance, as Pfizer’s first-to-market drug captured the lion’s share of women with metastatic HR+/HER2- cancer.

The U.S. Food and Drug Administration approved Ibrance in February 2015, two years before Kisqali.

The data released on Saturday showed about 70 percent of pre-menopausal women with hormone receptor positive, human epidermal growth factor receptor-2 negative (HR+/HER2-) advanced or metastatic breast cancer were alive 42 months after getting a cocktail of Kisqali and endocrine therapy.

That compares with 46 percent who received only endocrine therapy, which at the time of the study was the standard of care.

Doctors helping lead Novartis’s Kisqali study, called Monaleesa-7, said the statistically significant benefit it showed was good news for patients facing a challenging disease.

“To achieve overall survival improvement in an incurable disease, like metastatic breast cancer, is truly an outstanding advancement,” said Dr. Sara Hurvitz, head of breast cancer clinical trials at the University of California Los Angeles.

According to a Refinitiv poll, analysts expect Kisqali – priced at about $130,000 per year – to reap about $1.2 billion annually by 2024.

SURVIVAL ANALYSIS

The Swiss company is hoping its new survival analysis, released at the 2019 American Society of Clinical Oncology annual meeting in Chicago, will convince more doctors to consider Kisqali.

“Most physicians would practice evidence-based medicine, and in that case, having statistical significance certainly would have some persuasion in how they would actually move forward,” John Tsai, Novartis’ head global drug developer, said on a call.

Analysis of separate clinical trials is ongoing to determine potential overall survival benefit of taking Ibrance together with endocrine therapy, as well as of endocrine therapy with a similar drug, Eli Lilly’s Verzenio, that had $255 million in sales last year.

Kisqali, Ibrance and Verzenio have not been compared with each other in trials.

In addition to losing the race to market for Ibrance, Novartis’s Kisqali has faced some safety-linked hurdles.

Its label includes warnings for a possible heart condition, called QT prolongation, and liver toxicity that require monitoring that Pfizer’s medicine has avoided.

Kisqali, a CDK4/6 inhibitor that aims to halt hyperactive cellular machinery that drives tumor growth, is approved as an initial treatment for women with HR+/HER2- advanced or metastatic breast cancer, regardless of whether they have gone through menopause.

Ibrance and Lilly’s Verzenio have somewhat narrower first-line FDA labels, covering initial therapy for HR+/HER2- breast cancer in women after menopause.

Reporting by John Miller; Editing by David Holmes

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Merck’s Keytruda sets new five-year survival standard for advanced lung cancer

CHICAGO (Reuters) – Nearly a quarter of patients who received Merck & Co’s immunotherapy Keytruda as an initial treatment for advanced lung cancer were still alive after five years, according to data presented at a major medical meeting on Saturday.

FILE PHOTO: The Merck logo is seen at a gate to the Merck & Co campus in Linden, New Jersey, U.S., July 12, 2018. REUTERS/Brendan McDermid/File Photo

That represents a huge gain over the historical five-year survival rate of just 5 percent for those with the disease prior to the introduction of medicines like Keytruda that spur the immune system to fight cancer.

“The uniformly negative outlook that has been associated with a diagnosis of advanced non-small cell lung cancer is certainly no longer appropriate,” said Dr. Edward Garon, a lung cancer specialist at the University of California, Los Angeles, who led the study.

“It’s a very significant improvement,” Dr. Roy Baynes, Merck’s chief medical officer, said of the 5-year data in a phone interview. “This really is a fundamental change in the outcome” for patients.

Keytruda competes with rival drugs from Bristol-Myers Squibb, Roche and others in several types of cancer. This data is likely to further solidify its dominant position in newly diagnosed advanced lung cancer, by far the biggest commercial opportunity in oncology.

Keytruda, first approved for advanced melanoma in 2014, is Merck’s most important growth driver. It has overtaken Bristol’s Opdivo as the industry’s immuno-oncology leader with sales expected to top $10 billion this year and $20 billion in 2024, according to Refinitiv data.

The study, dubbed Keynote-001 and presented at the American Society for Clinical Oncology (ASCO) meeting in Chicago, involved 550 patients with advanced non-small cell lung cancer.

After five years, 23.2 percent of patients who had not received any treatment prior to Keytruda were alive. That compared with a 15.5 percent 5-year survival rate for previously treated patients who then got Keytruda.

Patients whose tumors had higher levels of the PD-L1 protein targeted by Keytruda fared best in the trial. In the previously untreated group, nearly 30 percent were alive after five years if their PD-L1 expression was 50 percent or greater, compared with a 15.7 percent 5-year survival with PD-L1 levels below 50 percent.

KEYTRUDA FOR GASTRIC CANCER

Separately, researchers presented more details of a late stage study of Keytruda as an initial, or first-line, treatment for advanced gastric or gastroesophageal junction cancers.

In late April, Merck said Keytruda failed to show a significant improvement over chemotherapy in that study, known as Keynote-062. Additional data, however, showed that Keytruda did extend the lives of some patients whose tumors had high PD-L1 levels.

Thirty-nine percent of patients with high PD-L1 expression who received Keytruda alone were still alive after two years. That compared with a 22 percent two-year survival rate for people treated with chemotherapy, the current standard of care for these patients.

Adding Keytruda to chemotherapy did not improve survival versus chemotherapy alone, researchers found.

Dr. Richard Schilsky, ASCO’s chief medical officer, said the findings introduce the potential of using Keytruda, which has fewer toxic side effects, in place of chemotherapy.

“For some, it can greatly extend survival,” he said.

Reporting by Julie Steenhuysen; Editing by Bill Berkrot

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