Poison Center trends, microplastic dangers, new biomarker testing law: Upstate's HealthLink on Air for Jan. 26, 2025

[00:00:00] Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a toxicologist goes over trends from the Upstate New York Poison Center.

[00:00:07] Willie Eggleston, PharmD: "...It's cosmetics, it's household cleaning supplies, it's pain medications, over-the-counter ones like ibuprofen, which you might know as Motrin, acetaminophen, which you may know as Tylenol..."

[00:00:18] Host Amber Smith: A doctor of family medicine talks about the dangers of microplastics.

[00:00:22] Kaushal Nanavati, MD: "...Within plastics, tools that are clear or lighter colored tend not to have as much of the e-waste. So that's one thing to keep in mind..."

[00:00:30] Host Amber Smith: And we'll hear about New York's new biomarker testing law.

[00:00:33] Thomas VanderMeer, MD: "...Biomarkers are molecules that indicate if cancer is present, what abnormality is causing the cancer to grow, how active it is, and how it will respond to different types of treatment..."

[00:00:44] Host Amber Smith: All that, plus a visit from The Healing Muse. But first, the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we'll address whether those black plastic kitchen tools are safe to keep using. Then, what's important to know about New York's new biomarker testing law. But first, we'll hear about the types of calls that came into the poison center last year.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Poisonings remain a leading cause of death and injury in the United States, but professionals staff poison centers, including the Upstate New York Poison Center, around the clock to offer preventive advice and treatment guidance. Today, I'm talking with one of those professionals about the stats for 2024.

Dr. Willie Eggleston is a toxicologist and doctor of pharmacy at Upstate, at the Upstate New York Poison Center.

Welcome back to "HealthLink on Air," Dr. Eggleston.

[00:01:54] Willie Eggleston, PharmD: Thank you so much for having me.

[00:01:56] Host Amber Smith: You're probably still working on the annual report, but can you say how many calls the poison center received in 2024 and how that compares with previous years?

[00:02:05] Willie Eggleston, PharmD: Yeah, so we're still kind of finalizing those numbers for the year, but we were well above the 50,000 mark again this year for calls, so similar to previous years. We've continued to be able to serve our community as a resource, both folks calling from home, as well as calling us from hospitals, urgent cares, a whole variety of settings.

[00:02:25] Host Amber Smith: And how many counties do the calls come from?

[00:02:28] Willie Eggleston, PharmD: So we cover 54 counties here in New York. We split the state with our colleagues in the New York City area. The New York City Poison Center covers the five boroughs, covers Long Island, and then we cover everything north of Westchester County.

So, most of the parts of Upstate that you're familiar with, chances are if you're calling a poison center, you're getting in touch with us here in Syracuse.

[00:02:49] Host Amber Smith: And are days or nights more busy? And what about weekdays versus weekends?

[00:02:55] Willie Eggleston, PharmD: It can vary from day to day, but certainly most of the time our busiest hours are in the morning, when people are getting ready for school, getting their morning medications out of the way.

Mistakes happen, errors happen, kids get into things that they shouldn't, so we typically get a little bit of bump in calls in our mornings. And then most of our calls come in the late afternoon and evening hours, getting kids ready for bed, getting evening medications out of the way, folks showing up at the hospital with drug toxicities or overdose symptoms.

So the bulk of our calls do happen in those late afternoon to evening hours, but we tend to stay pretty busy all day long and all night long.

[00:03:32] Host Amber Smith: Well, what were the most common exposure substances in 2024 for adults and children, based on the calls to the Upstate New York Poison Center?

[00:03:41] Willie Eggleston, PharmD: The most common things that we continue to see are the things that we see every year.

It's the stuff that is in your home, and that folks have easy access to. So it's cosmetics, it's household cleaning supplies, it's pain medications, over-the-counter ones like ibuprofen, which you might know as Motrin, acetaminophen, which you may know as Tylenol. And so it's those things that we find around the house that kids can get into easily remain our most common calls.

Certainly when we look into other, smaller groups of folks, folks who are coming in for drug toxicities or for self-harm, we still see those common over-the-counter things, but we also see things like antidepressants, antipsychotics and other prescription pain medications.

But certainly, when we look at most of our data, it's the stuff you find around your house that is the most common for folks to get into.

[00:04:32] Host Amber Smith: Across the nation, I've heard that poison centers saw a dramatic increase in children exposed to illicit fentanyl. Did the Upstate New York Poison Center see that as well?

[00:04:43] Willie Eggleston, PharmD: So it still remains a really small number of our cases. When we see news stories and stuff that talk about dramatic increases, we're talking from a baseline that's very small, so certainly it's still a big danger, and it's something we want folks to be aware of.

But it's not the most common thing that we're seeing kids get into, and it's certainly not the most frequent call we're getting that's resulting in kids being in the hospital.

For example, we see a whole lot more of cannabis exposures in kids here in New York, and that continues to be a trend here in 2024. In 2024 alone, we had almost 200 kids in our region of New York get into edible cannabis, and that makes up about 35% of all the marijuana-related calls that our center receives, so it's a huge piece of that problem. And it's one that we continue to try to encourage, whether it's prescription medications, illicit fentanyl, cannabinoids, marijuana edibles, all those things that we have in our home, it's important that we keep them locked in a safe place where kids can't get access.

[00:05:44] Host Amber Smith: So these edibles becoming more of an issue, is that because marijuana's become legal and maybe more people have edibles at home than used to?

[00:05:53] Willie Eggleston, PharmD: Yeah, certainly that's a big part of it, right? We know that by making it more broadly available, more people are interested in using it, and we have seen some positive trends. When we look at our data over the last three years, there were about 200 kids who got into edible cannabis products in our region in 2022. There were more than 250 in 2023, and we're back down to about two hundred in 2024. So I think a lot of the efforts that we're continuing to make, to educate folks on the risks, to talk about the importance of safe storage, I think those are having a positive impact, but we've still got a lot of work to do.

We're going to continue to remind parents, grandparents, people with small kids in the home, that just because it looks like a candy doesn't mean you should be storing it any different than your other medicines in the house.

[00:06:41] Host Amber Smith: So how would a parent know that their child got a hold of an edible?

[00:06:46] Willie Eggleston, PharmD: So the most common symptoms for a child are really, really profound sleepiness, like to the point where you can't wake them up. So if they go down for a nap, and you find they're unusually difficult to wake up, if they're acting different than their normal self, they're way sleepier than they would be at a time of day, that's where we would want someone to get checked out, potentially, for those symptoms. And certainly you have questions about those symptoms, folks can always reach us here at the poison center, 24 hours a day, seven days a week, and we're happy to help.

[00:07:17] Host Amber Smith: Can you tell me how is that treated if someone arrives at the emergency department with their child saying, "I think they got into my edibles," what happens? How do they take care of the baby?

[00:07:29] Willie Eggleston, PharmD: Once they're in the hospital, the best part about this is, most of these kids have a really positive outcome. They go home, and they live a normal life after that edible marijuana leaves their system.

But the symptoms they experience while the edible is in their system are very different than adults'. They can be severe, they can be life-threatening, and so we do want to make sure that for kids who do get into these products, they get to a hospital, and they're in a place where we can keep a close eye on their breathing and provide oxygen if necessary, or other ways to support them through that process while their body gets rid of the marijuana.

And once it's gone, like I said, they tend to do very, very well and go home and have a normal life. But it's really important that folks recognize that if this does happen, if you call us here at the poison center, we are likely to recommend that you go into a hospital to get checked out. And the reason for that is you just don't have the skills and equipment in your house to watch for the things that we need to watch for when a kid gets into edibles.

[00:08:27] Host Amber Smith: This is Upstate's "HealthLink on Air," with your host Amber Smith. I'm talking with Dr. Willie Eggleston. He's a toxicologist and assistant professor at the Upstate New York Poison Center, which you can reach at 1-800-222-1222.

We're looking back at what happened in 2024.

What about calls about energy drinks? Are you getting many of those?

[00:08:51] Willie Eggleston, PharmD: We don't get too many of those. On occasion, we'll get a call about someone excessively using them and coming into the hospital with an abnormally fast heart rate or just feeling generally unwell.

But for the most part, folks who are getting exposed to energy drinks kind of have a good idea of what they're doing and what they're taking, and so we don't get a ton of calls about energy drinks. But it is important to recognize that the amount of caffeine in there is high, and if you are particularly sensitive to caffeine, we want to be careful with that. And if you are experiencing any symptoms from an energy drink, like abnormal heartbeat or anything like that, in addition to calling us here at the poison center, certainly you would want to get that checked out.

[00:09:30] Host Amber Smith: What about e-cigarettes? Are exposures to children still an issue with e-cigarettes?

[00:09:36] Willie Eggleston, PharmD: So thankfully e-cigarettes have kind of continued a downward trend, and we're hoping that cannabis and edible cannabis is on the same path. E-cigarettes, while they do remain available, and while we do continue to get calls, we have seen those trends decline over the last several years as we've really aggressively tried to educate folks on the dangers and risks of those, so we have seen those drop off significantly. And we're hopeful thatwe can have a similar impact here with edible marijuana products, moving into 2025.

[00:10:08] Host Amber Smith: Well, let's talk about any other emerging concerns. I've heard in other communities about pink cocaine.

[00:10:15] Willie Eggleston, PharmD: So there have been some interesting new drugs that have made their way onto the market in 2024. Pink cocaine and Diamond Shruumz are two examples of those.

Pink cocaine is just a mix. You never know truly what it is, but in most cases it tends to be a mix of different stimulant drugs. There very rarely is any cocaine in pink cocaine, and it's pink because it's got food dye added to it. We have not had many cases here in New York. We've only had calls mainly with questions about the product, and nationally there have not been that many cases as of yet, but this is a very new trend, so it's one where both us here at the Upstate New York Poison Center and our national colleagues at the American Association of Poison Control Centers are keeping a close eye on cases.

Diamond Shruumz, another product that became popular over the summer, are food products; they're chocolate bars, they're gummies, and they containextracts from hallucinogenic mushrooms, so mushrooms that might make you see things that aren't there, hear things that aren't there. And so these products take compounds, chemicals from those mushrooms and add them into the food. And they're used for what folks call microdosing. So taking small amounts of these hallucinogens for perceived positive effects.

These food products contained all sorts of things, and we saw symptoms from some mild sleepiness all the way up to seizures and deaths. Here in New York, we had eight cases related to this. Nationally, our colleagues at America's Poison Centers were able to identify about 200 more, and they worked closely with the CDC (Centers for Disease Control and Prevention) to keep an eye on this outbreak and to trend this data.

We're trying to take a similar approach with pink cocaine to keep a close eye on this. And as I said, right now, it's a small issue. It's not a big issue. But it's one we like to keep an eye on that trend and make sure it doesn't make its way onto an upward trajectory.

[00:12:03] Host Amber Smith: One of the things that's become popular isthe weight-loss drugs that it seems like so many people are taking. Are you seeing abuse of those or are you getting any calls about them?

[00:12:14] Willie Eggleston, PharmD: Weight-loss drugs are a popular item in 2024, and predominantly, a class of weight-loss drugs that are called GLP-1 drugs. And so these are drugs that you might have heard of, like Ozempic and Wegovy.

And what these drugs do is, they are very effective at helping folks to lose weight in a healthy way, when they are prescribed at appropriate doses and when they are gotten from appropriate sources, like a pharmacy.

But we realize there's been a shortage of these drugs. They've been challenging to get, so people have turned to other sources. They've looked at compounding these products. They've gone to online pharmacies and online prescribers to try to get access to these products. And so people aren't always getting the right directions, the right dose. They're getting something that's not from the company that typically makes it.

And so we see people screw up the dosing and get not anything that's life-threatening, but they get very uncomfortable side effects. It's nausea and vomiting, and it lasts for several days.

Here at the Upstate New York Poison Center, we had 130 calls this past year related to these GLP-1 weight-loss drugs, some of them from compounded pharmacies, some of them from the companies, but typically they are dosing errors that result in really uncomfortable side effects. And nationally, since 2019, poison centers have seen a 1,500% increase in calls related to these drugs. Like I said, it's not necessarily going to cause you significant harm if you screw up the dose, but it's going to make you very uncomfortable for several days. And so we encourage folks when they are being prescribed these, have conversations with your doctor, have conversations with your pharmacist, and certainly they can always call us if they have questions.

[00:13:54] Host Amber Smith: Well, Dr. Eggleston, thank you so much for making time for this interview.

[00:13:58] Willie Eggleston, PharmD: Of course. Thank you so much for having me back.

[00:14:01] Host Amber Smith: My guest has been Dr. Willie Eggleston. He's a toxicologist and Doctor of Pharmacy at Upstate, at the Upstate New York Poison Center, which has a phone number that's answered around the clock at 1-800-222-1222.

I'm Amber Smith for Upstate's "HealthLink on Air."

Should you keep your black plastic kitchen tools? Next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink On Air." You may have heard concerns about the dangers of plastics to human health. So I'm turning to Dr. Kaushal Nanavati to explain. He's a doctor of family medicine and director of integrative medicine at Upstate. Welcome back to "HealthLink on Air," Dr. Nanavati.

[00:14:48] Kaushal Nanavati, MD: Thank you for having me, Amber. It's been a while, and I really enjoy coming on.

[00:14:53] Host Amber Smith: Why have black plastic food containers and kitchen tools like tongs and ladles and spatulas been singled out as potentially problematic?

[00:15:02] Kaushal Nanavati, MD: Well, there was a study that came out, and it really focused on the fact that black plastic tools are often made from recycled plastics, including what we call e-waste or electronic waste. And e-waste plastics can contain things like heavy metals, flame retardants and other potentially hazardous substances.

So in the study it talked about the increased risk potential for things like cancer. Now, I do have to kind of give full disclosure on the study is that initially the data that came out projected a much higher correlation for cancer risk. And so the authors looked at the data, and they realized that their actual calculation was off by a factor of 10. And so they did correct their information. But the correlation is still there, and the risk is still there. So I think it's a very, very important discussion to actually have and just to inform people on.

[00:16:04] Host Amber Smith: Well, I think everyone has black kitchen tools. Should we be getting rid of them?

[00:16:09] Kaushal Nanavati, MD: Well, I think the question really there is, what can we do? So if you don't have them, you don't necessarily need to get them. But really the thing with black tools are that, you want to think about what it is that they have. So there are certain types. So plastics that are marked with recycling codes number three, number six, number seven, may actually leach more harmful potential chemicals. So what we tell people is there are alternatives.

So fundamentally, within plastics, tools that are clear or lighter colored tend not to have as much of the e-waste. So that's one thing to keep in mind. But there are also alternatives, right? So wooden tools are safe. They're biodegradable. You just have to be careful about avoiding splintering, and then how well you clean them as far as harboring bacteria. Silicone tools, if it's a food grade silicone, they're durable, they're heat resistant and safer. And then even glass or stainless steel containers are ideal for food storage versus plastic.

So, there's fundamentals that we can do at home to think about how we can optimize, or rather minimize our exposure to potential chemicals that could lead to harmful effects when you have consistent exposure over the long term.

[00:17:31] Host Amber Smith: Are these tools safer to use if you're not dealing with hot food?

[00:17:35] Kaushal Nanavati, MD: So, well, with cold use, you may release fewer chemicals. You have to think about if there's wear or scratches in the tool itself, then that could sometimes leach some of the hazard compounds over time. So, you know, a one time use when you're visiting somebody isn't really the thing as much as what you use on a day-to-day basis at home in terms of serving spoons, utensils, that type of stuff.

[00:18:00] Host Amber Smith: Now, if you take the step to toss your black plastic tools, should they go in recycling or trash?

[00:18:07] Kaushal Nanavati, MD: So it's really a very interesting question because they don't really recommend recycling because recycling environments don't really know what to do with them. Generally the recommendation is that you throw them out in the garbage, and then they get disposed of that way.

[00:18:26] Host Amber Smith: Now the other thing is those black plastic food containers that you often get with takeout food. Are those safe to reuse?

[00:18:34] Kaushal Nanavati, MD: So, again, if they're not scratched up and banged up and kind of worn down, for storage, it is different. If you're using them to do things like microwave, even though some of them might say "microwave safe," we generally suggest using glass containers if you're going to do anything as far as reheating. I wouldn't suggest using those containers.

[00:18:58] Host Amber Smith: This is Upstate's "HealthLink on Air" with your host Amber Smith. I'm talking with Dr. Kaushal Nanavati. He's a doctor of family medicine and director of integrative medicine at Upstate, and we're talking about how to stay healthy in a world full of plastics and microplastics.

So I'd like to ask you about microplastics, these tiny shards of plastic that are in the air and the water. They're byproducts of our world, which is just full of plastics. We're all exposed to these, and it seems more and more studies are showing potential harms. What can you tell us about these?

[00:19:31] Kaushal Nanavati, MD: So microplastics are found in really everywhere, right? So from food, including fruits and vegetables, seafood, bottled water, honey, milk. I mean, wherever you look, things that are stored in plastics, as the researchers do more and look into more things, they're finding microplastics in the air and in the soil and within the body and multiple organs. The microplastics can cross the blood brain barrier, so they can impact the brain and development of young people. Breast milk, the placenta, testicles, heart, the liver, the kidneys. Clothing, cosmetics, cleaning products and also nail polish and that type of stuff. So they're pretty much everywhere. Trash, dust, tires, all of those things.

And what are the harms, right? So really when you think about it from the digestive tract, we think about inflammation that can be triggered, and that can affect the gut bacteria, which can affect nutrient absorption, toxin release, even things like abdominal pain and bloating, changes in bowel habits. Breathing issues. They can get into the lungs resulting in coughing or inflammation, shortness of breath for some people. For the brain, because they can cross the blood-brain barrier, we worry about things like neurotoxicity with repeated exposure over time.

And, we think about reproductive issues, endocrine, hormone related issues, as that can be affected as well. So, there's really a multitude of issues. And, part of the concern, really, is that they're ever present. Plastic is used around the world. And at this point it's not that we can necessarily completely avoid exposure. It's looking at minimizing the potential of exposure and where we can take individual steps to help ourselves, and to help our environment, to help our community.

I think that's really the way people want to think about. There's a famous thing about thinking seven generationally. And if you think how you want the world to look like seven generations from now, and we make some of the decisions that will leave it better for seven generations. That's a wonderful way to kind of approach the steps that we take on a day-to-day basis.

[00:21:46] Host Amber Smith: Do you think the microplastics are behind the rise in lung and colon cancers in young people? Because we've seen a huge increase in that.

[00:21:54] Kaushal Nanavati, MD: It's a good question. I don't know that the data clearly details that this is a primary cause. There's a lot of correlation that's been seen, and I think more research is being done to clarify how much of an impact microplastics have. Clearly they do lead to what we call oxidative stress and inflammation, both of which have the potential to trigger cell damage that could lead to pre-cancerous change. So a correlation is known. Causation, there's still more data coming. And clearly there's not a health benefit to exposure for sure.

[00:22:29] Host Amber Smith: How would we know if we have microplastics in our body?

[00:22:33] Kaushal Nanavati, MD: That's a great question. At this point, for most of us, we've been exposed to them. And unfortunately we don't really have tests like for a lot of things, even chemical exposures. We have blood tests and urine tests that can look for some exposures. With microplastics, we don't really have any standardized testing as of yet. There's a lot of research being done. What can we do to help ourselves, right? If we've all been exposed at some point, let's say, what can we do?

There's really not a specific method to remove microplastics specifically. However, coming back to if people have heard me come on the show before, the fundamentals are still fundamental, right? So what can we do? Having a fiber rich, antioxidant rich type of diet can help reduce the potential damage, the secondary effect. Staying well hydrated. And again, when we talk about staying well hydrated, it's not drinking from the plastic bottles. It's using the bottles that we use are glasses that are actually glass, or the stainless steel containers that are free of bisphenol A and some of these other chemicals that are plastic related to reduce the potential of inflammation, to reduce the potential of oxidative stress, and in fact, to help the body heal, and to stay healthy in the first place so that we can try to avoid the problems coming on in the first place.

[00:23:54] Host Amber Smith: Will that help us get rid of the microplastics from our body?

[00:23:58] Kaushal Nanavati, MD: That's very difficult. It'll reduce the potential of the microplastic doing as much damage. Microplastic has been found in feces, and so the body does get rid of some of it. Oftentimes a microplastic gets deposited into fat cells in the body as well. And so staying healthy is very, very important. Staying fit is very important as well. But we don't really have, like, I can't tell you that there's a pill or there's some medicine that gets rid of microplastic from the body at this point.

[00:24:30] Host Amber Smith: Do you think it would be realistic to live a life without plastic? It seems like it's everywhere.

[00:24:36] Kaushal Nanavati, MD: It is everywhere. So what can you do to reduce exposure? So first thing is to live it without (plastics) is very difficult around the world because of environment and the fact that it's found in air and other places, however, trying to use natural reusable materials such as glass or stainless steel, or even bamboo is used for utensils. Those are probably the ways to do it. Avoiding single use plastics, like those water bottles, that a lot of people get, they'll buy bottled water and they'll drink from that. What we don't know is how long that bottled water has been sitting there in a warehouse. We don't know how much the water's been exposed to the plastic container that it's in. Plus, plastic is very difficult if at all to degrade. So if we're using single use plastics, we're just creating more plastic pollution. So that's important.

And then on the broader scale in terms of institutional, community governmental policies, supporting policies that reduce plastic production and waste. I know that they're working on biodegradable plastic that's made from natural elements that biodegrade more easily. Over time with plastics engineering, if we're able to create storage materials that are biodegradable, that also have the ability to maintain food integrity. That would be ideal.

[00:26:02] Host Amber Smith: Well, Dr. Nanavati, thank you so much for making time for this interview.

[00:26:06] Kaushal Nanavati, MD: I appreciate it. I think it's a very important topic, and I appreciate you guys putting a spotlight on it.

[00:26:11] Host Amber Smith: My guest has been doctor of family medicine and director of integrative medicine at Upstate, Dr. Kaushal Nanavati. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- New York now has a biomarker testing law.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." New York Governor Kathy Hochul signed a bill that took effect January 1 requiring health insurers to cover life-saving cancer biomarker testing, which allows for targeted treatment. For help understanding the importance of this legislation, we spoke to two people last year: Dr. Thomas VanderMeer, the medical director of the Upstate Cancer Center, and Mr. Michael Davoli who is the American Cancer Society's senior government relations director for New York State. We're re-airing that interview now. Welcome to "HealthLink on Air," Dr. VanderMeer and Mr. Davoli.

[00:27:06] Thomas VanderMeer, MD: Thank you, Amber.

[00:27:07] Michael Davoli: Thank you.

[00:27:08] Host Amber Smith: Let's begin please with a description of what cancer biomarkers are and how they differ from genetic testing and why this has become important in cancer care. Dr. VanderMeer?

[00:27:21] Thomas VanderMeer, MD: There's lots of different kinds of biomarkers, but in general, a biomarker is a test to measure something that's happening in our bodies. In cancer, biomarkers are molecules that indicate if cancer is present, what abnormality is causing the cancer to grow, how active it is, and how it will respond to different types of treatment.

In the past few years, there have been major breakthroughs in our understanding of how cancer works and how to design treatments that target specific molecules and spare the rest of the body the toxicity of conventional chemotherapy. Some biomarker testing is done with blood tests and some requires tissue from a biopsy.

Genetic testing refers to, generally, a blood test that looks at what genetics we're born with. We call that germline testing. That differs from this type of testing, which evaluates the specific molecular alterations in the cancer cell.

[00:28:19] Host Amber Smith: So this sounds like it's fairly new. How long has it been that biomarkers have been a tool for cancer care providers?

[00:28:28] Thomas VanderMeer, MD: We go back to 2001 when the FDA (Food and Drug Administration) approved the first drug called Gleevec, that is designed to target a specific protein on a cancer cell. This was very new at that time. That drug was incredibly effective against a couple of rare cancers, but the concept was so exciting that the FDA approved it in about two and a half months.

Since then, molecular targets and their biomarkers have been identified in many different cancers with numerous new drugs created to interfere with cancer cell growth. And now there are so many potential molecular targets for treatment that testing is done on a panel of over 300 molecular alterations.

[00:29:08] Host Amber Smith: So at this point, which cancers is biomarker testing used in the most?

[00:29:14] Thomas VanderMeer, MD: Well, it's increasing. All cancers have, or can have molecular targets for treatment. They're most commonly seen in non-small cell lung cancer, melanoma, breast and colorectal cancer. But 37 of those 62 anti-cancer drugs launched in the past five years, require bar biomarker testing to determine effectiveness, and increasingly we're finding that these new drugs work against more and more types of cancer.

[00:29:41] Host Amber Smith: Do you ever have patients who need this, who need biomarker testing or would benefit from it, but whose insurance companies won't pay for it? Do you see that happen?

[00:29:51] Thomas VanderMeer, MD: Oh, definitely. And that's why this is so exciting.

My practice focuses on pancreatic cancer. And the typical policy for insurance companies is that they only cover biomarker testing for patients with metastatic disease. But as a surgeon, I see early stage pancreatic cancer, and we've had a number of patients where we wanted to get biomarker testing, and we figured out how to do it one way or another. And they received targeted treatment, which would be different than the treatment that they would receive if we didn't know about the specific molecular alteration in their cancer. And we've had patients who had the cancer completely eradicated, and there was none seen on surgical specimen.

[00:30:35] Host Amber Smith: Wow. So when you say targeted treatment, can you describe what is meant by targeted treatment and how it compares to, I guess, traditional treatment?

[00:30:47] Thomas VanderMeer, MD: Well, traditional chemotherapy agents interfere with cell growth throughout the body. They focus on growth patterns that tend to be more common in cancer cells. But all cells get affected, so there can be significant toxicity. These newer targeted treatments modify specific molecular processes that are unique to cancer cells and interfere with cellular signals that cause cancer cells to grow or limit our own body's immune response to fight the cancer. So as a result, there's much less collateral damage to normal cells because the activity of these drugs is so much more specific and limited.

And with newer targeted treatments coming down the line, they're using the molecular profile of a person's individual cancer to design custom vaccines or to reprogram a patient's own immune cells to kill their cancer.

[00:31:37] Host Amber Smith: Mr. Davoli, do I understand correctly that this bill was needed because only about a third of health insurers in New York were paying for biomarker testing?

[00:31:47] Michael Davoli: Yeah, that is correct. While all insurance plans in the state cover some biomarker testing for some patients, only around 31% of commercial plans cover what is considered comprehensive testing. And in addition, Medicaid does not cover comprehensive testing either. So Medicaid covers some testing for some patients.

So for example, a commercial plan or Medicaid may cover testing for, say, breast cancer only, but no other cancer. But they also may say we're going to cover it if it's a stage three or stage four diagnosis, but we're not going to cover it for an earlier stage. So comprehensive biomarker testing, which is what this bill would achieve, requires coverage for all testing for all diseases and at all stages when medically appropriate.

[00:32:44] Host Amber Smith: You mentioned Medicaid. What about Medicare, for seniors? Does that cover biomarker testing?

[00:32:52] Michael Davoli: Yeah, luckily Medicare already covers comprehensive biomarker testing. Since that's governed by the federal government, they established this in law several years ago. But Medicaid, on the other hand, the rules are governed sort of on a state-by-state basis.

And so Medicaid only covers some testing for some patients, similar to the way the commercial market. And in a state like New York, when you've got around 8 million people that are on Medicaid, that is so critically important.

[00:33:23] Host Amber Smith: Do you know if biomarker testing is covered in other states?

[00:33:27] Michael Davoli: Well, so New York State just became the 13th state in the nation to enact comprehensive biomarker testing. New York joined states like California, Texas, Rhode Island, even Arkansas and Louisiana. So it's a real mix of sort of larger and smaller states that have done this. And I do know that there are efforts underway in all 50 states to establish comprehensive biomarker laws similar to the one we now will have here in New York.

[00:33:56] Host Amber Smith: Are you familiar enough with the language of this bill to tell whether does it account for the advances in biomarker testing that are bound to happen in this field?

[00:34:06] Michael Davoli: It does. And and that's one of the exciting things about the bill is it's really a, it's not a cancer bill per se, it's a science bill. It's a pro-science bill that sets out a set of criteria that says if different tests for biomarkers meet these different sets of criteria, then they must be covered. And there's a list of different types of criteria, and as long as the test meets one or more of those sets of criteria, it would be covered.

So for example, if something is an FDA-approved test for that disease, it would be covered. Or if there are national guidelines set out for a certain type of disease and a test, it would be covered. If there is a Medicare approval already for that type of test, it would be covered. And so a test that, say, didn't exist 10 years ago, or even five years ago, but that is developed in the future, as long as it meets those criteria in the bill, it would be covered.

And a perfect example of this is, as the doctor mentioned, you know, you have individual tests for individual biomarkers that have been going on for 20 years where we've been able to sort of, say, test one biomarker at a time. But increasingly, we have companies that are developing these biomarker tests that are these multi-panel tests that really look for every known biomarker that exists within a patient's own blood sample. And the bill allows for coverage of that, if it's medically appropriate and if it meet one of those standards. So, like I said, it really is a pro-science bill that's going to evolve with the science as it develops moving forward.

[00:35:57] Host Amber Smith: Does the bill say anything about whether insurers need to pay for genetic testing to see if a particular cancer gene runs in family members, for instance?

[00:36:07] Michael Davoli: That's the one area where there is a lot of confusion. So this bill specifically does not deal with genetic testing and whether or not someone is likely to develop a disease in the future. It is focused exclusively on biomarker testing for the purposes of treatment rather than looking to see if someone is predisposed for cancer. So it does not cover that type of genetic testing for predisposition.

[00:36:32] Host Amber Smith: You're listening to Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Thomas VanderMeer, the medical director of the Upstate Cancer Center, and Michael Davoli from the American Cancer Society. He's the senior government relations director for New York. We've been talking about a new law in New York requiring health insurers to pay for biomarker testing.

How soon does the bill take effect, and how quickly would patients who need biomarker testing have it covered?

[00:37:01] Michael Davoli: So the bill takes effect on January 1st, 2025. So it'll be next year. However, we do know that putting this bill in place, a lot of insurance plans are already starting to add this comprehensive testing. So like I mentioned, 31% of commercial plans were not covering comprehensive testing. Well, that does mean that the majority were covering testing already, voluntarily. And so what we believe this is going to do is ensure that everyone's covering it beginning January 1st, but in the meantime, we do believe more and more insurance companies are going to add this coverage benefit because they see the value of it.

And now that they see the law that's on the books, they're going to recognize that they might as well start doing this for the benefit of their patients.

[00:37:52] Host Amber Smith: Dr. VanderMeer, can you walk us through how a hypothetical person might learn that they would benefit from biomarker testing?

[00:37:59] Thomas VanderMeer, MD: The most common gene panel that's looked at is called FoundationOne. And on their website there's a table that shows based on what type of cancer, what different molecular alterations there might be, and it even says which drugs are available too,to treat those. There's also guidelines published by the National Comprehensive Cancer Network, for each type of cancer, and so people can get information about that.

Generally just medical oncologists are very aware of this, that they are really enthusiastic about all these targeted therapies and the rapid growth and their ability to use targeted therapies. So, usually just talking to your medical oncologist will be probably the easiest and best way to do it.

[00:38:52] Host Amber Smith: So is this what happens almost immediately after you learn that you have cancer? Is this the next step is to find out whether a biomarker test could help?

[00:39:02] Thomas VanderMeer, MD: It hasn't been, because we haven't been able to get it approved. But I think with this bill, especially in the states where it's being enacted, that will increasingly be the case.

[00:39:16] Host Amber Smith: So is it like going to a lab for blood work, generally? I know you said sometimes there's a biopsy, but often is it a blood draw, and then you wait a certain amount of time to get the results?

[00:39:28] Thomas VanderMeer, MD: There are blood tests. What we find more useful, though, is a test on the biopsy specimen itself, because the alterations are frequently different in the cancer itself compared to what we see in the blood. All cancers are diagnosed with a biopsy. So if it's a solid tumor, like, say, lung cancer, then there's a biopsy of that. But even leukemias, there's a bone marrow biopsy. And so, these tests can be run on any specimen.

[00:40:00] Host Amber Smith: Is this a test where the results come back either yes or no, or is there more interpretation needed?

[00:40:08] Thomas VanderMeer, MD: The tests come back, and it'll say which molecular alteration is present and give you a lot of specific information about that. And the gene panels are really targeted to what would be actionable in terms of treatment. So they're all set up with a specific goal of identifying changes that would impact treatment.

[00:40:35] Host Amber Smith: So is treatment sort of put on hold until you get the results back, or are there certain parts of treatment that you would start ahead of time?

[00:40:43] Thomas VanderMeer, MD: Yeah, well we like to get the results back as quickly as possible. It usually takes from the time of the request, the tissue has to be sent out to another lab. Once that lab gets it, it takes about 10 days to get the information back. So it's usually about two weeks. So it depends on the severity of the cancer. If people can wait those two weeks without much harm, then a lot of times we would wait to get that information back.

Increasingly, larger institutions are trying to bring those tests in-house. So that we get the information more quickly.

[00:41:22] Host Amber Smith: If a person finds out they have a particular biomarker, does that mean that their children or other family members will have the same biomarker?

[00:41:33] Thomas VanderMeer, MD: No. The biomarker on the tumor is typically unique to the tumor. The germline testing, which is what we're born with and is the composition of all of our cells, that is heritable. And so if you take, say, like a BRCA mutation that may be in your gene line. That would be passed on to your children. That runs in your family. That's also going to be present on your tumor cell, most likely, but there may be other changes in the tumor cell that have occurred during your lifetime and have caused that cell to change from a normal cell to a cancer cell. And that's why the most important testing is done on the biopsy specimen itself.

[00:42:22] Host Amber Smith: And BRCA, that's the breast cancer gene?

[00:42:25] Thomas VanderMeer, MD: Yeah. The BRCA mutation put you at risk for other cancers too.

[00:42:29] Host Amber Smith: Okay. Gotcha.

Now, when this bill passed, there was talk that it was going to help reduce health disparities. Can you explain how?

[00:42:39] Thomas VanderMeer, MD: Yeah. Well, the out-of-pocket costs for the most commonly used panel is $3,500. And so, as was mentioned earlier, there's 8 million New Yorkers on Medicaid, and they probably don't have $3,500 to pay for this. So if you think about it, if you don't have access to biomarker testing, then you don't have access to these newer targeted treatments. And so every new advanced drug that comes out is widening healthcare disparities. Because there's more and more treatments that are unavailable to people in lower socioeconomic groups.

[00:43:17] Michael Davoli: When you look at who has access to biomarker testing currently in New York state and as well as nationwide, it's really fascinating. If you are a person of color or if you are lower income, but also if you are from a rural area, or if you get your healthcare from more of a community center as opposed to an academic center, you are less likely to get access to comprehensive biomarker testing. So, for example, if you get your cancer care, your medical care from an FQHC (federally qualified health center), maybe they do biomarker testing, but then they need to ship it out to a lab. It takes time. And then it comes back and everything. As opposed to if you are getting your treatment at a academic center where they literally do the biomarker testing right there in-house, and they and run it through their processes, it can speed up that process in order for getting you that care.

As well as, some of the larger cancer centers that have larger endowments and money will often cover the cost of biomarker testing for you as opposed to if you were in a community center where they just simply don't have those resources. So that's why this is so important that it really kind of levels the playing field and brings everyone up to that comprehensive level.

[00:44:35] Host Amber Smith: The Upstate Cancer Center is part of an academic medical center. You used the term FQHC. What is that?

[00:44:43] Michael Davoli: So that's a Federal Qualified Health Center. So these are the health centers that provide healthcare for a lot of our lower income folks, our Medicaid patients. They exist in New York City, but a lot of the urban areas across the country, and they provide treatment for millions of patients every single year. And they simply, they're not going to have the type of resources that a place like Upstate Medical would.

[00:45:09] Host Amber Smith: Now you both specialize in cancer, I realize, but biomarker testing is being used in other areas of medicine. Does this New York bill address any other diseases besides cancer?

[00:45:20] Michael Davoli: That is, again, that's one of the exciting things about this bill is that it's not a cancer bill, per se. It's actually disease agnostic. So, while biomarker testing is primarily being used in the treatment of cancer currently, there's research being done in a whole host of different medical conditions -- everything from mental health issues to heart disease, a lot of different neurological conditions, even Parkinson's and ALS (amyothrophic lateral sclerosis) there's research being done on biomarker testing and how they can be used for the treatment of those diseases.

What this bill explicitly says is, if the science shows that biomarker testing can be used to treat that disease, then it should be covered by the law, and the testing should be covered by your insurance.

Now, for example, just this past spring, a test for preeclampsia was approved by the FDA that would help doctors determine whether or not a patient of theirs needed to go on bed rest at home for a month, or if they needed to come to a hospital and spend potentially a month at the hospital prior to delivering their baby. And so you can imagine the mental and financial cost savings that would be if a patient could do bed rest at home versus having to spend a month in the hospital.

That test was just approved by the FDA back in April and now will be covered by this law because it meets that standard of FDA approved for the purposes of treatment. So that's just one example of how this law is going to go way beyond cancer in the future. As long as there is the medical science that sort of meets those standards laid out in the bill, the test would be covered regardless of what type of disease it is.

[00:47:25] Host Amber Smith: Well, that's good to know. I want to thank both of you for making time for this interview.

[00:47:29] Thomas VanderMeer, MD: Thank you, Amber.

[00:47:31] Michael Davoli: Thank you so much. Thank you, Amber.

[00:47:33] Host Amber Smith: My guests have been the medical director of the Upstate Cancer Center, Dr. Thomas VanderMeer, and the American Cancer Society's Senior Government Relations Director for New York, Mr. Michael Davoli. I'm Amber Smith for Upstate's "HealthLink on Air."

And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD

Anne Rankin gave us a beautiful but difficult poem that analyzes Vincent Van Gogh's "Starry Night" and finds in it an unsettling similarity with her own speaker. Here's her poem "Broken."

Staring again at Van Gogh's Starry Night,

I've a fervor all my own. Before me the sky

a sea of waves, the swirling almost holy.

But I can't pray here, can't turn away

from the weight of the cypress, the glaring

eyes of the stars. The moon

looks unwell but there's nothing I can do.

Subdued, the little boxes of the village stand

opposed to the curves of the swirls.

(Right angles never fix anything.)

There's so much pain here, I can almost hear

the canvas calling.

Most are dazzled by the strange

brushstrokes: the swell of his yellows,

the depths of his blues.

But it's too hard for me to watch.

Sickness, painted boldly.

They're never going to get

all the ways he's broken.

He had told Theo, Just as we take the train ...

we take death to reach a star.

He'd reached before, was reaching still.

But there's a black hole

in every galaxy, dark matter in every life.

I'm never going to fix

all the ways I'm broken.

There's nothing romantic about the mind

succumbing to its own black hole.

There is only the ear, calling, and the gravity

of the blade. In the end,

a small voice -- deep as the universe --

convinced that nothing will mend me.

This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at HealthLinkonAir.Org. Upstate's "HealthLink on Air" is produced by Jim Howe with sound engineering by Bill Broeckel and graphic design by Dan Cameron. This is your host, Amber Smith, thanking you for listening