The Mystery of the "Sausage Toe"

The Mystery of the "Sausage Toe"
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During the summer of 2013, my friend Brandon was diagnosed with “Sausage Toe.” A dancer, Brandon went to the doctor after his toe swelled twice its size and he developed sharp pain in the joints of his right thumb and feet, which affected his ability to perform.

Over the next several weeks, doctors ran tests to try to figure out what was wrong. His toe wasn’t broken. A course of antibiotics didn’t work. By the fall, Brandon’s symptoms were so severe that after performing he would walk off stage and immediately cry in pain.

By November, Brandon eventually saw a rheumatologist. After learning of Brandon’s long history of lower back pain, which Brandon usually attributed to dancing so much, the rheumatologist said he was a textbook case for Ankylosing spondylitis (AS).

AS is an inflammatory disease that, if left untreated, could cause some of the vertebrae in the spine to fuse together. An x-ray of Brandon’s lower spine confirmed that his sacroiliac joint was already fused, indicating that he had been suffering from AS for years. Absent effective treatment, Brandon feared that – at age 24 – his career would be over.

Today, Brandon is symptom and pain free thanks to Enbrel, a medication that is highly effective at treating AS and other autoimmune disorders. Enbrel is a special type of pharmaceutical called a “biologic.” Unlike most medications, which are created by a chemical process, biologics are a relatively new type made from living cells.

Biologics have become critical to treating serious diseases like cancer, cardiovascular disease, and HIV/AIDS. They’re also very expensive. Absent health insurance, Brandon would have to pay nearly $3,000 per month for Enbrel, which he needs to take for the rest of his life.

Expensive biologics like Enbrel are at the heart of a critical piece of legislation in New York State – and in state legislatures around the country – that will help reduce costs and make biologics more readily available to patients.

As patents for biologics expire, bio-pharmaceutical companies are able to offer copies of biologics, called “biosimilars,” which will lower health-care costs across the board. Europe began approving biosimilars a decade ago. The U.S. began last year. The Congressional Budget Office estimated that biosimilars would reduce total expenditures on biologics by $25 billion over 10 years.

The Affordable Care Act created a process for the FDA to approve biosimilars that work like the biologics they imitate. However, because biosimilars can be different from the original due to the complexity of the manufacturing process, state laws need to be updated to allow pharmacists to provide them to patients – as long as pharmacists notify doctors the substitution is being made.

So far, 20 states have passed these laws. It’s time for New York to join them.

Sponsored in the Assembly by Dick Gottfried and in the Senate by Kemp Hannon, A.8648-A / S.6311-A updates state laws so that when biosimilars are approved by the FDA, New Yorkers and their providers have a safe and transparent process for accessing these lower-cost, life-saving medicines.

With New York State's legislative session scheduled to end soon, it’s critical that our representatives place the health and well-being of all New Yorkers above politics.

New York has always been a leader in providing safe, comprehensive, and affordable health care. Passing this legislation will continue that legacy.

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