During his visit to the Inland Empire as part of his “National Latino Health Tour,” Secretary Becerra emphasized the positive impact of the Biden Administration’s Inflation Reduction Act.

“We have to remember that there were days before the Inflation Reduction Act became law and lowered the price of insulin, people were having to ration their insulin and make decisions about what to do in their daily lives if they wanted to afford it,” said Becerra. “Today, people paying no more than $35 for insulin when on Medicare is a big deal, and the fact that we now have the ability to negotiate the prices on medicine is huge.”

The $35 insulin cost cap is set to benefit 108,164 Californians on Medicare who use insulin, addressing a critical need in a state where one 10-milliliter vial of insulin can cost up to $400; a person usually needs two to three vials a month. “This is the right thing to do for our patient care. We are going to continue lowering the cost of healthcare here in the Inland Empire because it matters to people,” said Rep. Aguilar.

Further emphasizing the Act’s impact, Rep. Aguilar highlighted that drug negotiations will benefit more than 830,000 California Medicare enrollees, saving them between $64 and $4,297 in out-of-pocket costs for the first ten drugs subject to price negotiations.

Additionally, the Act ensures that recommended vaccines are now free for the more than 1.2 million Latinos in California enrolled in Medicare, and introduces a $2,000 annual out-of-pocket cost cap, effective in 2025, which will save 203,210 Californians an average of $341.84.

Secretary Becerra also noted the historic increase in Latino enrollment in health coverage through the Affordable Care Act, which jumped by 53% from 2020 to 2022, helping more than 900,000 Latinos nationwide gain health insurance than ever before.

The press event also featured a fireside chat between Congressman Pete Aguilar and Secretary Becerra, where they discussed important issues like the Affordable Care Act, health insurance, medication prices, and mental health. A SAC Health patient named Sheila provided a poignant testimony on the importance of insulin and the recent struggles faced in terms of cost and accessibility, underscoring the significance of the measures announced.

As the Inland Empire and the broader Californian community look forward to these changes, the hope is that the Inflation Reduction Act will pave the way for a healthier and more affordable future for all.

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A new version of the popular diabetes treatment Mounjaro can be sold as a weight-loss drug, U.S. regulators announced Wednesday.

The U.S. Food and Drug Administration approved Eli Lilly’s drug, named Zepbound. The drug, also known as tirzepatide, helped dieters lose as much as 40 to 60 pounds in testing.

Zepbound is the latest diabetes drug approved for chronic weight management, joining Novo Nordisk’s Wegovy, a high-dose version of its diabetes treatment Ozempic. Both are weekly injections.

The FDA approved Lilly’s drug for people who are considered obese, with a body mass index of 30 or higher, or those who are overweight with a related health condition, like high blood pressure, high cholesterol or diabetes. The drug should be paired with a reduced-calorie diet and regular exercise, the FDA said.

In the U.S., at least 100 million adults and about 15 million children are considered obese.

The drugs tirzepatide in Zepbound and Mounjaro and semaglutide in Wegovy and Ozempic work by mimicking hormones that kick in after people eat to regulate appetite and the feeling of fullness. Both imitate a hormone called glucagon-like peptide-1, known as GLP-1. Tirzepatide targets a second hormone, called glucose-dependent insulinotropic polypeptide, or GIP.

FDA’s approval was based on two large studies: More than 2,500 participants got different strengths of Zepbound and nearly 1,000 people got dummy shots over 16 months. Participants without diabetes who received the highest dose lost about 18% of their weight, or about 41 pounds (19 kilograms), compared to placebo. Those with diabetes, who have a harder time losing weight, cut about 12%, or nearly 27 pounds (12 kilograms), the FDA said.

In another recent study, the drug helped people lose up to a quarter of their weight, or 60 pounds (27 kilograms), when combined with intensive diet and exercise.

Overall, Zepbound appears to spur greater weight loss than Wegovy. Approved for weight loss in 2021, Wegovy helped people lose about 15% of their weight or 34 pounds (15 kilograms), according to study results.

“This would be the most highly efficacious drug ever approved for the treatment of obesity,” said Dr. Fatima Cody Stanford, an obesity medicine expert at Massachusetts General Hospital in Boston.

Touted by celebrities and on social media, semaglutide and tirzepatide drugs have already been in such demand that their manufacturers have struggled to keep up. Both have been listed on the FDA’s drug shortage site for months. All strengths of tirzepatide are currently listed as available, but a company spokesperson said that could vary by location and demand.

Side effects of the new weight-loss drug include vomiting, nausea, diarrhea, constipation and other gastrointestinal problems. In the most recent published trial, about 10% of people taking tirzepatide dropped out of the study because of such problems, compared to about 2% of people taking dummy shots.

While experts lauded approval of Zepbound, they worried that it wouldn’t necessarily mean greater access to the drug, which has been prescribed “off-label” to help people pare pounds.

“Most patients won’t be able to afford Zepbound without insurance coverage and many health plans exclude obesity care,” said Dr. Katherine Saunders, an obesity expert at New York’s Weill Cornell Medicine and co-founder of company focused on obesity treatment.

Eli Lilly and Co. said the list price will be about $1,000 a month, the same as Mounjaro. The drug is expected to be available in the U.S. by the end of the year, the company said. Dosing strengths are the same for Zepbound and Mounjaro.

Kelly Burns, 50, of St. Petersburg, Florida, lost nearly 100 pounds (45 kilograms) using tirzepatide after joining a study of the drug to treat obesity in 2021. When testing ended and she no longer had access to the medication, she struggled, but eventually lost another 50 pounds (23 kilograms).

“My whole life is completely different,” she said. Her health measurements improved and her confidence soared. Now that is is approved for weight loss, Burns plans to ask her insurance company about coverage.

“It would be ridiculous not to,” she said, adding: “I want to stay this way as long as I possibly can.”

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“I’ve seen the human face of this up close as a pastor. I’ve been there and witnessed what happens when diabetes goes on untreated,” Warnock said in an interview with The Associated Press. “I’ve been there with families when they received the news that a loved one will have to receive an amputation.”

That work as a pastor helped the freshman senator push Congress to take its first step in limiting the high cost of insulin for millions of Americans.

The passage of the expansive climate change and health care bill this month delivered key Democratic priorities to voters months before the midterm elections, including provisions to lower health care costs.

As a result, by 2026, Medicare will gain the power to start negotiating costs for pharmaceuticals and its beneficiaries’ out-of-pocket prescription costs will be limited to $2,000 starting in 2025.

But the most immediate relief will take effect in January when the cost of insulin for patients on Medicare will be capped at $35 a month.

The provision, a longstanding priority for Democrats, will bring relief to an estimated nearly 2 million people across the country who currently pay an average of $572 annually out-of-pocket for insulin, according to a recent analysis by the Kaiser Family Foundation.

In Warnock’s state, the annual average is higher, coming in at $591 for more than 50,000 Georgia residents whose lives are dependent on the drug.

Around 7 million Americans require insulin daily and 14% of them are spending nearly half of their income after food and housing costs on the medicine, according to a Yale University study.

“It’s devastating for a family to have to make those choices,” Lisa Murdock, chief advocacy officer for the American Diabetes Association, told the AP. “This is a life-saving medication. You can’t live without it, and we shouldn’t have people in this country who are having to choose to do that.”

The issue of insulin pricing is more pronounced in the U.S. than in other nations, and it has gotten worse over the past two decades. According to a 2016 study published in the Journal of the American Medical Association, between 2002 and 2013, the price of insulin tripled. And between 2012 and 2016, prices continued to climb, nearly doubling, a congressional report released in March found.

The issue has been a perennial one in Congress, with a broad bipartisan consensus recognizing the problem, but little agreement on a solution. That is why organizations like the American Diabetes Association have sought to fight the battle for affordable insulin in the states, starting in 2019 when Colorado became the first state to institute a cap on copays for insulin.

“From there, we just ran with it,” Murdock said. “We currently have 22 states and the District of Columbia with a monthly copay cap in place and we will continue to work on that as long as we need to raise the conversation.”

While several states passed legislation that capped the price for Medicare and private insurance, the new federal law doesn’t go as far. The legislation introduced by Warnock had initially included the monthly cap both for Medicare recipients and those privately insured.

But during an hourslong voting series, Republicans stripped out the portion that would have included private insurance, which is used by the majority of those in need of insulin. Some of the GOP senators who voted for it to be removed represent states with some of the highest mortality rates for diabetes, according to data from the Centers for Disease Control and Prevention.

At the time, Republicans who voted against the provision said it violated Senate budget rules, but Democrats intentionally did not drop it, daring their colleagues across the aisle to vote on the Senate floor to strip it out.

“In reality, the Dems wanted to break Senate rules to pass insulin pricing cap instead of going through regular order,” Sen. Ron Johnson, a Wisconsin Republican, tweeted after the vote. Johnson added that he had previously “voted for an amendment, that Dems blocked, to provide insulin at cost to low-income Americans.”

But Warnock said the quarrel over procedural rules meant failing on substance.

“The blocking of a provision that would have provided the same cap for folks on private insurance is yet another example of why people hate politics and, and what’s wrong with Washington,” he said.

The provision did however get seven Republicans on board. And while it wasn’t enough to pass the broader cap, it was more support than for any previous effort to cap insulin prices in Congress. Majority Leader Chuck Schumer indicated that expanding affordable access to insulin will be a priority for the chamber in September.

Advocates say a potential legislative response to address the gaps in coverage could come in the form of the Insulin Act, a bipartisan proposal introduced last month by Sen. Jeanne Shaheen, a Democrat from New Hampshire, and Sen. Susan Collins, a Republican from Maine, that would include a cap on the private marketplace. The legislation also has mechanisms in place that would lower the list price for insulin, providing relief for diabetes patients without insurance.

“We are grateful for the step forward in the Inflation Reduction Act, but now we’re focused and really urging Congress to bring up the Insulin Act as soon as possible,” said Campbell Hutton, vice president of regulatory and health policy at JDRF, a New York-based nonprofit that funds type 1 diabetes research.

By FARNOUSH AMIRI

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By Trudy Lieberman

It’s rare these days that we get an amazing piece of health journalism that really explicates what’s wrong with the U.S. health system. But “Out of Control: America’s losing battle against diabetes,” is a series of three stories published starting in August by Chad Terhune, Robin Respaut, and Deborah J. Nelson at Reuters, gets right to the troubles plaguing American health care. It’s a series about the patients who get too little care; the ones who get too much; and those who are injured by doctors and hospitals. It’s about a system guided by money and who gets it. And it’s about how and why the U.S. health system does not come close to being the best in the world, as politicians and the medical stakeholders are forever claiming.

The Reuters’ team forcefully illustrates the overuse, underuse, and misuse of medical care in America — the same trio of failings identified more than three decades ago by Dr. Mark Chassin and colleagues. Chassin, who was then at the Mt. Sinai School of Medicine in New York City, is stepping down at the end of the year as head of the Joint Commission, the hospital accreditation agency. It’s worth recalling his framework, which to me explains why the Reuters’ stories are so powerful and why we have not yet made much systemic improvement in our health care.

Reuters tells its story through the lens of diabetes, a disease that now plagues one in 10 Americans. In 2017, the Reuters team reported, the U.S. mortality rate for diabetes was 42% higher than the average among 10 other industrialized countries. Many of those Americans were being treated with insulin, a drug discovered a century ago and whose sales have increased 212.5% from $24 billion in 2011 to $75 billion in 2020, second in total revenue only to drugs used to treat rheumatoid arthritis and other inflammatory conditions. You would think with all that money spent on drugs to control the disease, the U.S. would have something to crow about. Not so, as the Reuters’ reporters showed. 

“We had been making a lot of progress until around 2010 or 2011,” Terhune told me. Then things began to change. “Complications from diabetes seem to have rounded a corner in 2019-2020 in middle-aged adults. This shouldn’t be happening given how much money and resources we have put into treating the disease.” He added, “Diabetes has followed the obesity crisis and has to do with healthy lifestyles and health disparities. It’s a reflection of the income inequality.”

The first story in the series, “How the pandemic laid bare America’s diabetes crises,” quickly summarizes the reasons for the medical catastrophe. “The reasons for the worsening outlook for diabetes patients are rooted in the American lifestyle and medical system,” the story explains. “More Americans are developing diabetes earlier, even in childhood, because of long-term societal shifts toward sedentary lifestyles and unhealthy diets, according to researchers and doctors.” Furthermore, those who do contract the disease may have a harder time managing it because of the lack of consistent medical care. Many ration medications and limit doctor visits to avoid large out-of-pocket costs from deductibles and coinsurance common in today’s insurance policies. Ironically, the insurance industry shoved those onerous costs onto policyholders to discourage them from seeing doctors in an attempt to lower the overall cost of health care, and in turn, the insurers’ costs as well. As the Reuters team shows, that policy has boomeranged by creating higher costs owing to delays in care that impose life-threatening health consequences on their victims. In one study cited by the report, researchers found that lower-income workers and their family members with diabetes had 22% more ER visits for preventable complications after switching to high-deductible plans. Ed Gregg, a former CDC researcher and now a professor at Imperial College in London, told Reuters, “The problem is worse in young adults, and there isn’t improvement in older adults. The magnitude of the problem has set us back 15 to 20 years.” 

So, it’s fair to ask: Is our health system killing Americans with diabetes?

The reporters answer that question by telling the stories of patients who struggled to get care, like 42-year-old Kate Herrin who lived in rural West Alexandria, Ohio, and had trouble controlling her diabetes even in better times. When the pandemic hit, the challenges of the disease became more demanding, often overwhelming. She was poor, and lived alone with only her two rescue dogs for company. When the virus came to Ohio, she stayed indoors, afraid to go to the grocery store and instead lived on fast food — pizza and chicken wings, delivered to her door. Getting medical care — always a challenge when doctors often turn away Medicaid patients and those who don’t keep bankers hours — was a struggle for Herrin. She had trouble finding diabetes supplies and grew frustrated trying. “This is why I hate shitty Medicaid,” she told a friend. “The only places that accept it are a million miles from anywhere and don’t have extended hours.” When the engine on her 2002 Honda Civic gave out last November, she didn’t have money to fix it, so she was unable to drive to a doctor’s office for overdue lab work. Medical records indicated she had no way to get to the office. Ten days before Christmas, she died in her bathroom clutching her phone while looking up symptoms of a heart attack, often a consequence of untreated diabetes.

While the first piece in the Reuters’ trilogy tackled medical underuse, the second story — “Drugmakers pushed aggressive diabetes therapy. Patients paid the price” — investigates medical overuse, a problem easy to overlook in an era when so many struggle to access or afford care. Using diabetes as the poster child for this American phenomenon, the reporters tell a chilling tale of what happens when someone gets too much medicine.

They share the story of a 66-year-old Minnesota man named Ron Carlson who died from chest trauma and hypoglycemia, extremely low blood sugar, which caused him to lose control of his motorcycle in the parking lot of Al’s Center Saloon in Center City, Minnesota two years ago. He had been on his way to a weekly dinner with friends. Hypoglycemia, Reuters told its readers, is a “medical emergency characterized by confusion, dizziness and loss of coordination. Untreated, it can quickly lead to coma and death, and it’s almost always a side effect of diabetes treatment.” His widow Lucy Carlson feared something like this would happen. She told Reuters her husband was obsessed with lowering his A1c score, a measure of average blood sugar over three months. “He really tried hard to be at” an A1c below 7%. “That is what actually killed him,” she said. “I feel like his doctors were trying to help him, but what they were trying wasn’t working. If Ron hadn’t been trying to reach that goal, he could still be here today.”

In part two, the reporting team tells a story about the overmarketing and public acceptance of new drugs and devices, which is becoming all too familiar for patients. They traced the public campaign that began in the early 2000s to convince Americans to push their A1c levels to 7% or lower. Reuters pointed out that the “intense focus on A1c and using drugs to lower it is largely an American phenomenon.” One of the major champions of this approach was the American Diabetes Association (ADA), whose treatment guidelines are considered the gold standard by doctors and patients. The ADA endorsed the lower levels, and embarked on a program to publicly recognize doctors for getting their diabetic patients to reach specific goals.  

Capturing the sweep of their reporting, the trio writes, “diabetes represents a major public health failure in the United States as the prognosis for the burgeoning number of people with the disease has worsened even while spending on new treatments has soared.”

The story of how low levels of A1c became the standard of care raises an important question, said Deborah Nelson, one of the Reuters series’ authors. “Where does the line between public awareness and marketing begin? In the world of drugs and devices it’s often hard to tell. The ADA (American Diabetes Association) had identified the A1c as an important target but with caveats in the fine print,” Nelson explained. “The cautions and caveats were dropped in the press releases for company-sponsored public awareness campaigns,” effectively turning them into propaganda pieces for the medical intervention.

In 2004, 50 mayors from the U.S. Conference of Mayors filmed public service announcements with the goal of encouraging their constituents with diabetes to hit the A1c target of less than 7%. Boston Mayor Thomas Menino spread the word through PSA spots on local TV and radio outlets, and announced in a press release he was “proud to be part of this nationwide effort to move more of our citizens with diabetes toward an A1C<7%.” In 2002, the Congressional Diabetes Caucus, a group of some 300 members of Congress who educate their colleagues and their staffs about the disease and support activities to improve research, education, and treatment on behalf of drug manufacturers, joined the A1c crusade. The caucus, in effect a built-in lobbying organization within Congress, began to sell the “wisdom” of lowering A1c scores.

Dr. Chassin’s framework back in the ’90s also called attention to misuse of health care, which occurs when a patient doesn’t fully benefit from a treatment because of a preventable problem, or when the treatment itself causes harm. Reuter’s third story published last week, “As red flags multiplied, Johnson & Johnson kept quiet on popular diabetes drug,” addresses misuse in medicine through the tale of Invokana, Johnson & Johnson’s blockbuster diabetes drug that debuted in 2013. The reporters found that when the drug was undergoing clinical trials in 2010, researchers learned that some patients had high levels of certain organic compounds in their blood that could lead to ketoacidosis, a life-threatening complication of diabetes. From the story: “Later, as injury reports piled up, J&J executives repeatedly overruled safety concerns raised internally, leaving doctors and patients in the dark about the health risk.”

Dr. Bruce Leslie, who led the company’s safety team and subsequently left, told the reporters, “In my opinion, they wanted to make this safety issue go away because it threatened sales,” and he urged his bosses to “get out in front” of the issue. He recommended that the company alert U.S. and European regulators, “Otherwise, it could come back and bite us in the ass.” Reuters reported J&J took no action as sales continued to pile up, and still do. Last year the drug raked in $795 million even though it now carries warnings about adverse reactions. Reports to the FDA from 2013 to 2020 about adverse events associated with the drug now number 23,000, although the reporters point out such events, which include deaths, do not establish that the drug caused the event.

Readers also meet Veronica Ryan, a 58-year-old Type 2 diabetic from Tennessee who spent 12 days in the hospital suffering from ketoacidosis. Her condition had deteriorated; she struggled to breathe; her kidneys were beginning to shut down; friends were called in to pray. During her hospital stay, the FDA announced it would require Invokana and other drugs in its class to carry warnings about ketoacidosis. “I warn anybody who has diabetes to be cautious of Invokana,” Ryan told reporters. “It was like it was slowly killing me.”

Capturing the sweep of their reporting, the team wrote, “diabetes represents a major public health failure in the United States as the prognosis for the burgeoning number of people with the disease has worsened even while spending on new treatments has soared.”

But the series also shows something else. Namely, that we as health journalists must refocus our reporting from press release coverage of the drug industry to telling the stories of patients who live or die using their drugs. “There are many challenges for people with diabetes,” Terhune said. “It’s not new drugs. It’s more of a system crisis rather than lack of innovation. But there are more incentives for innovation rather than for fixing complicated problems. We keep hearing stories about increasing access to technology,” he told me. “But what those people need is hard to get — food, exercise, more diabetic educators, more focus on primary care.”

None of that is as sexy journalistically as a new drug, even though that drug may be overpriced and ends up killing those who take it.

Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care column.

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NEW YORK (AP) — The U.S. saw remarkable increases in the death rates for heart disease, diabetes and some other common killers in 2020, and experts believe a big reason may be that many people with dangerous symptoms made the lethal mistake of staying away from the hospital for fear of catching the coronavirus.

The death rates — posted online this week by federal health authorities — add to the growing body of evidence that the number of lives lost directly or indirectly to the coronavirus in the U.S. is far greater than the officially reported COVID-19 death toll of nearly 600,000 in 2020-21.

For months now, researchers have known that 2020 was the deadliest year in U.S. history, primarily because of COVID-19. But the data released this week showed the biggest increases in the death rates for heart disease and diabetes in at least 20 years.

“I would probably use the word `alarming,’” said Dr. Tannaz Moin, a diabetes expert at UCLA, said of the trends.

Earlier this year, the Centers for Disease Control and Prevention reported that nearly 3.4 million Americans died in 2020, an all-time record. Of those deaths, more than 345,000 were directly attributed to COVID-19. The CDC also provided the numbers of deaths for some of the leading causes of mortality, including the nation’s top two killers, heart disease and cancer.

But the data released this week contains the death rates — that is, fatalities relative to the population — which is considered a better way to see the impact from year to year, since the population fluctuates.

Of the causes of death for which the CDC had full-year provisional data, nine registered increases. Those included Alzheimer’s disease, Parkinson’s, chronic liver disease, stroke and high blood pressure.

Some of the increases were relatively small, but some were dramatic. The heart disease death rate — which has been falling over the long term — rose to 167 deaths per 100,000 population from 161.5 the year before. It was only the second time in 20 years that the rate had ticked up. This jump, of more than 3%, surpassed the less than 1% increase seen in 2015.

In raw numbers, there were about 32,000 more heart disease deaths than the year before.

Diabetes deaths rose to 24.6 per 100,000 last year, from 21.6 in 2019. That translated to 13,000 more diabetes deaths than in 2019. The 14% increase was the largest rise in the diabetes death rate in decades.

The death rate from Alzheimer’s was up 8%, Parkinson’s 11%, high blood pressure 12% and stroke 4%.

The CDC offered only the statistics, not explanations. The agency also did not say how many of the fatalities were people who had been infected with — and weakened by — the coronavirus but whose deaths were attributed primarily to heart disease, diabetes or other conditions.

Some experts believe a larger reason is that many patients did not seek treatment in an emergency because they feared becoming infected with the virus.

“When hospitalization rates for COVID would go up, we would see dramatic declines in patients presenting to the emergency room with heart attacks, stroke or heart failure,” Dr. Donald Lloyd-Jones, a Northwestern University researcher who is president-elect of the American Heart Association.

Other possible explanations also point indirectly to the coronavirus.

Many patients stopped taking care of themselves during the crisis, gaining weight or cutting back on taking high blood pressure medications, he said. Experts said the stress of the crisis, the lockdown-related disappearance of exercise options, and the loss of jobs and the accompanying health insurance were all factors, too.

Increases in Kentucky, Michigan, Missouri, and West Virginia pushed the four into the group of states with the highest rates of death from heart disease, the CDC data showed. For diabetes, similar changes happened in Indiana, New Mexico, West Virginia and some other Southern and Plains states.

The death rate from the nation’s No. 2 killer, cancer, continued its decline during the year of COVID-19. It fell about 2% in 2020, similar to the drop seen from 2018 to 2019, even though cancer screenings and cancer care declined or were often postponed last year.

Lloyd-Jones’ theory for the decline: Many of the virus’s victims were fighting cancer, “but COVID intervened and became the primary cause of death.”

Earlier research done by demographer Kenneth Johnson at the University of New Hampshire found that an unprecedented 25 states saw more deaths than births overall last year.

The states were Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Indiana, Kentucky, Maine, Massachusetts, Michigan, Mississippi, Missouri, Montana, New Hampshire, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, West Virginia, and Wisconsin.

Traditionally the vast majority of states have more births than deaths.

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Screenings can check for:
The level of plaque buildup in your arteries, related to risk for heart disease, stroke and overall vascular health.

• HDL and LDL Cholesterol levels
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Screenings are affordable, convenient and accessible for wheelchairs and those with trouble walking.  Free parking is also available. 

Packages start at $149, but consultants will work with you to create a package that is right for you based on your age and risk factors. Also ask about our Wellness Gold Membership Program which allows customers to get all the screenings they need now, but pay $19.95 a month.  Call 1-877-237-1287 or visit our website at www.lifelinescreening.com. Pre-registration is required.

Screenings in Kansas are performed by Life Line Screening of America, LLS on behalf of Life Line Screening Physicians, P.A.  In Texas: Physician authorization is required.  A Life Line Screening affiliated physician will provide authorization for you if you qualify. Screenings in California are provided by Life Line Mobile Screening.

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