CDC confirms first
case of Ebola in the U.S.
The Centers for Disease Control and Prevention confirmed on Tuesday the
first case of Ebola diagnosed in the United States.
"An individual traveling from Liberia has been diagnosed with Ebola in the
United States," Thomas Frieden, director of the CDC, said in a news
conference Tuesday afternoon.
State and federal health officials announcing the confirmed case repeatedly
stressed the difficulties of contracting Ebola, which can be spread through
bodily fluids or infected animals but not through the air or by water.
This person who is infected left Liberia on Sept. 19 and arrived in the U.S.
the following day to visit family in this country. The person, who was not
identified, had no symptoms at the time and began showing symptoms four days
after arriving in the U.S.
"The bottom line here is that I have no doubt that we will control this
importation, or this case of Ebola, so that it does not spread widely in
this country," he said. "It is certainly possible that someone who had
contact with this individual could develop Ebola in the coming weeks. But
there is no doubt in my mind that we will stop it here."
This is the first time Ebola has been diagnosed in the U.S. and the first
time someone was diagnosed with this particular strain outside of Africa, he
said. Still, health officials expressed optimism going forward.
The patient with Ebola is being treated in intensive care, according to
Edward Goodman, the hospital epidemiologist at Texas Health Presbyterian
Health officials are going to work to identify everyone who may have been
exposed to this patient, Frieden said. This group, described as a "handful"
of people by Frieden, will be watched for three weeks to see if any symptoms
emerge. People who traveled on the flight with this man are not in danger
because the patient was not symptomatic at the time.
"There is zero risk of transmission on the flight," Frieden said. Frieden
declined to say if the person with Ebola is a U.S. citizen. This man was
visiting family members and staying with family members, he said.
David Lakey, head of the Texas Department of Health Services, said the
state's laboratory in Austin, Tex., was certified last month to do Ebola
testing. That laboratory received a blood sample from the patient on Tuesday
morning and confirmed it was Ebola shortly after 1 p.m., he said.
The Texas Department of Health Services said that the patient is at Texas
Health Presbyterian Hospital in Dallas.
The test, the Texas health department said, was conducted at the state
public health laboratory in Austin and later confirmed by the CDC.
In the statement, the health department said: The CDC recommends that
individuals protect themselves by avoiding contact with the blood and body
fluids of people who are ill with Ebola. DSHS also encourages healthcare
providers to ask patients about recent travel and consider Ebola in patients
with fever and a history of travel to Sierra Leone, Guinea, Liberia, and
some parts of Nigeria within 21 days of the onset of symptoms.
No Ebola cases had been confirmed in the United States previously, although
several American doctors and aid workers who were infected in West Africa
have returned home for treatment.
Visit the Washington Post for the story.
Ebola shot turned
down by WHO is best hope as virus rages
The calls started coming in August to the office of GlaxoSmithKline
Plc Chief Executive Officer Andrew Witty from the head of the World Health
Organization, Margaret Chan. The Ebola outbreak was raging out of control
and Chan needed the drugmaker?s vaccine as quickly as possible.
The sudden sense of urgency for an Ebola vaccine was an about face from a
few months earlier when Glaxo contacted the WHO, asking whether its vaccine
could help with the outbreak. At that time, the company was told the focus
was on containment and the WHO didn?t have a policy for using vaccines in
this type of situation. ?We?ll get back to you? was the message, said Ripley
Ballou, head of Glaxo?s Ebola vaccine program.
With no approved Ebola medicines, and experimental treatments in short
supply, a vaccine is now one of the best hopes for halting the virus?s
spread before it becomes entrenched in the region. That puts pressure on the
few drugmakers with a vaccine in development as they shift resources, delay
other projects, and spend millions in a race to immunize patients. Glaxo and
Johnson & Johnson are preparing thousands of doses of their experimental
vaccines to test in Africa as early as January.
When Glaxo contacted the WHO in March, the vaccine was seen as a ?diversion
of energy? at a time when it was believed the outbreak would be controlled
with traditional measures, such as contact tracing and safe burials, that
have helped contain every previous outbreak, said Marie-Paule Kieny, the
WHO?s assistant director-general for health systems and innovation. At the
end of March, there were about 100 cases of Ebola in Guinea, with early
reports the virus was spreading to Liberia and Sierra Leone, according to
the U.S. Centers for Disease Control and Prevention.
After receiving the request from Kieny and Chan last month, Glaxo pulled 20
people off various projects, many from its malaria vaccine program, one of
its most highly publicized research initiatives, and assigned them full-time
to the Ebola vaccine.
The company is aiming to have 10,000 to 15,000 doses by January to start
vaccinating healthcare workers on the front lines of the Ebola outbreak as
part of the next stage of testing. Glaxo will need six months to figure out
how to eventually produce hundreds of thousands of doses for wider use,
The U.K. government, the non-profit Wellcome Trust, and the Medical Research
Council, a U.K. research-funding organization are funding the production of
about 10,000 doses. Gavi, the world?s biggest funder of vaccines for
developing countries, which is backed by the Bill & Melinda Gates
Foundation, said today it is examining how it can help accelerate the
availability of Ebola vaccines.
Glaxo is among at least five companies that have announced plans to start
human testing of an Ebola vaccine, including Johnson & Johnson, Inovio
Pharmaceuticals Inc., NewLink Genetics Corp., and Profectus Biosciences Inc.
Glaxo started giving doses to healthy volunteers in the U.K. and U.S. this
month. Within the next four weeks, as many as six different trials will be
under way in the U.S., U.K., Switzerland and Mali. Early results on the
safety and efficacy of the Glaxo and NewLink shots, the most advanced in
development, should be available by November, Kieny said.
Until a few months ago, Glaxo?s vaccine got little attention out of the
London-based company?s hundreds of experimental compounds, and the drugmaker
has been ?essentially starting from ground zero,? said Ballou. Glaxo
acquired the vaccine last year as part of its $324 million purchase of
Okairos AG, which has inoculations in more advanced stages of testing for
hepatitis C and malaria.
?It wasn?t really until the first week in August when it was clear that the
epidemic was something very different from what we had ever seen before that
WHO came to us and said we really need you to accelerate this vaccine,?
Ballou said. ?Within 24 hours, we had all of our partners on the phone.?
Three weeks later, the first patient received the vaccine to kick off the
early-stage human trials. ?That?s an amazingly fast process,? he said.
Not far behind Glaxo in the race to get a vaccine to patients is Johnson &
Johnson, which plans to start human testing in March. J&J expects to have
hundreds of thousands of doses available through the course of 2015 and more
than a million in 2016, said Paul Stoffels, the New Brunswick, NJ-based
company?s chief scientific officer. Stoffels began ramping up work on the
vaccine on his own, without prodding from the WHO, as he saw Ebola beginning
to accelerate and making its way into cities in West Africa. He knew
first-hand the devastation it could cause. In 1995, a few years after
completing his training as an infectious disease doctor at a hospital in
Kikwit, he was told his former colleagues were infected with Ebola and would
be among more than 250 who died in that outbreak.
J&J?s vaccine has been more than a decade in the making. It started in 2002,
in the labs of Netherlands-based Crucell, which J&J bought in 2010.
The next steps won?t be cheap or easy, said Stoffels. J&J must develop
manufacturing capabilities for the vaccine, which must be made in a
carefully controlled environment, and develop and implement a plan for
testing it in volunteers.
Visit Bloomberg for the story.
In India, are
profits from medical devices used to bribe doctors?
India - A detailed investigation by the Maharashtra Food and Drug
Administration (FDA) had exposed how drug eluting stents are sold at triple
the price at which they are imported in India. A complaint sent to one of
the largest medical device companies, Medtronic USA, revealed how local
distributors for major medical device companies were allowed to charge huge
margins on devices and how the cash thus generated was used to bribe doctors
to persuade them to use their company's devices.
In March 2012, Medtronic USA had received a complaint about widespread
bribing of doctors by its distributor Bhalani. According to the complaint,
IMPL, the India arm of Medtronic, used distributors to distance itself from
the bribery as it went against the corporate ethics Medtronic claims to
adhere to. The complaint pointed out that the huge margin distributors were
allowed to charge was used to bribe doctors, thus leaving Medtronics' books
clean and yet ensuring that the corrupt practices help push their products.
In September 2012, a newspaper report in Mumbai exposed corruption in sale
of stents to government hospitals. Medtronics USA was informed about this
report and company officials said they took the allegations seriously and
initiated an investigation. Till June 2013, they claimed investigations were
on. They even took away the distributorship from Bhalani. But those in the
business of medical device distribution claim that business practices have
not changed as doctors and hospital managements continue to be bribed
through distributors to increase sales of devices.
When contacted by TOI, Medtronic USA declined to comment about the
investigation they had carried out into the allegations of bribing by their
distributor. They merely stated: "Medtronic has an extensive compliance
program to assess the conduct of its employees and representatives,
including distributors, and if necessary takes action against those who
violate its policies and the law. Furthermore, our employees and
representatives are provided extensive training and resources to ensure they
fully understand our business conduct requirements and local laws. We do not
condone nor do we tolerate improper payments of any kind, and we will
continue our efforts to ensure compliance with all applicable Indian and US
The Maharashtra FDA report included details of overcharging by Abbott as
well as Johnson and Johnson. Interestingly, while these multinationals claim
to have stringent compliance programs in place to prevent bribing and other
unlawful activities, almost all of them have been penalized heavily in the
US for bribing doctors to boost their sales. In May this year, Medtronic
agreed to pay $9.9 million to resolve allegations that the company used
various types of payments to induce physicians to implant its pacemakers and
defibrillators. This was a repeat offense for Medtronic, which had to pay
$23.5 million in 2011 too for settling charges of kickbacks to doctors.
Other US companies have also had to resolve allegations that the company
paid kickbacks to induce doctors to use their products.
Visit the Times of India for the report.
Costs can go up
fast when E.R. is in network but the doctors are not
Patients have no choice about which physician they see when they go to an
emergency room, even if they have the presence of mind to visit a hospital
that is in their insurance network. In the piles of forms that patients sign
in those chaotic first moments is often an acknowledgment that they
understand some providers may be out of network.
But even the most basic visits with emergency room physicians and other
doctors called in to consult are increasingly leaving patients with hefty
bills: More and more, doctors who work in emergency rooms are private
contractors who are out of network or do not accept any insurance plans.
When legislators in Texas demanded some data from insurers last year, they
learned that up to half of the hospitals that participated with
UnitedHealthcare, Humana and Blue Cross-Blue Shield ? Texas?s three biggest
insurers ? had no in-network emergency room doctors. Out-of-network payments
to emergency room physicians accounted for 40 to 70 percent of the money
spent on emergency care at in-network hospitals, researchers with the Center
for Public Policy Priorities in Austin found.
?It?s very common and there?s little consumers can do to prevent it and
protect themselves ? it?s a roll of the dice,? said Stacey Pogue, a senior
policy analyst with the nonpartisan center and an author of the study.
While patients have complained of surprise out-of-network charges in
hospitals from some other specialists ? particularly anesthesiologists,
radiologists and pathologists ? the situation with emergency room doctors is
even more troubling, patient advocates say. For one thing, patients cannot
be expected to review provider networks in a crisis, and the information to
do so is usually not readily available anyway. Moreover, the Texas study
found that out-of-network fees paid to emergency room physicians eclipsed
the amount of money paid to those other specialists.
When emergency medicine emerged as a specialty in the 1980s, almost all E.R.
doctors were hospital employees who typically did not bill separately for
their services. Today, 65 percent of hospitals contract out that function.
And some emergency medicine staffing groups ? many serve a large number of
hospitals, either nationally or locally ? opt out of all insurance plans.
As more insurance plans contract with narrower networks of doctors to form
offerings tailored to the Affordable Care Act, insurers have acquired
greater leverage in cutting payments to physicians. While an insurer would
have little power to drive a hard bargain with a major hospital that the
company needs in its network, it can often pick and choose among physicians,
excluding some or offering rates so low that many doctors say their
practices are unsustainable.
The average salary of an emergency room physician was $311,000 in 2014,
rising from $247,000 since 2010 ? a period when many other types of doctors
experienced declines in salaries, according to Merritt Hawkins, a physician
Hospital charges for emergency care vary widely. A recent study found that
hospital charges for a visit involving a serious medical issue in California
varied between $275 and $6,662, just for the facility fee. ?Much of the
variation we observe may in fact be entirely random,? wrote the authors,
emergency physicians at the University of California San Francisco Medical
Center. But that variation often does not directly affect patients, since
most hospitals participate in the big insurance plans in their area, and
patients tend to know which are in their network, so the insurer covers most
of the bill. But it is a different matter with emergency room doctors who
bill out-of-network fees, experts say.
Emergency physicians say they are not to blame. ?In general, E.R. physicians
try to align themselves with whatever networks their hospitals are in, but
sometimes the rates pale compared to what is offered to the hospitals,? said
Jeffrey Bettinger of the American College of Emergency Physicians. That
often leads to protracted negotiations, he said, but eventually the insurers
and the doctors come to agreement and sign a contract.
In the meantime, patients are stuck with out-of-pocket charges. Regulations
created by the Affordable Care Act specify that insurers must use the
best-paying among three methods for reimbursing out-of-network physicians
dispensing emergency care: pay the Medicare rate; pay the median in-network
amount for the service; or apply the usual formula they use to determine
out-of-network reimbursement, which often depends on ?usual and customary
rates? in the area.
But in most states, doctors can then bill patients for the difference
between their charge and what the insurer paid.
Visit the New York Times for the story.
Register now for
early registration discounts to the 9th Annual World Congress Leadership
Summit on Healthcare Supply Chain Management
Don?t miss your chance to join Healthcare Purchasing News and an
amazing speaker line up at the World Congress 9th Annual Leadership Summit
on Health Care Supply Chain taking place in New Orleans, January 26 ? 27,
Join us to hear industry experts as they address critical issues facing
healthcare supply chain operations today. Sessions include
thought-provoking panels and case studies by healthcare executives from
leading organizations who will address how they transformed their supply
chain departments into systems with a strategic, collaborative and
innovative focus to accomplish the overall business and clinical goals of
Technology, value analysis, and integration are all new and vital components
to consider when developing future healthcare supply chain strategy. The
Summit session will feature presentations on how hospitals and health
systems are addressing these components and others relating to physician
engagement, variation, utilization, distribution, clinical outcomes,
transparency, and new issues such as automation, value based contracts, and
The 2015 Summit will also focus on big-data and evidence-based purchasing,
including key insights to supplier-provider relationships that focus on
value, improved outcomes, and reduced costs. We?ll delve into strategies for
payer relations as well as creative approaches to value analysis, clinical
engagement, and cost control that will improve supply chain sustainability.
Hospitals and health systems can register for only $295 until October 17,
2014, a $600 savings on your registration fee! Don?t miss this outstanding
Visit World Congress for more information and to register.
As Obamacare pays
medical bills, red states pressured on Medicaid
A new report showing the continued pileup of unpaid medical bills in states
that didn?t expand Medicaid under the Affordable Care Act is escalating
criticism on these Republican-led areas of the country to expand the
health insurance program for the poor.
The report out last week from the Obama administration shows the costs of
uncompensated care are projected to fall by $5.7 billion this year largely
because millions of Americans are eligible for expanded Medicaid insurance
for the poor under the Affordable Care Act and they are taking advantage.
About half of U.S. states opted in favor of expanding Medicaid which the
Supreme Court allowed when it upheld the law two years ago.
?The projections?suggest that $4.2 billion of this reduction will come from
the 25 states plus Washington D.C. expanding Medicaid as of the beginning of
FY2014, representing a 25 percent reduction from baseline uncompensated care
spending and 74 percent total savings,? the authors of the report from the
Department of Health and Human Services? Office of the Assistant Secretary
for Planning and Evaluation wrote.
But public hospitals generally in rural areas and inner cities where there
are large numbers of uninsured say they are hit particularly hard in states
that haven?t expanded Medicaid.
?Essential hospitals still face high levels of uncompensated care and
looming cuts to disproportionate share hospital funding ? a problem of
particular concern in states that have denied patients the same opportunity
for Medicaid coverage so many others enjoy today,? said Dr. Bruce Siegel,
president and chief executive officer of America?s Essential Hospitals,
which represents public health systems across the U.S., in a statement
following the release of the uncompensated care report.
Pressure on GOP-led states has worked in some cases. In Pennsylvania, for
example, Republican Gov. Tom Corbett, who is facing a difficult re-election
challenge, dropped his opposition to the Medicaid expansion a few months
The federal government traditionally picks up a little more than half of the
cost of Medicaid. But funding under the health law is unlike past efforts to
expand Medicaid in that the federal government will pick up the full tab
this year as well as 2015 and 2016. The state gradually has to pick up some
costs in 2017, but by 2020, the federal government is still picking up 90
percent or more of the Medicaid tab.
Visit Forbes for the report.
chain pressured by cost increases, government regulations, study says
An environment of increasing risks, complex regulations and continuing cost
pressures is impeding healthcare executives from moving quickly to seize
untapped industry opportunities, according to the 7th annual UPS "Pain in
the (Supply) Chain" survey. Globally, healthcare executives are planning for
strategic partnerships and technology investment to mitigate risks and
capitalize on growth opportunities.
The most significant factors contributing to uncertainty in the healthcare
supply chain are more stringent regulations and increased product protection
challenges. For the third consecutive year, regulatory compliance is the top
supply chain pain point, cited by 60 percent of respondents. Further, 78
percent cite regulatory compliance and increasing regulations as a top trend
driving business and supply chain changes. Product protection also is
increasingly challenging in a highly global marketplace, with 46 percent
citing product security as a top challenge and 40 percent citing product
damage and spoilage as a top concern.
Economic factors are also at play, with 49 percent of those surveyed still
feeling an impact from the economic downturn six years later. The highest
percentage of respondents to express this are located in the U.S., where 60
percent of healthcare logistics decision makers cite economic concerns. In
this global economic environment, cost management remains top of mind, with
44 percent citing it as a top supply chain concern.
Despite operating in a risk-inherent environment, only 26 percent of
healthcare executives cite contingency planning as a top supply chain
concern. Meanwhile, 34 percent of those surveyed in Asia and 22 percent in
Latin America say that more than one-quarter of their companies? supply
chains were impacted by unplanned events in the past three to five years.
Specific challenges to addressing business continuity include events being
too unlikely or infrequent (61 percent), back-up infrastructure being too
expensive to deploy (46 percent) and little to no prioritization being given
to this area (42 percent) versus other more urgent matters.
Of those companies that are successful in mitigating risk and increasing
competitiveness, the majority are leveraging partnerships along with ongoing
technology investments. Of logistics decision makers surveyed worldwide:
78 percent cite logistics and distribution partnerships as a top strategy to
manage supply chain costs
65 percent use logistics and distribution partnerships to successfully
access global markets
61 percent use collaboration, including vested logistics and distribution
partnerships, to successfully embrace new distribution and go-to-market
channels, while 23 percent use mergers and acquisitions to do so
59 percent are working with a 3PL as a top strategy to increase efficiencies
and improve competitiveness
Again this year, investing in new technologies is a top strategy to increase
efficiencies and competitiveness for the next five years. Globally, over the
next three to five years, 80 percent of respondents say they will invest in
Despite progress in addressing industry challenges, opportunities remain.
One of these areas is in leveraging new distribution channels and models to
meet changing customer demands as ecommerce, urbanization and home
The rise of home healthcare is taking off with growth surges expected over
the next decade. Globally, 21 percent of survey respondents cite the shift
to home healthcare as a key trend driving business and supply chain changes.
Respondents report that 30 percent of products will support the home
healthcare channel in the next seven to 10 years.
Another area with untapped potential is collaborative partnerships.
According to this year?s findings, 59 percent cite it as a strategy over the
past 18 months and also over the next few years, indicating that while the
healthcare industry recognizes the importance of implementing these
strategies to increase competitiveness, companies are slow to act.
Visit UPS for the report.
More than half in
U.S. at greater risk in disasters
More than 50% of the U.S. population may be in need of special attention
during extreme weather events, with such emergencies putting the disabled,
seniors and children at greater risk. Nearly one in five Americans is
disabled, which means about 60 million people are more at risk during times
"Very little is known as to how to make these individuals safe," says Irwin
Redlener, head of the National Center for Disaster Preparedness at Columbia
University's Earth Institute and one of the foremost authorities on disaster
relief. Case in point, he says, are the many problems that arose during
2012's Hurricane Sandy, such as seniors stuck in high-rise buildings in New
York City, left without power or use of elevators.
Too few emergency planners have the expertise necessary to ensure
preparations make adequate provisions for disabilities, according to the
National Organization on Disability (NOD).
To their credit, government agencies such as the Federal Emergency
Management Agency (FEMA) and relief organizations such as the American Red
Cross as well as non-profits such as NOD have tips and information available
for people with disabilities to help them or caregivers during hazardous
events. There is even a campaign,
eSSENTIAL Accessibility, to help people with disabilities access vital
Yet, until further studies are completed on how to better respond to those
impaired during emergency situations, millions of Americans remain at risk.
But those studies cost money, and funding for disasters largely comes after
"Our response to disaster planning in this country is very reactionary,"
says Robert Ottenhoff, chief executive of the Center for Disaster
Philanthropy in Washington, DC, adding that about 90% of all donations for
disasters are given within 90 days of the event, and there is little in the
way of advance funding for disaster planning.
To be sure, the U.S. is not alone in its vulnerability problem. During a
brutal heatwave in the summer of 2003, an estimated 70,000 people died in
Europe, mostly seniors in France whose homes did not have air conditioning.
High temperatures affect seniors and children most, in terms of age groups,
because they have deteriorating or developing central nervous systems,
respectively. As numerous studies released during Climate Week in New York
prove, global temperatures will continue to rise, meaning more people will
be vulnerable to extreme weather events.
To prepare and care for those impaired, FEMA's Ready.gov
website recommends customizing an emergency supply kit with medical
equipment, prescription medications and medical necessities, including food
for special diets.
Visit USA Today for the story.
Spread the word: National Breast Cancer Awareness Month
Healthcare Purchasing News
would like to remind everyone that National Breast Cancer Awareness Month
starts today, October 1, and is a chance to raise awareness about the
importance of early detection of breast cancer, a disease that affects about
1 in 8 women in the United States.
The good news is that many women can survive breast cancer if it?s found and
treated early. A mammogram ? the screening test for breast cancer ? can help
find breast cancer early when it?s easier to treat.
Please help make a difference by spreading the word about mammograms and
encourage communities, organizations, families, and individuals to get
involved. For resources and information about how you and your organization
can help, visit the
U.S. Department of Health and Human Services.
The American Cancer Society (ACS) also needs your help to ?create an
unstoppable wave on Facebook to honor survivors and remind women everywhere
to get regular screenings for breast cancer.? Visit the
American Cancer Society on Facebook to help spread the news with the
ACS?s 2014 Breast Cancer Awareness image.