Pressure after rollout was 'awful'
Outgoing Health and Human Services (HHS) Secretary Kathleen Sebelius said
she was "flat-out wrong" to believe that HealthCare.gov was ready to go on
Oct. 1, 2013. Sebelius made the comment to NBC's Andrea Mitchell on "Meet
the Press" in her first post-resignation interview. The secretary has only a
handful of weeks left at the HHS until her replacement is confirmed.
In candid remarks about the healthcare rollout, Sebelius said she regretted
not taking a different approach when HealthCare.gov was under construction.
"If I had a magic wand and could go back to mid-September and ask different
questions based on what I know now," I would, she said. "I thought I was
getting the best information from the best experts but clearly that didn't
"The launch of the website was terribly flawed, terribly difficult," she
added. "Could we have used more time and testing? You bet."
The former Kansas governor handed in her resignation to President Obama in
early March, when the enrollment numbers on the exchanges began to rise. She
said she knew around the time of the election that she would not stay
through the second term, though she started discussing her departure with
Obama after Jan. 1.
Asked whether she was pushed out of the administration, Sebelius insisted
the departure was her choice. "I thought that at the end of open enrollment
was a logical time to leave," though there is "never a good time," Sebelius
As the official in charge of the healthcare rollout, Sebelius was blamed for
the massive technical problems with the federal enrollment website, and soon
became the target of partisan attacks over the law itself.
She said Sunday that while the exchanges were a "moving target" â€” states
were still deciding in early 2013 whether to run their own systems â€”
"clearly, the estimate that it was ready to go Oct. 1 was flat-out wrong."
"That was very alarming" when HealthCare.gov crashed for the first time, she
said, "because that took some real diagnostics in terms of what the problems
where and then analysis" about whether the system could be fixed.
"The good news was that we said it would be fixed in eight weeks, it was
fixed in eight weeks and we announced last week that 7 million people ...
had enrolled," she said.
Sebelius did not mince words when describing the pressure of last fall,
calling October and November a "dismal time." It was a "pretty scary thing"
preparing for Dec. 1, the administration's publicly announced deadline for
making the site work, she said.
Visit the Hill for the story.
spread raises alarms in Mideast
Saudi Arabia on Sunday confirmed a surge of cases of a deadly virus in the
kingdom over the past two weeks, even as it tried to counter criticism that
it wasn't doing enough to contain the outbreak.
The United Arab Emirates over the weekend separately announced six confirmed
cases of Middle East Respiratory Syndrome, or MERS, among paramedics there,
one of whom died of the illness. The high number of cases among medical
workers raised questions about how effective Arab Gulf governments have been
in controlling the 1Â˝-year-old outbreak.
"I'm not pretty sure that they are actually seeing how big this thing is," a
Saudi doctor said on Sunday at King Fahd General Hospital, the large public
hospital in Jeddah that has been hardest hit by a spike in the city this
The hospital reopened its emergency room on Friday after shutting it briefly
for what authorities said was disinfection measures against MERS. But
patients were avoiding the hospital, and health workers were "very worried"
after the MERS death of one colleague and sickness in another, the doctor
said. "What I really wish for is to shut the whole hospital down" until the
spread subsides, she said.
Last week marked the biggest number of cases since the outbreak began, Dr.
Ian M. Mackay, an Australian epidemiologist who has tracked the outbreak,
wrote on Sunday.
About 50 of the overall cases have been in healthcare workers, he said, a
strong warning sign about measures being taken to control the outbreak, he
and others have said. "As far as we know, MERS-CoV does not spread easily
from person-to-person, so these clusters suggest a breakdown in infection
prevention and control."
Saudi Arabia and other Arab Gulf countries have said they are taking
adequate measures against infection since the first laboratory-confirmed
cases of MERS, which kills largely through respiratory infections, in
September 2012. Since then, the WHO says it has confirmed 228 cases, 92 of
The number rose sharply this month. In just the four days to last Thursday,
Saudi Arabia notified the World Health Organization of 15 new confirmed MERS
cases, including two deaths, the WHO posted on its official Twitter account
The Saudi Ministry of Health said late Sunday that government precautions to
control the disease were sufficient and up to scientific standards. Ministry
of Health officials didn't respond to email and phone requests to comment on
the reason for the surge in cases in healthcare workers. The World Health
Organization said it couldn't immediately respond to similar questions
The majority of cases have occurred in Saudi Arabia. Authorities have
confirmed other cases as far afield as Europe, all of which were believed
linked to the Middle East. Yemen's government on Sunday said it confirmed
the first known case there.
Medical studies say camels are at least one host of the virus that causes
MERS, though the disease also has been confirmed to spread in limited
fashion from person to person.
Saudi health officials said last year that they were requiring all health
workers to treat arriving patients with respiratory problems as potential
MERS cases, and take precautions against patient-to-nurse exposure. The
doctor at the Jeddah hospital said authorities this month gave health
workers there infection-control pamphlets and face masks.
Visit the Wall Street Journal for the story.
Deadly H5N1 bird
flu needs just 5 mutations to spread easily in people
Itâ€™s a flu virus so deadly that scientists once halted research on the
disease because governments feared it might be used by terrorists to stage a
biological attack. Yet despite the fact that the H5N1 avian influenza has
killed 60% of the 650 humans known to be infected since it was identified in
Hong Kong 17 years ago, the â€śbird fluâ€ť virus has yet to evolve a means of
spreading easily among people.
Now Dutch researchers have found that the virus needs only five favorable
gene mutations to become transmissible through coughing or sneezing, like
regular flu viruses.
World health officials have long feared that the H5N1 virus will someday
evolve a knack for airborne transmission, setting off a devastating
pandemic. While the new study suggests the mutations needed are relatively
few, it remains unclear whether theyâ€™re likely to happen outside the
â€śThis certainly does not mean that H5N1 is now more likely to cause a
pandemic,â€ť said Ron Fouchier, a virologist at Erasmus University Medical
Center in Rotterdam, Netherlands, and coauthor of the study published in the
In the new study, the authors set out to determine the minimum number of
mutations necessary for airborne infection. To do this, the researchers took
a strain of the virus that had previously infected a human and altered its
genes in the lab. Then they sprayed the altered version of the virus into a
ferretâ€™s nose and placed the animal in a specially constructed cage with a
second ferret who had not been exposed to the virus.
The layout of the cages prevented direct contact between the animals, but
allowed them to share airflow. When the healthy ferret developed flu
symptoms researchers knew the virus had spread through the air. By exposing
ferrets and human tissue samples to a variety of genetically altered
viruses, study authors identified five key gene mutations.
Two of them improved the virusâ€™ ability to latch onto cells in the animalâ€™s
upper respiratory tract. Once there, it could enter the cell, disgorge its
genetic material and cause the cell to mass-produce copies of the virus.
â€śAnother mutation increases the stability of the virus,â€ť Fouchier said. â€śThe
remaining mutations enable the virus to replicate more efficiently.â€ť
The altered virus was much less deadly than the natural version. Only two of
the ferrets in the study died, but neither death was caused by the flu.
Fouchier said he thought this was because the virus attacked cells in the
upper airway instead of the lower airway and was therefore less likely to
Virologists who were not involved in the study said the findings were
important, as they provided health authorities with a means of discerning
whether mutations observed in the wild are dangerous to people.
â€śThis is important work,â€ť said Yoshihiro Kawaoka, a virologist at the
University of Wisconsin School of Veterinary Medicine. â€śThis could
contribute to surveillance of avian influenza viruses in nature.â€ť
Fouchier, Kawaoka and other researchers touched off an international
biosecurity furor in 2011 when they demonstrated that the H5N1 virus could
be made transmissible among ferrets. As a result of the controversy, the
U.S. National Science Advisory Board for Biosecurity asked the virologists
to omit some details of their work before publishing it in the journals
Science and Nature. Scientists responded by imposing a temporary
moratorium on their research.
Also, because of the Dutch governmentâ€™s concern that the virus could be
weaponized, it successfully sued Fouchier and now requires him to apply for
and receive an â€śexport permitâ€ť before publishing his studies.
Visit the Los Angeles Times for the article.
Clearwater facility will be latest in trend of standalone ERs
CLEARWATER â€” When Largo Medical Center executives broke ground for a
standalone emergency room on one of Clearwater's busiest thoroughfares, they
were mirroring a national trend: hospitals carving out highly profitable ER
niches in each other's territory.
Clearwater's Morton Plant Hospital did the same thing six years ago, opening
one of the state's first standalone ERs in Bardmoor in Largo Med's back
yard. The Largo hospital's Clearwater ER will be the third standalone in
Tampa Bay â€” Brandon Regional Hospital also has one in Plant City. There are
12 in Florida and more than 450 nationwide.
Hospitals want standalone ERs because they can charge hospital prices
without the overhead of a massive campus. They can build them without having
to prove a public health need to the state, as they must with hospital
construction. And the ERs are a useful funnel to the main hospital if
patients need more care, experts say.
Healthcare consumers love them. That's the tack taken by executives of Largo
Med and its owner, HCA, at the groundbreaking for the $8 million,
10,600-square-foot ER the hospital estimates will serve 18,000 a year on the
site of a former car lot at 2339 Gulf-to-Bay Blvd.
Standalone ERs also help hospitals compete against the explosive expansion
of urgent care clinics, which charge much less than standalone ERs and are
often a better option for less serious conditions, Ho said.
But in Florida, the 400 or so urgent care clinics must post a menu of
services and their prices. Standalone ERs aren't required to do that. The
different rules can "create an uneven playing field for urgent care," said
Sam Yates, founder of the Urgent Care Association of Florida.
Largo Med CEO Anthony Degina argues that eastern Clearwater has a
demonstrable need for a standalone ER due to distance from other facilities
and heavy traffic.
Largo Med's Clearwater ER will offer more comprehensive services than a
typical urgent care clinic, he said. It will have CAT scan equipment,
radiology, laboratory services and
six board-certified ER physicians, and it will be open 24 hours a day. But
it won't be a cheaper alternative. Fees will be the same as at the
hospital-based ER, a Largo Med spokeswoman said. And a patient transported
by ambulance to a standalone ER who then must be taken to a hospital for
admission may face two bills from the transport service.
Visit Tampa Bay Times for the story.
to benefit from new agreement for healthcare apparel from Cardinal Health
Amerinet Inc., announced a new agreement for protective healthcare apparel
from Cardinal Health. Through this agreement, Amerinet members will receive
significant discounts on a variety of protective apparel, including
isolation gowns, lab coats/jackets, coveralls, shoe/hair covers and bouffant
Cardinal Health is a participant in the Amerinet Strategic Savings Program (SSP).
Amerinetâ€™s SSP provides facilities best pricing on essential products in
exchange for manageable spend commitment. This contract is currently
effective through December 31, 2016.
Cost of drugs
used by Medicare doctors can vary greatly by region, analysis finds
An analysis of government data released shows that the cost of drugs
administered by doctors accounts for a growing piece of Medicareâ€™s spending
and varies widely from region to region in the United States, raising
questions about whether some physicians may be misusing the pharmaceuticals.
Most of the 4,000 doctors who received at least $1 million from Medicare in
2012 billed mainly for giving patients injections, infusions and other drug
treatments, those records show. A drugmakerâ€™s tactics may be one reason
taxpayers and patients are paying unnecessary billions.
The data, an unprecedented trove of millions of billing records from
Medicare â€” as well as interviews with doctors â€” highlight the role of
pharmaceuticals in the nationâ€™s staggering health-care costs. Of $64 billion
Medicare paid to doctors in 2012, $8.6 billion was used to cover drugs, an
amount that has been rising for years.
Yet Medicare seeking to rein in drug costs has been stymied by rules that
forbid the government to negotiate lower prices. In 2010, they even lost the
ability to mandate, when two equivalent drugs are available, that physicians
be paid only for the cheapest. At the same time, pharmaceutical companies
have offered physicians incentives, such as discounts, to use large volumes.
Now, with the data released by Medicare, the public has a clearer view of
individual doctorsâ€™ drug practices. Many of the physicians who have
submitted multimillion-dollar bills to Medicare blame high drug prices and
say the pharmaceutical industry is taking most of the money. Typically,
Medicare reimburses a physician for the price of the drug plus 6 percent.
The chief lobbying group for the pharmaceutical industry said the idea that
medicine prices play a significant role in the nationâ€™s healthcare costs is
â€śoff base and not supported by the data on healthcare spending.â€ť
Josephine Martin, executive vice president of Pharmaceutical Research and
Manufacturers of America (PhRMA), said in a statement, â€śThe spending growth
rate in several important areas of healthcare exceeds that of medicines,
which has dropped significantly in recent years and is lower than growth in
medical costs overall.â€ť
The data reflect what appears to be an astonishing variety in how and when
physicians in different parts of the country use drugs. For example,
Medicare spends far more on drugs administered by physicians in some areas
than in others, leading to questions about whether pharmaceuticals may be
overused in some areas or underused in others.
Doctors around Huntsville, AL, for example, annually bill for nearly $600
per Medicare beneficiary for drugs administered in medical facilities. This
is about the same as in places such as Sarasota, FL, and Fresno, CA. But it
is about five times the amount doctors around Boise, ID, and Mason City, IA,
bill for such drugs, according to a Washington Post analysis.
There could be differences in the rates of disease, â€śbut thatâ€™s not enough
to explain a $500 differenceâ€ť between what Medicare pays for drugs in those
cities, said Jonathan Skinner, an economist at Dartmouth College, where
researchers were the first to analyze geographical variations in medical
practices. He added that there may be differences in medical opinion not
â€śsupported by medical evidence.â€ť
Jonathan Blum, principal deputy administrator of the Centers for Medicare
and Medicaid Services, said, â€śIf we see more procedures, more spending going
to one part of the country than another, without necessarily a difference in
quality or satisfaction of care, thatâ€™s an important question to be asking.â€ť
Some oncologists say they tend to treat cancer more aggressively and may
tend to use a drug such as Neulasta, which helps fight infection during
Because Medicare generally has paid a doctor the sale price of a drug plus 6
percent, economists and some doctors have long noted that this system gives
physicians an economic incentive to use a more expensive medicine: After
all, the 6 percent take for doctors rises when the drugâ€™s price does. Most
physicians say financial matters do not affect their drug choices, however.
But the case of epoetin alfa, a drug used to treat anemia in dialysis
patients, shows that when the financial incentive is taken away, doctors may
use less of the drug.
In 2011, a change by Medicare removed the 6 percent payment incentive;
instead, dialysis centers were paid per overall patient treatment. The use
of the drug in dialysis patients has dropped 34 percent since then, said
Dennis Cotter, president of the Medical Technology and Practice Patterns
Institute, a nonprofit think tank based in Bethesda, MD.
Visit the Washington Post for the article.
Mass faintings in
Cambodian factories affect 118 workers; food poisoning and poor conditions
may be to blame
One of the most dishonorable effects of globalization is the increasing use
of the Third World as a sweatshop to manufacture products for First World
brands. Last year, the horrors of big business' exploitation of less
developed countries made headlines with the collapse of a building in
Bangladesh, which killed more than 1,110 workers. The workers produced
products for companies such as Walmart and made the world wonder who really
was to blame: poor construction or consumerism? Recently another tragedy
struck when 118 workers fainted at a series of factories in Cambodia.
The factories manufactured materials for companies such as Puma and Adidas.
Reports claim that in the past week over 200 workers have fainted at
factories in this region. Although the corporations are looking to blame
food poisoning for the mass faintings, workersâ€™ rights groups point to
dangerous working conditions, which led to poor health.
The faintings occurred at the Shen Zhou and Daqian Textile factories in the
city of Phnom Penh. Many workers reported serious symptoms such as vomiting
and diarrhea. Both Puma and Adidas are carrying out an investigation to
discover what caused workers to fall ill. The companies are analyzing food
samples from the factoriesâ€™ cafeteria to determine if food poisoning was the
This weekâ€™s mass sickness is not an isolated case. In 2011 alone, more than
1,000 cases of fainting were reported in Cambodia factories. Safety issues
are usually tied to these faintings. Many of the factories use harsh
chemicals to manufacture the goods, and the building have poor ventilation
systems. In Cambodia, the nearly 650,000 workers bring in annual revenue of
$5 billion for the impoverished country. Many see this weekâ€™s incident as a
sign of a larger problem in the overseas garment industry and remember last
which claimed 1,100 lives.
Visit Medical Daily for the story.
delivery devices market value to achieve $13.8 billion by 2019, as China and
India see rapid insulin pen adoption
As the prevalence of diabetes continues to expand rapidly across the world,
the insulin delivery devices market value is expected to increase from $8.78
billion in 2012 to $13.8 billion by 2019, at a significant Compound Annual
Growth Rate (CAGR) of 7%, says business intelligence provider GBI Research.
According to the companyâ€™s latest report, insulin delivery devices market
growth in the US and Europe is due to an increasing preference for insulin
pumps and the uptake of technical advances, such as artificial pancreas
devices, in the long term. Meanwhile, the high prevalence of diabetes and
low penetration of insulin delivery devices in developing countries will
also contribute towards the market expansion.
Srikanth Venkataraman, Analyst for GBI Research, says: â€śInsulin pumps will
continue to undergo rapid adoption in North America, where patients are
shifting from conventional insulin delivery devices, such as syringes and
pens, to insulin pumps. This is due to the need for improved glucose control
and flexible, lifestyle-compatible treatment options. The European market
will be driven by insulin pen sales thanks to their low cost and ease of
GBI Research states that the worldwide prevalence of diabetes was 381.8
million in 2013, and this is expected to increase by 55%, reaching 591.1
million by 2035. At this current rate, diabetes prevalence in China and
India is forecast to increase to 142.7 million and 109 million by 2035,
Venkataraman concludes: â€śIn previous years, fear of injections, coupled with
a cultural misconception that the use of injections over oral tablets is a
sign of deteriorating health, has impacted negatively on the adoption of
insulin delivery devices in Asia-Pacific. However, increasing awareness of
the benefits of insulin in managing diabetes will significantly improve the
uptake of syringes and pens in this region over the coming years.â€ť
Visit GBI for the study.