September 17, 2010  Download print version

Precursor to H.I.V. was in monkeys for millennia

Victorville Hospital files for bankruptcy

BagEasy manual resuscitation devices by Westmed, Inc.: Class 1 Recall

Early registration is now open for the 2011 GHX Supply Chain Summit

Calif. whooping cough: 9 dead, infections on rise

Hospital files lawsuit against FEMA

Disease transmission model says media coverage cuts infection rate and pandemic extent

Endocrinologists speak out about two 'Internet diseases': adrenal fatigue and Wilson's temperature fatigue

Precursor to H.I.V. was in monkeys for millennia

In a discovery that sheds new light on the history of AIDS, scientists have found evidence that the ancestor to the virus that causes the disease has been in monkeys and apes for at least 32,000 years — not just a few hundred years, as had been previously thought. That means humans have presumably been exposed many times to S.I.V., the simian immunodeficiency virus, because people have been hunting monkeys for millenniums, risking infection every time they butcher one for food.

And that assumption in turn complicates a question that has bedeviled AIDS scientists for years: What happened in Africa in the early 20th century that let a mild monkey disease move into humans, mutate to become highly transmissible and then explode into one of history’s great killers, one that has claimed 25 million lives so far? Among the theories different researchers have put forward are the growth of African cities and the proliferation of cheap syringes.

Confirming that the virus is very old also helps explain why it infects almost all African monkeys but does not sicken them. Over many generations, as any disease kills off vulnerable victims, the host adapts to it. The new research, published Thursday in Science magazine, was relatively simple. Scientists tested 79 monkeys from Bioko, a volcanic island 19 miles off the West African coast. Bioko used to be the end of a peninsula attached to the mainland in what is now Cameroon, but it was cut off when sea levels rose 10,000 years ago at the end of the last ice age.

Since then, six monkey species have developed in isolation on the island, and scientists from the National Primate Research Center at Tulane University in Louisiana and other American and African universities found that four of them — drills, red-eared guenons, Preuss’s guenons and black colobuses — had members that were infected with S.I.V. The four strains in the four species were genetically very different from one another — meaning they presumably did not come from monkeys carried over to the island by humans in the last few centuries. But each was close to the strain infecting members of the same four genuses on the mainland, meaning they must have existed before Bioko was cut off.

Knowing that all four strains were at least 10,000 years old, scientists recalculated the virus’s “molecular clock,” measuring how fast it mutates. They now believe that all the S.I.V. strains infecting monkeys and apes across Africa diverged from a common ancestor between 32,000 and 78,000 years ago.

“When we only had 25 years of data, we were dating from the tip at the end of a branch of the evolutionary tree,” said Preston A. Marx, a virologist at the Tulane primate center and an author of the paper in Science. “I knew that what we had before couldn’t be right, because the virus had spread from the Atlantic to the Indian Ocean to the southern end of the continent, and it couldn’t have done that in a couple of hundred years.”

The ancestor virus — which, like many diseases, may have crossed into simians from another, still-unknown species — may have existed for millions of years. That theory was given greater credence two years ago with the discovery that some Madagascar lemurs have in their genomes the remnants of a virus that was not an S.I.V., but related to it. Madagascar, a Texas-size island 250 miles off the southeastern African coast, separated from Africa 160 million years ago. It has no monkeys, but lemurs’ ancestors arrived there, possibly on floating mats of vegetation, probably more than 10 million years ago.

H.I.V., which is almost universally fatal to humans, is obviously very new to us. As Dr. Marx pointed out, if it had been in humans before the 20th century, it would have arrived in the Americas in some of the 12 million Africans kidnapped for the slave trade. Its immediate ancestor is probably also relatively new to chimpanzees. The virus has probably crossed over from simians into humans at least five times.

It is very likely, scientists said, that a little infected monkey or ape blood got into human veins many times in history as hunters cut themselves while butchering carcasses. But even if it sickened those hunters, it probably died out with them or their immediate contacts. The earliest confirmed H.I.V. case in humans was found in blood drawn in 1959 from a man in Kinshasa, in what was then called the Belgian Congo.

Sometime between the 1800s and 1959, something presumably allowed a human infection with a chimpanzee virus to spread widely enough to evolve into modern H.I.V.-1, which could spread easily among humans. Dr. Marx believes that the crucial event was the introduction into Africa of millions of inexpensive, mass-produced syringes in the 1950s. Campaigns to wipe out yaws, syphilis, malaria, smallpox and polio required syringes, and many were reused, often with official approval. Traditional healers adopted them for injecting their decoctions, and they became status symbols; a study in Uganda in the 1960s found that 80 percent of families owned one. Visit the New York Times for the article.

Victorville Hospital files for bankruptcy

Victor Valley Community Hospital in Victorville, CA, has filed for bankruptcy protection after mounting debt and thin caseloads made it impossible to maintain a viable operation, administrators said. Just over half of the nonprofit hospital’s 101 beds are filled, with many patients relying on the state’s Medi-Cal program for the poor that does not cover the full cost of their care, the hospital said.

In a last-ditch effort to ward off bankruptcy, the hospital earlier this month laid off 30 part-time or on-call workers, including administrative staff and nursing assistants, leaving it with about 600 employees. No doctors or nurses were fired. Even after that step, Victor Valley faces $20 million in debt and is anticipating a looming cut in reimbursements from the federal Medicare insurance program for the elderly.

The 43-year-old hospital, one of four in the High Desert region, filed for bankruptcy Monday evening. Its chief executive said it would remain open as it pursues a new owner, possibly the nonprofit Prime Healthcare Foundation Inc. in Ontario. Visit the Los Angeles Times for the article.

BagEasy manual resuscitation devices by Westmed, Inc.: Class 1 Recall

Westmed, Inc. is initiating a nationwide recall of 24,384 units of BagEasy Manual Resuscitation Devices. The BagEasy device have been found to have a potential for disconnection at the retention ring of the patient port manifold. Disconnection causes the unit to be inoperable, which potentially could result in treatment delays while another unit is obtained or technician switches to a different method of resuscitation.

Westmed has become aware of a potential for disconnection at the patient port retention ring assembly of the BagEasy manual resuscitation device after receiving reports from three separate facilities regarding units disconnecting during setup or use. The BagEasy manual resuscitation device was distributed to other medical device distribution companies as well as directly to hospitals and other treatment facilities. Read the complete MedWatch Safety Alert.

Early registration is now open for the 2011 GHX Supply Chain Summit

Registration is now open for the 11th annual Supply Chain Summit being held Monday, April 18 - Wednesday, April 20, in Dallas, TX. The summit offers attendees the ability to interact with and learn from industry experts. Join more than 500 large and small organizations seeking solutions to a common goal: creating a supply chain that strategically strengthens business performance.

Learn how leading organizations are adjusting their strategies and practices to offset declining revenues, measure and improve patient outcomes, and ensure professional caregivers are empowered to provide the best possible patient care.

Register early for the Summit and get ready to:

• Network with peers & collaborate with business partners
• Create a supply chain business case that aligns to your organization's strategy
• Learn about industry trends, challenges and anticipated future developments
• Control spend & the movement of goods
• Drive standards & compliance
• Automate more, enhance team performance and measure results
• Get hands-on exposure to proven supply chain tools
• Learn how other organizations are surpassing their goals in a variety of case studies

The Summit takes place annually, but that doesn't mean any two programs are ever alike! Each year, as our environment changes and new opportunities are created, the agenda is packed with all new sessions, speakers and networking opportunities, focusing on today's most progressive and successful supply chain management practices. Register Early and Save.

Calif. whooping cough: 9 dead, infections on rise

State health officials reported Thursday that California is on track to break a 55-year record for whooping cough infections in an epidemic that has already claimed the lives of nine infants. At least 4,017 cases of the highly contagious illness have been reported in California, according to the state. Data from the Centers for Disease Prevention and Control show 11,466 cases nationwide, though the federal numbers are known to lag behind local reporting.

Whooping cough is a cyclical illness that peaks in number of infections every five years. Symptoms are similar to the common cold, making it a challenge to diagnose, which in turn makes it difficult for officials to determine if the worst has passed, said Dr. Gil Chavez, an epidemiologist for the California Department of Public Health. A persistent cough that lasts weeks is the tell-tale symptom of the illness, which is also known as pertussis.

The state is on track to exceed the record 4,949 cases reported in 1955. The bacterial infection tends to peak during summer months, but infections could continue into coming weeks, said Chavez.

The federal numbers for nationwide cases were last updated Sept. 12 and represent 519 more cases than the same period last year, according to the CDC. Other states with high numbers of infections include Texas, where health officials reported 1,783 cases, and Ohio, where federal officials reported 1,019 cases. In South Carolina, officials reported one whooping cough death and 255 confirmed or suspected cases have been found. Epidemic levels of the illness there were seen earlier this year, but no statewide epidemic was declared.

All of the whooping cough-related deaths in California occurred in babies too young to be fully immunized against the illness, which is why parents and caretakers are being urged to get booster shots. Typically, babies are given a series of vaccinations, then receive booster shots between ages 4 and 6 and again after age 10. The vaccines against whooping cough are free of the additive thimerosal, a preservative containing mercury that has been the subject of a long-running public debate about whether it can cause autism.

An Associated Press analysis found that 127 of the 7,174 public and private schools in California reported 2009 whooping cough immunization rates of 50 percent or less for kindergartners. (Associated Press) Visit the Washington Post for the article.

Hospital files lawsuit against FEMA

COLUMBUS, IN -- Columbus Regional Hospital filed suit against the Federal Emergency Management Agency, claiming FEMA bungled providing financial assistance in response to the catastrophic flood that struck central and southern Indiana in 2008. Eleven feet of floodwater poured into the basement of the hospital that year, with 6 inches of water in the first floor.

The hospital claims FEMA failed to comply with Congressional mandates on severe flooding. According to court documents, the hospital suffered $167 million in damage, 6News' Derrik Thomas reported.

"The lawsuit is against FEMA on policy around accounting calculations, and that's the next step we need to take to follow that through," said Denise Glesing, hospital spokeswoman.

The hospital has moved forward despite issues officials said remain unresolved. A new clinical laboratory is open and performs 1.5 million tests a year, hospital officials said. The kitchen has been rebuilt and is running. Reconstruction work is ongoing, and the hospital hopes it will be completed by summer 2011.

"We were able to have cash reserves that we had set aside for a building project," Glesing said. "That has been put on hold … to rebuild from the flood."

The lawsuit claims that FEMA hired unqualified employees who told them the hospital was required to find replacement equipment on eBay that failed to meet medical standards. The hospital has constructed a temporary flood wall, approved by FEMA, to fend off future floods. A permanent flood wall is in the works. 6News called FEMA for reaction to the lawsuit but hadn't received a response as of Thursday evening. Visit 6News for the story.

Disease transmission model says media coverage cuts infection rate and pandemic extent

At the first sign of a disease pandemic, public health officials should begin strongly communicating about the extent of the outbreak and the steps that can be taken by the public to avoid infection. That's the recommendation of two mathematical biologists who have modified the most widely used infectious disease transmission model to account for the impact of news media coverage.

During outbreaks of serious infectious diseases, many individuals closely follow media reports and as a result, take precautions to protect themselves against the disease. These precautions may include staying home, getting vaccinated, avoiding crowds, using disinfectants, canceling travel plans and wearing face masks. Known as "self-isolation," these precautions can significantly reduce the severity of an outbreak, according to mathematical modeling done by researchers at the Georgia Institute of Technology and Marshall University in Huntington, WV.

"The more forcefully the media provides information about pandemic infections and deaths, the more the total number of infections is reduced," said Howard Weiss, a professor in the Georgia Tech School of Mathematics. "Media coverage also reduces the maximum number of infections at any particular time, which is important for allocating the resources needed for treating infectious diseases."

The benefit of publicly reporting disease outbreaks seems obvious, and public health officials in the United States have a policy of regularly communicating with the news media about such incidents. But according to Weiss, not all world governments choose to communicate so well – and nobody had used rigorous mathematical techniques to study the impact of that communication before.

Epidemiologists use the S-I-R model to anticipate the effect of disease outbreaks. The basic model places individuals into one of three groups signified by each letter of the acronym:

Susceptible individuals are those that are vulnerable to the disease; Infected individuals are those who have the disease; Removed individuals are those who are not in the other groups because they have been vaccinated, have isolated themselves from the population, have already recovered from the disease – or have died.

Weiss and collaborator Anna Mummert, an assistant professor of mathematics at Marshall University, modified that model to take into account ways that individuals could move from the "Susceptible" group to the "Removed" group without passing through the "Infected" group. By "self-isolating" as a result of news media warnings, they reasoned, individuals could move directly into the "Removed" class because they are no longer susceptible.

"On a chart showing the number of infected people at any one time, as you increase the intensity of the media coverage, you substantially decrease the number of infections," Weiss noted. "We are assuming that people self-isolate at a rate that is proportional to the amount of media coverage, though we would like to study that in more detail."

The sooner the media coverage of a pandemic begins, the fewer individuals will ultimately be infected. But Weiss said the model shows that almost any media coverage is helpful at reducing the extent of a pandemic. "Telling the public always helps, but the longer you wait, the less it helps," he said. "If you wait long enough, the effect of media coverage is essentially negligible." Visit PhysOrg,com for the article.

Endocrinologists speak out about two 'Internet diseases': adrenal fatigue and Wilson's temperature fatigue

Everyone knows there is a lot of garbage on the Internet, particularly medical information that is distorted, misleading or flat-out wrong. The Hormone Foundation, the public-education affiliate of the Endocrine Society, on Wednesday issued fact sheets about two "Internet diseases": diseases that exist only in the minds of people who post about them on the Internet. The so-called diseases in question are adrenal fatigue and Wilson's temperature syndrome, diseases apparently conceived only in an effort to sell products promoted to treat them.

Adrenal fatigue, whose symptoms are said to include tiredness, trouble falling asleep at night or waking up in the morning, salt and sugar craving and needing stimulants such as coffee to get through the day, is said to be caused by overstimulation of the adrenal glands. Long-term life stresses, the theory goes, wear out the adrenal gland so that it can no longer keep up with the body's daily needs for stress hormones such as cortisol.

Those symptoms, the foundation said, may be produced by other diseases and can also occur as part of a normal, busy life. Adrenal fatigue "is not a real medical condition," the foundation said. There are no scientific facts to support its existence, and it cannot be diagnosed through blood tests -- which would reveal a shortage of adrenal hormones.

Vitamins and supplements promoted to treat this "disease" often include extracts from human adrenal glands and hypothalamus that could be dangerous, and none of them have been tested for safety. Unfortunately, Congress has not given the Food and Drug Administration authority to regulate nutritional supplements such as those marketed for adrenal fatigue.

The foundation noted, however, that there is a very real disease called adrenal insufficiency. It is not caused by stress, but by physical damage to the adrenal glands or by tumors growing on them. Its symptoms include dehydration, confusion, weight loss, weakness, dizziness and low blood pressure. Other symptoms include stomach pain, nausea, vomiting and diarrhea. It can be diagnosed through blood tests and is treated with medications that replace the hormones the adrenal glands would normally make.

Wilson's temperature syndrome was supposedly identified in 1990 by "E. Denis Wilson M.D." of Longwood, FL. He said that stress and illness result in a hormone imbalance that causes a lack of the thyroid hormone T3, resulting in low body temperature and slow metabolism. He promotes a product called WT3 that is supposedly a time-released version of the hormone T3, as well as special herbal and nutritional supplements. Such treatments are dangerous because too much T3 can stress the heart and damage bones.

Again, there is no medical evidence to support the existence of Wilson's temperature syndrome, no medical test can diagnose it, and there's no clinical evidence that the drugs and supplements promoted by Wilson offer any benefit. "Doctors urge you not to accept an unproven diagnosis like Wilson's syndrome," the foundation said. "Your symptoms could be caused by a serious health problem. To take care of your health, it is important to get a correct diagnosis and proper medical treatment."

Wilson's temperature syndrome is also discussed at Quackwatch  along with other "fad diagnoses." Neither Medicare nor insurance companies will pay for treatments for either disease because they are not considered real conditions. Visit the Los Angeles Times for the article.

September 16, 2010  Download print version

Yet, when the entire football world saw the Eagles put Bradley at significant safety risk by not properly diagnosing his concussion, it only emphasized the crisis that exists in high school and youth football, where almost no one is watching at all. Visit the New York Times for the article.

These and other findings persuaded planners to cast aside even the most familiar sites seen in older hospitals, such as the sprawling central nursing station. TriPoint, which has all single rooms, has bedside computers and alcoves between rooms equipped with computers so nurses can update medical records and stay close to patients, says Cynthia Moore-Hardy, Lake Health president and CEO. To read the studies, go to: www.tinyurl.com/healthdesignstudy and www.tinyurl.com/leadershipstudy.

Visit the Cleveland Plain Dealer for the article.

The case first became known in 2003. Investigators said Brazilians and eastern Europeans were flown to South Africa, where their kidneys were extracted at a Durban hospital for transplants into Israeli patients. Netcare's board says, "Neither Netcare nor Dr. Friedland are guilty of any wrongdoing." (Associated Press) Visit the Washington Post for the story.

Office of Minority Health (OMH) and NIMHD will jointly evaluate the scientific progress of the recipients of the grant awards following standard NIH policies and procedures. Visit HHS for more information.

NOVAPLUS, Novation’s private label brand of pharmacy and medical-surgical products, delivers the best financial value for VHA, UHC and Provista members on the most frequently-purchased products. Originally founded in 1985 as VHAPLUS, the private label currently includes more than 1,100 products with annual purchases of $1.4 billion. Visit www.actionbaghealthcare.com for more information.

Bassett will be testing an early version of the system. GE officials said they have not yet estimated potential revenue for the business, which joins a healthcare portfolio ranging from CT-Scan machines to consulting with hospitals on how to run their operations more efficiently. GE's goal is for the smart room system over time to track a wider range of doctor and patient behaviors, which can be added on to the existing infrastructure over time. (Reuters) Visit ABC News for the article.

Anderson said that future research may compare results to the use of baby wipes or other inexpensive alternatives. “Considering [baby wipes are] two cents a sheet, you can get maybe the same efficacy; I wouldn't say it would, but if ... it's effective, it'd be a great way to go," Anderson said. More research may further test the 75% alcohol wipes for significant effectiveness, according to Anderson. Wipes in the study were supplied by Matguard USA and Sage Products. Visit here for the article.

Bisphosphonates include: Aclasta, Actonel, Aredia, Bondronat, Boniva, Didronel, Fosamax, Fosavance, Reclast, Skelid, and Zometa. Visit Healthday for the article.

September 15, 2010  Download print version

Medtronic spokesman Brian Henry said the company does not comment on pending litigation. However, in a statement, Henry said, "It does not appear that there is anything raised that was not already resolved in the first case." (Star Tribune) Visit QMed for the article.

But metals kill whatever bugs they come into contact with, which can be a problem in the human body, which has "good bugs" and live cells that need to be kept alive. Visit the Wall Street Journal for the article.

At the start of the project in April 2009, the participating hospitals were surprised to learn that their rate of hand hygiene compliance averaged 48 percent. By June 2010 they had reached an average rate of 82 percent that had been sustained for eight months. Nineteen small, medium and large hospitals across the country also collaborated with the Center to test the work of the original eight hospitals and provide guidance on the development of the solutions that are now available through the TST. These hospitals are experiencing similar gains as the original eight. Visit www.jointcommission.org/.

As issues such as wrong site surgery, surgical site infections and hand-off communications are tackled through the Center, the solutions developed by the projects will be incorporated into the TST. Learn more about the Center here.

That might help reduce the reporting-while-sick problem, said study co-author Dr. Vineet Arora, associate director of the University of Chicago's internal medicine residency program. A growing push to require flu shots for health workers also could help reduce the number of junior doctors who work while sick. (Associated Press) Visit the Washington Post for the article.

Before introduction of the new protocols, new VRE colonizations occurred at a rate of 10.0 per 100 patients screened. It fell to 7.9 per 100 after the new procedures were implemented. (World Book and News) Visit here for the article.

The panel did express support for making it illegal for anyone under age 18 to purchase medication that contains dextromethorphan and limiting sales of bulk dextromethorphan. Doing so would require an act of Congress. Visit here for the article.

Infectious diseases expert Dr. Marc Siegel, an associate professor of medicine at New York University in New York City, said that "the number of [NDM-1] cases is small, but what is concerning about this is this is a new bacteria that is emerging because of a genetic change that is causing a garden-variety bacteria to become resistant to most antibiotics." Antibiotic-resistant bacteria are emerging because of lack of cleanliness and sterility in hospitals, too many antibiotics being prescribed, and drug companies not developing new antibiotics because they aren't profitable, Siegel said. (HealthDay) Visit Business Week for the article.

September 14, 2010  Download print version

MedAssets signs definitive agreement to acquire The Broadlane Group

STERIS launches ComplyTrack Hand Hygiene Compliance Platform

VHA to recognize member hospitals leading the way in sustainability

Public handwashing takes a hike

New study: Serious gaps in medical journals' disclosure of physician relationships with industry

The cost of over-triage on our nation's health system

Survey: Most hospital CIOs plan to get first-round IT incentives

Surgical sponges designed to reduce infections may actually increase them in some cases

MedAssets signs definitive agreement to acquire The Broadlane Group

MedAssets, Inc. today announced that it has entered into a definitive purchase agreement to acquire The Broadlane Group. Based in Dallas, TX, The Broadlane Group is a provider of supply chain management, strategic sourcing of supplies and services, capital equipment lifecycle management, medical device or PPI cost management, centralized procurement, clinical and lean process consulting, and clinical workforce optimization.

The Broadlane Group serves more than 1,100 acute care hospitals and 50,000 non-acute care facilities across the United States, and MedAssets serves more than 3,300 hospitals (inclusive of 1,700 in its Spend Management segment) and 40,000 non-acute healthcare providers. The combined companies' client footprint will be calculated at closing.

"The Broadlane Group and MedAssets are an outstanding strategic fit, and this combination offers numerous benefits for our clients and stakeholders. We are bringing together some of the best contract pricing in the industry, with highly complementary technology and clinical consulting expertise from both companies," said John Bardis, chairman, president and chief executive officer of MedAssets. "Our core strategy is to enable broader clinical and operating effectiveness throughout our nation's health system, and this transaction will further enhance our ability to help hospitals and other healthcare providers drive their operating and supply costs lower, while improving patient care. The collective strengths and business models of our two companies will also enhance MedAssets' financial profile, with highly visible, recurring revenue as well as cash flow and profit expansion opportunities," Bardis added.

Patrick Ryan, chairman and chief executive officer of The Broadlane Group, is expected to join the MedAssets board of directors and also assume the role of President of the Company's Spend Management segment upon completion of the transaction. "This transaction offers an exceptional opportunity to bring together two very strong enterprises and deliver end-to-end cost management capabilities. As a combined entity, we offer a strategic opportunity for our clients to drive operating expenses down while improving quality of care," said Ryan. "The collective strengths of The Broadlane Group and MedAssets will provide expanded supply chain capabilities, and further enhance the financial improvement opportunities, both near and long-term, for our healthcare provider clients."

Under the terms of the agreement, MedAssets will purchase The Broadlane Group for approximately $850 million in cash, with $725 million to be paid at closing and $125 million to be paid in January 2012. To fund the transaction, MedAssets has obtained financing commitments from J.P. Morgan and Barclays Capital.

MedAssets hosted a conference call this morning, Tuesday, September 14, 2010, at 7:30 a.m. ET to discuss its proposed acquisition of The Broadlane Group. The live audio webcast will be accessible from the "Events & Presentations" page at http://ir.medassets.com.

To access the conference call, dial 866-811-1812 or 706-902-0609 (international), and provide the conference ID number 99384154. A webcast replay will be archived on MedAssets' website for 30 days. A conference call replay will be available for one week by calling 800-642-1687 or 706-645-9291 (international), and entering ID number 99384154. Visit www.medassets.com.

STERIS launches ComplyTrack Hand Hygiene Compliance Platform

STERIS Corporation announced the renaming and expansion of its hand hygiene compliance offering for healthcare providers. The new ComplyTrack Hand Hygiene Compliance Platform includes two programs; one that is already relied upon by U.S. hospitals, and a new, more automated program that tracks a second type of hand hygiene data.

The new FasTrack Hand Hygiene Compliance Program, expected to be available in October 2010, is a user-friendly, automated tool for tracking and providing reports on hand hygiene product purchasing in healthcare facilities. With a one-step command from the user, this program collects purchase-based data and generates monthly reports automatically. Trends for both hand sanitizers and handwashing products can be displayed in graph format, and the product mix by percentage can also be illustrated. Infection Preventionists can use the information to get trend data on their hospitals hand hygiene performance and can export the data for their own customized use.

The second option, the AccuTrack Hand Hygiene Compliance Program, is based on the program formerly known as Partners in Your Care; it tracks and provides detailed reports on hand hygiene product consumption. This program is already valued by more than 100 U.S. hospitals for its ability to report on hand hygiene compliance data down to the department level if needed, and for its ability to produce benchmarking data that allows comparison with other hospitals around the country. Users also have interactive around-the-clock access to the site, and the data is more detailed than the data supplied in the FasTrack Compliance Program.

In addition, current customers will not have to start over or learn different software when they go to the website to access their data. The name will be different, but the AccuTrack Hand Hygiene Compliance Program website (www.sterisaccutrack.com) will have the same functionality.    

In addition to these enhanced measurement tools, STERIS offers a menu of hand hygiene solutions that includes effective compliance-enhancing alcohol-based rubs, handwashing products and surgical scrubs, and hand hygiene awareness tools and posters. Moreover, STERIS University provides convenient, certified clinical education self-study modules on several hand hygiene topics to help facilities strengthen their knowledge base. Visit www.steris.com.

VHA to recognize member hospitals leading the way in sustainability

VHA Inc., the national healthcare network, announced that it will offer a new leadership award to honor not-for-profit member hospitals that are leading the way in developing and implementing outstanding sustainability programs.

"Most hospitals in the U.S. are intensely focused on the care they deliver to patients but not always as focused on the impact they have on the environment," said Michael Regier, senior vice president of legal and corporate affairs at VHA. "However, due to heightened awareness and commitment to the global and local communities, a growing number of hospital leaders are looking at their organization's environmental impact and they are doing some pretty amazing things about it. VHA plans to honor those leading hospitals and encourage others to step up."

VHA will recognize hospitals that have:

• Shown a commitment to the development, implementation and promotion of a sustainability strategy
• Developed a "best in class" sustainability program, such as on-site programs to save energy, recycle, reduce waste or conserve water
• Measured and reported progress toward sustainability goals
• Demonstrated a commitment to increasing awareness of its sustainability story in the community and/or among its employees

The Sustainability Excellence Award is part of VHA's existing Leadership Award series that honors hospitals for excellence in supply chain management, clinical care and community benefit leadership. The new award is also part of VHA's larger commitment to recognizing and advancing innovative sustainability initiatives through its own Corporate Citizenship & Sustainability program.

The Sustainability Excellence award program is open to VHA hospitals that were active members in 2010 and that have developed organizational sustainability programs and initiatives. To enter, visit VHA's Web site and download the Sustainability Excellence Award overview, criteria and application materials. Awards will be given in two categories -- one for large IDNS and one for hospitals, and winners will be recognized at the 2011 Leadership Conference in San Diego. Visit Marketwire for more information.

Public handwashing takes a hike

In the latest observational study sponsored by the American Society for Microbiology and the American Cleaning Institute (formerly The Soap and Detergent Association), 85% of adults washed their hands in public restrooms, compared with 77% in 2007. The 85% total was actually the highest observed since these studies began in 1996. The results were announced at the Interscience Conference on Antimicrobial Agents and Chemotherapy, an infectious disease meeting sponsored by the American Society for Microbiology. In a separate telephone survey, 96% of adults say they always wash their hands in public restrooms, a percentage that has remained relatively constant over the years.

On behalf of ASM and ACI, Harris Interactive discreetly observed 6,028 adults in public restrooms in August 2010 to note whether or not people washed their hands. Researchers returned to six locations in four cities where two previous studies were conducted: Atlanta (Turner Field), Chicago (Museum of Science and Industry, Shedd Aquarium), New York City (Grand Central Station, Penn Station), and San Francisco (Ferry Terminal Farmers Market).

Men stepped up to the sink a bit more than they have in the past when it comes to public handwashing. More than three-quarters of the guys (77%) washed their hands publicly in 2010, compared to 66% in 2007.

The men still strike out more on handwashing in sporting venues, though. Turner Field by far fielded the worst percentage for the guys – barely two-thirds (65%) – though that's still better than just 57% in 2007. Perhaps as a counter to the men's poor handwashing practices, Turner Field brought out the best in women's handwashing among all venues: 98%. Overall, the rate of women washing their hands in public restrooms improved from 88% in 2007 to 93% in 2010.

The best observed handwashing in 2010 was in Chicago and San Francisco, with 89% of adults lathering up in public restrooms. Atlanta was next (82%), followed by New York City (79%). The venue with the best overall handwashing regimen was Chicago's Museum of Science and Industry (93%).

In a 2010 telephone survey of 1,006 American adults, Harris Interactive's survey for ASM and ACI found the vast majority of us say we always wash our hands after using the bathroom at home (89%). More Americans now report that they always wash their hands after changing a diaper (82%), an increase from 2007 (73%). Women are better than men at this practice: 88% of the ladies say they always wash their hands after diaper duty, compared to 80% of the guys.

Those of us who say we always clean our hands before handling or eating food is staying about the same: 77% in 2010, compared to 78% in 2007. Among women, 83% say they clean their hands before touching their food; just 71% of men say they do. And only 39% of Americans say they always wash their hands after coughing or sneezing. More details from the surveys are available online at www.washup.org and www.cleaninginstitute.org/news.

New study: Serious gaps in medical journals' disclosure of physician relationships with industry

Nearly half the surgeons who made at least $1 million in payments from orthopedic device companies did not have that relationship published in their scientific articles, according to a study released today in the on-line edition of the Archives of Internal Medicine. The study shows that readers are not being adequately informed about conflicts of interest even when the funds involved are significant.

The study, conducted by researchers at the New York-based Institute on Medicine as a Profession (IMAP), is the first of its kind to use company records to check on the accuracy of disclosure information listed in medical journals. The five manufacturing firms studied disclosed the dollars they paid to consultants in a public database. IMAP researchers searched the database and compared the list to the financial disclosure information, if any, listed in the journal articles.

"The findings raise troubling questions about undisclosed payments or royalties and other fees from medical device companies that could lead to biased scientific conclusions," says senior author David Rothman, president of IMAP (www.imapny.org), a think tank based at the Columbia University College of Physicians & Surgeons in New York City. He co-authored the study with IMAP colleagues Susan Chimonas, associate research scholar and Zachary Frosh, research associate.

The authors note that journal editors typically don't check multiple databases that are now available and simply rely on the honor system. They expect a researcher to disclose all conflicts but do not verify if the information is complete and accurate. Rothman and colleagues argue that full disclosure in medical journal articles is vital. "These articles constitute a permanent scientific record that is used by practicing physicians, guideline committees, purchasers and patients to evaluate treatment options. Journal editors, reviewers and readers must be fully informed about authors' industry relationship to consider the potential for bias," they write.

IMAP compared 2007 physician payment information from five orthopedic device companies with disclosure of company payments in journal articles. These five companies (Biomet, DePuy Orthopedics, Smith & Nephew, Stryker, and Zimmer) made a total of 1,654 payments that amounted to $248 million in 2007 for consulting, honoraria or other payments for services. The analysis also showed that payments to 41 orthopedic surgeon researchers ranged from just over $1 million to a high of $8.8 million, representing 62 percent of all company expenditures.

These highly paid orthopedic consultants became the focus of the analysis because of the size of their payments. The IMAP team homed in on 95 articles published in the scientific literature after researchers received their large payments and found that fewer than half of the journal articles disclosed a financial relationship between the author and company. In no case did journal articles reveal how substantial the payments were to the authors. Almost all of articles were directly related to a device, like a hip implant, made by the company. This study focused on orthopedic surgeons but other studies suggest other medical specialists also fail to have their industry ties published.

Rothman says editors and others need to start using the company's data bases to get information about physician-industry relationships. No less than 15 drug and device companies are now putting payment information on their websites, says Rothman, a practice that will be accelerated by the Patient Protection and Affordable Care Act. Under the new health reform law, all drug and device manufacturers will have to report payments to physicians in a searchable public database by 2013. Editors, consumers, deans of medical schools and others will then be able to search for any doctor's name and a list of payments from drug or medical device manufacturers.

A copy of the article "From Disclosure to Transparency, The Use of Company Payment Data" in the September 13 issue of the Archives of Internal Medicine can be obtained by e-mail at mediarelations@jama-archives.org.

The cost of over-triage on our nation's health system

Researchers at the University of California, San Diego School of Medicine have identified "secondary over-triage" as a potential area of cost savings for our nation's healthcare. The phenomenon of over-triage occurs when patients are transferred twice, and discharged from a second facility in less than 24 hours. These findings will be published in the September 10th issue of The Journal of Trauma.

"By looking at the number of times patients are transferred, we can evaluate the overall efficiency of our trauma system and its impact on healthcare costs," said Hayley Osen, research analyst for the UCSD Center for Surgical Systems and Public Health. "The average cost of a patient who faces secondary over-triage is $5,917, a significant burden given that per capita spending alone in the U.S. is around $8,000."

"Primary over-triage" refers to the transport of patients from the field to hospitals while "secondary over-triage" refers to the transport of patients between hospitals, involving the decision making of hospital-based medical personnel. "The paper highlights the issue of defensive medicine," said David Chang, PhD, MPH, MBA, director of the UCSD Center for Surgical Systems and Public Health. "We found that pediatric patients are most prone to secondary over-triage, which may be due to physicians or hospitals being overly cautious for fear of legal repercussions."

The paper indicates that 20 percent of pediatric patients were discharged within 24 hrs after transfer to a second facility. Rapid discharge after transfer was defined as patients who were discharged within one day and did not receive any surgical procedure. Chang noted that if patients are discharged within 24 hrs, it is unlikely they needed to be transferred in the first place. Visit PhysOrg.com for the article.

Survey: Most hospital CIOs plan to get first-round IT incentives

The government’s final “meaningful use” regulations, which tell hospitals and medical practices to what extent they must implement electronic medical records in order to qualify for a first round of federal incentive payments, came out in July. And now there’s some word on whether hospital IT brass think they’ll actually be able to qualify.

A survey out today from the College of Healthcare Information Management Executives finds 28% of the 152 respondents expect to qualify for the stimulus funds before April 1, 2011. Another 62% say they’ll likely qualify between then and Sept. 30, 2012, when the first stage of the incentive program ends. That leaves just 10% of respondents who say they won’t qualify for funds until fiscal 2013 or 2014.

About 11% of the group’s membership responded to the online survey, and of course it’s possible that the institutions farther along on the road to digitizing records were more likely to respond.

Readiness varied by the type of institution — CIOs at academic medical centers were more likely than those from community hospitals to say they’ll qualify in the first six months. And larger hospitals were more likely than small ones to say they’ll qualify.

The hospital execs cited certification of applications, the need to implement a computerized order entry system and the need to gather data on quality measures as the major obstacles to meeting the requirements.

A survey of 120 CHIME members conducted by PricewaterhouseCoopers in June, before the final requirements were set, found about half of CEOs expected to meet requirements in 2011. Visit the Wall Street Journal for the article.

Surgical sponges designed to reduce infections may actually increase them in some cases

New data reported this week show that implanting sponges soaked with antibiotics into surgical wounds may not reduce the incidence of infections as intended and may, in fact, actually increase them. The findings represent a blow to the manufacturer's efforts to get the sponges approved for use in the United States.

Post-operative infections are a problem with all types of surgery, but are particularly troublesome with colorectal surgery because the bowels are loaded with bacteria. The reported incidence of such infections ranges from 8.2% to 26%, and most experts agree that a figure of 18% to 20% is typical for such procedures.

One effort to prevent such infections is a collagen sponge containing the antibiotic gentamicin, manufactured by Innocell Technologies of Gallowston, Ireland. When one to five such sponges are implanted at a surgical site, they produce a high local concentration of the drug without producing a high systemic concentration. The sponge itself biodegrades and disappears within days to weeks. The sponge was first approved in Germany in 1985 and is now marketed in 53 countries. More than 2 million of the sponges have been used to treat about a million patients.

A team headed by Dr. Elliott Bennett-Guerrero of Duke University studied 602 patients undergoing colorectal surgery, randomly assigning half to receive the sponge plus conventional systemic antibiotics and half to receive only the systemic drugs. The team reported Wednesday in the New England Journal of Medicine that 90 of 300 patients receiving the sponges (30%) developed an infection, compared with 63 of 302 patients (20.9%)  receiving conventional care. Patients receiving the sponges were also more likely to visit an emergency room or doctor's office for wound-related symptoms (19.7% versus 11%) or to be hospitalized for a surgical-site infection (7% versus 4.3%).

The same team of researchers reported in August in the Journal of the American Medical Association on a similar trial in heart surgery, where infections are less common. That trial enrolled more than 1,500 patients and found no benefit for the sponges: 8.4% of those receiving sponges developed an infection compared to 8.7% of those receiving standard care.

Both studies were sponsored by Innocell as part of its phase 3 trials to get the sponges approved by the U.S. Food and Drug Administration. Such approval now seems highly unlikely, experts said. The researchers seemed at a loss to explain the findings. Perhaps the most likely possibility is a different spectrum of germs abroad, with a higher prevalence of bacteria sensitive to gentamicin. Another possibility is differences in surgical procedures. Visit the Los Angeles Times for the article.

September 13, 2010  Download print version

AHRMM Membership selects 2011 Board of Directors

Cesareans more likely for women at for-profit hospitals, study finds

TeleTracking's RadarFind offers tamper-resistant reader real time locating system, application-specific tags

AHIMA files response to HHS Privacy rules

IV drips can be left in place

3M to buy Arizant in third acquisition in a month

After adverse effects, Roche ends trials of diabetes drug

India's market in generic drugs also leads to counterfeiting

AHRMM Membership selects 2011 Board of Directors

The Association for Healthcare Resource & Materials Management (AHRMM) has announced the results of its 2011 board of directors elections. Newly elected officials include: president-elect Beverly Slate, CMRP, FAHRMM; healthcare provider representatives Brent Petty, CMRP and Mickey Sparrow, CMRP, FAHRMM; and GPO/consultant/supplier/distributor representative Michael Ferris, CMRP, FAHRMM. The new board representatives will begin their terms on January 1, 2011. AHRMM elections are held each year via the association's website. AHRMM posts each candidate’s biographical information and platform so every member can make an informed decision when voting.

President-elect Slate is director of Supply Chain Operations for Memorial Health Care System in Chattanooga, TN, and brings more than 20 years of materials management experience to the president-elect position. Slate has been a member of AHRMM for more than 10 years and is currently serving as the Region 4 National Board Representative. Slate’s service history with AHRMM includes: member of the Fellow Review Committee, and member of the AHRMM/HFMA Benchmark Task Force, the AHRMM/HFMA Supply Expense Definition Task Force, and the Environmental Sustainability Task Force. She was also a board member and chapter president of the Virginia Association for Healthcare Resource Materials Management from 1996 to 2006. In her capacity as AHRMM president-elect, Slate’s responsibilities include serving on both the AHRMM Executive and Nominating Committees, developing the association's strategic plan and budget, and in the absence of the president, assuming the duties of that office.

The new healthcare provider representatives, Petty and Sparrow are responsible for advocating for their constituents by conveying provider issues to the board as well as carrying out the mission of the organization. Brent Petty is the system director of Supply Chain, Wellmont Health System in Kingsport, TN, and brings over 15 years of experience in the resource and materials management field and four years of AHRMM membership experience to the board. Mickey Sparrow is the Materiel Manager, Tuomey Healthcare System in Sumter, SC, and brings over 14 years of experience in the resource and materials management field and nine years of AHRMM membership experience to the board.

The new GPO/consultant/supplier/distributor representative is Michael Ferris, who is responsible for advocating for non-provider issues to the board as well as carrying out the mission of the organization. Ferris is the co-founder and executive vice president of operations for Management Health Solutions, Inc. in Ambler, PA. He brings over 33 years of experience in the resource and materials management field and 25 years of AHRMM membership experience to the board. Ferris also previously served on the AHRMM board of directors from 2004 to 2006.

"On behalf of AHRMM, I am honored to welcome these newly elected officials to the board. Their experience and insight will bring fresh perspectives to their positions and help AHRMM continue its mission of advancing healthcare through supply chain excellence,” said AHRMM president Ray Moore. "The AHRMM board of director elections are an important member event, as it is the board’s responsibility to determine AHRMM's strategic direction as well as new professional development opportunities for the field at large."

For more information, please visit www.ahrmm.org.

Cesareans more likely for women at for-profit hospitals, study finds

For-profit hospitals across the state are performing cesarean sections at higher rates than nonprofit hospitals, a California Watch analysis has found. A database compiled from state birthing records revealed that women were at least 17 percent more likely to have a cesarean section at a for-profit hospital than at a nonprofit or public hospital from 2005 to 2007. A surgical birth can bring in twice the revenue of a vaginal delivery. In addition, some hospitals appear to be performing more C-sections for nonmedical reasons -- including an individual doctor's level of patience and the staffing schedules in maternity wards, according to interviews with health professionals.

The statewide database revealed significant differences among 253 hospitals in California. New mothers with low-risk pregnancies had a 10 percent chance of giving birth by C-section at the public Santa Clara Valley Medical Center, for example, whereas low-risk pregnancies at the for-profit Los Angeles Community Hospital ended in a surgical birth nearly half of the time.

The numbers provide ammunition to those who have long suspected that unnecessary C-sections are performed to help pad the bottom line. This was the first independent analysis of C-section rates at the 253 hospitals reporting birth statistics to state health authorities. The data focuses on low-risk pregnancies where cesareans are more likely to be unnecessary -- excluding deliveries by older mothers, women with certain medical conditions and women with previous C-sections.

But some hospital officials dispute the notion that their institutions could be pushing C-sections for money. "Decision-making about C-section versus vaginal birth is between a doctor and the patient, and our goal is to support that decision-making process with evidence-based practices," said Leslie Kelsay, a spokeswoman for Good Samaritan Hospital in San Jose, which had the highest cesarean rate for low-risk pregnancies in Santa Clara County at 22 percent.

Rick Black of Tenet Healthcare, which owns a number of hospitals in California and elsewhere, agreed. "You don't just come into a hospital and they say, 'We want to give you a C-section so we can drive up profits'”, he said.

Gene Declercq, professor of community health sciences at the Boston University School of Public Health, agrees that hospitals would not explicitly push C-sections for profit. But subtle incentives to increase efficiency could have the same effect. "It's a lot easier if you can do all your births between seven and 10 in the morning and know exactly how many operating rooms and beds you need," he said. Vaginal births are unpredictable, creating inefficiencies that can hurt the bottom line.

In 2008, more than 180,000 C-sections were performed in California. Medical experts have been unable to pinpoint exactly why some hospitals perform far more C-sections, or "operative deliveries," than other medical facilities. Yet one important factor has always loomed over the debate about the rise in C-sections: the bottom line. In California, hospitals can increase their revenues by 82 percent on average by performing a C-section instead of a vaginal birth, according to a 2007 analysis by the Pacific Business Group on Health. The group -- a coalition of business, education and government agencies -- estimated that average hospital profits on an uncomplicated C-section were $2,240, and profits for a comparable vaginal birth were $1,230.

California Watch examined the births least likely to require C-sections, those in which mothers without prior C-sections carry a single fetus -- positioned head down -- at full term, and found that, after adjusting for the age of the mothers, the average weighted C-section rate for nonprofit hospitals was 16 percent, and for-profit hospitals had a rate of 19 percent.

That may seem like a small percentage gap to the casual observer, but medical experts consider it significant. It means women are 17 percent more likely to have a C-section if they give birth at a for-profit hospital. Visit the San Jose Mercury News for the article.

TeleTracking's RadarFind offers tamper-resistant reader real time locating system, application-specific tags

RadarFind, a subsidiary of TeleTracking Technologies, has developed a tamper-resistant version of its real time locating system's (RTLS) plug-in readers to further address hospital patient safety needs. Developed at the request of hospital clients, the tamper-resistant reader features a shutter system that prevents patients from inserting paper clips, pins and similar objects into the slots containing the energized contacts.

The product enhancement fully complies with National Electrical Code (NEC) safety standards applicable to tamper-resistant receptacles and patient care areas; many states commonly adopt NEC standards as law. When the RadarFind system is fully deployed throughout a hospital facility, these devices are typically used in high-risk areas where there may be limited supervision such as pediatric units, alcoholism and substance abuse units, psychiatric units, exam rooms and waiting areas.

RadarFind's enhanced plug-in readers are part of a distributed sensor-network based system where intelligent RTLS tags continuously communicate with readers placed throughout a hospital facility to report location, status, contextual awareness and environmental conditions regarding medical devices and people. Their pass-through design accommodates most electrical outlets, yet preserves electrical sockets for use by other medical equipment. RadarFind offers hospitals their choice of electrical socket colors to match existing outlets, including red receptacles to indicate outlets that are powered by back-up generators in the event of an electrical power outage.

The company recently announced plans to install their RTLS across five hospitals that are part of Methodist Healthcare in San Antonio, a 24-facility system jointly owned by Methodist Healthcare Ministries and Hospital Corporation of America. For more information, please visit www.teletracking.com and www.radarfind.com.

AHIMA files response to HHS Privacy rules

The following statement was released today by Rita K. Bowen, President, AHIMA Board of Directors: "While AHIMA continues to applaud federal government support for the ideal of protecting patients' health information rights, the proposed rule-making for HIPAA privacy, security and enforcement by HHS has a number of requirements that we do not believe the industry is ready to undertake; especially as it gears up for Meaningful Use. Today AHIMA is releasing its recommendations to the HHS Office of Civil Rights (OCR) that speak to the issues we believe are most critical to the patients of America, the healthcare industry and the best practice of health information management.

"As staunch supporters of patients' health information rights, AHIMA agrees the single most contentious issue in the proposed regulation is the ability of individuals to restrict the information held by their healthcare providers from being shared with their health plan. While AHIMA believes an individual's control over this data flow is valid, data flow restrictions in the HHS proposal creates unintended repercussions for data integrity, data processing and other elements within the current US reimbursement system.

"Many AHIMA members are engaged in providing patients' individual and aggregate data for a variety of approved uses. There is a continued discussion within the profession on how to best cover the costs of the retrieval, analysis and release of information within the context of the privacy and security regulations, patient restrictions; and the need to verify the requesting individual as a means of keeping released information available to a necessary minimum. Additionally, we remain concerned the charges permitted by states or HIPAA do not cover all costs and ultimately raise the cost of healthcare.

"AHIMA also questions the sale of patient health information when an organization is being absorbed by a second organization. The OCR's approach, while practical, raises the issue of whether consumers have the right to determine if their health information should be transferred with the ownership of a health organization.”

"Finally, AHIMA feels strongly that the OCR needs to provide greater clarification regarding the definition of 'agents' as it relates to covered entities and who should be covered by HIPAA, including its hybrid organizations." Visit www.ahima.org.

IV drips can be left in place

Small intravenous devices (IVDs) commonly used in the hand or arm do not need to be moved routinely every 3 days. A randomized controlled trial comparing regular relocation with relocation on clinical indication, published in the open access journal BMC Medicine, found that rates of complications were the same for both regimens.

Claire Rickard, from Griffith University, Australia, worked with a team of researchers to carry out the study with 362 patients at Launceston General Hospital, Tasmania. She said, "Recommended timelines for routine resite have been extended over the past three decades from 24 to 72 hours. Currently, 72- to 96-hour resite is recommended. Even with these extended durations, such policies still cause increased workload in hospitals, where the task of removing and replacing well-functioning IVDs generally falls to busy nursing and junior medical staff. Our results indicate that the average duration of IV therapy is 5-6 days and that many catheters can remain complication-free for this period, or even longer".

The researchers found that complication rates between the groups were not significantly different. The policy of resite on clinical indication led to one in two patients needing only a single cannula to receive treatment, whereas a 3-day change policy resulted in one in five patients having this scenario, with the rest requiring multiple cannulations and therefore additional pain and inconvenience. According to Rickard, "The routine resite of peripheral IVDs increases patient discomfort and healthcare costs, but does not reduce IVD complications as has traditionally been thought". Visit here for the article.

3M to buy Arizant in third acquisition in a month

3M Co. agreed to acquire Arizant Inc., a maker of blankets used to protect hospital patients against hypothermia, for $810 million to expand its infection-prevention offerings, marking its third acquisition in a month. Arizant, also the maker of gowns to keep patients warm on the operating table, will add to the St. Paul, MN-based 3M’s healthcare unit, its second biggest after the industrial and transportation division.

3M, whose products range from Post-It notes to flu tests and sanding tools, still sees one or two potential acquisition targets among industrial companies, Chief Executive Officer George Buckley said in a Bloomberg Television interview last week. He told the Financial Times this month that 3M may make two purchases still this year. The company plans to spend about $2 billion on acquisitions in 2010.

At the end of August, 3M said it would buy Cogent Inc., a maker of fingerprint-identification devices, for $943 million and Attenti Holdings SA, a maker of electronic tracking tools including ankle bracelets, for $230 million. Visit Bloomberg for the article.

After adverse effects, Roche ends trials of diabetes drug

The drug maker Roche has stopped giving patients its experimental diabetes treatment taspoglutide in late-stage clinical trials because of a high rate of adverse reactions, a major blow to a drug once expected to have $2 billion-a-year potential. Roche said on Friday that the decision was based on a higher-than-expected rate of discontinuations because of gastrointestinal intolerability and as a result of serious hypersensitivity reactions experienced by some patients, according to 52-week data from the trials.

“These discontinuation rates compromise interpretation of the long-term safety data from the T-emerge studies, therefore continuing treatment with the current taspoglutide formulation is not considered to be in the best interest of patients,” Roche said.

The drug, given once weekly by injection, suffered a setback in June, when it was reported that there were cases of patients’ suffering hypersensitivity reactions to the medicine in clinical trials. Roche said it was not abandoning its drug, but was considering a reformulation. (Reuters) Visit the New York Times for the article.

India's market in generic drugs also leads to counterfeiting

In New Delhi, private investigator Suresh Sati rattled off the popular brand names listed on the boxes of cough syrup, supplements, vitamins and painkillers sprawled across the desk and shelves in his basement office. "They look real, but all these are fakes," said Sati, head of a New Delhi-based agency that helps police conduct raids against counterfeit-drug syndicates across the country. "A regular customer cannot make out if a drug is fake. . . . The biggest giveaway is when someone is selling medicines very cheap. It is almost always fake."

India, the world's largest manufacturer of generic drugs, has become a busy center for counterfeit and substandard medicines. Stuffed in slick packaging and often labeled with the names of such legitimate companies as GlaxoSmithKline, Pfizer and Novartis, the fake drugs are passed off to Indian consumers and sold in developing nations around the world.

Experts say the global fake-drug industry, worth about $90 billion, causes the deaths of almost 1 million people a year and is contributing to a rise in drug resistance.

Estimates vary on the number of these drugs made in India. The Indian government says that 0.4 percent of the country's drugs are counterfeit and that substandard drugs account for about 8 percent. But independent estimates range from 12 to 25 percent. Indian officials say the clandestine industry has hurt the image of India's booming pharmaceutical industry and its exports, worth $8.5 billion a year, mostly to African and Latin American countries.

To clamp down on the illegal trade, the health ministry launched a reward program this year offering $55,000 to those who provide information about fake-drug syndicates. Last year, the ministry also strengthened its drug law to speed up court trials. Suspects found guilty of manufacturing and selling fake drugs can be sentenced to life in prison. The number of people arrested for manufacturing and selling fake drugs rose from 12 in 2006 to 147 last year, and drugs worth about $6.5 million were seized over this period.

The tricks of the trade include sticking fraudulent labels on expired products, filling vials with water, stuffing small amounts of real ingredients in packages of popular licensed brands and putting chalk power in medicine packets. But more than the concern for public safety, officials here have been particularly alarmed about recent incidents that discredit India's image abroad. In June, officials at Nigeria's Abuja airport caught a shipment of fake antibiotics, containing no active ingredients, with a "Made in India" label. Nigerian investigators later said that a Chinese company shipped the drugs via Frankfurt. In a similar incident last year, a shipment of fake anti-malaria drugs from China arrived in Nigeria with an Indian tag.

Over the years, drug companies have used holograms or embossed their logo on the packaging to protect their brands, but these have also been counterfeited in India. One company, MSN Labs, is using a technology developed by U.S.-based start-up firm PharmaSecure that allows consumers to check the authenticity of medicines by sending in a text message of the code written on them. Visit the Washington Post for the article.