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At least 500 apps taken off Google Play because of spyware fears
 More than 500 Android mobile apps have been removed from Google Play after it was discovered that an embedded advertising SDK called Igenix could be leveraged to quietly install spyware on devices.

More than 500 Android mobile apps have been removed from Google Play after it was discovered that an embedded advertising SDK could be leveraged to quietly install spyware on devices.

The SDK, called Igexin, was developed by a Chinese company and may have been used to install malware that could, among other things, exfiltrate logs from devices.

Researchers at mobile security company Lookout said on Monday that the 500-plus Android apps with the Igexin SDK had been downloaded more than 100 million times, though not all of them were infected with spyware.

Games developed for teen-agers that had been downloaded between 50 million and 100 million times were the largest concentration of apps containing the Igexin SDK. Weather apps, internet radio apps, photo editors, educational, health and fitness, travel and emoji apps were also identified by Lookout as classes of apps where the SDK was found.

“While not all of these applications have been confirmed to download the malicious spying capability, Igexin could have introduced that functionality at their convenience,” Lookout security engineers Adam Bauer and Christoph Hebeisen wrote.

The Igexin SDK, and others like it, are often used by app developers to connect to mobile ad networks in order to deliver ads and generate revenue. These services often collect user data that is co-opted to deliver targeted advertising based on their browsing habits and interests.

Lookout cautioned that Igexin bucks a trend where malware writers have, of late, been submitting benign apps to marketplaces, and then once on a device download malware or other malicious code.

“Igexin is somewhat unique because the app developers themselves are not creating the malicious functionality—nor are they in control or even aware of the malicious payload that may subsequently execute,” Lookout said. “Instead, the invasive activity initiates from an Igexin-controlled server.”

Lookout said it discovered the suspicious behavior of these apps because they were communicating with IPs and servers known to deliver malware. One app, Lookout said, downloaded large encrypted files after making requests to a REST API located at an endpoint used by the Igexin SDK.

“The encrypted file downloads and the presence of calls within the com.igexin namespace to Android’s dalvik.system.DexClassLoader (used to load classes from a .jar or .apk file) were enough to warrant more in-depth analysis for possible malware hiding in its payload,” Lookout said.

The researchers said that the app developers were likely unaware of the types of information that could be exfiltrated from devices because of the SDK. The malicious versions of the SDK implement a plugin framework through which the device downloads arbitrary code from the endpoint at http://sdk[.]open[.]phone[.]igexin[.]com/api.php. Commands sent from the endpoint cause the SDK to download and execute payloads, Lookout said.

“The functionality contained in the downloaded classes is completely under external control at runtime, and it may change at any time and can vary based on any factors chosen by the remote system operator,” Lookout said. “Users and app developers have no control over what will be executed on a device after the remote API request is made.”

In addition to moving logs off a device, other plugins can be used to register functionality such as a PhoneStateListener, which will save the time during which calls are made, the calling number and whether the call was ringing, idle, or off the hook.

Google, meanwhile, has been out front in marketing its successes, in particular at the RSA and Black Hat conferences. Adrian Ludwig, director of Android Security, said at RSA that Google analyzes its relationships with developers in order to find badly behaving apps.

Google said it analyzes aspects of the developer’s business, customer feedback, software code and application behavior. Then it compares those attributes to other seemingly unrelated apps that may also be problematic. Using machine intelligence, Google creates clusters of apps that share similarities. Next, apps and developers that have a high probability of bad behavior are red flagged and human analysis can confirm if there is a security problem.

Output: More than 500 Android mobile apps have been removed from Google Play after an embedded advertising software development kit (SDK) was found to be vulnerable to being used by hackers to install spyware. The kit, which is known as Igexin, was created by a Chinese company and may have been used as a vessel for malware that might exfiltrate logs from mobile phones. Mobile security firm Lookout found that the SDK had been downloaded over 100 million times, although not always with malware, with the software commonly used in games aimed at teenagers.


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Bloomberg, Tradeweb win post-MiFID APA status from UK regulator
 Several major financial services and technology firms have been granted authorisation to operate as approved publication arrangements (APAs) for reporting under MiFID II.

Tradeweb, MarketAxess’ Trax, NEX Regulatory Reporting, Bloomberg and the London Stock Exchange’s TRADEcho all received approval from the UK’s Financial Conduct Authority (FCA) this week.

As APAs, those firms will be able to publish reports on trades for post-trade transparency on behalf of clients as required under the impending European regulation.

Simon Maisey, global head of business development at Tradeweb, explained its APA service has already received support from a number of financial institutions.

“More recently, buy-side firms have shown particular interest in our ‘Assisted Reporting’ service, which helps them comply with post-trade reporting obligations without having to set up direct connectivity,” he added.

At Trax, Geoffroy Vander Linden, head of transparency solutions, commented that buy- and sell-side firms have been actively testing their readiness for reporting under MiFID II since November last year.

Colin Coleman, head of NEX Regulatory Reporting, described the approval to operate as an APA as an important milestone for NEX Group.

“The use of APAs will be essential for efficient functioning under MiFID II and we strongly encourage any market participants who have not yet commenced testing to do so immediately to ensure they can continue to trade post 3 January 2018,” he said.

Output: Several significant financial institutions have been granted permission to offer services as approved publication arrangements under new MiFID II regulation. Tradeweb, NEX Regulatory Reporting, Bloomberg, the London Stock Exchange’s TRADEcho and MarketAxess’ Trax are among the approved companies. The UK Financial Conduct Authority granted authorisation for publishing reports on trades' transparency for clients as part of MiFID II requirements.


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SEC suspends First Bitcoin Capital's trading licence
 In a statement that will likely make waves in the cryptocurrency community, the SEC announced it has suspended shares of the publicly traded First Bitcoin Capital (BITCF). The suspension is set to last through September 7 at 11:59AM. Prior to suspension, the share price was at $1.79.

The statement gave few details but did include the SEC’s concerns regarding the stated value of assets held by the company.

"The Commission temporarily suspended trading in the securities of BITCF because of concerns regarding the accuracy and adequacy of publicly available information about the company including, among other things, the value of BITCF’s assets and its capital structure.”

The company has been working in the Bitcoin market, running companies for travel, shopping, and cryptocurrency exchange. They also offer franchise opportunities in Bitcoin ATMs under the name BitCannPay.

SEC position is clear

The suspension reflects the SEC’s commitment to add additional controls to the cryptocurrency marketplace. The recent statement regarding the DAO token sale, coupled with today’s ruling, indicate the regulator is beginning to take a firmer role in the largely unregulated digital currency market.

The SEC’s statement regarding ICOs, however, has been met with some confusion given the CFTC’s willingness to clear LedgerX for Bitcoin futures and options trading.

While some have embraced the SEC’s hard stand, others see the position as far too restrictive.

The suspension of a single Bitocin company may have nothing to do with the SEC’s position on Bitcoin as a cryptocurrency. It does however indicate that the SEC is willing to take a stand on cryptocurrency issues. Recent predictions regarding fines and closures of cryptocurrency exchanges have come to fruition, and may signal more to come.

Output: First Bitcoin Capital has seen its publicly-traded shares suspended by the SEC until 7 September 2017. The SEC has said it is concerned about the claimed value of assets held by the company and the quality of available information on its capital structure. First Bitcoin Capital presently operates a cryptocurrency exchange, as well as travel and retail businesses, and a line of Bitcoin ATMs under the BitCannPay label.


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Snapchat to verify brands and influencers with 'Official Story'
 With more than 100,000 followers on Snapchat, graphic designer Cyrene Quiamco (known as CyreneQ on social) has run influencer campaigns on the platform for brands like Walmart, Samsung and Burger King since November 2014. Yet app parent Snap hasn’t been known for cultivating influencers. CyreneQ rarely received guidance from the company on how she could grow her following and views.

But on Wednesday, Quiamco received an email from Snapchat saying the company wanted to set up an Official Stories account for her, which is similar to a verified account on Instagram and Twitter. That means her profile will be featured when Snap users search for “art,” for instance, or in curated Live Stories.

“I’m so excited,” said Quiamco. “Snapchat has never verified creators or influencers before — only celebrity accounts. It’s a huge move from Snap, since it really didn’t show interest in creators a few months ago.”

Snapchat introduced Official Stories in 2015, but the feature was reserved mostly for public figures like Rihanna and Kylie Jenner, agency executives said. Now, the platform is extending Official Stories to influencers.

“Snapchat-only stars have expressed irritation with its neglect of them for a while now and have been leaving in droves for Instagram Stories,” said Marie Cravens, influencer and partnerships manager for We Are Social. “Snapchat is finally trying to woo them back and show [its] appreciation.”

Official Stories accounts come with benefits. They feature a emoji symbol selected by the account holder and receive customized filters for special occasions. Perhaps most importantly, Official Stories accounts will be more visible in search results, as discoverability is a big hurdle for both brands and social stars on Snapchat, according to Quiamco.

Snap confirmed it is expanding Official Stories and will include more “top creators” in the coming months. The company wouldn’t specify how it defines “top creators.”

It’s been a tough year for Snap, with Facebook-owned Instagram looming. In its first quarterly earnings in May, Snap reported a total loss of $2.2 billion and lower than expected user growth.

Gil Eyal, CEO of influencer marketing platform Hypr, thinks Snapchat needs to make a quick shift after two “terrible” quarters. He said there has been a huge decline in influencer marketing on Snapchat from his agency clients over the past year, with the majority shifting to Instagram, because of Snapchat’s lack of analytics and negative news about the platform.

“After completely abandoning influencers under the belief that they will stay because of the platform’s cool factor, Snap is understanding that Facebook stole its thunder,” said Eyal. “Remember Vine? It made the same mistakes, alienating its influencers instead of embracing them.”

Tom Buontempo, president of agency Attention, said he thinks Snapchat is wooing influencers to boost its stagnant user growth through benefits like Official Stories. And with more content from social stars, more advertising opportunities will emerge on Snapchat.

“Snapchat didn’t realize how fast Instagram brought Stories on board, and creators were moving to that platform,” he said. “Snapchat really needs to change its relationship with content creators to keep its audience engaged. After all, advertisers go where the audience is.”

Agency executives think it might be too late for Snapchat to build trust with content creators, as many already started building a large presence elsewhere. They also predict Snap will give influencers more analytics tools along with Official Stories.

“At this point, [social stars] have begun moving on. With the amount of monetization opportunities and the relationships that the Facebook and Instagram ecosystem is creating, it’s hard [for Snap] to compete,” said Marco Hansell, founder and CEO of influencer marketing platform Speakr.

Snapchat seems to be making progress in how it collaborates with social stars. Quiamco had a Skype conference call with about five executives on Snapchat’s partnership and product planning team two weeks ago, discussing what features she would need as a Snap creator. The Snap team also suggested it should host such meetings more often.

“I’m really happy that Snapchat is changing 180 degrees,” said Quiamco. “They asked about the community and were interested in knowing what would make our Snapchat experience better. They also mentioned that they were talking to other creators, not just me.”

Output: Snapchat will now verify brands and influencers to make it easier for followers to find them on the social media platform. Snapchat will set up "Official Stories" accounts, similar to verified accounts on Instagram and Twitter. Until now, verified accounts were only given to public figures and celebrities. The account features an emoji symbol chosen by the account owner, with customised filters for special events, and a higher profile in search results.


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Adani cleared of fraud in tax haven case
 India’s customs authority has cleared the Adani Group of illegally siphoning money into overseas tax havens, dismissing one of two sets of power equipment fraud allegations known to be facing the mining conglomerate.

The judgment this week involved separate Adani Group subsidiaries to those named in similar allegations reported by the Guardian earlier this month, but employed the same alleged company in Dubai and the same modus operandi.

In the allegations dismissed this week, Indian customs investigators had accused two subsidiaries of the Adani Group of using the Dubai company, Electrogen Infra FZE (EIF), to inflate the price of machinery and equipment for power plant projects in Maharashtra and Rajasthan states.

It had alleged that EIF charged the Adani Group subsidiaries up to 220% more for the equipment. It claimed the extra money was channelled to a holding company in Dubai owned by Vinod Shantilal Adani, the older brother of Adani Group chairman Gautam Adani.

The effect of the now-dismissed scheme would have been to move vast sums of money from the Adani Group’s domestic accounts into offshore bank accounts where it could no longer be taxed or accounted for.

In a judgment dated 22 August, an official from the Directorate of Revenue Intelligence (DRI) appointed to adjudicate the case fully dismissed the allegations.

The official, KVS Singh, found that one of the Adani Group subsidiaries, Adani Power Maharashtra Limited, had signed a contract with EIF to supply equipment more than one month before it had been taken over by Vinod Adani.

Therefore the companies “were not related ... on the date of the signing of the contract”, he concluded.

He found the other Adani Group subsidiary, Adani Power Maharashtra Limited, had signed the contract with EIF after Vinod Adani had taken control of the company.

But Singh said the evidence had led him to conclude “that the same relation has not affected the price [of the equipment] and that the same was at arm’s length”.

“I find that even though I have found that the two entities ... were related, the requirement of relationship influencing the price was not satisfied,” he said.

“Thus I find that the allegation that the impugned goods were over-valued does not hold water.”

Income tax officials who had scrutinised the transactions had also concluded that the transactions between EIF and the Adani Group subsidiaries had been conducted at arm’s length, he added.

Singh concluded the increased price that EIF charged the Adani Group subsidiaries could be justified on the grounds the company had provided extended warranties on the equipment it purchased, and had signed stringent supply contracts.

“EIF had undertaken the risk and financial burden to provide extended warranty over what the [suppliers] had added substantially to the said goods,” Singh said.

“This additional risk spread over an extended period of time was bound to add a cost premium to the value of the imported goods.”

The judgment said the Adani Group subsidiaries had chosen to employ EIF to source the equipment based on a competitive evaluation process in which EIF’s bid had been the lowest in price.

“I find that the [Adani Group] has arrived at the price transparently and independently where the price has been finalised based on global tender following international competitive bidding process as prescribed by the Government of India,” he said.

A second set of fraud allegations, detailed by the Guardian earlier in August and valued around 15bn rupees, are still pending adjudication, according to the Times of India.

The DRI had been contacted to provide an update on the current status of both cases.

The Adani Group could not be reached for comment, but said in an earlier statement on behalf of itself, its subsidiaries, and Vinod Adani that it “strongly denies the allegations of overvaluation”.

“It is a standard procedure for the group to follow international competitive bidding route for major capital expenditures to ensure transparency and competitiveness in the process. All our transactions are always conducted within the framework of extant regulatory guidelines and provisions,” it has said.

“The fact that our projects have incurred the lowest cost across central, state and private utility players has gone to establish the robustness of the processes followed by our group.

“It may be noted that Mr Vinod Adani who is the elder brother of Mr Gautam Adani has been a non-resident Indian for about 30 years and has his own established business interests outside India,” its statement said.

“Adani Group is aware of the investigations being conducted by the DRI, and has fully cooperated, and shall continue to cooperate with the investigating agencies.”

Output: Adani, the Indian multinational corporation, has been cleared of illegally routing money to tax havens by India’s customs authority. The case was founded on allegations that two subsidiaries of the group inflated power plant equipment prices via the Dubai firm Electrogen Infra. Further fraud allegations involving sums of approximately INR15bn ($234m) are still awaiting adjudication.


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UK banks anticipate PPI compensation claims following £42m TV ads
 Britain’s banks are bracing themselves for a new wave of compensation claims likely to be sparked by a £42m advertising campaign urging customers to complain about their payment protection insurance policies.

The campaign by the Financial Conduct Authority is due to launch on 29 August – exactly two years before the cut-off point for any fresh PPI claims – and is being paid for by 18 of the biggest players in the industry.

The FCA hopes the imposition of the deadline will help the industry draw a line under the scandal. It is by far the UK’s costliest misselling scandal, having forced the industry to set aside more than £43bn to handle the claims and pay compensation, according to calculations by the thinktank New City Agenda.

The big four banks – Barclays, Royal Bank of Scotland, HSBC and Lloyds Banking Group – are sitting on £6.5bn of funds to cover future claims. Lloyds said in its interim results this month that the unused £2.6bn proportion of its £18.1bn provision was “consistent with total expected complaint volumes of 5.3m, with approximately 1.2m still expected to be received, including approximately 9,000 reactive complaints per week through to August 2019”.

RBS, which is 71% owned by the taxpayer, has £1.1bn it is yet to use, while HSBC has $1.1bn (£860m). Barclays has not used £2.1bn out of the £9.1bn it has set aside, which it describes as its “best estimate of expected PPI redress”.

In its interim results, Barclays also referred to the advertising campaign starting on 29 August and said its impact is “uncertain but has been considered in Barclays’ provision estimate”.

The sums also include the potential cost of administering the claims in a scandal that has cost far more than expected. Regulators initially estimated 3 million people might be affected, but four times that figure – 12m – have so far received £27.4bn in total, according to a tally compiled by the FCA.

When Lloyds broke ranks with the industry in May 2011 and started to pay out claims, it set aside £3.2bn which at the time it hoped would be sufficient to tackle the scandal. The bill for Lloyds alone now stands at £18bn.

Ian Gordon, an analyst at Investec, said the parts of the unutilised provisions were “an estimate of all future redress costs through to August 2019. Will that be enough? My guess is no, but almost enough.”

An extra £1bn may be needed across the industry – but, he cautioned, “most of us have been wrong here many times before”.

Up to 60m policies were sold, the majority before 2005. While 12 million people have made claims, this could equate to between 20m to 24m policies as some customers had more than one.

The FCA head, Andrew Bailey, justified the decision not to force banks to write to customers, instead putting the onus on customers. In a comment piece for the Mirror, he said: “We don’t believe this would work. How many times have you ignored a generic letter through your door?”

Bailey added: “Most of us see reminders every day of the PPI scandal from calls on our phone and adverts in newspapers. Yet there remain a large number of people who may be entitled to complain but have not yet made a complaint.”

Nick Baxter, independent chair of the Professional Financial Claims Association, said that the FCA data showing £24.7bn had been paid out “presents the illustration of progress but we’re only part way there”.

This is because the FCA’s data does not separate out the interest customers receive from the premiums that are being repaid. About half the total payouts are thought to cover interest which, according to some industry estimates, could push the total misselling bill as high as £100bn.

Claims management firms have been extremely active in touting for PPI business, often taking a large slice of any compensation they secure for customers. The National Audit Office estimated they have received as much as £5bn.

For some customers, the deadline represents a second opportunity to receive compensation: 1.2 million customers previously rejected are being told they may have other grounds for complaint. This is because of a crucial court ruling in 2014 – named after the Paragon customer Susan Plevin – that means customers can make claims for the commission they paid when the PPI was sold.

The FCA has said compensation can be paid if the commission was 50% of the cost of the PPI. According to Moneysavingexpert.com more people could receive payments as commission was typically 67% of the value of the policy.

Dominic Lindley, policy director at New City Agenda, warns that the deadline to make a claim will be earlier than April 2019 for 5.5 million individuals already contacted by their bank.

Output: UK banks are likely to face a wave of compensation claims following the launch on 29 August of a £42m ($54m) advertising campaign encouraging customers to complain about payment protection insurance (PPI) policies. The campaign by the Financial Conduct Authority has been paid for by 18 leading providers in the sector. Its launch will take place exactly two years before the final date for fresh claims. The PPI scandal has forced the industry to set aside over £43bn for claims and compensation, making it the most expensive misselling affair in UK history.


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Amazon's AI Fashion Designer
 Amazon, meanwhile, is making moves to bolster its apparel business, developing its own clothing brands, investing in high-quality photography for products, and launching Prime Wardrobe, which lets customers try on clothes before buying them. Its Echo Look app will even give you feedback on your outfits.

But Amazon appears to be pushing that algorithmic approach even further. For instance, one group of Amazon researchers based in Israel developed machine learning that, by analyzing just a few labels attached to images, can deduce whether a particular look can be considered stylish. The software could conceivably provide fashion feedback or recommendations for adjustments. The work is innovative because computers usually require extensive labeling in order to learn from visual information. But in many real-world situations, such as an image posted to Instagram, there might be just one label.

An Amazon team at Lab126, a research center based in San Francisco, has developed an algorithm that learns about a particular style of fashion from images, and can then generate new items in similar styles from scratch—essentially, a simple AI fashion designer. The approach is crude and hardly ready for Project Runway, but it hints at the possibilities.

This work uses a cutting-edge tool called a generative adversarial network, or GAN. It consists of two deep neural networks operating in tandem to learn efficiently from raw data. The GAN internalizes the properties of a particular style simply by looking at lots of examples, and it can then apply that style to an existing item of clothing. GANs, which were developed by a researcher on the Google Brain team, are a hot topic in machine learning today (see “Innovators Under 35: Ian Goodfellow”).

Both these projects were revealed at the workshop organized by Amazon. The event included mostly academic researchers who are exploring ways for machines to understand fashion trends. The company declined to comment on the projects.

Some at the workshop showed how the techniques being developed to track fashion trends could provide broader insights into human behavior. Bala and her colleagues are using information gleaned from Instagram as a form of anthropological research. “We’re trying to understand how people live their daily lives,” she says. “It really is unprecedented in human history that we have this extent of visual records.”

Output: Amazon is developing machine-learning systems to find and react to fashion-forward trends. The systems would scan social media-featured items and other images to understand user preference for style and generate similar fashionable clothing for sale. Amazon hopes to expand its current fashion offering using the technology. “This is completely changing the industry”, said Cornell University's Kavita Bala.


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Marketo migrates marketing products to Google Cloud Platform
 What is Lemon8 and why is everyone talking about it on TikTok?

Output: Marketing automation company Marketo will be moving its products to the Google Cloud Platform in a multi-year deal with the firm. Marketo's Engagement Platform will merge with Google's G Suite and data analytics offering. The companies will work together to create joint MarTech and AdTech solutions. Marketo currently has over 6,000 business customers for its products, including GE Healthcare and Panasonic as well as Google.


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Google offers mental health tests to users
 With technology at our fingertips, it’s easier than ever to find answers to questions — even medical ones. All you have to do is type your query into the Google search bar.

Thus, quite fittingly, Google has teamed up with the National Alliance on Mental Illness to give users more access to mental health information.

More specifically, the tech giant and NAMI are helping educate the population on depression.

When Google users in the United States search for “depression” or “clinical depression,” they will now see a box that reads “Check if you’re clinically depressed.”

Upon clicking on said box, they’ll be lead to the PHQ-9, a clinically validated questionnaire that tests a person’s level of depression. The assessment, which is private, can help individuals decide if they need to be evaluated in person by their doctor. It’s not, however, intended to serve as a singular diagnosis tool.

In today’s world, easy access to a tool like the PHQ-9 is greatly needed.

“Clinical depression is a very common condition — in fact, approximately one in five Americans experience an episode in their lifetime,” NAMI CEO Mary Giliberti wrote in a blog post about the collaboration. But only half of people who suffer from depression receive treatment, she added.

By teaming up, the organizations hope to increase awareness and aid people in getting proper assistance.

This isn’t the first time Google has dipped its toes into the world of healthcare.

Earlier this summer, it began removing people’s private medical records from its Search results. Just last month, it unveiled Glass Enterprise Edition, a new version of Google Glass that’s catered to the workplace. The technology has been of particular use to various hospitals and health systems, including San Francisco-based Dignity Health and Sacramento-based Sutter Health.

Photo: ANDRZEJ WOJCICKI, Getty Images

Output: Tech giant Google has joined forces with the National Alliance on Mental Illness to provide US users searching for the terms “depression” or “clinical depression" with a clinically valid questionnaire. The private assessment, called PHQ-9, can help individuals decide if they should seek medical assistance for their depression. The test should also help to raise awareness of the condition, which around one in five Americans experiences in their lifetime.


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Robot exoskeletons help children with cerebral palsy to walk
 In the first clip, the boy appears to drag his feet as he walks, while his knees—particularly the left one—stay bent throughout his steps.

In the second clip, his knees remain bowed inward. But his legs—now clad in a robotic exoskeleton—swing more as they move, and his feet lift off the ground and his knees bend and flex in time with his step.

The boy is one of seven children with cerebral palsy who were outfitted with exoskeletons in hopes that the robotic devices could improve their crouched posture, making it easier for them to take simple steps. Those steps will otherwise become more difficult over time; 50 percent of people with cerebral palsy stop walking when they reach adulthood.

In a study published Wednesday in the journal Science Translational Medicine, researchers reported that the exoskeletons helped most participants straighten their legs as they walked, alleviating the permanent knee bend that causes the crouching disorder known as “crouch gait.” The researchers also found that while the exoskeletons provided support when it was needed, participants were still in control of their own steps.

A test of the NIH pediatric exoskeleton, which was built to provide walking assistance to children with cerebral palsy. Credit: Functional & Applied Biomechanics Section, Rehabilitation Medicine Department, NIH Clinical Center

The study was an initial attempt to show that exoskeleton technology should be explored further as a tool to help children with cerebral palsy maintain mobility, said Thomas Bulea, a biomedical engineer at the National Institutes of Health and one of the paper’s authors. Now, researchers want to determine whether long-term use of the exoskeleton, including outside of a research setting, could ease crouch gait even when the exoskeleton isn’t being worn. The hope is that such extensive training could enable people with cerebral palsy to walk on their own for much longer.

“We want to transfer the walking patterns we see with the exoskeleton to walking without the exoskeleton,” Bulea said. “If we can correct or treat this crouch gait at a young age, then throughout their life, we may be able to increase their mobility.”

Cerebral palsy is a neurological condition that leads to problems with movement and coordination. With crouch gait, children can often walk on their own, adapting to taking steps in a crouched position. It’s often treated with therapy, surgery, or injections that relax the knee flexors. But still, as people get older and get bigger, it becomes harder to walk.

The new research is a long way from showing that exoskeletons would be an effective clinical solution, and many outstanding questions remain.

For the study, researchers only recruited children who were still able to walk well independently. They want to investigate whether an exoskeleton could help children who have already lost more mobility, as well as with children with other conditions that lead to mobility problems, such as spina bifida or muscular dystrophy.

“It may be useful for some of those kids, but more severe kids may not benefit,” said Dr. Bruce Dobkin, the director of the UCLA Neurological Rehabilitation and Research Program, who was not involved with the study.

Moreover, there is the concern that exoskeletons may not help preserve mobility as children age. That has also been the case with some surgeries and medications, Dobkin said. In those cases, the interventions may not be worth the effort or cost, in part because children have an “amazing ability to compensate” and walk with gait problems while they are still ambulatory, he said.

Still, those are concerns that a longer and larger study could help answer. In this study, six of the seven participants saw improvements in their crouch gait and knee extension, gaining an average of about 13 degrees in knee angle as they stepped. The children also saw improvements over the course of their training sessions, which Bulea said suggests that further gains may be possible with additional exoskeleton use.

The researchers hope that they can refine the exoskeletons so they can be worn outside the lab. That could provide the amount of training necessary to extend benefits even when the device isn’t being worn.

The study is one of the first attempts to bring exoskeleton technology to children and adolescents. So far, exoskeleton trials have largely been aimed at restoring movement in adults who were paralyzed after a stroke or spinal injury, including the exoskeleton-wearing man who kicked a soccer ball at the start of the 2014 World Cup.

In those cases, patients needed the exoskeleton to restore lost movement. But in the new study, the exoskeletons were being used in an attempt to assist children who remain ambulatory and who could still control their own steps. Importantly, the researchers found that the participants maintained their muscle activity while wearing the device.

“That shows us that these participants were working with the exoskeleton rather than offloading the knee extension to the robot,” Bulea said.

Republished with permission from STAT. This article originally appeared on August 23, 2017

Output: A study published in the journal Science Translational Medicine has suggested that robotic exoskeletons can help children suffering from cerebral palsy to straighten their legs as they walk. The condition induces a permanent knee bend in many sufferers, causing a walking disorder known as "crouch gait". Trials with the exoskeleton have shown improvements in knee extension and alleviation of crouch gait, but more research needs to be done to see if the technique will have long term benefits.


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UAHC funds expansion of McAfee’s bitcoin mining operation
 The cybersecurity and Bitcoin mining firm MGT Capital owned by John McAfee has secured a total of $2.4 mln in new funding. This money will be used to expand the company’s Bitcoin mining operations in the Northwestern U.S..

The funding was raised from a 10 percent convertible note issued to UAHC Ventures LLC.

What is Bitcoin mining?

Bitcoin mining is the process used to add transactions to a universal public ledger called the Blockchain. Mining is an energy intensive process and therefore is expensive. As a reward for the miner who creates the next block in the Blockchain, 12.5 new Bitcoin are created and given to the miner.

Brief background of MGT Capital

MGT Capital is led by John McAfee, who established the eponymous anti-virus company in the late 1980s. His software firm was acquired by Intel for $7.6 bln in 2010.

Besides Bitcoin, MGT Capital also mines the digital currencies Ethereum and Ethereum Classic. The company is also involved in the development and production of cybersecurity products and a privacy-oriented phone.

In a May 2017 interview with Bloomberg, McAfee expressed his full confidence in the profitability of Bitcoin mining, even boasting that his company would be in the black by the end of the year.

Output: John McAfee’s latest venture, MGT Capital, has raised $2.4m by issuing a 10% convertible note to UAHC Ventures, a newly-formed subsidiary of United American Healthcare. The funds will be used to expand MGT Capital's bitcoin mining operation. McAfee boasted earlier this year that given the profitability of bitcoin mining, his company, which also mines other digital currencies and develops cyber security products, would be in the black by year end.


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UAHC funds expansion of McAfee’s bitcoin mining operation
 CHICAGO, Aug. 23, 2017 (GLOBE NEWSWIRE) -- UAHC Ventures, LLC, a wholly-owned subsidiary of United American Healthcare Corporation (OTC:UAHC) (“UAHC Ventures”), has partnered with MGT Capital Investments, Inc. (OTC:MGTI) (“MGTI”) by providing a $2 million investment to MGTI, the proceeds of which will be utilized by MGTI to further expand and develop its Bitcoin mining operations.

In exchange for UAHC Ventures’ $2 million investment, MGTI has issued UAHC Ventures both a Secured Convertible Promissory Note and a warrant to purchase shares of MGTI’s common stock. Monthly redemption payments due under the financing begin three months following the close of the transaction, and may be made in cash or by converting redemption amounts into shares of MGTI’s common stock.

UAHC Ventures is a newly formed subsidiary of UAHC, created to pursue strategic-investment opportunities in promising growth industries, such as blockchain technologies and digital currency. Mining of Bitcoin and other digital currencies within the digital currency space has experienced immense momentum and growth.

“Today we see Bitcoin and related-mining activities as a promising and fast-growing segment of the digital currency sector. Accordingly, we’ve identified MGT Capital Investments, Inc. as a leader in Bitcoin mining that is uniquely poised to capture market value as it expands its mining operations. As our commitment to making strategic investments through UAHC Ventures continues, we will further explore potential value-adding opportunities in the digital currency space, as they present themselves,” said John Fife, CEO of UAHC Ventures, LLC.

About United American Healthcare Corporation

United American Healthcare Corporation (“UAHC”), through its subsidiary, UAHC Ventures, LLC, pursues strategic investment opportunities in various growth industries. Additionally, UAHC, through its subsidiary Pulse Systems, LLC, is a contract manufacturing company that provides services to the medical device industry.

UAHC nor any of its existing subsidiaries are an "Investment Company" as defined by Section 3(a)(1) of the Investment Company Act of 1940 (the "Act") and are therefore not subject to the regulations contained in the Act.

Forward-looking Statements

This press release contains forward-looking statements. The words or phrases "would be," "will allow," "intends to," "will likely result," "are expected to," "will continue," "is anticipated," "estimate," "project," or similar expressions are intended to identify "forward-looking statements." All information set forth in this news release, except historical and factual information, represents forward-looking statements. This includes all statements about the Company's plans, beliefs, estimates and expectations. These statements are based on current estimates and projections, which involve certain risks and uncertainties that could cause actual results to differ materially from those in the forward-looking statements. These risks and uncertainties include issues related to: rapidly changing technology and evolving standards in the industries in which the Company and its subsidiaries operate; the ability to obtain sufficient funding to continue operations, maintain adequate cash flow, profitably exploit new business, license and sign new agreements; the unpredictable nature of consumer preferences; and other factors set forth in the Company's most recently filed annual report and registration statement. Readers are cautioned not to place undue reliance on these forward-looking statements, which reflect management's analysis only as of the date hereof. The Company undertakes no obligation to publicly revise these forward-looking statements to reflect events or circumstances that arise after the date hereof. Readers should carefully review the risks and uncertainties described in other documents that the Company files from time to time with the U.S. Securities and Exchange Commission.

Output: John McAfee’s latest venture, MGT Capital, has raised $2.4m by issuing a 10% convertible note to UAHC Ventures, a newly-formed subsidiary of United American Healthcare. The funds will be used to expand MGT Capital's bitcoin mining operation. McAfee boasted earlier this year that given the profitability of bitcoin mining, his company, which also mines other digital currencies and develops cyber security products, would be in the black by year end.


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Curbing Prescription Drug Prices Through the PBM Model
 Congress and the White House continue to focus on addressing challenges to the U.S. health care system, one of which is the impact of rising prescription drug prices on the financial health of working Americans, state budgets and our economy. Many policymakers are looking for answers, and one such solution is the use of pharmacy benefit managers. This is confirmed by a recent study from the Coalition for Affordable Prescription Drugs and the actuarial firm Oliver Wyman, based on actual Medicare Part D bid information, which finds the current PBM model is already working — and is expected to produce significant cost savings for the Part D program over the next decade.

According to research from the study, titled “Savings Generated by Pharmacy Benefit Managers in the Medicare Part D Program,” Part D costs would run an estimated 58 percent higher without PBM management tools and the pharmacy pricing and manufacturer discounts negotiated by the PBM. In aggregate, this research estimates that PBMs saved the Part D program $47 billion in 2014. And the cost savings expected to be realized over the next decade are even more dramatic. PBMs are projected to save Part D $896 billion between 2016 and 2025. That’s $308 billion more than the net amount the U.S. government spent on Medicare in 2016 and nearly the entire amount paid out to American citizens in Social Security the same year .

Two-thirds of that Part D savings figure, or $604 billion, will come from PBMs leveraging their scale and clinical expertise to negotiate discounts and price concessions from pharmacies and drug manufacturers. More than $240 billion in savings will stem from PBMs’ effective clinical management of the Part D benefit, including their ability to encourage utilization of lower cost, clinically equivalent treatments, such as generic drugs. The final $49 billion in savings will come from PBM-developed and administered programs and tools that help patients get and take their medicines as prescribed.

The value that the PBM model offers is needed now more than ever before, given the explosive growth projected in the number of Americans enrolled in Part D — and the related projected growth in costs. According to the Centers for Medicare & Medicaid Services, more than 39 million seniors receive coverage for prescription drugs through the Medicare Part D program and the aggregate Part D costs reached $80.5 billion in 2014. By 2025, that price tag is expected to balloon to $215.1 billion, as the number of seniors enrolled climbs to 55 million.

Against this backdrop, PBMs can play a critical role in keeping costs in check and ensuring affordable access for all beneficiaries. The Oliver Wyman study estimates that without PBMs, beneficiary premiums would be 66 percent higher. Because of PBMs, the Part D program will save more than $1,800 per year per beneficiary – benefiting taxpayers and plan enrollees. For context, that figure is roughly what older households spend on food for more than three months .

The savings that PBMs generate for Part D are also highly encouraging for the employers, unions, health plans and others in the private sector working to keep prescription drug costs in check for their employees and members. This new Part D analysis demonstrates how PBMs work in a large public program and the value they can continue to drive for their partners in the private sector.

There is clear consensus that the prescription drug marketplace has to evolve and, in particular, has to focus on increasing competition and tackling anti-competitive practices. However, it is in the best interest of America’s seniors, taxpayers and all stakeholders to take note of what is working today, as they explore the solutions of tomorrow. As this new study shows, the proof of the PBM model’s power lies in the numbers: nearly $900 billion in expected savings for the Part D program over the next 10 years. That’s savings that will directly benefit Americans and the U.S. economy – savings we can’t and shouldn’t leave on the table.

Meghan Scott is the executive director of the Coalition for Affordable Prescription Drugs, a broad-based group of employers, pharmacy benefit managers, unions, health plans, and public sector employees and retirees who are working together to be part of the prescription for affordable health.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be found here.

Output: Congress and the White House continue to focus on addressing challenges to the U.S. health care system, one of which is the impact of rising prescription drug prices on the financial health of working Americans, state budgets and our economy. Many policymakers are looking for answers, and one such solution is the use of pharmacy benefit managers.


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Getting a Handle on Generic-Drug Prices
 US Pharm. 2017;42(6)(Gen Drugs suppl):

ABSTRACT: Although the generic-drug market has experienced overall stable drug pricing since the enactment of the Hatch-Waxman Act, there have been an increasing number of spikes in generic-drug pricing. These spikes are usually the result of a lack or absence of market competition. Specifically, they occur when there are no entrants to generic-drug markets or due to the exit of existing competitors from the markets, often creating a climate for rising prices. While these spikes do not impact the overall national drug spend, they do severely impact patients, who often have no other option but to pay higher prices for the same treatment. Given the moral and economic implications of spikes in generic pricing for the patient population, solutions must be able to address both competition and public need.

The healthcare and pharmaceutical industries are often viewed from different perspectives. Nevertheless, the pharmaceutical market is based on an economy driven by profitability, and with life-saving treatments and cures on the line, it is no surprise that pharmaceutical corporate decisions are often evaluated using moral and ethical standards. Hence, a question arises: How should we judge the actions of pharmaceutical companies? Should we, without any reservation, extend our country’s principles of free-market capitalism to pharmaceutical companies? Or should we demand that all pharmaceutical companies act only in furtherance of the public good and nothing else? Or is there a middle-ground approach?

Unfortunately, there is no magic answer here. In fact, this dilemma is the result of a “hybrid” industry in which both the public’s needs and competitive market forces must be balanced, especially when designing solutions for important issues such as spikes in generic-drug costs. In this article, we will explore the nature of the generic-drug market and pricing. Namely, we will discuss the different factors that impact the level of market competition and its effect on generic-drug pricing, particularly on spikes (we will not, however, explore other factors such as the backlog of abbreviated new drug applications [ANDAs] at the FDA). We will also introduce potential solutions designed to keep spikes in generic pricing at bay.

Robust Competition Creates a Healthy Generic Market

The enactment of the Hatch-Waxman Act of 1984 led to the creation of a robust generic pharmaceutical market that successfully decreased the prices of generic drugs, partly through the increase in competition among generic-drug manufacturers. In fact, the resulting increase in competition among generic manufacturers has led to decreased drug prices, increased generic utilization, and significant cost savings for purchasers of healthcare. Generic-drug manufacturers’ 8% share of the prescription drug market in 1984 jumped to 39% of that same market in just 5 years. Also, the number of generic-drug applications more than doubled between 1984 and 1985, from 470 to 1,069. In addition, generic pharmaceutical companies started to flourish after passage of the Hatch-Waxman Act. For example, the earnings for Mylan grew by 166%, and its stock value grew by 800% in the 18 months following the act’s passage.1

The enactment of Hatch-Waxman generated increased competition among generic-drug manufacturers, which has led to significant decreases in generic- drug pricing. Just as in a commodities market, due to the fungible and interchangeable nature of the products sold, purchasers often drive down prices by leveraging each competitor’s need to obtain or maintain a sizable market share—and thereby be profitable.2 As a result, robust competition between market players has led to the lowering of drug prices. According to a 2016 GAO (Government Accounting Office) Report to Congressional Inquiry, generic-drug manufacturers reported that competition is the primary driver of generic-drug costs, and that less competition could drive generic-drug pricing upward.2 Also, a recent 2016 IMS Institute for Healthcare Informatics report showed that generic-drug pricing decreases after entry into a generic pharmaceutical market results in significant savings during subsequent years. The report also showed that less competition (i.e., lower number of generic-drug manufacturers) results in generic-drug pricing increases.3

As a consequence of decreased generic-drug pricing, purchasers of healthcare and the public have benefited from increased access and significant cost savings. Under one estimate, of the total 4.4 billion drugs dispensed in the United States during 2015, 3.9 billion were generic drugs, making up 89% of all prescription drugs dispensed in the U.S. that year. In fact, in 2015 alone, the utilization of generic drugs saved Americans $227 billion.4 This is in contrast to annual savings of $100 million per year during the first few years after enactment of Hatch-Waxman, through the Pharmacists’ Incentive Program, where pharmacists were encouraged to drive more generic substitution.1

Lack of Competition Increases Generic-Drug Pricing

In the lack or absence of competition, purchasers of healthcare and the public pay higher prices for generic drugs. According to the 2016 GAO report, generic competition is the key driver for drug pricing, and the lack of generic competition leads to increased drug pricing. The GAO also provided insight into factors that led to a lack or absence of competition: Raw material shortages, production difficulties, consolidation among manufacturers, and the backlog of ANDAs at the FDA contributed the absence of competition.2 Stated slightly differently, “The most important factor that allows manufacturers to set high drug prices is market exclusivity.”5

Overall Stable Generic-Drug Pricing

Looking at the U.S. generic-drug market as a whole, generic-drug pricing has remained relatively steady. In fact, a recent government analysis shows a modest pricing decrease for a cohort of 1,441 established generic drugs within the Medicare Part D program between 2010 and 2012, followed by a plateau between 2012 and 2015. This represented a 0.7% decrease in generic-drug pricing each quarter between 2012 and 2015.2

Also, the cost of generic drugs to the U.S. healthcare market is also quite modest, especially when taking into consideration the extensive utilization of generic drugs. Though 88% of prescriptions were filled with generic drugs, the cost of these medications accounted for only 28% of the total drug expenditure. This is in sharp contrast to the impact of a handful of high-cost brand-name drugs. For example, IMS reported that spending on specialty drugs accounted for 73% of the total growth in medication spending in 2013.6 And according to Prime Therapeutics, although only 0.6% of the 4.4 million Prime members with continuous commercial insurance between 2012 and 2015 utilized one or more autoimmune drugs, the autoimmune-drug spend accounted for 10% of the prescription drug spend in 2015.7

In fact, given that generic drugs generally cost little, are utilized extensively by the public, and have experienced overall stability in pricing, it is unsurprising that even enormous spikes in generic pricing have had a minimal impact on overall prescription and healthcare spending. For instance, an analysis of Medicaid generic-drug spending by Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation, showed that generic drugs that experienced a greater than 20% increase in price represented only 14.4% of all generic-drug spending in the Medicaid Program between 2013 and 2014. Also, a 17,714% increase in the price of tetracycline 500-mg capsules accounted for only 0.001% of overall Medicaid prescription spending between 2013 and 2014.8

Pricing Spikes Put Patients at Risk

Although government and employers may not reel from spikes in generic-drug pricing, it is the patient who is put at harm’s way. According to the HHS, “Review of evidence strongly supports the conclusion that generic-drug prices are not an important part of the drug cost problem facing the nation.” However, “[t]hese spikes are on one hand troubling in that they disadvantage particular patient groups but also sufficiently limited so they exert no sizable influence on overall drug spending.” Using the tetracycline example, before the price spike, the cost for 30 capsules was $1.45. After the price spike, the cost increased to $257.70. Even with insurance coverage, the patient is likely to face increased out-of-pocket costs.8

Severe increases in generic-drug pricing have become increasingly common in recent years. The GAO found that among a cohort of 1,441 established generic drugs (i.e., drugs that existed in generic form continuously and throughout from 2012 to 2015), 315 of them experienced pricing increases of 100% or more. Of those 315 generic drugs, 183 (58%) experienced increases between 100% and 200%. However, 48 of those drugs (15%) experienced increases of 500% or higher, and 15 drugs (4.8%) experienced increases of 1,000% or higher. The GAO analysis also found that the 315 generic drugs drastically increased the average cost of the 1,441 cohort of drugs by 25%. Furthermore, the GAO found that once a generic-drug price increased, the vast majority (71%) of the increased prices persisted for at least 1 year after the initial price increase, and the vast majority (74%) of the highest increases did not decrease in subsequent years.2

Notwithstanding the cost and prevalence of spikes in generic pricing, the patient harm is real, immediate, and often life-threatening. A recent, notorious example is the price increase of the drug Daraprim (pyrimethamine) from $13.50 to $750 per pill, bringing the cost of a bottle of 100 pills from $1,350 to $75,000. Owing to this spike, one mother faced a total cost of $360,000 to treat her infant daughter, who was born with congenital toxoplasmosis. According to a recent U.S. Senate hearing, many patients experienced interruptions or delays in treatment, while some patients even went without treatment as a direct and immediate result of the spike.9

What Causes Spikes in Generic-Drug Pricing?

Even within an overall stable market, there have been spikes in generic pricing that resulted in price increases upward of 54,556%. Many have been left to wonder how and why this could happen. Several investigations and analyses have been done to determine the cause and motivations for such extreme increases.

The U.S. Senate Special Committee on Aging conducted one such investigation between 2015 and 2016. Though the investigation focused on egregious increases in pricing, its findings are easily translatable to generic-price increases—that removing competitive market forces creates an environment that promotes, ensures, and sustains drastic spikes in generic-drug pricing. According to the recently released Senate report, there are five central elements to a business model for imposing and protecting spikes in generic pricing. First, the generic drug should have only one source to eliminate competition. Second, the generic drug should be a gold standard (or the best drug available to treat the indicated condition) to ensure sufficient and persistent demand. Third, the specific generic-drug market should be small enough to deter competitors, ensure patient reliance, and prevent any organized resistance from patients. Fourth, the distribution of the generic drug should be controlled through a specialty pharmacy or a closed distribution system to limit the supply of the drug. Lastly, the generic-drug manufacturer should then “price gouge,” or increase the price as high as possible.9

Recently, in another analysis of the generic-drug market, researchers found an association between generic-market consolidation and generic-drug price increases. Specifically, research showed that as the number of competitors decreased, generic-drug prices tended to increase compared to generic-drug markets with more competition.10

The GAO also reported on several ways that the level of competition could be reduced in a generic-drug market. First, limited access to active pharmaceutical ingredients could lead to decreased production and, therefore, limited supply. Second, generic products that are more difficult to manufacture could have a low production volume due to the limited entrants to the market and the resources and skills required to manufacture the product (e.g., sterile products, narcotics, liposomal products). Third, market consolidation could result from the lack of profitability or from mergers and acquisitions of generic-drug manufacturers. Fourth, consolidation of buyers could result in lower prices but could also result in the loss of market share for some generic-drug manufacturers, which might drive them out of certain generic-drug markets. Finally, if the generic-drug market served a small population, there might not be enough incentives for new entrants into that particular market, leading to decreased competition.2

In reviewing the investigations, surveys, and analyses presented above, a general pattern of competition-limiting factors becomes more apparent. Essentially, to keep prices low and for a generic-drug market to work like a commodities market, the number of generic-drug competitors must be maximized. Factors that limit entry into a generic-drug market or push competitors out of a market could lead to increased drug pricing, or perhaps even spikes in pricing. Such factors may include a nonprofitable market, specialized skills or resources required to produce the drug, a generic-drug market that only serves a small patient population, and the merger or acquisition of generic-drug manufacturers.

Leveraging the Hybrid Nature of Generics

Even though there have been numerous solutions proposed over the years, many have been focused on symptomatic relief rather a curative solution, which likely will need to address both the necessity for more competitive market forces and the public’s need over profits. In fact, two recently proposed potential solutions stand out by confronting the needs of both sides of the hybrid nature of the generic pharmaceutical industry. They do this by creating new pathways toward increasing the level of competition and filling the gaps left behind by a profit-driven market.

One proposal suggests opening up the U.S. generic market to international competition through two avenues. The first step would entail the creation of a single-window, multicountry generic-drug application pathway where generic-drug manufacturers that exist predominantly within markets outside the U.S. would be able to more easily enter the U.S. generic-drug market. The second step would involve the creation of a reciprocal drug-approval pathway in which existing generic drugs not currently marketed in the U.S. would nonetheless be able to obtain generic-drug approval in the U.S. The authors of this proposal suggest that doing so will improve and increase the competitiveness of our generic-drug market.10

Another proposal creates nonprofit pharmaceutical entities.11 Essentially, instead of working toward profits and satisfying investors, these nonprofit entities would instead prioritize the needs of the public. For instance, many established therapeutic uses exist for many generic drugs that have not been approved by the FDA. If an entity were to pursue clinical studies to validate new and novel uses of existing drugs (e.g., allopurinol used as a renal protectant in patients with diabetes and/or hypertension), this would serve to create new markets and promote competition among generic manufacturers.12 Another function might be to produce drugs that have historically experienced frequent shortages (e.g., sterile normal saline or potassium chloride solutions for intravenous use). Additionally, such entities could even eventually work closely with researchers from the National Institutes of Health and in academia to produce first-in-class innovator drugs.

Conclusion

Though the generic-drug market has benefited from competition by generally seeing low and stable pricing, there have been numerous instances of spikes in generic-drug pricing, particularly in markets where there is little to no competition. Even if national healthcare spending remains unaffected, actual lives are adversely impacted by every generic-drug pricing increase. To prevent these spikes, solutions that address both market competition and the public need are required.

REFERENCES

. Lewis RA. The emerging effects of the Drug Price Competition and Patent Term Restoration Act of 1984. J Contemp Health Law Policy. 1992;8:361-378. http://scholarship.law.edu/cgi/viewcontent.cgi?article=1539&context=jchlp. Accessed May 3, 2017.

2. U.S. GAO Report to Congressional Requesters: generic drugs under Medicare. Part D generic drug prices declined overall, but some had extraordinary price increases. August 2016.

3. IMS Institute for Healthcare Informatics. Price declines after branded medicines lose exclusivity in the U.S. January 2016.

4. Generic Pharmaceutical Association. 2016 Generic Drug Savings and Access in the United States Report.

5. Kesselheim AS, Avorn J, Sarpatwari A. The high cost of prescription drugs in the United States: origins & prospects for reform. JAMA. 2016;316(8):858-871.

6. IMS Institute for Health Care Informatics. Medicines use & spending shifts: a review of the use of medicines in the U.S. in 2014. April 2015.

7. Prime Therapeutics finds autoimmune specialty drug spend has doubled, account for 10 percent of drug expenses. Press release. www.primetherapeutics.com/content/dam/corporate/Documents/Newsroom/Pressreleases/2016/newsroom-autoimmune-pressrelease-092016.pdf. Accessed May 3, 2017.

8. ASPE Issue Brief: Understanding Recent Trends in Generic Drug Prices. January 2016.

9. U.S. Senate Special Committee on Aging. Sudden price spikes in off-patent prescription drugs: the monopoly business model that harms patients, taxpayers, and the U.S. health care system. December 2016.

10. Bollyky T, Kesselheim A. The Brookings Institute. Can drug importation address high generic drug prices? www.brookings.edu/wp-content/uploads/2017/05/wp29_bollykykesselheim_drugimportation.pdf. Presented May 2, 2017.

11. Goicoechea M, de Vinnesa SG, Verdalles U, et al. Effect of allopurinol on chronic kidney disease progression and cardiovascular risk. Clin J Am Soc Nephrol. 2010;5(8):1388-1393.

12. Health Affairs Blog. A strategy for lowering brand drug prices: patent buyouts and licensing. http://healthaffairs.org/blog/2017/04/05/a-strategy -for-lowering-brand-drug-prices-patent-buyouts-and-licensing/.

To comment on this article, contact rdavidson@uspharmacist.com

Output: Although the generic-drug market has experienced overall stable drug pricing since the enactment of the Hatch-Waxman Act, there have been an increasing number of spikes in generic-drug pricing. These spikes are usually the result of a lack or absence of market competition. Specifically, they occur when there are no entrants to generic-drug markets or due to the exit of existing competitors from the markets, often creating a climate for rising prices.


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Lawmakers show hesitance in cutting Medicare programs
 The Medicare Payment Advisory Commission last week argued that the federal government could have saved $11 billion by now if it had heeded repeated proposals to cut or freeze payments to skilled-nursing facilities, inpatient rehabilitation centers, long-term acute-care hospitals and home health agencies.

"Constraining unit prices could create pressure on providers to control their own costs and be more receptive to new payment methods and delivery reform systems," MedPAC Executive Director Mark Miller told a House Ways and Means subcommittee, suggesting that profits off of Medicare patients are excessive. Home health agencies and skilled-nursing facilities see profits exceed 15% on average and have for a decade, he added.

Miller's remarks got a cool reception. Rep. Peter Roskam (R-Ill.) said an inpatient rehab facility in his district is a crown jewel, and that officials there have told him their overall margin is only 3.6%, and they lose 20 cents on the dollar on Medicare patients. Miller reassured him that there would be extra payments to the outlier pool to make up for ratcheting down the rate across the sector.

MedPAC has asked Congress to cut Medicare payments to home health agencies and inpatient rehab facilities by 5% as well as freeze payments to skilled-nursing facilities for two years during payment reform.

MedPAC does recommend rate increases for some categories, notably, 1.85% for hospitals. Miller testified that it is "imperative" for Medicare to restrain payment rates for hospitals.

Output: The Medicare Payment Advisory Commission last week argued that the federal government could have saved $11 billion by now if it had heeded repeated proposals to cut or freeze payments to skilled-nursing facilities, inpatient rehabilitation centers, long-term acute-care hospitals and home health agencies."


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Nottingham trials dutch-pioneered energy saving initiative
 Nottingham selected for revolutionary housing approach

Homes in Nottingham been selected as part of a UK first pilot to radically improve older houses using energy saving and energy generation measures.

Nottingham City Homes (NCH) has become the first in the UK to adopt the Dutch-pioneered “Energiesprong” - which upgrades a home with new outside walls and windows, a solar roof, and a state of the art heating system, all in a few days.

The systems sees a household pay an ‘Energy plan’ and maintain a flat rate cost for energy, which will not rise significantly when energy bills rise. The affordable model brings houses up to 2050 standards of energy efficiency, and is currently being rolled out in France, Germany, Luxembourg and the US.

Jane Urquhart, the council’s Planning, Housing & Heritage portfolio holder, said: “We’re very excited that Nottingham is at the forefront of this revolutionary approach, which can help tackle both fuel poverty and climate change. Many of our residents live in fuel poverty so creating more energy efficient homes to reduce people’s energy bills is a high priority for us. Our Greener HousiNG programme has seen over 6,000 hard-to-treat homes in both social and private sectors receive energy efficiency measures and this pilot will inform the next steps for our programme to tackle hard-to-treat housing.”

Nick Murphy, Nottingham City Homes chief executive, added: “While we’re delighted to be part of a UK-first pilot programme, it’s more important to us that we’re creating warmer, more energy efficient homes, which are cheaper to run for residents. The Greener HousiNG programme is dedicated to finding the most efficient and reliable solutions, to help us future proof our housing stock and tackle issues such as fuel poverty. As an added bonus the improvements will greatly improve the look and feel of the area.”

Other pioneering landlords in London, Essex and Devon are set to sign contracts over the next few months.

Output: Houses in Nottingham will form part of a pilot programme to drastically upgrade older UK homes with energy saving and generation technology. Nottingham City Homes will be the first UK entity to use the Dutch “Energiesprong” technique, which upgrades homes by replacing outer walls and windows, adding a solar-panel roof, and installing a state of the art heating system in just a few days. The model is affordable, with homeowners paying a flat rate, and updates homes to 2050's projected energy efficiency standards.


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Indian payments start-up Ezetap raises $16m
 Missed the GamesBeat Summit excitement? Don't worry! Tune in now to catch all of the live and virtual sessions here.

Ezetap wants to enable businesses in India to accept any form of payment and today announced funding of $16 million to further that goal. Jonathan Soros’ investment firm JS Capital Management led the round, with participation from Jeff Skoll Group, Social Capital, and Horizons Ventures.

“Due to Narendra Modi’s unprecedented demonetization initiative last November, India is experiencing a full-blown digital transformation that’s enabling millions of Indian citizens to electronically transact for the first time in their lives,” wrote Ezetap cofounder and CEO Abhijit Bose, in an email to VentureBeat. “Ezetap has done its part by quietly building the infrastructure to support the 100+ million new bank accounts resulting from India’s fintech explosion.”

Founded in 2011, the Bangalore-based startup provides its software as a service (SaaS) solution to more than 200,000 merchants and users across India, according to Bose. These include Airtel, Big Basket, and Urban Ladder. The chief executive claims that by using the Ezetap device, merchants can accept any payment type, including physical cards, online payments, mobile wallets, and QR codes, from any bank using any device or app. The startup charges a monthly fee of Rs. 250 to Rs. 450 (four to seven dollars) per subscriber for its service.

The concept of leapfrogging technology in emerging markets is well-known by now. Countries like Nigeria, Kenya, and India are prime examples of this disruptive movement, especially when it comes to mobile payments. Bose argues that this gives them a certain edge.

“Countries like the U.S. have relied heavily on credit cards for a long time, which has discouraged the adoption of digital payments technologies,” he wrote. “On the contrary, India basically started from scratch after the demonetization announcement, so Ezetap’s flexible fintech platform is needed to accommodate new payment technologies unfamiliar to the U.S.”

Ezetap isn’t the only startup to be surfing India’s fintech wave. Competitors include Pine Labs, Mswipe, and Alibaba-backed Paytm. Foreign tech companies are also sniffing an opportunity, with Google, Apple, and Samsung doubling down on mobile services in India.

To date, Ezetap has raised a total of $51 million, and it currently has more than 200 employees. The startup will use the fresh injection of capital to further develop its product and increase sales and marketing.

Output: Bangalore-based start-up Ezetap has raised $16m in funding in a round led by JS Capital Management, and featuring participation from Social Capital, Jeff Skoll Group and Horizons Ventures. Ezetap provides a "software as a service" solution which it claims enables Indian merchants to accept any payment type, from physical cards and online payments to mobile wallets. The latest funds will be used to increase sales and marketing, and in product development.


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10 Questions: Terry Fulmer, PhD, RN
 Terry Fulmer, PhD, RN, believes in the importance of creating age-friendly health systems and fostering open communication between healthcare professionals and patients. Since receiving her master's and doctoral degrees in nursing from Boston College, followed by her Geriatric Nurse Practitioner Post-Master's Certificate from New York University in 2001, Fulmer has dedicated her career to the advancement of intra-professional science, education, and practice in order to improve the care of older adults.

She currently serves as president of The John A. Hartford Foundation, a New York-based organization which promotes high-value, evidence-based healthcare for the elderly, and was recently recognized for her leadership as one of the top 50 Influencers in Aging by PBS's Next Avenue.

Her resume also includes trusteeships for the Josiah Macy Jr. Foundation and the Bassett Healthcare System, and she is co-chair of the National Academy of Medicine's Forum on Aging, Disability, and Independence.

1. What's the biggest barrier to practicing medicine today?

Competing demands and priorities with finite time. Clinicians are working hard to meet the strident demands required to provide evidence-based, value-driven care while at the same time struggling with complex governmental requirements for reimbursement and challenging electronic health record systems. Sometimes it can feel like the personal connection with the patient is diluted.

2. What's the most important healthcare issue that nobody is talking about?

The healthcare system as it currently operates does not always meet the needs of older adults or support vibrancy as people age. This is an important issue because of the demographic changes that will transform our nation over the next 20 years. Few hospitals and health systems are consistently age-friendly, even though older adults are, and will continue to be, their largest customer base. It's important to create age-friendly health systems that seamlessly provide care across the multiple settings and systems of care, with minimal redundancy and a keen eye for the reduction of unnecessary and unwanted care.

3. What changes, if any, will the Trump administration impose on medical practice?

Right now it's hard to determine how Congress will move forward with the revisions required to adjust the Affordable Care Act in a way that addresses bipartisan concerns. The recent vote that rejected repeal and replace and instead calls for addressing improvement in our current Obamacare will require excellent communication and coordination. Foundations like ours stand ready to help provide the evidence needed to improve care of older adults and all patients in our healthcare system.

4. What country do you think has a better healthcare system than the United States?

The recent work by the Columbia University School of Public Health under the direction of Jack Rowe with the Research Network on an Aging Society is moving forward with a global aging index to help us better understand the answer to this question. According to their data, Norway and Sweden are ranked more highly for health and well-being of aging populations then the United States. This work is critical given the growing number of older people across the globe.

5. How often do patients ask you about some medical finding they heard discussed by a celebrity doctor?

This happens all the time and is a perfect opportunity to educate the public more broadly. Usually people are looking for a magic bullet that can help them stave off aging and remain highly functional into late life.

6. Have you ever been afraid of a patient? (If so, can you briefly describe the situation?)

I have had moments where I was afraid, but they always took place when the patient was cognitively impaired and it was my job to figure out how to get out of harm's way. Sometimes the patients were chemically impaired and other times they had severe dementia. Most of us have been there, and the goal in that moment is safety for all.

7. Do you discuss drug costs with patients?

I do – usually the issue is pricing, not cost!

8. What do you consider the best advice you could offer patients (medical or otherwise)?

When you have a doctor's appointment, bring a list of questions and don't be afraid to offend nurses and doctors by asking them. Challenge their answers, and please feel confident that this is a partnership that can only work when both sides are forthcoming.

9. If you weren't a nurse, what do you think you would be doing today?

I can't imagine any other career for me. My PhD has certainly been essential to the advancement of my research career and practice.

10. What is the biggest difference between your expectations of medical practice when you graduated from nursing school and the reality?

I could not have imagined the dramatic advancement in genomics and technology. It has been fascinating and will change the nature of care for the future.

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Output: Terry Fulmer, PhD, RN, believes in the importance of creating age-friendly health systems and fostering open communication between healthcare professionals and patients.


Instruction: create a high quality summary of the given input

Input:
UK publishers remain wary about Amazon's server-side headers
 Amazon is more aggressively pitching its server-side header solution to U.K. publishers, but many are confused or unimpressed by its approach.

The e-commerce giant has provided publishers with header-bidding products for more than four years and revealed it was taking its header tag server-side late last year. U.S. publishers including Bauer Xcel Media and Meredith are already using Amazon’s server-to-server solution, with others interested in testing it. In the last six months, U.K. publishers have been contacted by the Amazon team more about using it.

Amazon wouldn’t share any details about the size and makeup of its U.K. A9 team, the group in charge of pushing publisher products of Amazon’s ad programs, though publishing sources are confident it’s growing.

“They’re plugging their server-to-server solution very hard. We’ve been chased by Amazon for the last nine weeks,” said a publishing exec who spoke on condition of anonymity. “They offer such great unique demand, so we’re keen to get it implemented.”

Header bidding has increased page yields for publishers, but it has scale issues. Only so many demand partners can plug in before page latency is affected, even with a wrapper. Server-side solutions remove latency headaches by unburdening the publisher’s header and pushing the auction onto a third-party ad server.

Server-to-server solutions aren’t as widespread in the U.K. as they are in the U.S., and Amazon is trying to capitalize on that momentum, targeting publishers that have or are seeking a server-to-server setup. Those with advanced header-bidding solutions haven’t received as much attention, given Amazon doesn’t like being within other vendors’ wrappers.

While some publishers are excited by what Amazon’s unique demand could offer them, others remain cynical about the trade-off. “So there’s a new vendor in town who wants to take control of our supply and decisioning — what’s new? This time it just happens to be Amazon,” said another publishing exec who spoke on condition of anonymity. “It’s not the start of the revolution; the paradigm shift will be stimulated by publishers taking back control for themselves.”

Publishers’ relationship with Amazon goes back years, with the retail giant helping monetize their editorial content with commerce and more recently letting them monetize on its voice-activated home assistant, Echo. Its push into ad tech makes it a front-runner to rival Google and Facebook for digital advertising spend. Amazon can offer differentiated demand compared to other exchanges in what’s become a highly commoditized supply-side platform space because of its mountains of first-party customer data, including shopping-intent data. Added to that, its server-side product could help publishers scale header bidding without causing page latency and integrate video inventory at scale.

But publishers are wary of the potential conflict of interest with Amazon buying and selling media, and whether it will be agnostic about its demand. “Only idiots will accept Amazon’s [ad tech] spiel without question,” said one publisher exec, speaking anonymously. “They need to figure out if they’re an e-commerce company with an ad tech platform or an ad tech company that’s owned by an e-commerce firm. Because if they’re a media-tech firm, that means they need to be totally agnostic with regards to demand, but they won’t give you a proper answer on that if you ask.”

Others said Amazon is unapologetic about putting its own demands first. “It’s very much ‘Our way or no way,’ which is fairly typical of the big U.S. tech firms,” said another publishing exec.

For now, Amazon doesn’t represent the threat to publishers as it does to broadcasters. What’s more, publishers are accustomed to frenemy-like relationships, which they already have with Facebook and Google, and many are interested in working more closely with Amazon. But unanswered questions remain, and they all center on conflict of interest.

“Any company that owns a media business as well as technology has an incentive to prioritize their own demand. However much those companies try to convince users of their tech that they are agnostic toward demand, the concern will always exist,” said another publishing executive. “The only way to guard against it is to use truly independent technology, which is easier said than done.”

Output: Amazon is having to push harder to sell its server-side header solution to UK publishers, despite promises of reduced latency issues. Server-to-server solutions are less common outside the US; however, it appears a lack of independence and answers regarding potential conflicts of interest has made UK publishers wary. The e-commerce firm has offered header-bidding products for over four years, moving its header tag server-side in 2016. While it may be a front runner to Google and Facebook, Amazon is not yet perceived as a threat to publishers, who would seemingly prefer to take back control themselves.


Instruction: create a high quality summary of the given input

Input:
Neoenergia closes merger with Iberdrola's Elektro unit
 Spanish energy group Iberdrola (BME:IBE) announced today the closing of the merger of its Brazilian unit Elektro Holding SA with Neoenergia SA, thus creating a company with a substantial renewable energy portfolio.

The completion comes after the deal was approved by Brazil’s energy regulator Aneel and antitrust watchdog Cade, as well as by the country’s development bank BNDES. Iberdrola now holds a 52.45% interest in the enlarged Neoenergia, while pension fund Previ and Banco do Brasil SA holds stakes of 38.21% and 9.35%, respectively.

The move brings together Neoenergia and Elektro's electricity distribution, transmission, generation and retail assets and services. Iberdrola described the transaction as “one of the most important corporate operations ever”. The Spanish group has pledged to channel all its investments in Brazil through Neoenergia. In addition, it has committed to list the new company on the stock exchange.

The enlarged Neoenergia, now being Brazil’s largest electricity utility by number of customers according to Iberdrola, will serve an area with a population of over 34 million people. The company will be active in the wind power segment through Forca Eolica do Brasil. Its total wind and hydropower capacity, either in operation or under construction, total 3,546 MW. The company also has 530 MW of thermoelectric generation capacity.

Neoenergia regulated asset base amounts to BRL 14 billion (USD 4.45bn/EUR 3.77bn). Taking into consideration Elektro’s figures, the larger company’s 2016 earnings before interest, tax, depreciation and amortisation (EBITDA) would have been BRL 3.6 billion, with a revenue of BRL 30 billion, Iberdrola said.

Under a newly-signed agreement between the stockholders, Iberdrola has the right to appoint the majority of the members of the new company's board of directors.

(BRL 1.0 = USD 0.318/EUR 0.269)

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Output: Bilbao-based utility Iberdrola has completed the merger of Brazilian unit Elektro Holding with Neoenergia, following approval from Brazil’s energy regulator Aneel, antitrust watchdog Cade and development bank BNDES. The deal leaves Iberdrola with a controlling 52.45% stake in the newly enlarged Neoenergia, which will be Brazil's largest electricity utility by number of customers. The Spanish firm has pledged to channel all its investments in Brazil through Neoenergia, and is set to list the company on the stock exchange.


Instruction: create a high quality summary of the given input

Input:
Zuma Energía secures $600m for largest Mexican wind farm
 Vestas has received a firm order to provide 123 of its V136-3.45MW turbines (pictured) to Zuma Energía's 424MW Parque Eólico Reynosa project in the northeastern Mexican state of Tamaulipas.

The deal to supply the country's largest wind farm, first flagged last week, takes the Danish manufacturer's order intake from Mexico's energy auctions to almost 500MW.

Vestas will also install the project's wind turbines and has signed a 15-year output management service agreeement.Turbine delivery is expected to begin late in 2017, ahead of commissioning in 2018.Mexico wants to generate 35% of its power needs from renewable energy sources by 2024.Image: Vestas

Output: Mexican renewable energy group, Zuma Energia, has raised $600m to fund the construction of the country's largest wind farm. The 424 MW Reynosa Wind Farm will be capable of producing enough power to supply 1 million homes, while avoiding roughly 739,000 tonnes of CO2 emissions per annum. Zuma Energia was founded in 2014 and secured the funding through Bancomext Banobras, Nafin Santander and EKF.


Instruction: create a high quality summary of the given input

Input:
Zuma Energía secures $600m for largest Mexican wind farm
 Growth markets investor Actis has announced its renewable energy arm, Zuma Energía, will build the largest wind farm in Mexico.

On completion, the 424 MW Reynosa Wind Farm is expected to produce enough electricity to power one million homes and, according to Actis, will mitigate some 739,000 tonnes of CO 2 emissions a year.

Zuma Energía – formed in 2014, by Actis (80%) and Mesomerica Investments (20%) – secured US$600 million in financing for the project through Bancomext Banobras, Nafin Santander and EKF. It is expecting to commence commercial operation on the farm in 2018.

The project is the first to reach financial close on project financing, following a number of electricity auctions, held in Mexico in 2016. The auctions followed the Mexican government’s decision to open its electricity market up to competition, following decades of state control.

Adrian Katzew, CEO of Zuma Energía, said, “This is a great achievement for Zuma. In only three years the company has secured an 800 MW portfolio, reached financial close for its largest project and positioned itself as a leader in Mexico’s renewable energy sector,”

He said, “We are currently witnessing the transformation of the country’s energy sector, where renewables are increasingly competitive and a real solution to reach sustainability.”

Output: Mexican renewable energy group, Zuma Energia, has raised $600m to fund the construction of the country's largest wind farm. The 424 MW Reynosa Wind Farm will be capable of producing enough power to supply 1 million homes, while avoiding roughly 739,000 tonnes of CO2 emissions per annum. Zuma Energia was founded in 2014 and secured the funding through Bancomext Banobras, Nafin Santander and EKF.


Instruction: create a high quality summary of the given input

Input:
Zipline's drone medical delivery service expands to Tanzania
 Its Tanzania service, set to begin in early 2018, will include blood as well as emergency vaccines, medications for HIV and malaria, and emergency supplies like sutures and IV tubes. These products will be delivered by an all-new fleet of fixed-wing drones, or “zips,” capable of hauling two kilograms of cargo and traveling 160 kilometers round-trip. According to Keller Rinaudo, Zipline’s CEO, delivery costs will be roughly on par with traditional means of transport.

In Tanzania, Rinaudo believes, the company’s on-demand model can dramatically improve delivery of products—like vaccines for rabies and tetanus and anti-venom for victims of snakebites—that depend on an uninterrupted temperature-controlled supply chain, known as a cold chain. Because these products are costly to keep and only sporadically in demand, they’re rarely stocked in rural areas. But when they are needed, someone’s life is in immediate danger, and deliveries by road often arrive too late, if at all. Drones, Rinaudo says, offer the best way to deliver such treatment in time.

Zipline’s approach to more routine items, such as anti-malarials, anti-retrovirals, and other common drugs, will be slightly different. Here, the company will function as a “last line of defense” to supplement an existing supply chain. In particular, its drones will be available to respond to stock-outs—a common problem in Tanzania, as in much of the developing world, which may result from funding shortages, poor demand forecasting, or logistical bottlenecks. In a 2013 survey, the Tanzanian civil-society group Twaweza found that 41 percent of respondents were unable to obtain prescribed medications at a public health facility. Both Zipline and Tanzanian health authorities are betting that drone deliveries can efficiently fill those gaps.

Tanzania, Africa’s sixth most populous country, figured into Zipline’s plans long before Thursday’s announcement. In 2014, Rinaudo and fellow cofounder William Hetzler were both influenced by visits to the country as they looked for ways that Zipline, which was established as a more conventional robotics firm, could help save lives. Ultimately, Zipline launched in Rwanda first: Rwandan authorities were ready, and the country’s size was more manageable. (Rwanda is slightly smaller than Maryland, which means a single hub can service nearly half the country; Tanzania is bigger than Texas.) They piloted the drone-delivery model with blood, a product that expires after 42 days in storage, must be kept refrigerated, and is frequently needed on an emergency basis. Since last October, Zipline drones have made more than 1,400 flights to deliver 2,600 units of blood to 12 Rwandan health facilities. Roughly three-quarters of the deliveries there are for routine restocking, and one-quarter are in response to emergencies.

In Tanzania, Zipline’s results will be watched closely. Once the country’s first drone distribution center is in operation near the capital, Dodoma, a team composed of researchers from the University of Glasgow and Tanzania’s Ifakara Health Institute will begin to evaluate the service’s impact. In particular, they’ll be looking at facilities’ ability to administer new drone-enabled products, like the rabies vaccines, as well as the impact of airborne logistics in mitigating stock-outs.

Stock-outs are “a problem that global public health has tried to solve for like 60 years, which has proven to be intractable,” Rinaudo says. “So the idea that we finally have a solution, potentially, to solve the problem once and for all is incredibly exciting.”

Output: Drone delivery firm Zipline has expanded into Tanzania. The Silicon Valley company launched the world’s first national drone delivery service in Rwanda, and has now enabled delivery to over a thousand health facilities in Tanzania in remote and hard-to-reach locations. The company will use four distribution sites to deliver medical products such as vaccines, HIV medications and emergency supplies to three areas of Tanzania. The service will begin in early 2018.