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Pharmaceutical sector lobbying fuels US opioid crisis
 Donald Trump was not wrong. Hours before his nominee for “drug czar” withdrew from consideration over his part in a law limiting the Drug Enforcement Administration’s ability to crack down on pharmaceutical distributors feeding the US’s opioid epidemic, the president took a shot at the influence of drug companies over Congress.

“They contribute massive amounts of money to political people,” he said, standing next to Mitch McConnell, the Senate majority leader.

“I don’t know, Mitch, maybe even to you,” he added.

Q&A Why is there an opioid crisis in America? Show Almost 100 people are dying every day across America from opioid overdoses – more than car crashes and shootings combined. The majority of these fatalities reveal widespread addiction to powerful prescription painkillers. The crisis unfolded in the mid-90s when the US pharmaceutical industry began marketing legal narcotics, particularly OxyContin, to treat everyday pain. This slow-release opioid was vigorously promoted to doctors and, amid lax regulation and slick sales tactics, people were assured it was safe. But the drug was akin to luxury morphine, doled out like super aspirin, and highly addictive. What resulted was a commercial triumph and a public health tragedy. Belated efforts to rein in distribution fueled a resurgence of heroin and the emergence of a deadly, black market version of the synthetic opioid fentanyl. The crisis is so deep because it affects all races, regions and incomes Was this helpful? Thank you for your feedback.

Trump was right on both counts. Pharmaceutical companies spend far more than any other industry to influence politicians. Drugmakers have poured close to $2.5bn into lobbying and funding members of Congress over the past decade.

Hundreds of thousands of dollars have gone to McConnell – although he is hardly alone. Nine out of 10 members of the House of Representatives and all but three of the US’s 100 senators have taken campaign contributions from pharmaceutical companies seeking to affect legislation on everything from the cost of drugs to how new medicines are approved.

Trump’s nominee for drug czar, the US congressman Tom Marino, was forced to withdraw after a report by the Washington Post and CBS’s 60 Minutes highlighted his role in forging legislation that hinders the DEA’s ability to move against drug distributors or pharmacies recklessly dispensing the opioid painkillers at the heart of the epidemic, which claims more than 100 lives a day.

Marino’s acceptance of substantial donations from those same companies compromised his nomination to head the federal agency charged with tackling the opioid crisis.

But for Congress, the process was nothing unusual. Hundreds of millions of dollars flow to lobbyists and politicians on Capitol Hill each year to shape laws and policies that keep drug company profits growing. The pharmaceutical industry, which has about two lobbyists for every member of Congress, spent $152m on influencing legislation in 2016, according to the Center for Responsive Politics. Drug companies also contributed more than $20m directly to political campaigns last year. About 60% went to Republicans. Paul Ryan, the speaker of the House of Representatives, was the single largest beneficiary, with donations from the industry totaling $228,670.

The impact of so much drug company money coursing through the veins of Congress is often incremental or largely unseen by the American public, such as the industry’s efforts to block competitors in India from making generic versions of HIV/Aids medicines that are more affordable to developing countries.

But on occasion it has a hugely visible impact.

In his comments alongside McConnell, Trump was vocal in his criticism of what he said were pharmaceutical manufacturers “getting away with murder” by charging much higher prices in the US than other countries. That is the result of a 2003 law, in effect written by the industry, preventing the federal government from seeking bids for the manufacture of drugs and medical devices – a process used in other areas, such as defence spending.

Instead, the pharmaceutical companies can charge whatever price they want for drugs bought for the publicly run Medicare and Medicaid programmes – and the federal government has no choice but to pay up.

Tom Marino, second left, at a Trump rally in Hershey, Pennsylvania, in 2016. Marino faced scrutiny over donations from pharmaceutical companies. Photograph: Matt Rourke/AP

Meanwhile, the drug companies say that to allow foreign imports would endanger the quality and safety of medicines in the US. But that justification has been widely scorned in the face of escalating and sometimes opportunistic pricing, such as the surge in the price of EpiPen antidotes to allergic reactions last year, to $600.

Britain’s National Health Service negotiated a price of about $70 for the same product. Scores of attempts by some members of Congress to introduce legislation to bring down the price of prescription medicines or to let people buy them from Canada, where they are often cheaper, have failed to make it out of committee.

While lobbying shapes medical policy across the board, it has had a profound impact on the opioid epidemic as deaths quadrupled between 1999 and 2015. The pharmaceutical industry poured resources into attempting to place blame for the crisis on the millions who have became addicted instead of on the mass prescribing of powerful opioids.

The relatively small number of members of Congress who led the charge against the epidemic years before it became a significant political issue have struggled to push through legislation.

Representatives Hal Rogers and Mary Bono saw repeated efforts to pass laws curbing the mass prescribing of opioid painkillers fail amid concerted campaigns by the drug makers. Rogers and Bono founded the Congressional Caucus on Prescription Drug Abuse in 2010 and proposed several pieces of legislation over a number of years.

Bono, who was alerted to the opioid crisis after Chesare, her son with the late singer Sonny Bono, became addicted, said there was a false but effective campaign by companies profiting from the epidemic to portray any attempt to rein in the mass prescribing of painkillers as depriving millions of people of legitimate treatment for chronic pain.

“We were getting tremendous pushback from the industry. It was a massive, well-organised effort,” she said. “Of course we felt it, maybe indirectly at times. We didn’t have an awful lot of people lining up to help us.”

Some of the pressure came through industry-funded groups such as the Pain Care Forum, which spent $740m over a decade lobbying in Washington and state legislatures against limits on opioid prescribing and similar issues, according to the Center for Public Integrity.

Among those who received political contributions from the group were Senator Orrin Hatch, who took $360,00. The senator introduced legislation intended to head off one of the bills put forward by Rogers and Bono by proposing a federal study of pain treatment. Hatch, who is running for Senate again in 2018 even though he previously said he would not, is the recipient of the most political donations from the pharmaceutical industry so far this year, at $208,000.

Bono said the American Medical Association was instrumental in blocking another law, the Ryan Creedon act, to require doctors to get training on the risks of opioids. The AMA objected to it as a burden on physicians.

Drug companies gave more than $200,000 in campaign contributions to Jason Chaffetz (who recently left Congress), acting as the single largest donor to his re-election fights. Chaffetz, as chair of the committee on oversight and government reform, led an effort against the Centers for Disease Control and Prevention to reduce opioid prescribing by recommending that doctors first seek alternative treatments for chronic pain.

Lobbying by the wider healthcare industry also had an important impact on the shape of Barack Obama’s Affordable Care Act (ACA), widely known as Obamacare.

The chair of the committee drafting the ACA legislation, Senator Max Baucus, was at the time the single largest recipient of health industry political donations, with $1.5m given to his political fund over the previous year. Baucus led votes in the committee against the inclusion in the legislation of public insurance strongly opposed by private insurers who saw a threat to its profits.

Baucus was known within the health industry for annual fly-fishing and golfing weekends in his home state of Montana that lobbyists paid handsomely to attend. Other members of the committee received hundreds of thousands of dollars, including Senator Pat Roberts, who at one point tried to hold up the bill by claiming lobbyists needed three days to read it. The drafting of large parts of the ACA was done by a former vice-president of a major health insurer, Wellpoint.

In his attack on drug company money in American politics, Trump failed to mention that the companies were among the leading donors to his inauguration alongside tobacco and oil companies.

Pfizer, the maker of Viagra, was the largest pharmaceutical donor, giving $1m.

Output: Lobbying by pharmaceutical companies in the US has had a major impact on the opioid epidemic in the country, according to The Guardian. The sector spends more than any other on political lobbying, and has committed $2.5bn to lobbying and funding members of Congress over the past decade. All but three of the 100 currently serving US senators have received contributions from drug companies, as have nine out of 10 Representatives. While opioid deaths have quadrupled between 1999 and 2015, the pharmaceutical industry has sought to blame addicts rather than mass prescription of the drugs.


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Frail elderly patients comprise 44% of potentially preventable Medicare spending
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Frail elderly patients comprise 44% of potentially preventable Medicare spending

High-cost frail elderly individuals accounted for 44% of total potentially preventable Medicare spending, despite only comprising 4% of the Medicare population, according to findings published in Annals of Internal Medicine.

“For clinical leaders, finding areas of care where money can be saved and quality improved is an imperative but has often proved difficult,” Jose F. Figueroa, MD, MPH, from Harvard T.H. Chan School of Public Health, and colleagues wrote.

“One approach that has received substantial attention recently has been focusing on high-need, high-cost patients. By definition, this population is very expensive to care for; however, we know less about whether their spending is preventable,” they wrote.

Figueroa and colleagues sought to identify potentially preventable total spending across six distinct subpopulations of “high-cost” patients, or those in the highest 10% of total standardized individual spending: nonelderly disabled, frail elderly, major complex chronic, minor complex chronic, simple chronic and relatively healthy. The researchers reviewed fee-for-service claims from 2012 for 6,112,450 high-cost Medicare beneficiaries.

They calculated potentially preventable spending using the Billings algorithm and inpatient and associated 30-day post-acute costs for ambulatory care-sensitive conditions to sum costs for avoidable ED visits. Then, Figueroa and colleagues compared the amount and proportion of potentially preventable spending across the high-cost subpopulations, as well as individual ambulatory care-sensitive conditions.

The researchers found that the proportion of Medicare spending that was potentially preventable was 4.8%, most of which (73.8%) was incurred by high-cost patients. Only 4% of the Medicare population consists of high-cost frail elderly persons; however, they accounted for 43.9% of total potentially preventable spending ($6,593 per person). Nearly 15% ($3,421 per person) and 11.2% ($3,327 per person) of potentially preventable spending was attributed to the high-cost nonelderly disabled group and the major complex chronic group, respectively. Most spending for urinary tract infections, dehydration, heart failure and bacterial pneumonia admissions was incurred by frail elderly individuals.

“We found large variations in potentially preventable spending across Medicare subpopulations,” Figueroa and colleagues concluded. “Frail elderly persons were at particularly high risk for incurring potentially modifiable costs. Therefore, as we continue to move toward value-based frameworks, interventions that focus on frail elderly patients may be particularly valuable.”

In an accompanying editorial, Bruce Leff, MD, from Johns Hopkins University School of Medicine, and Arnold Milstein, MD, from Stanford University School of Medicine Clinical Excellence Research Center, wrote that these findings expand knowledge of the high-need, high-cost population.

They noted that the health care culture needs to shift toward value-based care under the Affordable Care Act. This shift requires rapid acceleration, as well as new data collection and analysis and treatment planning that focuses on the social determinants of health and patient functional status, according to Leff and Milstein. There is also a need for new payment and patient assignment models, they wrote.

“This all needs to happen as our health system addresses the critical challenges of lack of universal access to health care, underinvestment in primary care, administrative inefficiency, and disparities in delivery of care,” Leff and Milstein concluded. “Studies like that of Figueroa and colleagues can help point the way to ‘coolable’ hot spots. The onus is now on organizations and systems to shift culture and learn to implement the care and contracting methods used by their ‘coolest’ peers.” – by Alaina Tedesco

Disclosure: Figueroa reports receiving grants from The Commonwealth Fund. Please see the study for other authors’ relevant financial disclosures.

Output: Frail senior citizens represent 44 percent of the Medicare spending that could be preventable, even though they account for only 4 percent of Medicare beneficiaries, according to the Harvard T.H. Chan School of Public Health. High-need, high-cost patient spending could be preventable. The researchers tried to identify non-essential spending across six types of “high-cost” patient, or those that are in the highest 10 percent of standardized individual spending. These types include the nonelderly disabled; the frail elderly; the simple chronic, the minor complex chronic, the major complex chronic and the relatively healthy. The study examined fee-for-service claims in 2012 from across 6,112,450 high-cost Medicare recipients. Potentially preventable spending was calculated using the Billings algorithm, and found that the proportion of spending that could be prevented was 4.8 percent, with 73.8 percent.of that amount caused by high-cost patients. Frail elderly persons represented 43.9 percent of total potentially preventable spending, at a value of around $6,593 per patient. Most of the total expenditure spent on urinary tract infections, heart failure, dehydration and bacterial pneumonia admissions was spent on this group. A value-based framework could benefit Medicare, given that it could resolve many of these high-cost issues. The Harvard team concluded that health care culture needed to shift rapidly towards value-based care, as well as collecting new data and forming treatment planning that focuses on social determinants of health and patients’ function. The team also recommended a new payment and patient assignment model be implemented.


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H&M denies burning 60 tonnes of waste clothing since 2013
 H&M has been accused of burning tonnes of unsold items every year, flying in the face of its widely-publicised sustainability drive.

According to Danish TV programme Operation X, H&M has burned 60 tonnes of unsold clothing since 2013, totaling around 15 tonnes a year.

Journalists from the TV programme began investigating what the retailer did with clothing it didn’t sell, and were led to a Danish disposal company called Kara/Noveren where they reportedly saw over 1500kg of garments being delivered before being destroyed.

Else Skjold, a professor of sustainable design at the Kolding Design School in Denmark, told Operation X that the incineration was due to large-scale overproduction.

“It’s dramatic if we’re talking about fashion because the trends in fashion are temporary. If something is not in fashion, then it can’t be sold anymore,” he said.

H&M have denied the accusations, telling FashionUnited that they were “of course not true” and that the garments featured could not be sold to the public.

“The clothes featured in the program are stopped orders that have been sent to incineration because of mold or not complying with our strict chemical restrictions, which is according to our routines for stopped orders,” a spokesperson said.

“Circularity is at the core of our sustainability strategy and we work hard to ensure that we maximize the use and the value of our products in line with the principles of the circular economy and waste hierarchy.

“Incineration is, therefore, the very last option that we only allow under very special circumstances when re-use or recycling is not an option, such as when our products are contaminated by mold or not complying with our strict chemical restrictions.”

Despite this, Operation X took two garments from the incineration plant and had them independently tested, stating that they found no harmful levels of bacteria and normal deposits of bacteria.

In response, H&M published their test findings on the garments.

“The products media refers to have been tested in external laboratories. The test results show that one of the products is mold infested and the other product contains too high levels of lead,” the retailer told FashionUnited.

“According to the test we have, the test for lead performed by the Danish programme didn’t include the whole garment and not the part affected by too high levels of lead. The other test performed by the Danish program didn’t include tests for mold. This is the reason why our tests differ.

“We are puzzled why some media is suggesting that we would destroy other products than those required. There is absolutely no reason for us to do such a thing.”

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Output: H&M has burned 60 tonnes of unsold clothing since 2013, equivalent to 15 tonnes a year, according to Danish TV programme Operation X. The items were burned by Danish disposal company Kara/Noveren. H&M has denied the allegations, claiming that the clothes were mouldy, or failed to comply with chemical regulations. However, critics said that the burning was due to excessive production.


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87% increase in data stolen during cyber attacks on UK businesses
 The overwhelming majority of cyber attacks on small to medium-sized enterprises (SMEs) result from poor password management, a study of 1,000 UK and US SMEs by the Ponemon Institute shows.

Despite this fact, SMEs are doing very little to boost visibility into the password practices of their employees, according to the study sponsored by password management firm Keeper Security.

The study report said employee negligence is the top root cause of successful data breaches.

“Survey respondents believe cyber attacks are becoming more targeted, more severe in terms of consequences, and more sophisticated,” said Larry Ponemon, chairman of the Ponemon Institute. “So you would think things would be getting better in terms of protecting themselves, but they are really trending to worsening.”

According to the survey – 61% of respondents reported a cyber attack, up from 55% a year ago – while 54% reported a data breach, up from 50% a year earlier.

Ransomware attacks were reported by 52% of respondents, with 53% of those reporting they were hit by more than one ransomware attack.

The total costs associated with successful cyber attacks on SMEs now total well in excess of £1m, meaning a single attack could bring an SME to its knees financially.

Amount of stolen records on the increase Not only has the cost of data breaches risen to an average of just over £1.2m including all attack mitigation and business disruption costs from £717,909 a year ago, but the average number of records stolen has soared from just over 5,000 per attack last year to 9,350 this year – an 87% increase. While 54% of respondents say the root cause of the attacks are negligent (not malicious) employees, a full third of the companies surveyed could not even determine the root cause. An ongoing lack of attention to password usage underlies much of the cyber security woes at SMEs, the study said, referring to the latest Verizon Data Breach Investigations Report, which noted that 81% of all cyber attacks result from poor password management practices. Read more about SME security SMEs are failing to address cyber threats despite the risks.

The UK government has announced initiatives aimed at boosting SME cyber security, promoting the cyber security profession and supporting cyber security innovation projects.

SMEs typically face the same threats as bigger organisations, but lack the same level of expertise and other security resources.

The London Digital Security Centre has been set up by the Mayor’s Office for Policing and Crime as part of the mayor’s business crime strategy. The latest Ponemon research shows that 59% of respondents said they have no visibility into their employees’ password practices, which is unchanged from a year ago. Among the bad practices cited are using the same passwords for access to multiple accounts and servers; sharing passwords in highly insecure ways; and failing to use strong passwords, settling instead for 123456 or other very easily compromised passwords. Less than half – 43% – of SMEs surveyed have any sort of password policy in place. And of those that do have such a policy in place, 68% (up from 65% last year) said they either do not strictly enforce the policies or are unsure if they are enforced. “SMEs can respond to this overall situation by quickly establishing mobile device and BYOD [bring your own device] internal control policies,” said Darren Guccione, Founder and CEO of Keeper Security. “Then implement software that controls the information being protected and transacted via these and other devices. The combination of password management software and enterprise mobility management tools can mitigate up to 80% of the cyber risk those devices pose,” he said.

Greater data protection implementation needed According to the study, SMEs need to implement greater data protection beyond the “traditional” protection tools, with two-thirds of respondents reporting cyber attacks that evaded the company’s intrusion protection defenses, up from 57% a year ago, and 81% reporting such attacks evading traditional antivirus defences, up from 76% last year. The Ponemon study shows that the top barriers to adopting better cyber defences are: a lack of trained security staff (73%) and inadequate budget (56%). However, the report said given the enormous costs associated with a data breach, failing to protect against today’s dynamic threat environment could prove disastrous, and the costs associated with doing so may not be as high as imagined. “There is more great protection software targeting SMEs today than ever before,” said Guccione. “The cost-to-benefit spread in terms of value to what the real risks are, and in consideration to how productivity can actually be enhanced with the right software solutions, puts better protection well in reach of SMEs.” For example, he said, by implementing a comprehensive password management system, many organisations have experienced a marked decline in helpdesk calls related to lost or forgotten passwords.

SMEs targeted through phishing The Ponemon research into the rising incidence of ransomware attacks on SMEs noted earlier found the attacks were unleashed 79% of the time through phishing or other social engineering, most notably burying harmless looking clickable URLs into a scam email. A prime defense against this, said Guccione, can be ongoing phishing simulations to try to educate negligent employees. Organisations polled also exhibited high levels of concern over security breaches caused by internet of things (IoT) devices. They notoriously lack security mechanisms and typically come with no mandate or set of requirements regarding password length or strength or whether they should have single or two-factor authentication. Nearly a quarter of respondents reported an IoT-related data breach, with two-thirds reporting feeling “concerned or very concerned” about their lack of security. In fact, 56% said IoT and mobile devices represent the most vulnerable endpoints in their organisations. London is taking the lead in the UK by helping to make the city’s small businesses, which number more than one million, safe from cyber crime through the London Digital Security Centre (LDSC). The centre was set up as a not-for-profit organisation in 2015 by the Mayor’s Office for Policing and Crime (Mopac) and is run as a joint venture between the mayor of London, the Metropolitan Police and the City of London Police. The LDSC provides a free cyber security assessment and improvement programme for SMEs and created a “marketplace” of selected products and services to help London’s businesses protect themselves.

Output: The cost to businesses of data breaches resulting from cyber attacks has risen in the last year, with the number of records stolen increasing by 87%, according to research by online security analysts the Ponemon Institute. The average total cost of a cyber attack on an SME is over £1m ($1.32m), and the number of records stolen has risen from 5,000 last year to over 9,000 this year, according to the reports. More than half of those who responded to the survey reported that the main cause of such breaches was poor password security by employees.


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Clearbanc offers Chrged loans to Facebook advertisers
 You have to spend money to make money, and financial technology company Clearbanc now has a way to get some of that money to brands on Facebook.

Clearbanc and Facebook teamed up to launch the Chrged program, which gives advertisers on Facebook that connect their ad accounts on the social network and their payment processors access to:

Custom financing of up to $500,000, with flexible repayment options

Financial support

Cross-border resources

Learning tools via the Facebook Blueprint e-learning initiative

Clearbanc said in a release introducing Chrged that it will establish affordable, fixed fees for businesses, adding that credit checks are unnecessary as advances of financing are based on companies’ business data.

Facebook

Output: Clearbanc, which specialises in providing financing to online businesses, has partnered with Facebook on a new service offering loans of up to $500,000 to companies that advertise on the social media site. The Chrged programme uses sales and ad buying data from companies' Facebook accounts to decide whether to offer the funds, which are then repaid from sales revenue. The model allows companies to raise capital for investment for a flat fee of 10%, without giving up equity.


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Call to end use of vaginal mesh implants in UK as scandal grows
 Labour has called for an immediate halt to the use of vaginal mesh implants and urged the government to launch an independent inquiry into the “ongoing public health scandal” surrounding the treatment of women for urinary incontinence and pelvic prolapse.

Sharon Hodgson, the shadow public health minister, said the government must stop allowing the use of mesh implants before a debate in parliament about their safety, after reports that some women have suffered debilitating complications including perforated organs and chronic pain.

The National Institute for Health and Care Excellence (Nice) is due to publish updated guidance for the use of mesh implants in January, after NHS England said in a report in July that the treatment for urinary incontinence and prolapse “is a safe option for women”.

Q&A What is a vaginal mesh implant? Show The implants have been widely used as a simple, less invasive alternative to traditional surgical approaches for treating urinary incontinence and prolapse, conditions that can commonly occur after childbirth. For the majority of women the operation is successful.

However, concerns are mounting over the severe complications suffered by large numbers of patients, including chronic pain, mesh cutting through tissue into the vagina and being left unable to walk or have sex. Johnson & Johnson, whose subsidiary Ethicon produces one of the most widely used mesh products, is fighting a major class action in Australia. The Guardian revealed in August that thousands of women have undergone surgery to have vaginal mesh implants removed during the past decade, suggesting that about one in 15 women fitted with the most common type of mesh support later require surgery to have it extracted due to complications. Was this helpful? Thank you for your feedback.

However, since then further evidence has emerged about apparently high rates of complications, and the issue is gaining political momentum. The Guardian revealed in August that thousands of women have undergone surgery to have vaginal mesh implants removed during the past decade, suggesting that about one in 15 women fitted with the most common type of mesh support later require surgery to have it extracted due to complications.

Hodgson said the issue had become a “public health scandal” as mesh implants have left some women in permanent pain, unable to walk and unable to work.

“This is an ongoing public health scandal and the government need to do much more to support those affected,” she said. “Mesh implants should be taken off the market now until we know more about the threat they pose to women’s safety.

“The government have failed to answer big questions about the extent of this public health scandal, including how many women have been affected and why a product with such terrible risks was allowed into the market in the first place.

“Labour is calling for a full inquiry to uncover the extent of the harm done by mesh implants so we can be sure that this never happens again.”

However, some leading gynaecologists have warned that a ban would risk depriving women of the option of a treatment that, for incontinence at least, has been shown to be effective.

The debate in Westminster Hall has been called by the Labour MP Emma Hardy and the issue has also been repeatedly raised by Owen Smith, a shadow cabinet minister, who chairs the all-party parliamentary group on surgical mesh implants.

Hardy said her email inbox has been filling up with people telling her their horrific stories after having mesh implanted.

“I was first alerted to the issue of mesh complications after a constituent contacted me who had been suffering in silence for years. I hope that the government will take action and heed Labour’s call for a public inquiry into the use of mesh,” she said.

Smith also said mesh injury was “one of the worst medical issues” he had come across as an MP.

“Since working with Sling the Mesh campaign, I have been contacted by

countless women from right across the UK who have shared their heartbreaking

stories of their suffering following mesh surgery. The government must immediately review all mesh surgery and suspend the use of mesh until more is known about its risks,” he said.

Kath Sansom, a campaigner at Sling The Mesh, said: “People are waking up to the global scandal that is surgical mesh implants and at last it is on the political agenda at Westminster.”

Last week, the health minister Jackie Doyle-Price told MPs she was aware women had suffered complications, but added that it was “equally the case that many women also experience considerable relief from symptoms”. Doyle-Price said: “I think it’s very important that the work that Nice are doing should be allowed to be undertaken so that we can actually make a very clear view of this.”

Sohier Elneil, a consultant urogynaecological surgeon at University College Hospital, London, is calling for the use of mesh procedures for incontinence and prolapse to be stopped for two years. “The time has come for us to truly revisit everything we know about both these clinical states,” she said. “Clearly, the knowledge we have had to date has been limited both in scope and relevance. A change needs to happen now.”

Output: The UK Labour Party has called for an immediate end to the use of vaginal mesh implants and the launch of an independent inquiry into an ongoing scandal around their use. There have been growing reports that the implants, used to treat women suffering from urinary incontinence and pelvic prolapse, have caused complications including chronic pain and perforated organs. A report from NHS England in July declared the use of mesh implants “a safe option”. However, evidence that complications have forced one in 15 women with the most common implant to have it removed, has since emerged.


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UK businesses cut cybersecurity budgets
 UK businesses have slashed their cyber security budgets by a third

Businesses in the UK have cut the amount of cash they are spending on cyber security despite the growing threat of attacks.

Budgets for security are a third of what they were this time last year, down to £3.9m on average, compared to £6.2m according to research from PwC.

The cost of attacks has fallen, however, down to £857,000 compared to £2.6m a year earlier. But the impact of attacks were felt more widely across the business in areas such as operations and data, while the uktimate cost can be hard to quantify.

Read more: Iran has been blamed for the cyber attack on Parliament over the summer

Firms experienced 19 hours of down-time from incidents while 23 per cent had customer records compromised.

The findings come from PwC's annual Global State of Information Survey which surveyed nearly 10,000 senior executives from over 100 countries.

It also found that more than a quarter of firms don't know how many cyber attacks they suffered in the past year, up from the 18 per cent who said the same last year, shedding light on how businesses are handling the cyber threat.

And one in five firms were found to have no kind of preparation drills for cyber attacks. It comes in the wake of several high profile attacks which have hit business this year, including massive breaches at Equifax and Yahoo. WPP, Reckitt Benckiser (RB) and Maersk were also affected by ransomware earlier this year while a similar attack shut down some NHS services.

Read more: Hot UK cyber startup Digital Shadows has raised $26m

“Cyber attacks could happen to any organisation at any time, so it’s important that all businesses and public sector organisations are getting the basics right and continually testing their approach to prepare themselves in the right way," said PwC cyber security partner Richard Horne.

"In that critical moment when an attack hits, the ability to act quickly and effectively is key to minimising business disruption and reputational harm.”

Just two in five businesses in the UK were found to have formal partnerships with others in their industry to improve security and reduce risks, fewer than those across the rest of Europe and globally.

Output: The amount of money UK businesses spend on cybersecurity has fallen by a third since last year, according to a PwC survey. The research showed average spending has fallen from £6.2m last year to just £3.9m, and that one in five companies have no preparation drills for cyber attacks. However the reported cost of such attacks has fallen from £2.6m to just £857,000, although more than a quarter of firms didn't know how many attacks they had suffered, compared with 18% the year before.


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US adults turn to the internet before primary care physicians
 Fifty-nine percent of American adults used a website like WebMD to look up symptoms instead of visiting a primary care physician, according to a new survey, while only 12 percent used telemedicine in place of primary care.

The data comes from the University of Phoenix College of Health Professionals, which completed an online survey of 2,201 individuals across a range of demographic backgrounds. The data provides interesting insights into adoption of health technologies.

“The healthcare industry is shifting to a patient-centered model that harnesses technology to both open communication channels and create a platform for patient engagement,” Doris Savron, executive dean for the College of Health Professions, said in a statement. “Given this shift, it is crucial that patients not only have access to these technologies, but also view them as important resources for improving their health and overall care experience.”

Respondents were also asked about their use of online health records, online appointment booking, online chat capabilities, text message appointment reminders, and e-prescription refills.

For online health records, 37 percent said they currently had access to their records, but only 25 percent said they had used accessed online health records in the past year. Seventy-four percent of respondents rated online health records access as somewhat or very important.

For appointment booking, 27 percent had access, but just 15 percent had made use of it in the past year. Fifty-nine percent considered it important

Online chat had the lowest adoption, with 17 percent having access and only 5 percent using it, but 49 percent of respondents still rated it as somewhat or very important.

Twenty-eight percent had used text message appointment reminders though 35 percent had access to them. Sixty-four percent rated them as important to their care.

Finally, for e-prescribing, 39 percent had access, 26 percent had taken advantage of that access over the last year, and 72 percent considered it an important resource.

Certain demographic trends held across each of the technologies asked about in the survey. In every category except online chat services, women were considerably more likely than men to have used the technology, which could be explained by the fact that women are more often caregivers and often responsible for healthcare within a family.

In most categories, usage of technology correlated with income and educational level. For instance, in the e-prescription category, 38 percent of those earning $100,000 per year or more had used the technology in the last year, compared to just 21 percent of those earning less than $50,000.

Correlations with ethnicity were less consistent. In fact, in the category of online chat capabilities, people who identified as Hispanic were more than twice as likely as white-identifying respondents (11 percent versus 5 percent) to have used these services — perhaps because chat tools are easier to navigate with a language barrier.

The full survey asked about a number of issues beyond technology, including what qualities participants valued in their providers and questions about insurance coverage decisions.

“The data shows that technology is just one piece of the puzzle when it comes to patient care,” Savron said. “Although new technologies are resources that we should lean on to help improve communication, interpersonal skills are the foundation for ensuring patient trust and better care.”

Output: More than half of adults in the US have reported using internet searches to look up symptoms of illness before seeking primary medical care, according a survey conducted by the University of Phoenix. It found that 74% of patients believe access to online health records is important, although only 37% currently had such access, and only 25% had used them in the last year. Similarly, while 59% considered the ability to book an appointment online to be important, only 15% had made use of the service in the last year.


Instruction: create a high quality summary of the given input

Input:
Consumer genetics apps derided as 'pseudoscience'
 In response to critics, Helix cofounder Justin Kao cautions against a “paternalistic” attitude toward what kind of information consumers should be able to spend their money on. “People should be able to choose how they want to interact and experience DNA-powered insights and decide for themselves what is of value to them,” he says.

Helix has a detailed process for screening the science behind tests it markets and has rejected more than a dozen, according to Kao. Others have been modified to restrict what they claim DNA can do. Helix also gets advice from a panel of six scientific advisers who meet by phone or in person, including to talk about upcoming apps.

One is Gonçalo Abecasis, a population geneticist at the University of Michigan. “We say ‘That makes sense,’ or ‘That is crazy.’ It’s a lively discussion every time,” says Abecasis. He thinks Helix is an important experiment because it is exploring what mass-market uses of the genome will look like. And some apps that bother Topol don’t bother him at all: “If I sell you a scarf patterned with your DNA, you could say, ‘Hey, is that worth it?’ But you wouldn’t say, ‘Where is the scientific evidence?’”

To Ewan Birney, director of the European Bioinformatics Institute, the direct-to-consumer DNA phenomenon is a typically American approach, led by private companies and focused on individuals. By contrast, in Europe there’s more emphasis on national projects whose findings can be integrated into national health services, he says.

Diet apps

One of the newest apps on Helix is from Arivale, a spinout of the Institute for Systems Biology in Seattle, which calls itself a “scientific wellness company.” The concept is to surround customers with a “data cloud”—comprehensive information about their blood, gut microbes, and DNA—that could be used to suggest dietary changes.

Helix

The full program costs more than $1,000 per year. But for $89, via Helix, the company is offering customers an initial look at their genes and one consultation with a dietitian. The weight loss app, called Beat Your Genes, lets people view screens indicating whether, genetically, they are more or less predisposed to having a high body-mass index.

These DNA clues can inform personalized diet advice, says Arivale CEO Clayton Lewis. Do you taste bitter foods more intensely? Maybe the dietitian can suggest that you sauté your onions. Do you have a propensity for higher weight on a paleo diet? Try a switch to carbs.

Output: The potentially lucrative market in direct-to-consumer gene reports could be at risk from a slew of products which, some critics have argued, do not have a strong scientific basis. Helix, a spin-out from gene sequencer Illumina, sells a range of products based on genetic information on behalf of third-party firms that do everything from helping people manage their weight to offering a look at what a couple's future child may look like. California-based geneticist Eric Topol said: “The data has no basis. It’s pseudoscience.” The US Federal Trade Commission is monitoring the sector closely but said it does not want to impede innovation.


Instruction: create a high quality summary of the given input

Input:
Death toll in San Diego's hepatitis A outbreak rises to 19
 The death total in San Diego’s ongoing hepatitis A outbreak reach 19 Tuesday, one more than last week, according to a newly-released health department update.

Case counts also increased from 490 to 507, according to the county Health and Human Services Agency. The increases are the latest mileposts in a public health emergency that has grown among the region’s homeless and drug-using residents every week since it was first detected in early March.

While the increases have been relentless, there are reasons, said Dr. Wilma Wooten, the county’s public health officer, to think that the outbreak’s growth may be slowing.

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Last week, she said, 10 new cases were reported to the county and, while that’s surely more than anyone would hope, it’s significantly less than the number of new cases coming in every week just a few months ago.

“The numbers are slowing down. It’s not the 20 cases a week that it has been in June, July and August,” Wooten said on Tuesday.

But the physician was reluctant to say that she’s seeing a new trend. Outbreaks are unpredictable and, because the virus causing so many infections and has a very long incubation period, it is still possible to see the number of cases surge.

“We have to be cautious. We know that this virus has an incubation period of 15 to 50 days, and we know that there are cases out there that just haven’t started to show symptoms yet,” Wooten said.

Vaccination has always been the lynchpin of the county’s outbreak-fighting strategy. As of last week the county reported that 68,500 hepatitis A vaccinations have been administered since March.

Nearly 100 hand-washing stations and more portable toilets have been installed around the region, while regular sidewalk cleaning is taking place in certain areas.

On Friday, the California Department of Public Health declared a statewide public health emergency, a move that allows the state to purchase additional vaccine doses directly from manufacturers after the state hit the limits of a special free vaccine program run by the U.S. Centers for Disease Control and Prevention.

While declining to say exactly how many doses the county has on hand, Wooten said she believes that there is enough supply to keep giving shots to those who are at highest risk of infection, including homeless residents, drug users, those with existing liver disease, gay men and those with compromised immune systems.

Anyone outside specified at-risk groups, she added, are now being actively advised to wait due to the constraints on vaccine supply mentioned last week by the state.

“We are asking health providers to not vaccinate those individuals right now that might want to be immune to wait until the beginning of the year when more vaccine is available,” Wooten said.

With large vaccination efforts underway to control outbreaks in several states, it has been unclear how much the nation’s supply of hepatitis A vaccine has been depleted. The CDC, which has indicated that it is in direct communication with the two manufacturers who make the vaccine in the U.S., has provided no solid answers.

“While CDC communicates with vaccine manufacturers to help manage vaccine supply constraints and disruptions, this information is proprietary and used solely for planning and public health response purposes,” Ian Branam, press officer for the CDC’s National Center for Immunization and Respiratory Diseases, said in an email Tuesday.

A shrinking vaccine supply has created a bit of an awkward situation for many in the prevention community. Scott Suckow, executive director of the American Liver Foundation’s Pacific Coast Division, said late last week that the standard message has been for everyone to get a hepatitis A vaccination just in case they are exposed. Recent months, though, have called for a shift in strategy toward those whose liver disease makes them at a higher risk of death than the overall population.

“We don’t want to overburden a public system when the public system is really focusing on those most at risk,” Suckow said.

The county health department has recently doubled down on its efforts to reach those at risk, with than 500 foot team missions in areas where homeless people gather, in addition to focusing on vaccination clinics at shelters and other nonprofits serving them homeless.

Wooten said a growing crew of volunteer nurses from the region’s many health systems in addition to paramedics, who were recently granted temporary vaccination powers by the state, are getting ready to start vaccinating residents in single-room-occupancy hotels and substance abuse treatment facilities.

Wooten said she does not expect these volunteer teams to begin their work until November because four hours of training is required before they can head out to pre-arranged locations.

While nurses and paramedics already know how to give shots, Wooten said they need to know follow specific public health requirements, including keeping the vaccine cold, while vaccinating residents.

Asked how many people the county estimates it must vaccinate to reach a level of community immunity strong enough to end the outbreak, Wooten did not share a specific number. She did say that there are estimated to be about 125,000 intravenous drug and methamphetamine users who are at risk along with somewhere between 9,000 and 25,000 people who are either homeless or who have insecure living conditions.

Getting about 80 percent of the people in high-risk categories immunized, she said, should create the kind of “herd immunity” that can stop an outbreak from spreading.

Hepatitis A is spread when a person swallows even a tiny amount of feces from an infected person. Proper hand washing with warm soapy water for at least 20 seconds after using the bathroom kills the virus.

Health Playlist × On Now Video: Leaders urge public to help extinguish hepatitis outbreak On Now San Diego starts cleansing sidewalks, streets to combat hepatitis A On Now Video: Scripps to shutter its hospice service On Now Video: Scripps La Jolla hospitals nab top local spot in annual hospital rankings On Now Video: Does a parent's Alzheimer's doom their children? On Now EpiPen recall expands On Now Kids can add years to your life

paul.sisson@sduniontribune.com

(619) 293-1850

Twitter: @paulsisson

Correction: A previous version of this story mistated the incubation period of the hepatitis A virus.

Output: The death total in San Diego’s ongoing hepatitis A outbreak reach 19 Tuesday, one more than last week, according to a newly-released health department update.


Instruction: create a high quality summary of the given input

Input:
California law may minimally impact drug pricing transparency
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California law may minimally impact drug pricing transparency

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Lisa Kroon

California Gov. Jerry Brown approved legislation that will require pharmaceutical companies to give the state advanced notice of, as well as justify, dramatic drug price increases.

The intent of this bill is to increase transparency of drug price increases to the public, Ben R. Handel, PhD, an assistant professor of economics at the University of California, Berkeley and a faculty research fellow at the National Bureau of Economic Research, told HemOnc Today.

“This is something that most people in the health care sector are in favor of and pharmaceutical companies are heavily against,” he said.

Retail prices for 268 widely used brand name prescription drugs increased by 15.5% from 2014 to 2015, which marked the fourth straight year of double-digit average annual price increases, according to a 10-year price trends report by AARP’s Public Policy Institute.

Additionally, the average retail price for 113 common brand name drugs used to treat chronic conditions increased 188.7% from 2006 to 2015; for comparison, general inflation increased 19.4% during the same period.

“The social and political fabric is being ripped apart,” Gov. Brown said during a press conference announcing the legislation. “The inequities are growing. The rich are getting richer, the powerful are getting more powerful and a growing number of people are getting more desperate, more alienated.”

Shift toward increased regulation

The legislation would require pharmaceutical companies to provide 60 days’ notice to health plans and other purchasers of a planned price hike if the increase exceeds certain thresholds.

“Hopefully health plans, by having forewarning about drug price increases, will be better able to plan for this, and then not push the costs onto consumers; or better yet, be able to push back on the price increases,” Lisa Kroon, PharmD, chair of the department of clinical pharmacy at the University of California, San Francisco, told HemOnc Today.

“I think the timing of the notices to health plans about intended drug price increases will be important, as consumers make decisions about their choice of a health plan in the fall every year. Health plans will need information about drug cost increases in their planning for open enrollment season, so consumers have this information when making choices.”

Although there are some positive aspects about the bill, Handel does not envision it having a significant impact.

The bill places some constraints on drug manufacturers by setting a threshold — 16% over 2 years — before being required to give notice and justification, but Handel said manufacturers will likely make it a priority to come in under that threshold.

“I’m not sure if drug companies will actually care about this,” he said. “They don't like the law because it’s moving toward a more regulated environment, but drug companies could also say, ‘well we’re going to raise our prices by 40% and we’re going to justify it in some way and that’s it,’ because there’s nothing in the law actually restricting their prices. It just requires them to justify them.”

‘All eyes on California’

California could impose hassle costs on manufacturers if the state believes the justification is invalid.

“But at the end of the day, I think they’d be able to raise the price if they wanted to,” Handel said.

Both Kroon and Handel said that there is a strong possibility that California will serve as a leader and that this legislation will help propagate similar legislation and create a ripple effect across the rest of the country.

“All eyes are on California now with this law,” Kroon said. “There is a reason the drug companies lobbied so hard to not have this pass.”

However, Handel said drug manufacturers could take drastic steps if more states try to enact similar legislation.

“Say that this was a nationwide rule, then from an economics standpoint, a drug manufacturer would probably consider charging a high initial price,” he said.

For instance, a drug manufacturer could consider charging an initial price of $1,500 for a drug instead of $1,000, because the company would not have to worry about meeting certain requirements laid out in legislation.

“Drug companies are learning what the optimal price of a drug is when they go to offer a drug for the first time,” he said. “If they’re learning in an environment [that has this legislation], then they might want to shade the initial price higher, and I think that’s something people are generally missing.” – by Ryan McDonald

References:

http://www.aarp.org/content/dam/aarp/ppi/2016-12/trends-in-retail-prices-dec-2016.pdf

https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB17

https://www.gov.ca.gov/news.php?id=19995

https://www.youtube.com/watch?v=wF38WmiVIW4

Disclosures: Handel and Kroon report no relevant financial disclosures.

Output: California Gov. Jerry Brown approved legislation that will require pharmaceutical companies to give the state advanced notice of, as well as justify, dramatic drug price increases.


Instruction: create a high quality summary of the given input

Input:
Congress isn’t acting to curb drug prices, so states are stepping up. Here’s how
 Congress isn’t acting to curb drug prices, so states are stepping up. Here’s how

President Trump has complained that drug makers are getting away with murder — and he may be right.

Despite vociferous complaints from consumers that drug prices are too high, Congress has failed to act. And with few exceptions, the pharmaceutical industry has successfully delayed or thwarted state bills that would force drug makers to explain or justify price hikes.

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But that may be starting to change. Last week, to the fury of the pharma industry, California enacted a law demanding transparency on rising medicine costs. Vermont already has a similar policy in place. Nevada recently began requiring drug makers to disclose pricing data about diabetes medicines. And Maryland has a new law that penalizes generic companies for price gouging.

Output: President Trump has complained that drug makers are getting away with murder — and he may be right. Despite vociferous complaints from consumers that drug prices are too high, Congress has failed to act.


Instruction: create a high quality summary of the given input

Input:
Questions Loom About Obamacare As Covered California’s Open Enrollment Nears
 About Capitol Desk Capitol Desk delivers the latest in health care policy and politics from Sacramento and around the state. Have an idea? Let us know.

Hear Chad Terhune on KPFA’s Letters And Politics starting at the 40-minute mark: https://californiahealthline.org/wp-content/uploads/sites/3/2017/10/20171017-tue1000.mp3 Can’t see the audio player? Click here to download.

Listen to Chad Terhune’s appearance on KPCC’s AirTalk: https://californiahealthline.org/wp-content/uploads/sites/3/2017/10/what_trump_s_new_executive_order_means_for_the_aca_and_covered_ca-3ab8b3ad.mp3 Can’t see the audio player? Click here to download.

With open enrollment a little more than two weeks away, President Donald Trump took a one-two punch at the Affordable Care Act.

Last week, Trump said he would stop paying key subsidies, known as cost-sharing reductions, which compensate insurers for providing discounts on deductibles and copays. He also signed an executive order aimed at loosening the rules for association health plans — organized by certain types of professional, trade or interest groups — and short-term medical insurance. Trump argues these changes would give consumers cheaper coverage options, but experts warn that people may lose critical protections and face higher premiums when they’re sick.

Californians are somewhat insulated from harm, in part because health insurers here have already raised 2018 premiums for certain plans to offset the loss of the cost-sharing subsidies. In addition, California’s attorney general, Xavier Becerra, joined with other states to file a lawsuit last week challenging Trump’s decision to end the payments.

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On Tuesday, Sens. Patty Murray and Lamar Alexander announded a bipartisan agreement to restore the cost-sharing subsidies and stabilize the ACA marketplaces. Trump appeared to support the effort as a “short-term” solution.

Still, time is running short for 2018 open enrollment, which kicks off Nov. 1.

Before the announcement of the Murray-Alexander agreement Tuesday, Chad Terhune, a senior correspondent at California Healthline and Kaiser Health News, appeared on KPFA’s “Letters And Politics” show, speaking with guest host Max Pringle about the health care debates in Washington, D.C., and California. In addition to the ACA, they discussed the nation’s opioid crisis, prescription drug prices and growing support in California for a single-payer health system.

Terhune also appeared last Thursday on KPCC’s “AirTalk” show, discussing with guest host Libby Denkmann what’s next for the ACA under Trump.

Output: With open enrollment a little more than two weeks away, President Donald Trump took a one-two punch at the Affordable Care Act. Last week, Trump said he would stop paying key subsidies, known as cost-sharing reductions, which compensate insurers for providing discounts on deductibles and copays.


Instruction: create a high quality summary of the given input

Input:
A spate of deadly disasters for the elderly
 Story highlights Seniors tend to die at disproportionate rates after major disasters Many seniors with chronic illnesses can quickly deteriorate in a disaster setting

CNN —

Recent wildfires in California and hurricanes in Florida, Texas and Puerto Rico have put a spotlight on vulnerable seniors – including a number of deaths that authorities have said were preventable.

“The bulk of them are in their 70s and 80s, so there is that commonality,” Sonoma County Sheriff Rob Giordano said of the first wildfire victims to be identified during a press conference Thursday.

The majority were found in their homes, reduced to “ashes and bones,” Giordano said. Several were identified using medical implants, such as a hip replacement, with unique serial numbers.

On Sunday, the Sonoma County Sheriff’s Office identified four more victims of the fires, all over the age of 70.

An empty wheelchair sits among the charred remains of a housing development in Santa Rosa, California. Elijah Nouvelage/Getty Images

Over a dozen residents of a Florida nursing home died in the month after Hurricane Irma knocked out the facility’s air conditioning.

Just weeks later, after Hurricane Maria hit Puerto Rico in September, some were trapped in homes and shelters, unable to get the crucial medical care they needed.

The elderly have died disproportionately in disasters around the world, including a 2004 tsunami in Indonesia, a 2003 heat wave across Europe and a 1995 earthquake in Japan, according to a United Nations report.

Experts continue to grapple with how best to protect the elderly, who face difficulties evacuating from disasters, more health issues on average and perhaps even a greater share of the psychological impact.

“You can’t always predict an emergency event,” making preparedness key for seniors, said Ashley Chambers, communications director for the Florida Department of Elder Affairs.

To evacuate or not

Many adults can’t easily evacuate – some because they don’t drive, others because they are physically unable, according to research.

And some people refuse to evacuate in the first place.

“Some seniors don’t want to leave a home that they’ve been in all their lives, because the future may be uncertain,” said Vicki Eichstaedt, a spokesperson for the American Red Cross.

Others feel they might be better off remaining in a facility that has the means to take care of them.

“This is a very nice, sturdy concrete building,” Herbert Dreisbach, a 94-year-old resident of a nursing home in Jacksonville, Florida, told CNN before Hurricane Irma. “It’s still better than being at a facility that would not be properly prepared to take care of us.”

“Not all residents … should be evacuated,” Lisa Brown, a psychology professor and director of the Trauma Program at Palo Alto University, previously told CNN.

Brown, who is also Dreisbach’s daughter, showed in past research that nursing home residents with dementia had an increased risk of death in the months following a 2008 hurricane if they had evacuated.

“Those who can safely shelter in place may fare much better than those who are physically evacuated,” Brown said. “There’s not a one-size-fits-all, is the main point.”

Eichstaedt, who called from the Sonoma County Fairgrounds where there is a makeshift shelter, said that many seniors refuse to evacuate because they have pets, which may be their only companions.

“It may be the only connection they have to their old life,” Eichstaedt said.

The fairgrounds were equipped with a pet-friendly shelter, with veterinarians to take care of sick and aging pets, too. “That’s been a blessing for many seniors,” she said.

A matter of health

In emergency situations, once-manageable health conditions, like diabetes or an infection, can quickly spiral out of control.

CNN previously told the story of Josefina Alvarez, 62, who escaped to a shelter outside of San Juan before Hurricane Maria. She remained stuck there for nearly two weeks before doctors were finally able to treat an abscess that could have turned into a life-threatening infection.

“Nobody is taking care of us,” Alvarez said at the time.

About three out of every four Americans 65 and older have multiple chronic health conditions, such as high blood pressure and obesity, according to the US Centers for Disease Control and Prevention.

Rafael Robles-Ortiz kisses his mother Josefina Ortiz, staying at an elderly care facility in San Juan, Puerto Rico. Mr. Robles-Ortiz was concerned for his mother, hoping aid and supplies would get through to the facility after Hurricane Maria. Joe Raedle/Getty Images

After Hurricane Katrina in 2005, nearly half of those who died were 75 or older – despite making up less than 6% of the state’s population, according to one study. While most of these deaths were drownings or injuries, 11% were caused by heart conditions.

Before Hurricane Irma, nursing homes in Florida stocked up on supplies, and pharmacies issued early refills of medications for people in evacuation zones.

The Florida Health Care Association, which represents 81% of the state’s nursing centers, instructed each facility to prepare seven to 10 days of medication, oxygen and other medical necessities for each resident, according to spokesperson Kristen Knapp. The association does not represent the Hollywood facility where multiple residents died last month.

Even without a health issue, age can take its toll on the body.

An average healthy person can survive 100 hours without water if they’re not becoming dehydrated because of injury or temperatures, according to Dr. Paul Auerbach, a professor of emergency medicine at Stanford University who worked with rescue teams after earthquakes in Nepal and Haiti. They can even survive two or three weeks without food.

But for the elderly and infants, that time period can be much shorter, he previously told CNN.

Older adults are also more sensitive to extreme temperatures, making them more susceptible to heat stress and hypothermia, according to the CDC.

The exact causes of death of the Florida nursing home residents have not been announced, but a number of the 141 residents who were evacuated were treated for heat-related issues.

In Sonoma, Eichstaedt said that seniors with difficulties breathing or respiratory problems have been affected by “smoke and ash in the air.” Even younger and healthier people are wearing masks to avoid the worst air pollution on record for Northern California.

“It’s a big concern,” said Eichstaedt.

In the aftermath

For many people, a disaster often continues long after the fires have been put out or the flooding has receded.

The shelter in Sonoma is only a temporary fix, Eichstaedt said. Many displaced seniors will need assistance getting back home – if they still have a home to go back to.

Seniors may also be more susceptible to scams that happen after a disaster, said Chambers, including unlicensed contractors or people posing as assistance organizations.

“Our senior population is very trusting, and we want to make sure they know what to watch out for,” she said.

Even years after a disaster, some research has suggested that senior survivors are more likely to develop PTSD and other mental health problems – shown in a study of survivors of a 2008 earthquake in China.

“One of the things that we notice is the emotional frailty of many seniors,” Eichstaedt said, “particularly when they face the unknown.”

The prevalence of PTSD in Alabama, Louisiana and Mississippi rose from 15% a few months after Katrina to 21% a year later, found a 2008 study. In that study, however, the highest increases were seen among those aged 40 to 59.

In addition, older adults face a number of stresses that healthy, able-bodied people might not, such as fear of losing their independence or financial stability, according to FEMA.

For seniors who are also low-income, it’s an “extra level of concern,” said Lisa Marsh Ryerson, president of American Association of Retired Persons Foundation.

Many seniors also deal with social isolation, which has long been flagged as a risk factor for mortality.

Marsh Ryerson, whose foundation launched an initiative last year to combat loneliness and isolation among seniors, said that people don’t always think to reach out to elders in their communities while they’re rushing to prepare for an upcoming disaster.

“Check on your neighbors,” she said. “In times of disasters, or often in everyday living, older adults who are vulnerable can often be invisible, and they may not always ask for the help that they need.”

Follow CNN Health on Facebook and Twitter See the latest news and share your comments with CNN Health on Facebook and Twitter.

Vendetta Craig, whose 87-year-old mother was among the survivors of the Florida nursing home, had some choice words about how the deaths at Hollywood Hills reflected society’s treatment of seniors.

“We throw away our elderly,” she said at a press conference in September. “That’s my mother.”

Output: Recent wildfires in California and hurricanes in Florida, Texas and Puerto Rico have put a spotlight on vulnerable seniors -- including a number of deaths that authorities have said were preventable.


Instruction: create a high quality summary of the given input

Input:
Most ACOs in Next Generation, Pioneer models saved money, earned payments for 2016
 The Next Generation and Pioneer ACO models earned payments for 11 out of 18 health systems participating in Next Generation in 2016 and for six out of eight in Pioneer.

Seven Next Generation ACOs lost money, according to the Centers for Medicare and Medicaid Services. Three had dropped out in 2016 due to financial targets they said were set too high to earn savings.

[Also: ACOs score high on MIPS, but low on payment adjustment]

But three-quarters of Next Generation ACOs in 2016 reaped financial rewards from the risk program, from a low of $272,140 for Steward Integrated Care Network in Massachusetts, to a high of $12 million for Baroma Accountable Care in California.

The results are important because they show that for most, shared risk works, as CMS is currently asking health systems for feedback on existing payment models.

ACOs interviewed in September said they support changes out of CMS's innovation center that would allow for greater flexibility in future models. This was true whether the system made or lost money in current models.

Montefiore has seen success in both Pioneer and Next Gen. The health system's five-year experience has been positive, said Kirstin Mooney, assistant vice president of regulatory and legislative poiicy for Montefiore.

Despite instability in the Affordable Care Act and the move to make bundled payment models voluntary, rather than mandatory, providers interviewed have said they expect the push to value-based care will remain the same. ACOs move health systems in this direction.

But there were also big losers under Next Generation. The largest losses were reported by LifePrint ACO in Delaware, a subsidiary of UnitedHealth Group, which owed $6.1 million, OSF HealthCare in Illinois, which lost $5 million and MemorialCare Regional in California, which also lost $5 million.

[Also: ACOs increasing their participation in downside risk contracts, study says]

OSF began with Pioneer in 2011 earning high quality scores in 2014 before transitioning to Next Generation.

High earners included Iowa Health Accountable Care, at $10.5 million, Triad HealthCare Network in North Carolina at $10.7 million, Trinity Health in Michigan, at $6.5 million and Deaconess Care Integration in Indiana, which earned $5.7 million.

[Also: Medicare Shared Savings ACOs saved $1 billion over 3 years, report says]

In 2017, Next Generation gained an estimated 28 new ACOs, for an estimated 44 health systems taking part.

Next Generation builds on the Medicare Pioneer ACO model, which was in its final year of the program in 2016.

Eight health systems took part in Pioneer in 2016, with six reporting financial savings.

The Banner Health Network in Arizona realized the highest rewards at $10.9 million. Its benchmark of $504 million for 42,040 beneficiaries was met with an actual expenditure of $489 million.

None of the Pioneer ACOs owed money, but the results were financially neutral for Monarch HealthCare in California and Partners HealthCare in Massachusetts. Though both successfully reported quality and their quality scores were 90.25 percent and 94.51 percent, respectively, which were higher than some of the other health systems that earned money.

The Michigan Pioneer ACO had a lower quality score of 88.93 percent and still earned $7.4 million. Michigan performed better than its benchmark expenditure of $232 million for its 14,319 beneficiaries. It's actual expenditures were $220 million.

Monarch's actual expenditures were $264 million compared to its $266 million benchmark, for a savings of $1.5 million, not enough to earn savings.

Partners actual expenditures were also lower than its benchmark - $1.054 billion compared to $1.059 billion, for a savings of $5 million, which was not enough for a payment.

But Allina Health in Minnesota also saved $5 million and earned $3 million in shared savings, from a $268 million benchmark versus $263 million actual.

Atrius Health in Massachusetts earned $6.8 million, Fairview Health Services in Minnesota, $1 million and Montefiore ACO in New York, $7.4 million.

Telehealth benefits allowed in the Next Generation ACOs helped to save them a collective $58 million last year, according to Politico's figures from the CMS Innovation Center.

When including 2016 results from the Pioneer ACO and dialysis models, participants saved Medicare $200 million, with three-quarters of them hitting savings targets, Politico said.

Results for Medicare Shared Savings ACOs, which account for the vast majority of ACOs, will be posted at the end of October, CMS said.

Individual Medicare ACO Aledade and Caravan Health, have already released their results.

In 2016, Aledade in Maryland, saved $9.3 million, with five of its seven ACOs coming in under benchmark and one at benchmark.

Caravan in Missouri achieved $26 million in savings for its 23 ACOs in 2016. ACO participation can increase MACRA performance scores by 20 percent, Caravan said.

Twitter: @SusanJMorse

Email the writer: susan.morse@himssmedia.com

Output: The Next Generation and Pioneer ACO models earned payments for 11 out of 18 health systems participating in Next Generation in 2016 and for six out of eight in Pioneer.


Instruction: create a high quality summary of the given input

Input:
Uber's head of policy for Europe quits to join Chargepoint
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Uber’s head of policy for Europe, Middle East and Africa has quit the company to join electric vehicle charging network firm Chargepoint.

Christopher Burghardt is the latest senior figure to walk out of Uber after Jo Bertram, former regional manager for Northern Europe, left on 2 October.

Mr Burghardt leaves after just one year at the ride-hailing firm and will become managing director for Chargepoint in Europe.

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He said the decision to leave Uber was “a tough choice”, but one he "couldn't turn down".

"Europe is at the point of getting to mass adoption of electric vehicles and Chargepoint is at the forefront of that", he added.

"I remain a great believer in what Uber does and I know our new chief executive has a vision that will take the company into a bright future.”

The ride-hailing firm faces a number of challenges internationally from regulators and lawsuits.

Uber chief executive Dara Khosrowshahi flew into London in October to meet Transport for London chiefs after the regulator refused to renew Uber’s licence in September.

The new chief executive is also dealing with accusations of a company culture rife with sexism under the leadership of his predecessor, Travis Kalanick.

Meanwhile, the company faces a dozen lawsuits and at least five criminal investigations in the US, two more than previously reported, according to Bloomberg.

Output: Ride-hailing platform Uber has been hit by the loss of another senior executive as it faces growing challenges to its business. Christopher Burghardt, the company's head of policy for Europe, the Middle East and Africa, has left to head up electric vehicle power company Chargepoint. His departure comes shortly after that of Jo Bertram, who had been regional manager for northern Europe. Uber's new CEO Dara Khosrowshahi recently met transport regulators in London after they denied a renewal of the company's licence to operate in the UK capital.


Instruction: create a high quality summary of the given input

Input:
Making Time to Really Listen to Your Patients
 Hurried health care incurs hidden costs and offers false economy: Not taking the time to listen to and understand the patient harms both the patient and the clinician, who won’t have the benefit of pooled knowledge, ability to make fully informed mutual decisions, or time to build trust. The authors offer six steps health care organizations might take to reshape their cultures and learn not only what’s wrong with their patients, but what matters to them.

Modern medicine’s true healing potential depends on a resource that is being systematically depleted: the time and capacity to truly listen to patients, hear their stories, and learn not only what’s the matter with them but also what matters to them. Some health professionals claim that workload and other factors have compressed medical encounters to a point that genuine conversation with patients is no longer possible or practical. We disagree.

Our experiences — as a critical-care physician whose own critical illness led her to train physicians in relationship-centered communication (Rana Awdish) and as a health services researcher who has interviewed and observed hundreds of patients, doctors, and nurses (Len Berry) — teach us that hurried care incurs hidden costs and offers false economy. In other words, it might save money in the short term but wastes money over time.

Why Listening Matters

Actively listening to patients conveys respect for their self-knowledge and builds trust. It allows physicians to assume the role of the trusted intermediary who not only provides relevant medical knowledge but also translates it into options in line with patients’ own stated values and priorities. It is only through shared knowledge, transmitted in both directions, that physicians and patients can co-create an authentic, viable care plan.

A doctor’s medical toolbox and supply of best-practice guidelines, ample as they are, do not address a patient’s fears, grief over a diagnosis, practical issues of access to care, or reliability of their social support system. Overlooking these realities is perilous, both for the patient’s well-being and for efficient delivery of care. We believe not only that a clinician should share medical decision making with the patient but also that it must occur in the context of an authentic relationship.

The Costs of Hurried Encounters

Compressed medicine has real risks. Clinicians become more likely to provide ineffective or undesired treatment and miss pertinent information that would have altered the treatment plan and are often blind to patients’ lack of understanding. All of this serves to diminish the joy of serving patients, thereby contributing to high rates of physician burnout. These consequences have clear human and financial costs.

The medical literature increasingly offers potential solutions to the inefficiencies that rob patients of physicians’ time and attention, including delegating lower-expertise tasks to non-physician team members, improving the design of the electronic health system, and greatly reducing the paperwork bureaucracy that adds little or no value. We can create more space for active listening. Unhurried medical care may be elusive, but it is practical.

Reimagining Roles

Beyond time pressures, the typically unquestioned roles that physicians and patients assume also inhibit relationship-building. In their medical training, physicians often are taught to maintain a clinical distance and an even temperament. They are warned not to get too close to patients, lest they internalize the suffering and shoulder it themselves. The best physicians, we know, reject this advice because it diminishes their humanity and disadvantages their patients, who need more than a highly-qualified body technician, especially when they’re seriously ill.

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Patients learn roles, too: adhere to the doctor’s plan, squelch errant thoughts that might sound foolish, don’t ask too many questions, defer to the expert, be “a good patient.” In a new article we co-authored with others, we show that many patients, especially those with serious disease, behave like hostages in the presence of physicians — unwilling to challenge authority, understating their concerns, requesting less than they desire. Most physicians certainly don’t want patients to feel like hostages, but the patients often do. When patients feel like hostages, the ideal of shared decision making is a pipe dream.

It’s no wonder, then, that for patients with serious illness, the emotion they most often cite is “overwhelmed.” The diagnosis, the options, the treatment, the myriad side effects, the change in identity when living with disease — all of it can indeed be overwhelming. In this complex, fraught situation, people need a compassionate guide — a wise, comforting sherpa who knows the mountain, the risks of various routes, the viable contingency plans. The physician-sherpa should be a partner on the journey, not simply a medical operative, extracting formulaic rules and implements from a toolbox. Patients need and deserve much more.

When doctor and patient join forces, the team dynamic dismantles the harmful hierarchy. Both members of the dyad can rely on each other because neither owns all the data that matter. Speaking at a White Coat ceremony for medical students, Dr. Rita Charon, a pioneer in the rising discipline of narrative medicine, stated:

I used to ask new patients a million questions about their health, their symptoms, their diet and exercise, their previous illnesses or surgeries. I don’t do that anymore. I find it more useful to offer my presence to patients and invite them to tell me what they think I should know about their situation.…I sit there in front of the patient, sitting on my hands so as not to write during the patient’s account, the better to grant attention to the story, probably with my mouth open in amazement at the unerring privilege of hearing another put into words — seamlessly, freely, in whatever form is chosen — what I need to know about him or her.

An Organization that Listens and Heals

Not hearing the patient’s voice harms the patient and the clinician. They don’t have the benefit of pooled knowledge, ability to make fully informed mutual decisions, or time to build trust. Health systems that want to avoid those pitfalls need leaders who invest in shaping an organizational culture that values hearing patients’ voices. Here are some steps such organizations might take:

Share patient stories and related lessons at every meeting. Perhaps one should be a story of success (what we did well for a patient) and another of a failure (where we must improve).

Offer a communications curriculum to clinical and non-clinical staff. The professional development should be engaging and dynamic so that adult learners seek it out because they view it as worthwhile.

Encourage and reward clinical curiosity, whereby generous questions are asked to elicit generous patient responses. Emphasize listening for not just what is said, but also how it is communicated. Consider a narrative-medicine component.

Convene patient advisory boards that meet regularly with practice leaders to convey concerns and make suggestions about improving patients’ experiences.

Use multiple methods to identify and systematically address impediments in clinicians’ daily work — the “pebbles in the shoes.” Examples include rounds, conducted by senior leaders, with both staff and patients; staff focus groups and anonymous surveys; and CEO feedback meetings with small groups who speak openly about what prevents them from delivering better care.

Create a balanced scorecard of physician performance that tracks not only productivity but also professional development, team building, safety and quality metrics, timeliness of care or access, communication skills, and care coordination — measures that matter to patients.

A Way Forward

Medicine is constantly evolving as new ways to treat, heal, and even cure emerge. We must continually reflect on the changes, and correct the course as needed. This work cannot happen in a vacuum of forced efficiency. Physicians, patients, and administrators all must maintain and build on what is sacred and soulful in clinical practice. We must listen generously so that we nurture authentic, bidirectional relationships that give clinicians and patients a sense of mutual purpose that no best-practice guideline or algorithm could ever hope to achieve.

Output: Modern medicine’s true healing potential depends on a resource that is being systematically depleted: the time and capacity to truly listen to patients, hear their stories, and learn not only what’s the matter with them but also what matters to them. Some health professionals claim that workload and other factors have compressed medical encounters to a point that genuine conversation with patients is no longer possible or practical. We disagree.


Instruction: create a high quality summary of the given input

Input:
MIT: Innovative Designs Will Soon Transform Aging in Place
 In a bizarre and developing story, as many as 80,000 patients in Canada may have had detailed medical, financial and personal records stolen by a hacker group after it infiltrated the computer systems of home care services provider CarePartners.

Ontario-based CarePartners, which has provided government-sponsored personal, rehabilitation and nursing care services to hundreds of thousands of patients over the years, announced the breach in June. At the time, the home care provider and cyberattack victim claimed “sophisticated actors” had “inappropriately” gained access to and held information pertaining to the personal health and finances of its patients and employees.

To determine the full extent of the breach, CarePartners announced it had retained the services of cybersecurity firm Herjavec Group.

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Now, about a month after the initial cyberattack, CBC News is uncovering additional details—with the help of the hackers.

According to a CBC News report, a group claiming responsibility for the breach reached out to the news outlet and provided a sample of the data it had allegedly accessed.

The sampled data reportedly included thousands of patient medical records with phone numbers, addresses, dates of birth and health care numbers. The data included extensive medical histories, CBC News reported, complete with information on conditions, diagnoses, surgical procedures, care plans and medications prescribed.

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The sampled data also reportedly shows that more than 140 active patient credit card numbers, expiration dates and security codes had been stolen.

Overall, the data appears to contain names and contact information for more than 80,000 patients in total, according to CBC News, though the hacker group says the breach was actually far larger in scope.

“This data breach affects hundreds of thousands of Canadians and was completely avoidable,” the group told CBC News. “None of the data we have was encrypted.”

The news outlet contacted 10 patients whose records were included in the provided sample and confirmed that they had been patients of CarePartners. All 10 patients said they had not been directly notified by the home care provider and were unaware there had even been a breach.

“We are concerned that the cyber-attackers may be using the CBC to further their own extortion agenda,” CarePartners said in a statement published by CBC News in its report. “It is a common strategy of cyber-attackers to contact media in an effort to embarrass and shame their victims.”

Besides stealing patient data, the hacker group says it is holding the stolen information for ransom.

“We requested compensation in exchange for telling them how to fix their security issues and for us to not leak data online,” it said.

The cyberattack is being investigated by the Office of the Information and Privacy Commissioner of Ontario.

The CarePartners hack is not the first time in-home care providers have had their networks compromised.

In 2015, Amedisys, Inc. (Nasdaq: AMED) notified state and federal agencies—as well as 6,909 individuals—that personal information was possibly subject to a data breach. The incident was linked to missing encrypted computers and laptops belonging to former employees.

Cybersecurity attacks and health plans

U.S. health plans have reported 24 breaches so far in 2018, compared to 15 during the same period in 2017, representing a 60% increase in the number of entities impacted, according to Fortified Health Security’s 2018 Mid-Year Report.

The total number of patients impacted by those breaches increased by more than 1,000%. Of the health plans impacted by a breach thus far in 2018, 38% were either state or city-affiliated health plans.

The 24 identified breaches have affected more than 884,000 individuals.

Fortified Health is a Tennessee-based cybersecurity firm.

Written by Robert Holly

Output: The rising number of aging Americans is likely to drive transformation in how seniors age in place, from technology advances to real estate designs, according to a recent report from the Massachusetts Institute of Technology (MIT) Center for Real Estate.