Obama's health reform push seen buoying health IT

• Reuters, Wednesday November 26 2008

By Debra Sherman and Lewis Krauskopf

CHICAGO/NEW YORK, Nov 26 (Reuters) - A wealth of small companies focused on information technology may be poised to benefit should the U.S. government make good on vows to run the U.S. healthcare system more efficiently.

U.S. President-elect Barack Obama reiterated his commitment at a news conference on Tuesday to increasing investments in the healthcare system as a way to save costs in the long term.

Obama cited as an example the government's role in helping local hospitals and providers set up electronic billing and medical records.

Such words could be music to the ears of small companies that specialize in improving and automating systems, services, and record-keeping in hospitals and doctors' offices.

The industry has been talking about electronic medical records for years, but the divide among political parties has been partly to blame for minimal progress, said Ira Loss, a policy analyst with Washington Analysis.

"There was no leverage to get things done," Loss said. "It may be different now. I think we're going to have a president who is more engaged in this area. He believes in it."

JP Morgan analyst Ipsita Smolinski said a likely first step the new administration would take toward increasing the use of electronic medical records would be to require them for claims under Medicare, the large government health insurance program for the elderly.

"That could happen within the first year (of the new administration)," Smolinski said. "It would have a ripple effect."

Stifel Nicolaus analyst Todd Weller said Obama's administration would likely boost the healthcare IT sector, although he cautioned investors against thinking Obama's election would be a quick windfall for these companies.

"We view it as ... another positive catalyst behind a secular trend of more adoption of health IT; but I don't think it's real prudent to go out and invest in these stocks under an assumption that all of a sudden in 2009 their business is going to accelerate in a big way," Weller said.

"You're going to see doctors and hospitals increasingly adopt technology and automate just like every other industry has done," Weller said.

Analysts said potential beneficiaries from a health IT push would be those focused on establishing electronic medical records in physicians' offices, as well as on billing software and other administrative tasks. Among them are Allscripts-Sisys Healthcare Solutions Inc, Athenahealth Inc, and Quality Systems Inc.

Physicians have been reluctant to spend money on major IT systems, analysts said.

"What we need are more carrots and sticks out there," said Richard Close, managing director of equity research at Jefferies & Co. "Obama could develop grants and enable physicians to access funds to develop systems ... It sounds as though it's a high priority."

Hospital-centered IT companies that could benefit include Cerner Corp, MedAssets Inc, Computer Programs and Systems Inc and Eclipsys Corp. Large pharmaceutical wholesaler McKesson Corp also has a substantial IT business.

Adoption of healthcare IT has lagged in smaller rural hospitals which lack the money to invest compared with larger urban hospitals, Stifel Nicolaus' Weller said. He said there has been an increase in state and federal grants to these hospitals in the past year to finance such purchases.

"I would look for a push to help smaller rural hospitals come up to speed on health IT," Weller said.

Large technology companies are also angling to be involved in healthcare, including Intel Corp, which introduced health monitoring systems to connect patients with clinicians, and Google Inc and Microsoft Corp, which are trying to drive greater penetration of electronic medical records.

Loss, of Washington Analysis, said the government has failed to come up with uniform standards that would ease the way for electronic medical records.

"The first thing that has to happen is ... they have to make one system talk to the other," Loss said.

Analysts cautioned that the timing remains unclear for any new requirements that could lead to greater IT investments. Healthcare reforms may take a backseat as Obama focuses on the weak overall economy.

"It won't be like turning on a faucet full blast," Close said. "I suspect it will take a little while, maybe a year or two." (Editing by Gerald E. McCormick)

Tata to commercialise healthcare portal

  Johannesburg, 27 November 2008 ] - Tata to commercialise healthcare portal

Tata Consultancy Services (TCS), an Indian IT services company, plans to commercialise its WebHealthCentre, an online portal for medical consultations, healthcare information and telemedicine, says PCWorld.

The WebHealthCentre site was set up by TCS in 2000 as part of fulfilling its corporate social responsibility. The site was started to offer patients in rural areas access to specialist doctors.

Using the analogy of Google's YouTube, Debashis Ghosh, VP and head of TCS life sciences and healthcare practice, said having set up WebHealthCentre and making it popular, TCS is exploring a number of revenue streams, including offering new services such as electronic medical records facilities through the site.

Merge offers Web solutions

Merge Healthcare, a medical imaging solutions provider, has unveiled two Web applications, Cedara WebAccess and Cedara WebScheduler, available through its OEM division, says Market Watch.

These solutions give health IT software providers plug-in portals that help expedite and automate tasks such as patient and resource scheduling, and image and information distribution.

Cedara WebAccess is a thin-client viewer, which provides technology for Web distribution of radiology images and reports to the referring physician community and beyond. Cedara WebScheduler helps health IT application developers that add centralised capabilities for managing and scheduling imaging resources.

Internet service keeps families informed

Connect4Healthcare is offering an Internet service that enables long-term care providers to give families regular proactive wellness updates through a secure Web page, e-mail or text message, says Market Watch.

The solution addresses the problems for families of the more than 3.8 million people in the US living in nursing homes, assisted living facilities or receiving home care as they struggle to stay up-to-date with the well-being and needs of their loved ones.

The company is introducing its service to long-term care providers, but plans to begin marketing directly to consumers early next year.

Your Data becomes their Data becomes Extortion Attempt

zogger

Sat Nov 08 15:47:00 -0800 2008

Security.

manage

Another example of databases gone lacking for security. This one involves a prescription writing service that some badguys are trying to extort money from. They threaten to disclose personal customer data unless the company pays up, which they haven't, they have taken it to the feds instead.

St. Louis-based Express Scripts said Thursday that in early October it received a letter that included the names, birth dates, Social Security numbers and, in some cases, prescription data on 75 of its customers. The authors threatened to expose millions of consumer records if the company declined to pay up, Express Scripts said in a statement. ed.z.: Here's a thought..stop giving your social security number out to every dipsquat corporation that asks for it. I say no all the time, just slap refuse. They put up a stink, I say, "give me a written and signed by some officer here indemnification guarantee, that if you lose my data or it is stolen, I am paid x-amount of serious dollars" along those lines. That's *my* data, it ain't *your* data just because you happen to own a hard drive and want something to stick on there because I am hiring you for some service or you are selling me something. Because inevitably the first thing out of their pieholes is how they are "secure" and blah blah and it is their "policy" and nonsense blah blah. Demand they prove that statement with a written indemnification policy, just turn it around on them, talk is cheap, written contracts are what matter.

Every single dad burn company out there claims they are "secure". Uh huh, that's a lot of truthiness..not. Go by a default every single one of them is already compromised, then see how you feel about handing over *your* data that somehow magically becomes *their* data to be lost, stolen, traded, used and abused.

We see these security compromises all the time, and it wouldn't amount to much at all if people stopped handing over everything they are asked for and stuck to their guns past the initial shock period of saying "no" to the clerk/receptionist and they don't know what to do then. Deer in th headlights time when yoiu say no, so you have to nudge them a little, use your best Bene Geserit action. Just be polite, say that "I'm sorry, this isn't necessary, and.." whatever, wing it. (and in a lot of cases it isn't even a legal requirement for the service or product you are trying to get, check with your bartender or barber for more exact legal advice in your jurisdiction..or at least google it) because Social Security is for employment and taxing purposes, and bank account records because they are required by uncah sam, and that's about it. If they squawk, get their manager, or ask to speak to the company lawyer, and demand to see their data security breach indemnification policy. Boy, that gets 'em. Shuts 'em right the heck up, because it don't exist, not as regards YOU anyway, it might exist for some dotgov agency, but that means absolutely nothing to YOU the potential victim. Worked for me any number of times since I started that policy of saying no. I got nailed with ID theft years ago-pre being on the internet at all- and it was a serious PITA getting it cleared up, some of it never was really. Sucks. Since then, I got a new attitude of saying "no" because they will hang you out to dry if they get compromised. And I am unaware of any medical procedure or drug that requires your age down to the exact day for that matter, the nearest year once you are an adult is sufficient.

If you don't care about your data integrity, imagine how much less some other person/corporation cares when you are just some big number in an even larger set of numbers. Oh, they may or may not even inform you if they get pwned, how quaint. Didja catch that little bit in the article about how some "financial services" are paying off the extortionists now? Security is always in layers, and it starts with you.

November 2, 2008 Union Yes? Pharmacists fill prescriptions, educate patients and sometimes carry union cards. How might that play out in Boone County? By John Russell john.russell@indystar.com With their white coats and six-figure salaries, pharmacists might seem like an unlikely group of card-carrying union members. But around the country, 15,000 pharmacists, or about 6 percent of the U.S. total, belong to the Steelworkers, Teamsters and other unions, joining ranks with blue- collar workers who smelt aluminum, build tires and drive beer trucks. Most of the unionized pharmacists work in big industrial markets such as Pittsburgh and Chicago, along with smaller cities, such as Tampa, Fla., and Gary, Ind. No union pharmacists work in Central Indiana, according to the Indiana Pharmacists Alliance, a statewide trade group. But that could change. The United Steelworkers union is keeping a close eye on a massive mail-order pharmacy springing up in Boone County. The $150 million distribution center, being built by Medco Health Systems, will cover an area the size of six football fields when it opens next year. It eventually will employ 1,300 people, including hundreds of pharmacists and pharmacy technicians who may need help negotiating contracts and addressing grievances. "We do represent other Medco pharmacies, and we would seek to address representation issues with Medco at that new facility," said Maria Somma, international organizing coordinator with the Steelworkers' Health Care Workers Council in Pittsburgh. The Steelworkers union represents more than 5,500 Medco workers, including pharmacists in Florida, Texas and Pennsylvania and pharmacy support workers in Nevada, New Jersey and Ohio. The union, better known for organizing workers at steel mills, said it has represented health-care workers for more than 50 years, including hourly workers in hospitals, pharmacies, mental health centers, drug factories and medical offices. But following the loss of tens of thousands of steel jobs as one massive mill after another has closed, the union is pushing aggressively to expand its reach in health care. It's too early to say whether the union will find a receptive ear with pharmacists here, or whether it will face stiff resistance from Medco, the nation's largest mail-order pharmacy. The company said employees are free to join unions if they wish, following the established legal procedure. "Medco values all of its employees, regardless of their union representation status," spokeswoman Ann Smith said. But the union and company have a rocky past. Two years ago, Medco locked out more than 500 pharmacy tech workers at its Las Vegas mail-order center in a bargaining dispute, replacing them with uncertified temporary workers. During that time, the union called for the Nevada Board of Pharmacy to investigate the company's practices and suspend its license. The two sides settled their differences a few weeks later. So why would a pharmacist, who typically holds a doctoral degree and makes more than $100,000 a year, want to join a union in the first place? "When I tell people I'm a pharmacist and I belong to a union, they kind of give me a blank stare, because they cannot put the two together," said Tom Hanson, a staff pharmacist at Walgreens in Chicago. But unions, he said, have helped pharmacists -- who are on their feet all day and under pressure to fill prescriptions quickly -- win a raft of better working conditions, such as getting every other weekend off, avoiding 14-hour shifts, and the right to bid on store locations and vacation schedules. "Because we have a contract in place, we're treated fairly," said Hanson, a pharmacist for 32 years and president of Local 1969 of the United Steelworkers/ National Pharmacists Association. Leo Hans, a pharmacist at a Medco facility in Tampa, Fla., said his union has helped give his colleagues a stronger voice and better hours. Hans, for example, works 6:30 a.m. to 3 p.m., Monday through Friday, hours that are almost unheard of in the industry. "It's great for me," said Hans, president of Local 991 of the Steelworkers union. "When you work in retail, it's usually crazy hours, working on weekends, overnight, stuff like that." In some markets, pharmacists are turning to organized labor to help fight back against drug chains, which monitor how quickly pharmacists fill prescriptions. "If you are filling prescriptions fast enough, a green light appears on the computer screen. If you fall behind, a red light appears," according to a newsletter from Steelworkers Local 1969 in Chicago. "Records are kept and the red-light (pharmacists) are deemed incompetent because they are too slow." That pressure, some say, cuts back on the amount of time pharmacists can talk to patients about drug interactions, side effects and other important health issues. "I probably get four or five calls a month from retail pharmacists who say, 'Help me. I can't be the professional I was trained to be,' " said Somma at the Steelworkers union. Medco, one of the nation's largest pharmacies, dispenses about 550 million prescriptions a year, many of them from a network of highly automated mail-in distribution centers. The company boasts of its speed, efficiency and technology. Its 2007 annual report says its distribution centers help "maximize the efficiency of the dispensing function." Medco's newest center, under construction at the AllPoints industrial project at Anson, west of Zionsville, will be its largest, with the capacity to dispense more than 1 million prescriptions a week. Pharmacists will oversee all dispensing, from scanned-in prescriptions from around the country. The automated centers are springing up, in part, to help alleviate the stress caused by a national shortage of pharmacists, the result of a surge of retirements, a flurry of hospital and drugstore expansions, an aging population and an increased number of prescriptions written. The Pharmacy Manpower Project predicts a national shortage of 157,000 pharmacists by 2020. Some experts, however, point out that pharmacists still are expected to fill prescriptions quickly and accurately. "No question, there's a lot more pressure on pharmacists and their staff to dispense prescriptions quickly," said David Zgarrick, chair of the pharmacy practice department at Drake University in Des Moines, Iowa. But whether that pressure will prompt pharmacists to join a union remains an open question. Some say they have no desire to do so because that could diminish their professional status. "I'm not sure what benefit it brings to me as a professional," said Kelley Viola, a staff pharmacist at Meridian North Pharmacy. "If a pharmacist has too much pressure to crank out pills by the hundreds in any given day, they need to stand up and push back. You can't compromise your license and your ability to serve your patients."

Healthy debate on electronic health records

By Steve Johnson

Mercury News
Article Launched: 10/31/2008 07:00:00 PM PDT

Backed by both presidential candidates, Silicon Valley tech giants and
other companies are leading an effort to create electronic health
records containing data about your most intimate health conditions —
from your bunions and bad back to your chronic hemorrhoids and
psychiatric history — so the information can be easily shared with
doctors, insurers and others.

Proponents of electronic health records believe they can dramatically
cut medical costs and lessen the likelihood of patients being
improperly treated. As a result, voluntary programs to test the
concept recently have been launched by major corporations, from
Silicon Valley tech titans Google and Intel to Microsoft.

But despite assurances the records will be kept confidential and
patients will control who sees them, consumer advocates fear the trend
will lead to widespread privacy violations and relentless marketing by
hucksters misusing the data.

"Increasingly, consumers will be receiving an array of pitches and
promotions and product offerings based on very sophisticated
analytical assessments of their health information," said Jeff
Chester, executive director of the Center for Digital Democracy. "This
is an area rife with problems."

Saying the paper records used by most doctors are inefficient, waste
money and make it hard for health professionals to exchange vital
information about patients, President Bush in 2004 ordered the federal
government to begin planning
for the nationwide adoption of electronic health records. And that
goal is being enthusiastically pushed by his would-be successors.

Computerizing such records makes sense "instead of you filling out
forms in triplicate when you go to the hospital, that will reduce
medical errors and reduce costs," said Barack Obama during the
candidate's second debate Oct. 7.

"Let's put health records online," replied John McCain.

Major corporations are promoting the concept, as well.

In May, Google set up an area on its Web site, dubbed Google Health,
where people can place their health records and share the information
with doctors and others. Patients now can exchange health data with
only a few doctors participating with Google Health, but Google plans
to broaden its record-sharing features.

Not to be outdone, Microsoft in June announced a deal to let Kaiser
Permanente's 159,000 employees store their medical data on Microsoft's
HealthVault site. Late last month, Microsoft unveiled a similar
arrangement for patients covered by insurer Aetna.

In addition, Santa Clara computer-chip maker Intel has teamed with
several large companies, including Applied Materials, Wal-Mart and
Pitney Bowes, to create an independent Web-based entity, called
Dossia, where the companies' employees can manage their health data.

The services are free for patients and the companies involved insist
they're not in it for the money.

"None of us are approaching this because we think we can create a new
product line," said Colin Evans, an Intel manager who is Dossia's
chief executive, insisting Intel's interest is to help improve its
workers' health.

"Most doctors keep their data on paper. That's dangerous. If doctors
can't exchange information or have an incomplete view of the patients
because they don't have the records," he said, it can have serious
consequences and has even led to some patients' deaths.

As Microsoft has promised, Google won't pepper patients with unwanted
ads, said Dr. Roni Zeiger, product manager for Google Health. Instead,
he added, the Internet search giant believes it can benefit indirectly
by providing a vital consumer service.

"We think that when people are signed in to applications they trust
and appreciate, they will tend to use other Google products,"
including Google's main search site, which does have ads.

So far, just 13 percent of U.S. doctors use some computerized records
and 4 percent do so extensively, according to a New England Journal of
Medicine national survey of nearly 3,000 physicians in July. But if
the adoption of such records becomes widespread, it could open up a
huge business opportunity. Research firm Kalorama Information
estimates the annual market for products related to such systems could
hit $4 billion by 2015.

Much of the equipment needed to link the network would have to be
powered by computer chips, for example, a potential big plus for
Intel. Google also might be able to charge businesses such as
weight-loss services to put their nutritional or other medical tips on
Google Health, said Andrew Rocklin, a health expert at Diamond
Management & Technology Consultants in Chicago.

But the concept has run into resistance.

Of 1,003 Americans surveyed two years ago by the New York-based Markle
Foundation, which promotes new communication technologies, 77 percent
suspected their information could get into the hands of marketers and
80 percent feared they could be exposed to identify theft and fraud.

Those worries are warranted, consumer advocates say. "One of the
ongoing concerns I think with both Microsoft and Google is these
business models are constantly in flux," said Marc Rotenberg,
executive director of the Electronic Privacy Information Center in
Washington. "They may say today there is no advertising. Once they are
in possession of the medical data, they can change the business
model."

Recent medical-data breaches also have contributed to the misgivings.
In April, federal prosecutors in New York charged a former hospital
employee with improperly accessing nearly 50,000 computerized health
records of patients so he could sell the information to others.

Contact Steve Johnson at sjohnson@mercurynews.com or (408) 920-5043.

Google Health Launches Non-Profit Patient Assistance Web Site

November 03, 2008

by Becky Jacoby, Reporter

Information on thousands of patient assistance programs can be found online at PatientAssistant.com, Inc. (PatientAssistant), a new nonprofit organization and integrated service launched by Google Health.

A patient assistance program is a service offered by pharmaceutical companies to help low-income, underinsured or uninsured individuals or families procure medications for free or low cost. Based on medications listed in the patient's Google Health profile, the application facilitates a search for eligible patient assistant drug programs. PatientAssistant helps users to identify affordable pricing, thus saving money on the prescription drugs that they need.

"The more medications a patient is required to take, the longer and more difficult it can become for them to find patience assistance programs that meet all of their needs," stated Rex Bowden, President, PatienceAssistance.com, Inc. "Our new integrated service on the Google Health platform is designed to make that process much easier by allowing users to search for programs on multiple medications at once, while using existing information to save time in searching for eligible programs that meet all, or most, of the patient's needs," he said.

How does Google Health work? Users create a Google account, register their medical records and health information then log in to www.google.com/health and "Explore Online Health Services." A walk-through of the program's features is available prior to sign-up.

PatientAssistant also shows users the costs of their prescriptions within their geographic area. It also offers related tools such as the ability to send reminders to patients to submit enrollment forms.

Aetna Teams Up With Microsoft For Health Records Storage

Submitted by Piyush Diwan on Thu, 10/23/2008 - 08:13.

• Featured
• Health News
• TNM
• United States

In a first of its kind, health insurer Aetna Inc. teaming up with Microsoft Corp. is offering clients medical record storage, allowing them to access the Internet-based vault, even if they change jobs or replace their health plan for another.  According to Wall Street Journal, beginning next month, all Aetna clients will be able to transfer information from their Aetna 'personal health record', an online repository of data, such as, claims, diagnoses, test results and prescriptions, to HealthVault.  Patients will be allowed to choose what they want to transfer between Aetna and Microsoft.

A recent trend, of late, several firms like Google Inc., have created web sites that allow people to store health information e.g. doctors, hospitals and pharmacy records at one place.  Not to be left behind, even IBM and Duke University have set up a web site, specifically for allowing people to pay medical bills, schedule doctor appointments and store medical records, amongst other things.

The customer retains total control over access of his /her health data, including information that can be seen.  No one, not even doctors or care providers, not even Microsoft officials can access the information, unless and until they have been permitted to do so by the patient.  A highly advantageous system, it not only gives clients continued access, but also helps improve communication with care and service providers.

Launched just about a year ago, Microsoft's free HealthVault has about 40 firms that currently allow customers to store information on it, including hospitals and CVS Caremark's Minute Clinic.  A cost effective measure for both the insurer and its customers, Health Vault is not only free, it will also help the insurer save tens of thousands of dollars it currently spends on answering benefit queries over the phone.  As soon as, the electronic personal health records of 6-million Aetna customers transfer online, there will be little need to pick up the phone.

	THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING

Subjects' DNA secrets to be revealed Web postings may boost research By Carey Goldberg, Globe Staff  |  October 20, 2008 The human ability to let it all hang out is about to reach a whole new level. Ten genome-era explorers assembled by a Harvard Medical School genetics professor are expected to announce today that they will post their medical records and the DNA sequence of about one-fifth of their genes on the Web for all to see. The 10 include the genetics professor himself, George Church; Harvard psychology professor Steven Pinker; and technology investor Esther Dyson - and they are leading the way for a hoped-for crowd. In April, Church's "Personal Genome Project" received approval from the university's ethical review board to sequence and post the genes and records of 100,000 willing subjects. The project aims to advance genome research by tapping volunteers who have a Facebook-mentality sense of privacy - minimal - and enough excitement about genomic science that they are willing to lay out their genetic and medical information so any researcher can sift through it for links between genes and traits.  (Personally I would like to be able to recognize the DNA of the Facebook mentality.) "There's a hope that by making these data public, you can harness crowd-sourcing power in the same way that Wikipedia and YouTube and Google and Linux all emerged from cooperative, distributed efforts," Pinker said. The project's approach - its sense that genetic self-disclosure is not necessarily scary - contrasts sharply with the concerns about genetic privacy that recently prompted Congress to pass the Genetic Information Non-Discrimination Act, which bars insurers or employers from holding people's genes against them. Personal Genome Project participants voluntarily relinquish their genetic privacy for the sake of research - and out of curiosity about what will emerge. The idea, Church said, is that researchers need to explore how genes and environment interact to produce everything from disease to personality, and for that, they need both faster, cheaper DNA sequencing and great databanks of people's characteristics. "As far as I know," he said, "this is the first time an attempt has been made to put a collection of all those together in a way that anyone can access it." Interviewed by phone last week, several of the project's participants said they were committed to disclosing their gene information, even though they will have a last-minute chance to decline. They plan to talk about their results and decisions at a press conference this afternoon. They said they believed deeply in others' rights to genetic privacy, but they had good reasons to let go of theirs, and had the luxury of holding positions in life that left them unworried about potential discrimination. ( Thieves very rarely discriminate against individuals of position, when they choose to steal their identities. ) "I'm a physician and a chief information officer, and I believe in the rich tradition of self-experimentation," said Dr. John Halamka of Beth Israel Deaconess Medical Center. "What we have to learn as a society is: What does this data show, how do we use it, how do we protect it, what are the pitfalls?" Halamka got his initial results yesterday, and said they suggested he could be at heightened risk for several diseases that have not in fact affected him, including a paralyzing neurological disease and tuberculosis. He also carries a single mutation that, if a person has two of them, doubles the risk of prostate cancer. So "today's disclosure changes the way, for the rest of my life, I relate to doctors in that if I have a change in PSA [Prostate Specific Antigen] or prostate exam, I'll be much more likely to follow it up. Doctors can be the worst patients." Halamka had a preparatory talk with his 16-year-old daughter, he said, telling her that his genes would be posted publicly and reminding her that half of her genes came from him. A future suitor of hers, he said, "could look at my data on the Web and say, 'You know, I just don't think this is a suitable life mate because look at the risk for this and the risk for that.' And her response was very mature, which was, 'If a prospective boyfriend evaluated me based on your genome, I wouldn't want him as a boyfriend anyway!' " Along similar lines, Rosalynn Gill, a founder of Sciona, a Colorado-based personal genetics company, said that part of her motivation for baring her genes was to make the point that "it's not just your genes that determine who you are." The project at this point, Church said, has sequenced only about 20 percent of the participants' genome regions that instruct cells how to make proteins, the tiny machines that make the body run. But it will ultimately scan all their genes, he said, and at a cost of $1,000 or $2,000 per person. It would be hard to calculate the sequencing cost for current volunteers, Church said, because the technology is still in the development stage. Attaining a "$1,000 genome" is the focus of hot competition in the DNA technology field, and Church co-founded a Cambridge company, Knome Inc., that offers to sequence a person's complete genome for $350,000. Many predict the $1,000 genome will be possible within a few years. Personal genome companies that already offer consumers data on hundreds of genes of interest currently charge about $1,000 or less, but they examine only myriad small chunks of their customers' genomes.  There may be significant downsides to posting your genetic data on the Web, said Dr. David Altshuler, a leading genomics researcher at the Broad Institute and Massachusetts General Hospital. Would you really want your DNA and medical records to come up when a date or prospective employer Googles you? What if, in the future, an enemy can synthesize your DNA and plant it at a crime scene? But Altshuler said he welcomed the public debate that the Personal Genome Project will surely spark. "The project is forcing a societal discussion of what it would mean to put up your data - what uses it could be put to, and what limits it would have, and that's a very useful discussion to have," he said. To see the postings: http://www.personalgenomes.org Carey Goldberg can be reached at goldberg@globe.com.

© Copyright 2008 The New York Times Company
 

Remember when it is on the web, it is there forever. 
And there is no guarantee of security for your identity.

This free offer may be the most expensive choice you make in your entire life.

---

October 12, 2008

Novelties

Keeping Your Own Health Chart, Online

By ANNE EISENBERG

BUSY people can easily forget to take their medications, or to write down symptoms or reactions during a course of treatment — information that could later be meaningful to a doctor.

New tools are being developed that may help harried patients, including those with chronic health conditions, monitor their medications, home tests and other details. The information can then be posted to a Web page that the patient can choose to share with a doctor, pharmacist, friend or caregiver.

Zume Life, of San Jose, Calif., for example, is testing a small hand-held device, the Zuri, that prompts users to take their pills on schedule and to keep track of health-related matters like diet and exercise.

"We're going after users who are mobile, social, active people" who need to follow a health routine in the midst of busy lives, said Rajiv Mehta, the chief executive of Zume Life.

All of the data from this pocket-size electronic minder, which beeps or flashes when it's time to take a pill, are uploaded to a Web portal. There, users can inspect, for example, graphs or charts of their exercise or other activities of the last few days or week. And, if the users wish, a caregiver can do so, too.

The Zuri will cost about $200 when it is released in the spring, Mr. Mehta said. Users will also pay about $40 to $50 a month for Web services. A software version of the device that will run on an iPhone is also in the works.

Kathleen Weaver, a high school teacher of computer science in the Dallas Independent School District, is testing a Zuri, using it to keep track of symptoms as well as medication related to diabetes, cardiovascular complications and a persistent cough.

"If I had to write all of this down, I don't think I could," she said. "I'm busy all day taking care of other people."

People who are monitoring their health at home may also take advantage of new online data-storage services being developed by Google, Microsoft and other companies. HealthVault (www.healthvault.com) by Microsoft lets users upload data directly to their account from about 50 devices, including many blood pressure and heart rate monitors, blood glucose meters and weight scales, said Sean Nolan, a computer scientist and chief architect of the Microsoft Health Solutions Group in Redmond, Wash.

Owners of the account can then share the data with, say, a nurse or case manager who is tracking how they are responding to a new medication. They can also share information with compatible applications — for example, a free blood pressure manager program from the American Heart Association (www.americanheart.org).

The number of applications that can exchange information with HealthVault is growing, Mr. Nolan said. NoMoreClipboard (www.nomoreclipboard.com), for instance, can draw data from HealthVault to fill in information in medical forms typically required for an initial visit to a doctor. (The basic service is free.)

TrialX (www.Trialx.org) matches patients to relevant clinical trials based on their health information (no charge for patients).

Users of HealthVault can even arrange to have faxes sent directly to their accounts through a number arranged with MaxEmail (www.maxemail.com). All faxes sent to the number, like those for immunization records and lab results, are automatically uploaded to the account ($8.95 a year).

Until recently, there was no easy way for most people to make their health information available to others on the Web, said David Lansky, president and chief executive of the Pacific Business Group on Health, in San Francisco, a coalition of health care buyers.

But people will use the new sites being developed by Google, Microsoft and others as they now use online tools to manage their finances, travel and shopping, Mr. Lansky said.

"This is part of a shift toward a medical system that is more centered on and directed by patients themselves," he said.

First, however, patients will have to become comfortable placing medical data like readings from home tests online.

Mr. Nolan of Microsoft said that with HealthVault, "you, the account holder, control your health information" and can decide whether and what to share.

If people's concerns about confidentiality and security are addressed successfully, online repositories could have advantages, said Dr. Robert Steinbrook, a national correspondent for The New England Journal of Medicine.

For example, Dr. Steinbrook said, "a nurse could review information about weight on a daily basis sent directly from a scale to a repository, and not necessarily have to send out someone to weigh a patient."

But such programs are still under development, he said, and "all of this remains to be seen."

E-mail: novelties@nytimes.com

Medicare and Medicaid: What's the Difference?

Medicare and Medicaid coverage explained.

Medicare and Medicaid are very different. Medicaid is a federal program for low-income, financially needy people, set up by the federal government and administered differently in each state. (This program is called Medi-Cal in California.)

Eligibility for Medicare, also a federal program, is not tied to individual need. Rather, it is an entitlement program; you are entitled to it because you or your spouse paid for it through employment or self-employment taxes. Medicare was created in an attempt to address the fact that many older citizens have medical bills significantly higher than the rest of the population, while it is much more difficult for most seniors to continue to earn enough money to cover those bills.

Although you may qualify for and receive coverage from both Medicare and Medicaid, there are separate eligibility requirements for each program -- being eligible for one program does not necessarily mean you are eligible for the other. Also, Medicaid pays for some services for which Medicare does not. If you are eligible for Medicaid, Medicaid may pay Medicare deductibles and the Medicare premium.

Do you know where your medical records are?

IBM Launches Cloud Computing Center in India Date Submitted: Thu Oct 02, 2008

BANGALORE: IBM has unveiled a cloud computing center in Bangalore. The center will give enterprise customers including mid-market, universities and government bodies in India immediate access to the resources they need to pilot cloud infrastructures and applications, and deliver new and innovative services to their customers. The center in Bangalore joins other new Cloud Computing centers in Korea, Vietnam and Brazil. These centers will cater to an increasing demand in emerging markets such as India for Internet-based new computing models and skills.

IBM Cloud Computing Centers host computing activities for clients or provide access to expertise and infrastructures for clients to design and deploy their own cloud environments. This computing model allows businesses and consumers alike to remotely access a vast computing resource that can be tapped on-demand to deliver next-generation services that consumers demand, like online medical records or mobile stock portfolio management. It also improves energy efficiency because of its principle as a shared infrastructure, and allows organizations to better track information, pay for what they use and access more computing, storage, services or applications on demand.

IBM is already collaborating with partners, government and academia in other emerging countries to facilitate innovation supported by a Cloud infrastructure. In India, clients such as mid-market vendors, academic institutions, telecommunications companies and government bodies will be able to access the center for the resources they need to pilot cloud infrastructures and applications, and deliver new services to their customers.

"Cloud computing enables server centric virtualization which helps IT ecosystem to achieve smaller footprint, efficient resource utilization and server consolidation. Enterprises are looking at alternate ways to support their dramatically increasing computing needs, one that will allow for massive scalability while providing an energy efficient and resilient infrastructure. Technology collaboration between IIT Kanpur and IBM India will drive new developments in computing to support academic advancement and economic development in India," Said, Prof. Sanjay G. Dhande, Director, Indian Institute of Technology, Kanpur.

Dr. Ponani Gopalakrishnan, Vice President, India Software Lab, said, "The convergence of personally empowering technologies into the hands of the consumer is fundamentally changing consumer behavior and expectations. Cloud computing offers an answer for many of these needs and allows an organization to further reduce costs through improved utilization, reduced administration and infrastructure costs, and faster deployment cycles."

One of the prime agendas for the center in India will be to help enterprises looking to transform their data center for service delivery and innovation, as well as startup businesses or organizations that do not have or cannot afford to build an entirely new infrastructure. There will be a special focus on the fast growing communications industry including content providers, internet service providers and telecom companies.

Human error to blame for Grady data breach

By CRAIG SCHNEIDER

The Atlanta Journal-Constitution

Tuesday, September 23, 2008

Private medical records of Grady Memorial Hospital patients were made public on the Internet, in a way that has become an increasing concern to information security experts.

Human error — not hackers — apparently caused the medical records of 45 patients to make their way onto an unsecured Web site in July, where they remained for a few weeks, Grady officials said.

Recent headlines:

• Air quality a bit better in Atlanta 
• CNN anchor gets restraining order 
• Fast lines at Hartsfield this week -- for a fee 

   • Atlanta and Fulton County news

The records were thought to be on a secured Web site, but the site turned out to be unsecured and open to the public, officials said.

Grady has since made sure the information has been removed from public access, said Grady lawyer Timothy Jefferson.

At a time when more and more information is stored and moved electronically, often on Internet sites protected with passwords and firewalls, experts say they see an increasing amount of information inadvertently slip onto unsecured sites and become available to the World Wide Web.

"Very few keystrokes can make a system that is secure become unsecure," said Tom Dager, director of information technology at SecureWorks, an Atlanta information security firm. He said he is seeing more data breaches due to human error than from hackers.

The Grady data breach follows an incident earlier this year. WellCare of Georgia, a partnership between the state Department of Community Health and private health care management organizations, reported that the private records of 71,000 Georgia families who are members of the state health insurance programs were accidentally made available on the Internet for several days.

Any time private health information is made public, it is a potential violation of federal HIPAA regulations, the Health Insurance Portability and Accountability Act.

The Grady problem also speaks to the dangers of outsourcing work on such information, said Dager, the security expert.

The information on the 45 patients included doctor's notes on patients, and possibly names and ages of patients, medical conditions, diagnosis and medical procedures. It did not include Social Security numbers, patient addresses or any credit card information, said Grady spokeswoman Denise Simpson.

Grady outsourced the job of transcribing the notes to a Marietta firm, Metro Transcribing Inc., which outsourced the work to a Nevada contractor, Renee Lella. Lella, in turn, turned the work over to a firm in India, Primetech Infosystems.

Attempts to reach the firms in India and Nevada were unsuccessful Monday. Caroline Johnson, president of the Marietta firm, issued a statement Monday saying the breach was "totally unintentional. It was thought that the Internet site was entirely secure and it was not."

The problem was discovered when a Grady doctor performed a search of his name on Google, and found information on his patients, said Jefferson, the Grady attorney.

The Atlanta Journal-Constitution learned the details of the data breach from documents obtained through the state open records law. Hospital officials said they had initially been told that the patients information had been stolen. But further review revealed there was no theft — that the India firm had let the information slip onto the Internet, according to correspondence from Grady's legal firm, Alston and Bird, to the Marietta contractor.

Grady has notified the patients of the security breach and officials say there is no indication that patients suffered due to it.

Jefferson said Grady is close to hiring a separate contractor to transcribe these medical records, and that the contract will stipulate that the company does the work itself.

Staff researcher Richard Hallman contributed to this article.

Allscripts ePrescribe Integration Launched With Google Health

Posted on: Monday, 22 September 2008, 09:00 CDT

Allscripts, a provider of clinical software, has announced that its Allscripts ePrescribe integration has been launched with Google Health.

The web-based electronic prescribing solution from Allscripts has been offered free of charge to every physician in America via the National ePrescribing Patient Safety Initiative (NEPSI), of which Allscripts is a national co-sponsor. Google is the search sponsor of NEPSI.

The integration between Allscripts and Google products helps physicians with a new means of sharing their patients' medication history over the internet with their patients through Google Health.

According to Allscripts, Google Health is a new product that allows users to store, organize, and manage their medical records securely online. The product is free to patients and partners who integrate. The relationship with Allscripts allows patients to transfer their medication history, allergies, and conditions from their physician's Allscripts ePrescribe application to the patient's Google Health account.

If a patient has a physician who uses the Allscripts ePrescribe solution, they can ask for a secure personal identification number from their physician to establish a sharing link between the physician's Allscripts ePrescribe solution and Google Health. Once the sharing relationship is established, the patients can import their medication history, allergies and conditions into their Google Health Account, said Allscripts.

Glen Tullman, CEO of Allscripts and co-chair of NEPSI, said: "Allscripts views our partnership with Google as another way to improve communication between physicians and their patients. This relationship makes it possible for our physicians to create an electronic dialogue with thousands of their patients and provide them with their medication information online. We believe this will enhance the quality of care and could help to prevent potentially harmful drug interactions that injure millions of people each year."

Google Exposing Thousands of Korean ID Numbers

Cracks in Korea's Online Industry Must Be Closed Internet Providers Face Class Action Suit Over Data Leak Korea Produces Safer Online Registration Guidelines Bigger, More Dangerous Hacker Attacks Threaten Net Industry Portals Withhold Leak Info From Members Concerns Mount Over Massive 'Auction' Info Leak Web Firms to Face Heavy Penalties for Info Leaks Auction Identity Thieves Nabbed A query of Excel documents under "residence registration number" on the Internet search engine Google generates some 6,900 results, most of them containing national identification numbers. One search result shows a file containing the ID numbers and mobile phone numbers of the 2006 steering committee of an elementary school in Busan. The document had already been deleted from the school's website, but the Google search results showed the intact file. Another file showed the names and residence registration numbers of 933 people. The file, apparently medical records, listed even the weight of patients. The exposed ID numbers could be used to set up mobile phone numbers or even credit card accounts under other people's names, but Google insists it has no way of stopping this from happening, raising fears of a rise in identity theft. According to a survey of Google search results on residence registration numbers by the Korea Information Security Agency, the personal IDs of 164,536 individuals were exposed during the first half of this year alone. A total of 60,558 websites had exposed the IDs of Koreans. Considering the incidents that KISA was unable to discover, the actual extent of identity exposure could be much higher. KISA developed a software program that automatically detects the exposure of residence registration numbers and began monitoring such incidents in July last year. But with thousands of national ID numbers being exposed daily, it is difficult for KISA to ferret out each case. An official at KISA said it is a lot of trouble having to confirm each time residence registration numbers are exposed and ask the webmaster of that particular site and Google to delete the information. Other Internet portals like Naver and Yahoo Korea take precautionary measures to prevent ID exposure. For example, those portals exclude from their search functions groupings of numbers in "XXXXXX-XXXXXXX" format like Korean residence registration numbers. But Google Korea is refusing, citing its policy of maintaining the free flow of information. Lois Kim, head of communications at Google Korea, said the company is not directly responsible since the ID numbers are not saved in Google, and the search engine merely looks up the IDs contained in various websites. But a bigger problem is that it is not easy for individual victims of identity exposure even to ask Google to delete their ID numbers. Such a request made online requires Google membership, and the entire process takes a week. Over that period, the damage could spread. One Korean citizen said Google Korea does not even operate a customer service center, making it difficult to report one's own ID being exposed in cyberspace. Another Korean said when Google entered the Chinese market, however, the search engine promised the government it would not show the results of queries involving certain words, showing what the Internet user called "double standards" in dealing with the two countries.

           Medicare expands online health records programs                                                              
                                  By Jeffrey Young                                      
                    Posted: 08/10/08 09:07 AM [ET]                          
                          

The Bush administration is not waiting on Congress to pass legislation that increases access to online personal health records.  

Beginning in January, the administration will expand access to online records in Arizona and Utah as part of an ongoing effort to encourage greater use of health information technology.  

 The records will contain up to two years of information from Medicare's records. Patients will be able to add to their records and share them with physicians, pharmacists and other healthcare providers.

Congress's efforts to pass legislation promoting health IT have been stymied so far but the Bush administration has been moving ahead with its own efforts related to Medicare.  

The administration rolled out a similar program in South Carolina for traditional Medicare enrollees in April. In June 2007, the Centers for Medicare and Medicaid Services (CMS) launched a personal health records pilot project for some beneficiaries enrolled in private Medicare Advantage and Medicare Part D prescription drug plans.  CMS also said in May it is preparing to move ahead with an electronic medical records pilot project in four geographic areas.  

"This exciting pilot will be a major step forward in Medicare. We believe that it will provide information that will empower consumers to manage their health," Health and Human Services Secretary Mike Leavitt said.  

Increasing the use of health IT is a mainstay of health reform plans spanning the political spectrum, including those proposed by the presidential campaigns of Sens. John McCain (R-Ariz.) and Barack Obama (D-Ill.).  

Advocates believe personal health records -- which are controlled by patients -- and electronic medical records -- which are controlled by medical providers – along with other utilities like electronic prescriptions can reduce medical errors, improve efficiency and lower costs in the healthcare system.  

The private sector is also acting on to advance these technologies. An increasing number of health insurance companies are incorporating electronic health records and personal health records into their offerings. The market for providing these records also is growing, with major technology companies such as Microsoft and Google recently debuting health records products.  

Move to Medicare can be painless for GM retirees

BY MEGHANA KESHAVAN and PATRICIA ANSTETT • FREE PRESS BUSINESS WRITERS • July 22, 2008

General Motors retirees facing the loss of their top-flight health coverage should shop around aggressively to save money on Medicare coverage, say Ford retirees who went through the same thing last year.

It's actually possible to save money, despite losing a generous, company-backed health plan and having to pay to supplement Medicare coverage. A big part of the reason is a payment the auto companies are giving retirees in place of their coverage.

"Last year, we were going through the same thing at Ford. Felt like someone stabbed you in the stomach," said Fred Roperti, a salaried Ford retiree. "But it turned out well. I was actually shocked at how reasonable it was."

John Pottow, an associate professor specializing in bankruptcy law at the University of Michigan Law School, said many other retirees could face the same choices in the coming years.

"If you look at teachers, cops, people in the auto sector, many workplaces promise health care benefits into retirement," he said. But employers can't "afford the exorbitant promises they make. ... There's no way that no-paid, zero-percent premiums will survive."

Roperti advises people to get through the initial shock and carefully shop around. He said he has saved more than $600 a year out of pocket in his first year with a Blue Care Network Medicare plan.

Roperti, 76, has served for the past eight years as Salem Township supervisor and draws a pension from his 26 years as an engineer at Ford Motor Co.

"I did a little side-by-side comparison of the plans, and I can't really complain," he said.

Roperti, a widower, takes three medications daily for his heart, following bypass surgery a few years ago. He said his new plan covers his prescriptions, in addition to dental, vision, rehabilitation, chiropractic and medical costs.

In a meticulously organized black binder that characterizes his approach to the problem, Roperti kept a log for the last year of all his health expenses. In 2007, with Ford's insurance, his out-of-pocket expenses were $1,270. This year, he calculates that he will spend $2,408, but he gets $1,800 a year from Ford in place of the paid insurance plan. With that subsidy, he expects to save $662 compared with last year's expenses.

• He uses the Medicare Part B plan, which is now $96.60 per month out of pocket, or $1,157 per year -- a cost previously covered in full by Ford.

• For supplemental medical insurance, in 2007 he paid $31 per month, or $372 yearly. This year, he paid $26.60 per month, or $319 yearly.

• His dental co-pay remains $250 per year. He paid a total of $48 for dental insurance in 2007. Now he pays $36 a month, or $432 yearly.

• He estimates his doctor co-pays this year at $100, the same as the year before.

• With Ford, Roperti spent about $500 on prescription drugs, whereas with his Blue Cross plan, he spends about $150.

Extend Health, a San Francisco company working with GM to help the 97,000 affected retirees find affordable Medicare plans, will not have precise cost comparison numbers for retirees until September. Bryce Williams, Extend Health president and chief executive officer, said the company is "doing some dramatically improved things from last year," when it helped Ford retirees.

The window to enroll has been extended a month, beginning Oct. 15 this year and lasting until Dec. 31. The company is doubling the number of phone representatives and will personalize assistance so that retirees can contact the same person each time they have a question.

Representatives will instruct the children, grandchildren or caregivers of retirees who may not be able to help with the choices.

Medicare specialists at the Michigan Medicare/Medicaid Assistance Program say that seniors can find affordable plans if they do their homework.

Jo Murphy, executive director of the program, which provides free help for people who want to compare and enroll in Medicare plans, said that seniors have nearly 250 Medicare plan choices.

But by the time they factor in key issues -- the prescription drugs they take, whether they want to stay in a network of their current doctors and whether they spend more than one month a year away from their Michigan residences -- the choices may narrow to two or three.

She advises retirees to consider buying a Medicare Supplemental policy along with a Medicare Part D prescription plan, or a Medicare Advantage plan, which offers comprehensive prescription drug and doctor visit coverage, at a cost of about $150 a month for the two plans.

But Lou Isabell, an insurance broker who runs All Choice Insurance, a large Northville agency, warned that Medicare Advantage programs and Part D prescription programs can be costly, so it's important to compare plans, particularly when a person travels extensively. "It's critical that they know what their out-of-pocket expenses will be," said Isabell.

Contact PATRICIA ANSTETT at 313-222-5021 or panstett@freepress.com.

Have scientists discovered a cure for Alzheimer's?

Scientists were amazed when a 20-year-old hay fever drug was found to be highly effective in treating dementia. Jeremy Laurance reports on a startling discovery

Tuesday, 22 July 2008

A hundred years after Alzheimer's disease was discovered, a cure for the degenerative condition that strips sufferers of their memory and personality remains a dream. The main advances have been in drugs to control symptoms such as agitation and restlessness. Restoring memory and cognitive ability has proved much harder.

That is why the publication last week of research showing that an old Russian drug once prescribed for hay fever may be the most effective treatment yet for the devastating condition has captured the attention of scientists and patients' groups.

A single 20mg pill of the drug, called Dimebon, taken three times a day, appears to be twice as effective in improving cognitive performance and preventing deterioration in memory as existing drugs.

The discovery was greeted by charities as perhaps the most exciting development in treatment of the disease. Existing drugs – cholinesterase inhibitors such as Aricept – have limited effects and were introduced over a decade ago.

According to the American researchers who led the trial, Dimebon is the furthest advanced of 65 agents being investigated for Alzheimer's, and holds the most promise.

However, British experts cautioned that the results were from a single trial of the drug, which is not licensed for Alzheimer's, and said further studies were necessary. A second international trial of the drug, which started last month in the USA, Europe and South America, is due to be completed by the end of the year.

Dimebon was used as an antihistamine in Russia 20 years ago, but it was withdrawn from the market when newer drugs superseded it. Investigations by the Russian Academy of Sciences revealed that it had a potential neuroprotective effect and it was bought by a US company, Medivation.

The company asked Professor Rachelle Doody, director of the Alzheimer's and Memory Disorders Center at the Baylor College of Medicine in Houston, to lead the randomised trial run by American and Russian scientists. It involved 183 patients with mild to moderate Alzheimer's in 11 hospitals in Russia.

Doody, who set up the Houston centre in 1987, is one of the world's leading researchers on Alzheimer's. She was the lead investigator in the trials of Aricept, the best-known existing Alzheimer's drug.

The results of the Dimebon trial she led, published last week in The Lancet, show that it improved performance on all five rating scales used to assess Alzheimer's patients, including cognitive performance, behaviour and capacity to carry out ordinary daily activities. Patients taking the drug scored better than they did at the start of the study, while those taking placebo got worse over the initial six-month period of the trial.

In a smaller group of patients who continued with the drug for a further six months, an even greater gap of 6.9 points on the cognitive performance test opened up between those on the drug and those on placebo. This compares with a 2.5- to three-point gain in trials of existing drugs.

Doody said: "I was surprised that all five of the outcome measures were positive and that the benefit [against placebo] widened over time. You don't see that with the other drugs... But this wasn't a comparison study – you can't say that makes Dimebon better than the other drugs."

She added: "I am very happy with the results. They show a clear signal and I am hopeful that the new international study which started last month will replicate them. US regulators have indicated that the trials are potentially acceptable as evidence for approval [for a licence]. There are a couple of dozen agents I am working on, and 65 that I follow, and the good news is that this is the furthest along in Alzheimer's research."

Clive Ballard of the Alzheimer's Society said the findings were "encouraging" and the discovery of a new application for an old drug was "potentially exciting". But it was a single trial of a small size and the results needed confirming, he said.

Caution was also expressed by Professors Alastair Burns of the University of Manchester and Robin Jacoby of the University of Oxford, who wrote in a commentary in The Lancet: "Addition of treatment options is good news for patients and clinicians – it promotes choice and offers the possibility of bespoke treatment packages which maximise the chances of response. [The] trial shows that Dimebon is better than placebo which is no mean feat considering the positive placebo responses in dementia."

But Jacoby said that he retained a "healthy scepticism" about the findings. "They need to be replicated before I will start prescribing it," he said.

If the results are replicated, it will be a boost for a new approach to drug research – taking old drugs and investigating their potential in other areas of medicine. Old drugs can go rapidly into clinical trials for new conditions because they are known to be safe. This speeds up development and cuts the cost.

A cure for Alzheimer's is not imminent, but it's good news that an old drug may be an effective treatment. Everything hangs on the second Dimebon trial now under way.

Alzheimer's: the facts

About 400,000 people suffer from Alzheimer's in the UK and 25 million worldwide.

It is the commonest form of dementia, costing £17bn in the UK for care and treatment.

The condition is caused by the accumulation of protein deposits in the brain, producing the dementia symptoms.

There are three drugs that claim to halt the progress of the disease (but not to reverse it) – Aricept, Reminyl and Exelon.

In 2006, the NHS's use of these drugs was restricted to the moderate stage of the disease by the National Institute for Clinical Excellence because of their limited effect.

There are currently no drugs available on the NHS for the tens of thousands of patients in the UK with mild Alzheimer's.

Walmart  - INDIA's Drug Connection

In 2003, a new kind of "drugstore" appeared across America, promoting cheaper prescription drugs from Canada. Instead of pills, these stores had fax machines and computers that could process orders from senior citizens in the U.S. desperately seeking lower cost drugs.

But federal and state regulators stepped in to interrupt the supply chain. "To some extent, we're caught in the middle of a problem that is not our responsibility, which is drug prices. Our responsibility is safety," a Food and Drug Administration (FDA) official, told USA Today. The FDA issued warning letters to these storefront pharmacies, saying importing Canadian drugs violated federal law. At the time, at least one million Americans were sourcing their medications from Canada. More than $1 billion in product was being imported from Canadian suppliers. The FDA ruled that anyone enabling U.S. citizens to buy drugs from other countries was violating federal law. Storefront owners countered that they were not violating the law, because they were not dispensing drugs -- just helping customers with paperwork.

The pharmaceutical industry was largely seen as driving the FDA to be more aggressive on cross-border imports, because of the potential loss of profits. But the FDA said its concerns about drugs entering the U.S. were all about safety. Seniors were warned that their drugs could be counterfeit, or from countries with weak regulatory standards. "They allege these are Canadian versions of drugs approved in the United States, but we don't know what they are, because there is no regulatory oversight of these drugs," the FDA told USA Today. The importers insisted that the drugs were coming from licensed Canadian pharmacies.

One Oklahoma-based importer, Rx Depot, was shut down by the FDA for violating drug importation laws. A federal judge ordered 85 Rx Depot stores closed in 2004, ruling that only drug manufacturers were allowed to import drugs for sale. The court also ruled that the safety of these imported drugs could not be verified. Rx Depot appealed the court's decision. "We're going to fight like a wild animal," one of Rx Depot's co-founders said---but the stores never reopened. To stop cross-border selling, some drug manufacturers, like GlaxoSmithKline, stopped shipping drugs to Canadian wholesalers who sold to U.S. customers. That led elderly rights groups to call for a boycott of Glaxo.

Beginning January 1, 2006, the entire drug importation issue changed dramatically with the implementation of Medicare Part D by Congress. Talk of Canadian imports all but disappeared from the media. Within 9 months of the creation of Medicare's new drug program, Wal-Mart announced that it would begin selling in the Tampa, Florida trade area, a month's supply from a list of 150 generic drugs for $4 each. One industry analyst told the NewsHour that Wal-Mart's drugs "come from all over the world. They're U.S. manufacturers, Israeli and Indian manufacturers. They have a choice of where to buy these drugs. They are the lower cost drugs in the system today, and that's part of the reason why they're able to price them at this low price point." Wal-Mart was buying drugs directly from manufacturers.

By the end of April of 2007, Planet Retail was reporting that Wal-Mart was "in advanced talks" with the largest Indian pharmaceutical exporting companies -- unknown to most Americans -- like Ranbaxy, Dr. Reddy's Labs, Cipla, Lupin and Sun Pharma. In March of 2003, the Los Angeles Business Journal reported that Cipla and Ranbaxy had 81 applications before the FDA to sell generic drugs in the United States. The companies were taking advantage of India's low labor costs and highly-skilled work force to expand outside their home base. Ranbaxy had challenged the patents on blockbuster drugs such as Pfizer's Lipitor and AstraZeneca's Nexium. A U.S. district court ruled in favor of Pfizer, but Ranbaxy appealed the decision. Even if it ends up losing the challenge, Ranbaxy will be the only generic manufacturer for six months after the patent expires, because under FDA law, the first company to file a challenge on a patent has six-month exclusivity rights, during which time the generic price can be as high as 80% of the original drug. This position could be worth billions to Ranbaxy.

About 14.3% of unapproved medicines entering the US market come from India, according to a group called GS1, a global organization "dedicated to the design and implementation of global standards" to improve the efficiency of supply chains globally. GS1 is described as a joint industry-Government initiative to bring international best practices into India. Wal-Mart began requiring its drug suppliers to use radio frequency identification tags (RFIDs) to help track drug supplies, and check counterfeits.

Historically, according to Bain & Company, Indian companies would copy drugs from other companies and make inexpensive versions, because the Indian government required the indigenous manufacturers to adhere to foreign patents on the manufacturing process, but not on the final drug product. They could alter the manufacturing process and produce generic versions of foreign branded drugs even while they were under patent. But India' laws have been amended to prevent big generic manufacturers like Ranbaxy from making inexpensive copies of foreign drugs patented after 1995.

A drug industry group called Pharmexcil, set up in December of 2004 by India's Ministry of Commerce & Industry, says that Indian drug makers have "tremendous opportunities...in the post 2005 era to manufacture and export many products getting off-patented. Its immense strength [is] in manufacturing quality medicines at affordable prices." According to Pharmexcil, "The generic drug prices in the US market have substantially gone down with Indian generic players quoting low prices...It is good to see that the quality of Indian generic products are accepted in the US."

In 2005, Ranbaxy won Wal-Mart's Supplier Award for outstanding performance. Ranbaxy expects that its U.S. division, largely buoyed by Wal-Mart, will bring in 50% of the corporation's revenues. The Indian drug company's sales in the U.S. increased ten-fold from 1999 to 2003, according to Bain.

From this complex global manufacturing and distribution network, a few basic facts emerge:

· * most Americans have no idea that the drugs they are buying at Wal-Mart are produced in India, made by companies that are copying another company's products.

· * although India has the highest the number of U.S. FDA-approved facilities (84) outside the U.S., no one knows how reliable the quality of Indian drugs really are. The World Health Organization (WHO) has warned that the global counterfeit and substandard drug trade is a $35-billion business, with little risk of prosecution.

· * when consumers buy their drugs at Wal-Mart, the retailer uses that money to buy more products from India, in the same way they buy more clothing or toys from China. Once again, the U.S. takes what other countries make. Wal-Mart's sourcing of drugs from foreign countries exacerbates our unprecedented foreign trade imbalance.

Ironically, the same federal government that hassled senior citizens over importing small quantities of drugs from Canada, now seems content to allow Wal-Mart to import billions of dollars annually worth of Indian drugs to enhance the retailer's bottom line. The Indian drug companies have found a generic drug niche to fill, and they are using their poorly-paid workforce and less than stringent regulatory requirements to satisfy America's growing need for pills. Unlike clothing or toys---there is no label on the pill that says "made in India."

Al Norman is the founder of Sprawl-Busters, and the author of "The Case Against Wal-Mart."