Soaring Health Costs Pinned On Medical Devices
United States (KaiserHealth) – While squabbles over the rules for approving new medical devices rarely attract much attention outside the insular world of manufacturers, regulators and medical professions, a fight is brewing that could have a major impact on efforts to control health-care spending.
The device industry has launched an aggressive campaign to avoid tighter Food and Drug Administration rules that would help generate the information needed to show whether newer devices are actually superior to the ones they replace. The latest devices – from heart valves and defibrillators to artificial knees and hips – are usually significantly more expensive than older devices, and the intense marketing surrounding the introduction of new devices has become a major driver of rising health care costs.
Many medical specialists say tighter rules are needed to ensure newer devices are safe and effective, which could help hold down costs. “Better regulation of medical devices has the potential to reduce health care costs,” said Steve Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. “New devices are often more complex and expensive than existing products, but may not offer any improvements in health outcomes. The current regulatory approach allows these devices to reach the market with little or no clinical data.”
“Requiring evidence of benefit of effectiveness for patients before device approval would prevent billions of dollars from being spent on technologies that are not helpful for patients and are even harmful,” said Rita Redberg, editor of the Archives of Internal Medicine and a cardiologist at the University of California, San Francisco. “There are many examples, such as vertebroplasty and kyphoplasty for back pain [compression fractures], on which Medicare spends approximately $1 billion annually. After they were FDA-approved, randomized clinical trials showed they were no more effective than a sham procedure in relieving symptoms.”
Despite the cry for tighter rules, think tanks funded by industry in recent weeks have released several studies claiming that the FDA is standing in the way of improved devices getting to market. Congress is holding hearings to investigate the issue. And a third of the members of the House has signed a letter calling for legislation that would roll back a small excise tax that proponents claim is choking off “innovation.”
The 2.3 percent tax projected to generate $20 billion over the coming decade was part of the health care reform law and was similar to excise taxes slapped on the drug and insurance industries, which have not launched similar campaigns. All three industries are among the most profitable in America.
The controversy has important regional political significance because many of the device manufacturers are major employers in the Midwest – especially in Minnesota, Ohio, and Indiana. With the backing of Midwestern lawmakers, the industry is fighting back. Rep. Erik Paulsen, R-Minn., whose district abuts the headquarters of industry giant Medtronic, last week released a letter with 154 co-signers, including four Democrats, that called for repealing the $2 billion-a-year tax.
“Device manufacturers will have to cut R&D or may be forced to lay off employees due to this disastrous tax,” the letter said.
Proponents of the industry warn that what they describe as hostile government action could lead to a loss of jobs. Moreover, some manufacturers claim that they are looking overseas for a more permissive regulatory environment. There are over 8,000 medical device companies in the U.S.; they generated about $136 billion in sales and employed over 422,000 last year, according to industry officials.
While the industry did better than the economy as a whole through the recession, losing only 1.1 percent of its jobs compared with nearly 5 percent of all manufacturing workers, its job performance lagged behind the rest of the health-care economy, which added employment throughout the downturn.
Two years ago, the medical device industry, which manufactures everything from heart valves to ace bandages, came under tougher scrutiny. The FDA had become more aggressive overseeing the industry in response to criticism that it had repeatedly caved to corporate and political pressure when approving new products. After health-care reformers targeted the industry for higher taxes to help pay for covering the uninsured, Democratic leaders in Congress asked the prestigious Institute of Medicine (IOM) to convene a blue-ribbon panel to determine if the industry needed tougher regulations to ensure the safety and effectiveness of its products. With the IOM’s final report due later this month, the industry is mounting a major public relations offensive to blunt calls for stronger oversight.
The Institute for Health Technology Studies, which is primarily funded by the industry, late last month released an industry survey showing American companies are increasingly going to Europe to get new devices approved. Industry executives also claimed that the FDA in the last few years has arbitrarily toughened its standards for new devices that are similar to products already on the market. In the past, those look-alike products usually received a less rigorous review than brand new medical innovations.
“As the FDA considers regulatory revisions, what’s at stake is the ability of companies to attract investors in order to continue developing innovative, life-saving products and sustaining American competitiveness in the global marketplace,” said John Linehan, a professor of biomedical engineering at Northwestern University and lead author of the survey.
Paulsen, the Minnesota lawmaker, cited the example of Xtent, a Menlo Park, Calif., device maker that tried to gain approval to start a U.S. clinical trial for its coronary stent. Surgeons had already inserted the company’s stent in hundreds of European patients. When the FDA refused to consider data from the European experiences and insisted on a prospective clinical trial, the company closed its doors and sold the technology to foreign investors.
Last week, the House Oversight and Government Reform Committee called in the FDA’s top device regulator to explain the changes underway at the agency, which Republican members claimed had gone too far. “In some cases, the conveyor belt for medical devices has come to a grinding halt,” charged Rep. Trey Gowdy, R-SC., who chairs the health subcommittee.
Jeffrey Shuren, a lawyer and physician who 18 months ago replaced the previous head of the troubled Center for Devices and Radiological Health at FDA, promised to “do a far better job to make the process more efficient without compromising our standards for safety and efficacy.”
Earlier this year, the FDA proposed new rules that would give companies more certainty about what would be expected from them when bringing new products to the agency. But it postponed consideration of any major changes in the oversight process pending the IOM report, which could propose companies do more clinical trials proving efficacy for follow-on devices.
The current rules are a product of the 1976 law that ushered in the modern era of medical device regulation. They require any new device whose failure would pose a serious risk to public health to go through rigorous clinical trial testing in humans for both safety and effectiveness before going on the market. But the law also set up a regulatory scheme, known as the 510(k) process, which allows follow-on devices deemed substantially similar to something already on the market to get approved without the same level of testing. Regulators have discretionary power to order more tests.
The vast majority of new devices use the follow-on process, even though their manufacturers often claim superior performance to the older models and charge accordingly. The result is a lack of scientific data for making those comparisons, which leaves Medicare, private insurers and physicians in the dark as to their relative worth.
The regulatory framework for potentially life-saving devices differs from drugs, where follow-on products – say, the four or fifth statin to come to market for lowering cholesterol – must still go through rigorous clinical trial testing. While that doesn’t meet the gold standard of head-to-head comparisons between competing products, at least that gives medical analysts sufficient information to know if one drug is significantly better or worse than another product in the same class.
Safety issues can arise when there are no clinical trials for follow-on devices. And that also contributes to rising health care spending, since it can result in costly recalls or even follow-on operations to replace faulty devices. The updated devices often change materials or tweak the engineering, which can alter their performance once put in the body or deployed in health care settings.
A study published earlier this year in Archives of Internal Medicine found that of 113 major product recalls between 2005 and 2009, only’ percent had gone through the more rigorous clinical trial testing required for new products, while 71 percent had used the follow-on process. There had been only 49 major recalls in the prior five years.
“Yes, the FDA’s getting tougher and it’s long overdue,” said the study’s lead author, Diana Zuckerman, executive director of the National Research Center for Women and Families. “Too many things were sailing through without clear evidence they were safe and effective.”
She cited last December’s recall of 359 million glucose test strips manufactured by Abbott Laboratories, whose malfunction could give diabetics false readings and lead to under or over-medication. Last week Redberg of UCSF told the oversight subcommittee to reject calls for speeding up the regulatory review process in the name of fostering greater innovation. She cited a 2009 Government Accountability Office report that found that a majority of high-risk devices do not go through clinical trial testing prior to marketing. “Only high-quality clinical trials can assure safety and effectiveness, especially when it comes to high risk devices that are used with invasive procedures,” she said.
– Provided by Kaiser Health News.
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Americans Like Their Health Care, But Think The System Stinks
Washington, D.C., United States (KaiserHealth) – If America has the best health care system in the world, as some people like to say, then the setups in other countries must really be crummy.
How come? Well, check out the disheartening results of a poll just out from the Robert Wood Johnson Foundation and the Harvard School of Public Health. Fifty-five percent of adults surveyed gave the U.S. health care system a C or D, when asked to assign it a grade. Eleven percent gave it an F.
Can we send the health system to its room until it gets those grades up?
Familiarity trumps data when it comes to picking a hospital, the poll finds. Most people – 57 percent – would chose a hospital they or someone they know has had experience with over a hospital that does well on quality measures – 38 percent.
Indeed, when it comes to health care, people’s views are a little more charitable when the questions focus on their personal experience instead of the abstract. When asked about the quality of care they’ve actually received, nearly a third – 31 percent – of people give it an A. Thirty-four percent say it’s a B. Only 13 percent grade it D or F.
When it comes to some things, such as picking a surgeon, data seem to count for a little bit more. People were pretty much evenly divided on whether the experience of family or friends would be decisive (48 percent were in that camp) and about an equal proportion (47 percent) leaned toward quality ratings.
Data-driven decision making for surgery, at least, seems to be gaining steam. In 2000, the same question got 50 percent in the family-and-friends column and 38 percent in the quality-ratings column.
The results were presented at a meeting of the American Hospital Association. In a statement, Robert Blendon, professor of Health Policy and Political Analysis at the Harvard School of Public Health, said:
The pace of change in having consumers use independent expert ratings when they choose a hospital has been slower than anticipated. More can be done to encourage this.
Blendon’s group conducted the poll, which included responses from 1,034 people and has a margin of error of +/- 3.7 percentage points.
– Provided by Kaiser Health News.
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Give Yourself The Gift of Goji
Certified organic Goji juice is the most effective because Goji is absorbed better by your body when taken in liquid form. It is free of chemicals, preservatives and is not mixed with another juice for enhanced flavor. I first learned of this little miracle juice when I took home a CD from the local health food store that explained its benefits and history. Fun ways to stay updated on health topics and learn about hidden gems like Goji are by gathering information online from reliable sources, watching interesting and informative shows on TV networks like Discovery Health and taking advantage of free reading materials and CD’s from your local health food store.
Goji grows in South Eastern Europe and in Asia and wasn’t shipped to the U.S. until recently, even though its history dates back to ancient times. Ningxia Goji is the most pure and potent type of Goji juice. The first person to ship it here to the U.S. was Doctor Gary Young when he learned of its benefits. An Olympic swimmer from China came along next and admitted her secret to outperforming all of her competitors was drinking Goji juice.
She had to let the cat out of the bag in order to protect herself from being accused of taking drugs! The word was out, and companies in the United States wanted in. Goji eventually graced the shelves of health food stores across America and in a few select grocery stores. It is easier to buy it today as it is more abundant, but you must understand that Goji juice is expensive to distribute and to buy. Some companies find that it is a greater benefit to sell less expensive, diluted versions of this juice, as it is more affordable and more likely to sell. Uninformed consumers can assume that these versions of Goji juice are just as beneficial as the real thing when in fact they’re not. You can find the closest form of Goji to the real thing at various health food stores if you know what you’re doing. The “good stuff” is only found in China.
There are numerous reasons why you should at least consume one ounce of Goji juice every day (more if you’re feeling under the weather). I have gained many benefits from doing just that. As soon as I drank my first drop of this amazing super juice, the first thing I noticed is that my eyes became clearer. I was amazed at the clarity because I didn’t even notice that my eyes were cloudy until everything became bright and clear. The next thing that I observed is a general sense of contentment. I was relaxed, de-stressed and in a great mood. Goji improved my sleep-wake cycle. I sleep deeper and wake up more rested than ever before. I can also recall the dreams I had when I was sleeping which rarely happens. Blemishes on my skin disappeared one week after religiously taking my morning Goji shot. My skin started to glow and my fingernails were so shiny that it looked like I was wearing clear nail polish. Ladies, if you want to look beautiful, eat organic and take your daily dose of Goji!
Goji helps your body rid of waste naturally and if taken along with eating organic (and perhaps a teaspoon of apple cider vinegar with mother) it will help you shed some extra pounds. I didn’t need to lose weight when I started drinking Goji, but I did have some unnecessary, unwanted meat on my hips that slowly began to disappear. Goji gets rid of that pocket fat that collects in certain areas of your body. My hips became narrower and if I gain weight, it will now be evenly dispersed rather than clumping into those trouble areas! These are just a few of the ways Goji has helped me. This juice works inside and out, optimizing the functions of your mind and body. Here is a partial list of the many amazing benefits of Organic Goji juice:
* Balances skin tone and helps to reduce dry skin * Antioxidants help prevent aging * Reduces risk of cancer * Increases energy * Helps to maintain a stable mood * Improves metabolism * Regulates blood pressure * Cleanses your blood * Improves memory * Improves heart function * Fights Hepatitis B * Boosts your immune system * Lowers cholesterol * Helps regulate blood sugar level I’m assuming you’re ready to buy it, so your probably questioning what you should be looking for in an effective Goji juice. Here are some pointers of what to look for before you buy your “happy berry” juice:
* #1 100% Certified Organic Goji berry juice
* Get pure concentrated Goji juice that is not mixed with another juice so you’ll get the full effect. If you’re spending good money on your Goji, you don’t want it diluted with other juices you can buy for just a few dollars at the grocery store.
* Do not fall for cheaper “natural” versions of Goji juice, as it will at the very least contain a preservative like Sodium Benzoate. This preservative is a carcinogen so it defeats the purpose of taking Goji in the first place.
* You may choose Goji that is sold in a glass container vs. plastic because it stays fresher longer.
Celebrities that swear by Goji juice:
* Mischa Barton * Madonna * Liz Hurley * Mario Lopez * Paula Abdul * Lisa Edelstein
Man offers burly men, supermen; God counters with shepherd boy’s and blind men
Thomas Yanoti America loves their heroes big! Both human heroes and sandwich heroes! Our cholesterol count and our adoration for the biggest of the big reveals our ineptitude towards just judgment!For as today’s Mass readings reveal, those of us… April 03, 2011
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About Hypothyroidism – a Common Health Problem
By hypothyroidism, the thyroid gland is producing too less hormones to stimulate the metabolism, or the body is not able to utilize the hormones. The lack of thyroid hormones slows down the metabolism and thus all the activities in the body, giving a combination of many symptoms related to slowness of bodily processes.
Hypothyroidism is common, but the frequency of the condition is not well determined. Some authorities estimate that 0.5% of the total American population have the disease to some degree. The frequency is much greater among people over 50 years of age than among young people.
THE SYMPTOMS AND COMPLICATIONS OF HYPOTHYROIDISM
The most common early symptoms are: Mental and physical fatigue, weakness, weight gain or over-weight, and depression.
One or more of these symptoms also use to appear early: Constipation, sensitivity to coldness, cold hands and feet, thick tongue, decreased sweating, dry hair, thin brittle hair, thin brittle nails, muscle and joint pain, pale or yellowish skin, rashes and itching.
One or more of these symptoms usually appear later: Poor memory, slow thought process, drowsiness, slow speech, thinning of eyebrows, hoarseness, low blood pressure, poor circulation, dry and flaky skin, decreased taste and smell, menstrual irregularities, skin thickening, puffy face, puffy hands and feet, swelling of extremities, overall swelling, muscle spasms, muscle atrophy, joint stiffness.
In children or young persons hypothyroidism may give developmental problems, like disturbed tooth development and short stature.
Hypothyroidism increases the risk of elevated cholesterol levels, heart disease and diabetes (diabetes mellitus). This occurs even by moderately decreased thyroid production.
THE THYROID GLAND AND ITS HORMONES
To understand the hypothyroidism, some knowledge about the thyroid gland and its hormones is essential.
The thyroid gland produces hormones that accelerate and in other wise regulate metabolism. A part of metabolism is the process of breaking down energy containing nutrients, and using the energy to produce molecules that all the processes and activities in the body use as fuel. Another part is the production of molecules that the body use as building materials.
The thyroid makes four hormones: Thyroxin (T4), triiodothyronine (T3), diiodothyronine (T2) and monoiodothyronine (T1). The hormones contain iodine, and the figures tell about the number of iodine atoms in each hormone molecule. T3 is not made directly, but is produced from T4. T3 is a more efficient hormone than T4. Therefore this conversion is important.
The pituitary, a gland under the brain, produces a hormone called thyrotropin or thyroid stimulating hormone (TSH) that enhances the activity of the thyroid gland. If the body has too less thyroid hormone in the blood, the pituitary produces more thyrotropin. This makes the thyroid gland speed up its own production. By a too heavy thyroid hormone concentration, less thyrotropin is produced by the pituitary, and the thyroid gland slows down. This feed-back mechanism regulates the metabolism of the whole body.
THE MECHANISMS AND CAUSES OF HYPOTHYROIDISM
By hypothyroidism the body does not get enough thyroid hormone, or the hormones do not work effectively in the body. This causes the metabolism to slow down. When the metabolism decreases, the processes in the body do not get enough fuel and building materials, and all the body activities will therefore slow down. Energy containing nutrient will also be stored as fat, since they are not broken down.
Serious variants of hypothyroidism are called myxedema. This is a rare condition. However, less serious, but painful variants are common. There are several reasons for hypothyroidism, each giving a variant of the disease:
*An autoimmune reaction against the thyroid tissue can destroy the capability of the thyroid gland to produce hormones (for example Hashimoto’s disease).
*Sometimes the production of T3 by conversion from T4 is impaired. The total amount of hormones may be normal in these cases, but the body is still lacking T3, and gets the symptoms of hypothyroidism.
*Iodine deficiency can cause hypothyroidism, since the thyroid hormones contain iodine. In Europe and America the food is seldom short in iodine, but bad nutrition may result in iodine deficiency.
*Surgery or radiation at the thyroid area can destroy enough tissue to cause hypothyroidism.
*Injury or disease in the pituitary or of the part of the brain controlling the pituitary may cause a decrease in secreted thyrotropin, and then the thyroid will respond by producing less of its own hormones with hypothyroidism as a result.
*Some people have symptoms of hypothyroidism even though the amount of thyroid hormone in the blood is normal. One of the symptoms is raised levels of thyrotropin, indicating that the body signals need for more thyroid hormones. This variant may be caused by conditions elsewhere in the body that make it difficult for the hormone to reach their destination in the cells. In many of these cases the immune system produces anti-bodies against the thyroid hormones. This variant is called sub-clinical hypothyroidism, and responds to the same treatment as ordinary hypothyroidism.
*Some types of food can contribute to a depressed thyroid function or aggravate hypothyroidism when eaten raw in great amounts: Brussel sprouts, broccoli, corn oil, cabbage, cauliflower, kale, kohlrabi, radishes, rutabaga, soy and turnips. By cooking these vegetables, the depressing effect is decreased
*Factors suspected for causing hypothyroidism are: The artificial sweetener aspartame, mercury pollution, dental fillings containing mercury, fluoride and heavy metal pollution.
HOW CAN HYPOTHYROIDISM BE TREATED
For serious hypothyroidism caused by tissue destruction, external supplement of thyroid hormones is necessary.
When the condition is caused by lack of iodine in the diet, dietary changes and iodine supplements will be a part of the treatment.
Less serious, but painful hypothyroidism is sometimes also treated with hormone supplements. In these cases it is difficult to find the right dose, and treatment may result in hormone poisoning.
You can sometimes alleviate hypothyroidism by reducing the amount of food suspected for depressing the thyroid function: Brussel sprouts, broccoli, corn oil, cabbage, cauliflower, kale, kohlrabi, radishes, rutabaga, soy, soy products and turnips. However, these food types are valuable in many ways, so it is probably not wise to cut them out totally. Also try to avoid artificial ingredients like the sweetener aspartame, conserving additives and fluoride.
Changing out mercury dental fillings and avoiding mercury or heavy metal exposure may help to ameliorate the condition.
You may also alleviate the condition by eating food that stimulates the thyroid function according to practical experience: Chia seed, dulse, fish from the ocean, flax seed, pumpkin seed, seaweed, coconut and brewer yeast.
You can find nutritional supplements to help for hypothyroidism. The compositions of these products vary:
*They may contain building materials that the thyroid uses to make its hormones, for example: iodine, acetyl-L-tyrosine or L-phenylalanine.
*They may also contain vitamins and minerals that stimulate the mechanism of hormone production by being a part of necessary enzymes, or by helping the absorption of the ingredients that hormones are made from, like: Magnesium, zinc, selenium, copper and vitamin E.
*They may furthermore contain constituents that stimulate tissue regeneration by being part of tissue building enzymes, and thus helping to restore a degraded thyroid, for example: Folic acid or folate, vitamin B2 (riboflavin), B3 (niacin), B5 (pantothenic acid or pantothenate), B6 (pyridoxine), B12 (cyanocobalamin) and molybdenum.
About Author Knut Holt is an internet consultant and marketer focusing on health items. To find more advices and natural products to help against hypothyroidism and other health problems please visit:
Bank of America repurchases $2.5 billion debt from Fannie Mae, Freddie Mac in settlement
Charlotte, NC, United States (AHN) – Bank of America repurchased $2.5 billion in debt from Fannie Mae and Freddie Mac because of complaints from the two largest mortgage firms that the mortgages were based on faulty data.
The bank agreed to buy back the mortgages to resolve the dispute.
The repurchase actually cost BofA approimate $3 billion, which included loss reserves for loans that were not part of the agreement.
The buyback may cause similar settlements by other large U.S. banks such as Wells Fargo, Citigroup and Washington Mutual as mortgage buyers try to force the banks to repurchase loans made with incorrect income data and wrong home values.
In October, BofA disclosed that it has $12.9 billion unresolved put-back demands, 50 percent of which were linked to government-sponsored entities. BofA then said it reserved $4.4 billion for costs related to the problem.
After the buyback, BofA’s shares rose 61 cents to $13.95 at the New York Stock Exchange composite trading.
In addition to the Fannie Mae and Freddie Mac claims, BofA faces a lawsuit from MBIA which claimed the bank fraudulently induced MBIA to insure $21 billion in mortgage-backed securities.
The Pacific Investment Management Company and Federal Reserve Bank of New York similarly demanded from BofA repurchase on loans packaged into $47 billion of bonds.
Fannie Mae and Freddie Mac, bond insurance companies and private investors still have $2 trillion of bad loans.
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Obama Signs Bill to Extend Tax Cuts and Unemployment Benefits
Washington, D.C., United States (AHN) – President Obama signed into law an $858 billion tax bill Friday that extends tax cuts and unemployment insurance benefits throughout next year.
“It’s a good deal for the American people,” Obama said during a signing ceremony. “This is progress and that’s what they sent us here to achieve.”
The House approved the measure late Thursday.
The bill passed by a 277 to 148 margin with strong support from Obama, who said the measure is needed to help households recover from recession.
The new law will “protect our middle class, grow our economy and create jobs,” Obama said.
Critics of the legislation – some from Obama’s own Democratic Party – said the reduction in tax revenue from the bill would deepen the nation’s $14 trillion deficit.
They also said some of the tax breaks – particularly for estate taxes – benefit the rich but do little for middle-income and low-income persons.
The tax breaks were enacted during the Bush administration but set to expire on New Year’s Day 2011.
“This bill, the president of the United States believes and I believe, will have a positive effect on the economy,” said House Majority Leader Steny H. Hoyer (D-Md.). “I will vote for this bill because I don’t want to see middle-income working people in America get a tax increase, because I think that will be a depressant on an economy that needs to be lifted up.”
The Senate approved the same measure on Wednesday by an 81 to 19 vote.
The measure grants unemployed workers in states with the worst joblessness as much as 99 weeks of unemployment insurance benefits through the end of 2011.
It also seeks to stimulate the economy with incentives for consumer spending.
A two-percent reduction in Social Security payroll tax would allow wage-earners to keep as much as $2,136 out of their paychecks that normally would go to the federal government.
The bill represented one of Obama’s greatest bipartisan successes after drawing strong support from Republicans.
In addition, 31 conservative Democrats wrote a letter to Speaker of the House Nancy Pelosi before the vote urging that it be passed quickly.
“It is time for us to put aside the partisan talking points and accomplish what the American people sent us here to do,” the letter said.
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Language barrier key for Nepali in New York
Kathmandu, Nepal (AHN) – Nepali Diasporas living in New York face a language barrier, creating a major challenge that causes immigrants to miss out on jobs and other opportunities in the United States.
Most of the Nepalis who reached the U.S. in search of green pastures are at the receiving end of downward socio-economic mobility, forcing them to lower their living standards in order to survive and support family members back home, a study has revealed.
“While in Nepal, people have dreams of doing well in the U.S. However, there is a huge difference between what you think of America and when you actually come here,” says New York-based non-profit organisation Adhikaar. “People have to work really hard to survive here.”
“Even if you are educated, you won’t be able to find a job of your choice if you don’t have the [right] documents,” a Nepali worker told the group. “You can earn money here, but not respect.”
Much of the problems faced by the Nepali-speaking community in New York City are typical of those faced by emerging communities. The federal minimum wage of $7.25 is not enough to survive and support a family in New York City, the report adds. Making matters worse, migrant workers in the informal sector are often exploited by the employers and are paid below the legal minimum wage.
The report titled “Snapshots of the Nepali-speaking Community in New York City: Demographics and Challenges” reveals that language barrier has become a major challenge for most of the Nepali-speaking people in finding jobs and other services. For example, many Nepalis in the U.S. do not have health insurance, and almost three-fourths of them face challenges in obtaining healthcare.
Many Nepali migrants are unable to transfer their work experience, skills and education from Nepal. Over half of the Nepalis in New York were involved in business or a professional sector in Nepal. While most Nepali immigrants are able to find jobs in New York, they are often low-wage jobs consuming long hours and providing few benefits. While immigration status is a reason for Nepali immigrants doing low-wage jobs, it is not the only one, the report adds. “Nearly half of the respondents to survey have the legal right to work in the U.S., yet most of them faced challenges.”
The most common types of job for men are works in restaurant, gas station, taxi or limousine and moving industry, while women often work as domestic workers and at nail salons or beauty parlours. Report has it that those who intend to earn degrees find themselves unable to attain their goal due to the number of hours they must work to pay for their education and living expenses.
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Pfizer CEO switch stuns Wall Street
Wall Street initially welcomed the departure of Pfizer CEO Jeffrey Kindler – but now questions abound. |||
New York – Wall Street initially welcomed the abrupt departure of Pfizer CEO Jeffrey Kindler, but quickly turned to questions about the condition of the pharmaceutical company and the behaviour of its board.
Many analysts were amazed that the world’s top drugmaker – a Dow component company, worth $130-billion – could lose its chief without warning on a Sunday night and with no explanation beyond a claim that the job was simply too tiring for Kindler.
The Pfizer board immediately promoted company veteran and global head of pharmaceutical operations Ian Read, apparently not bothering with a wider CEO search.
“It has to raise some red flags, and if nothing else, it’s poor communication by Pfizer,” said Tom Villalta, lead portfolio manager for Jones Villalta Opportunity Fund.
“Couldn’t the transition have been done more tactfully?” Villalta said. “I like Read’s marketing experience and don’t think he’s a bad choice. But this is a weird way to replace the CEO of one of the largest companies in the world.”
Shares of Pfizer rose as much as 2.2 percent on the news of Kindler’s resignation, as investors hoped Read would push through asset sales, cost cuts, share buybacks or higher dividends to boost the company’s lacklustre share price.
But the stock ended the day barely higher with a rise of 0.4 percent, as the suddenness of the news suggested disorganisation at Pfizer.
Mike Krensavage, principal at Krensavage Management LLC and a long-time drug industry watcher, said Kindler, 55, had yet to lead Pfizer through the biggest challenge in its history: the US patent expiration of its top-selling Lipitor cholesterol drug in November 2011.
“It’s a big surprise,” Krensavage said. “Companies usually have a more orderly change of leadership.”
Nell Minow, editor of GovernanceMetrics International, an independent research firm specialising in corporate governance, said boards have become “a bit trigger-happy when it comes to CEOs,” calling it the “new normal”.
“We’re living in an off-with-his-head environment,” Minow said. “I’m not saying they should have given him more time. I am saying they should have been clearer with him about what they wanted… This situation reflects poorly on the board. It makes them look impulsive and desperate.”
Still, few shed tears over Kindler’s exit. Over the course of his tenure, which began in July 2006, Pfizer’s shares have lost 27 percent of their value, underperforming a 10 percent decline in the NYSE Arca Pharmaceutical index of large drugmakers.
A lawyer by trade, Kindler was previously Pfizer’s general counsel and before that led the McDonald’s owned Boston Market restaurant chain.
Analysts said Read could be more active since he knows the pharmaceutical business inside out.
“I have long thought it would be very positive if Kindler left,” said Jordan Schreiber, senior investment officer of Princeton Capital Management Inc. “The manner was highly unusual, but I’m glad he’s gone.”
Kindler said in a statement issued by Pfizer on Sunday night that the job had been “extremely demanding” and that he wanted to “recharge my batteries.” He was also replaced by Sanofi-Aventis CEO Christopher Viehbacher as chairman at the Pharmaceutical Research and Manufacturers of America trade group.
“People are hopeful there will be some more aggressive restructuring that takes place within Pfizer,” said Edward Jones analyst Linda Bannister. “We’re up against the patent expiration of Lipitor…It’s right around the corner.”
Kindler’s departure comes more than a year after Pfizer completed the signature move of his tenure – the $67-billion acquisition of rival Wyeth.
That acquisition, which brought Pfizer more access to biotech drugs and vaccines as well as cost cuts, was intended to help Pfizer move through the decline of Lipitor. But the deal has failed to spur stock gains.
Goldman Sachs analyst Jami Rubin said she had “long argued that Pfizer should be more aggressive in achieving greater efficiencies in both its $28.5-billion operating expenses base as well as its massive balance sheet and portfolio of various businesses, some of which should be divested.”
“We are delighted to see the board taking action as Pfizer’s share price continues to underperform amid a flurry of questions about strategic direction,” Rubin said in research note.
JPMorgan analyst Chris Schott said the CEO change could lead to more aggressive actions at Pfizer, including share repurchases or dividend increases.
“While a CEO transition in the midst of a major merger integration will likely create added uncertainty with the story, the key question, in our view, remains on the changes this transition will bring to the Pfizer story,” Schott said in a research note.
Rubin of Goldman Sachs called Read, who joined Pfizer in 1978, a “seasoned executive with over 20 years of experience running many different regions and businesses in pharma”.
“Some investors may be concerned that the new CEO may not shake up the company to the degree that some would like to see, but he has the ability to focus the strategy and get the ship going in the right direction,” Rubin said.
But Read can only do so much restructuring, and the company will need some promising experimental drugs to succeed, Edward Jones’ Bannister said, citing drugs in development for pain, rheumatoid arthritis, blood clots and Alzheimer’s disease.
“In order for the stock to really start to move on a sustainable basis, it’s going to have to come from positive results from their pipeline,” Bannister said.
Pfizer’s shares ended up seven cents at $16.80 on the New York Stock Exchange. – Reuters
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Banking on the Bacon
Back in the heyday of the Atkins diet, who would’ve guessed that swine would someday, quite literally, bring home the bacon? The Internet has facilitated a congregation of bacon connoisseurs across America, some of whom have allowed their appetite for the cured meat to give rise to their bottom line.
A simple Google search will lead you into a subculture that has spawned everything from vodka , to candles , to crowdfunded ventures . If you’re a diehard fan, you may have already written an essay for the Bacon Baby Contest sponsored by Bacon Salt , so that your newborn might be one of the first recipients of Bacon Baby Infant Formula .
Two sets of New York City-based entrepreneurs that began operations in 2010 saw their handcrafted concoctions featuring real bacon pique the curiosity of outdoor market patrons. Macaron Parlour , run by Christina Ha and Simon Tung, began selling their candied bacon macarons with maple cream cheese frosting at the Hester Street Fair in the Lower East Side. Says Tung, that particular macaron is the best seller at the fair, and the best seller overall when combining both fair and online orders. Similarly, Jess Eddy, one half of the duo behind Phinizy & Phebe Ice Cream , says Maple Bacon Pecan was their best seller at fairs this summer, although it has yet to debut in stores with their other offerings.
Although these businesses use bacon as both an alternative ingredient and a talking point, other entrepreneurs saw their existing ventures consumed by their personal passion. Rocco Loosbrock, CEO of Coastal Vinyards , started a small online wine club with his wife as a side business in 2003. For a fresh idea, they began pairing assorted wines with different flavors of bacon. Soon, the Swine and Wine Club was born. The popularity of the bacon pairings prompted Loosbrock to add a bacon club to the mix in late 2007. Bacon sales on the site began booming, soon surpassing their wine sales.
Loosbrock founded Bacon Freak in late 2008, and the site now hosts the Bacon of the Month Clubs , as well as several other bacon-centric products. He now runs the business full-time and hosts a series of other bacon sites including the Bacon Today blog and Bacn.me , a URL shortener that receives a reported 3,000 to 4,000 hits per month. His company also developed bacon jerky and has acquired Bacn.com , a competitor bacon club.
Bloggers often face an uphill battle in the quest to monetize their online publications. Jason Mosley of Mr. Baconpants , a graphic designer by trade, stumbled into a niche market that presented him with an opportunity to accomplish this elusive goal. After starting his personal blog Pagewaiter in 2004, he found that he ended up writing more about bacon than his other interests, so much so that he went in search of a more appropriate domain name. Mr. Baconpants was born in 2005 and pulls in roughly 10,000 unique page views per month. As a result of direct advertising by bacon-centric sponsors and ads placed via the Gourmet Ads network, Mosley brings in approximately $800 to $1,000 monthly. He also sells clothing items on the site. Along with Sean Brett, he began hosting Bacon Live two years ago, a weekly podcast that is “fifty percent about bacon and the other half is about whatever we want to talk about that day.”
David Wahl, the director of marketing at novelty item distributor Archie McPhee , states that seven to ten of their top selling items are bacon-themed. According to Wahl, they began selling bacon-themed items in 2005 and have since gone full-speed ahead. “We think bacon is popular because there is something a little unhealthy and naughty about it. It’s a rebel food,” says Wahl. Tung echoes that theory. “You know how people were going on the health craze for a few years? Low fat, no cholesterol, yada yada yada? This is a rebellion towards that.”
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