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Saturday, February 2, 2019

Missouri Supreme Court suspends second talc cancer trial in weeks

The Missouri Supreme Court on Thursday halted an upcoming trial in a case brought by women who claim talc supplied by Imerys Talc America for use in Johnson & Johnson products gave them cancer, saying it wanted to consider a jurisdictional challenge by Imerys.
It is the second major talc case the Missouri high court has stayed in recent weeks on jurisdictional grounds. Both were in the St. Louis’ 22nd Circuit Court, which has issued several large verdicts against J&J and Imerys, including one for $4.7 billion in July.
The vast majority of the plaintiffs in the St. Louis cases are from other states, and the defendants have repeatedly challenged their right to sue in Missouri as opposed to their home states or in states where the companies are headquartered or have a substantial presence. J&J is based in New Jersey and Imerys, a unit of Imerys SA, is based in California.

In the case stayed on Thursday, which had been scheduled to go to trial on April 8, only two of the 24 plaintiffs were from Missouri.
The plaintiffs claim asbestos in Johnson’s Baby Powder and other cosmetic talc products caused their cancer, alleging that J&J and Imerys knew of asbestos contamination since at least the 1970s, but failed to warn consumers.
Reuters on Dec. 14 published a Special Report detailing that the company knew that the talc in its raw and finished powders sometimes tested positive for cancer-causing asbestos from the 1970s into the early 2000s – test results the company did not disclose to regulators or consumers.
J&J and Imerys, a unit of Imerys SA, deny those allegations and have repeatedly said decades of studies have shown their talc products to be safe and free of asbestos.
“Imerys Talc America is pleased the Missouri court has ordered the trial court to take no further action while it reviews the merits of whether the Missouri court has personal jurisdiction over the company in this product liability matter,” the company said in a statement on Thursday.
Mark Lanier, the plaintiff’s lawyer in the case stayed on Thursday, did not immediately respond to a request for comment. He also represented the plaintiffs in the $4.7 billion case, most of whom were also from outside Missouri.
J&J, which is a co-defendant with Imerys, said it had also asked to postpone the upcoming trial and its petition remained pending. The company declined comment on Thursday.
The Missouri Supreme Court previously stayed a talc case against J&J and Imerys that was due to begin on Jan. 21 on the same jurisdictional grounds.
A number of multi-million-dollar talc verdicts against J&J and Imerys in the St. Louis court have been thrown out following a 2017 U.S. Supreme Court decision limiting state courts’ jurisdiction over claims by non-residents against out-of-state companies.
However, the St. Louis trial court has allowed many out-of-state plaintiffs, including most of those who won the $4.7 billion verdict, to proceed based on state ties the defendants say are tenuous. That verdict is now under appeal at an intermediate court.

University, Pangea to develop 5G video triage system for ambulances

Kingston University and Internet of Things (IoT) specialists Pangea are teaming up to develop a 5G video streaming service that could allow paramedics to triage patients from ambulances before reaching A&E
The project’s aim is to develop enriched video compression and data transfer techniques over 4G+ and 5G networks. Pangea said the tech would be “the first of its kind”.
Pangea said that ambulance trusts could save up to £90 million if response times were sped up by just 5 minutes.
“The idea is to give doctors and surgeons a virtual environment to see what they are dealing with in real time,” said Kingston’s professor of wireless communications Dr Christos Politis, one of the project leaders.
“It could help with triaging care or even allow medics to advise ambulance crews on treatment, improving chances of survival in life or death cases. It would mean medical teams know exactly what they are dealing with when the patient arrives at hospital, which would be a real game changer.
“Alongside speed increases which will rival those delivered by optical fibre, 5G will incorporate IoT technology, which opens up so many possibilities for the health sector and across the emergency services through the use of smart devices.”
Video compression specialist associate professor Dr Nada Philip, another project leader, said that the team would be trying to solve the challenge of how to deliver optimal high quality video consistently through wireless networks when travelling at high speed.
“When you stream multimedia content, it will be affected by different network conditions. We will be looking at how to ensure the moving images arrive in high-definition, allowing for accurate medical diagnosis.”
The project has received funding from government-backed public body Innovate UK.
Investing in 5G networks has become a key funding target for the UK government.
In September the West Midlands were selected to become the world’s first multi-city 5G test bed, meaning that hospital outpatients in the region could soon have emergency consultations with fast and reliable video links.

McKesson expects opioid-related legal costs to exceed $100 million this year

McKesson Corp. expects to shell out more than $100 million in legal costs stemming from opioid lawsuits this year, its executives said on their third quarter earnings call Thursday.
The wholesale drug distributor, one of the country's largest, is one of several distributors facing lawsuits from a number of municipalities that argue it overlooked high volumes of prescriptions that should have been flagged as suspicious.
Brian Tyler, the company's chief operating officer and incoming CEO effective April 1, said the actual magnitude of the lawsuits will depend on judges' decisions and is out of the company's control.
"We take our fiduciary responsibility to our shareholders seriously," he said.

McKesson drew nearly $3 billion in gross profit in the third quarter of its fiscal 2019, which ended Dec. 31, 2018, up 9% from $2.7 billion in the prior-year period. The company generated $56.2 billion in revenue during the quarter, up 5% year-over-year.
Tyler downplayed McKesson's role in the opioid crisis, noting that McKesson delivers the products to Drug Enforcement Agency-licensed pharmacies, who fill prescriptions written by licensed physicians. The DEA even controls the quantity of opioids that are dispensed, he said.
"While we have a role in that physical supply chain, we feel like a disproportionate amount of attention has been placed on wholesalers to this point," Tyler said.
Fellow drug distributor AmerisourceBergen held a similar position on its own earnings call Thursday morning, when CEO Steven Collis said the company gets the drugs from FDA-approved drugs from pharmaceutical manufacturers to DEA- and state-registered pharmacies and dispenses them based on prescriptions from licensed healthcare providers.
"Notably, we do not have access to patient information and we are not qualified to interfere with the very personal clinical decisions made between patients and their physicians," he said.
Collis added AmerisourceBergen takes its role in the supply chain seriously, including giving daily updates to the DEA of all controlled substances shipped to its customers and proactively stopping suspicious orders.
AmerisourceBergen's revenue jumped 12.2% in its first quarter of fiscal 2019 to $45.4 billion. The company also drew $1.3 billion in gross profit during the quarter, a 16.6% increase over the prior-year period.
https://www.modernhealthcare.com/article/20190131/NEWS/190139971

Foreign cash, loose capital bolstering healthcare real estate

A confluence of factors is feeding demand for healthcare real estate, including robust domestic demand, related interest from investors outside the U.S. and relatively easy access to capital.The rapidly ascending ambulatory sector—one of several trends impacting the undulating healthcare real estate landscape—is feeding a booming medical office market. That, in turn, has drawn increased foreign investment and loosened the purse strings on a vast supply of capital that also has fueled construction and mergers and acquisitions.
While foreign investment isn’t yet significant enough to dictate a change in medical office pricing or supply and demand, it could eventually shift market dynamics, said Hunter Beebe, a managing principal at healthcare real estate advisory firm Healthcare Real Estate Capital.
“There is a lot of capital pursuing healthcare real estate beyond foreign—private equity, REITs, domestic—the list goes on,” he said.

Care transformation spurring demand

A sweeping transformation is taking place in terms of where healthcare is being delivered. Vast hospital footprints are giving way to more convenient outpatient space, as consumers and payers seek affordable and accessible care.The number of outpatient facilities jumped from 26,900 to 40,600 between 2005 and 2016, according to a recent report from commercial real estate firm CBRE.
Meanwhile, health systems are looking to keep pace with new competitors aiming to draw people from hospitals.
Reimbursement pressures and capitated payments are pushing people out of expensive care settings while technology is enabling more complex care in outpatient facilities and the home.
Those factors drove many systems to adopt a change in approach, such as Vanderbilt University Medical Center’s transformation of about half of a struggling 900,000-square-foot Nashville shopping center into an outpatient hub.
Medical office ownership
Revenue has followed these trends, according to data from the American Hospital Association. Hospitals’ net outpatient revenue was $472 billion in 2017, coming close to equaling inpatient revenue, which totaled nearly $498 billion.
This has fueled investment in healthcare real estate domestically and abroad.
Twenty years ago, healthcare real estate wasn’t carved out as a separate sector, said Jeff Calk, a partner at law firm Waller Lansden Dortch & Davis. Demand has increased with the evolution of the industry, he said.
“Now portfolio managers want to have 8% in healthcare real estate, 12% in general office and 32% in hotels,” Calk said.
That makes sense given the outlook of other asset classes and markets, said John Claybrook, a partner at Waller. More people are working from home, which is softening the office market. Retail’s upheaval isn’t doing the sector any favors. A slumping oil and gas market as well as geopolitical turmoil involving what is the not-so United Kingdom, the eurozone and the Middle East have caused investors to look elsewhere.
“In comparison, healthcare real estate looks stable and profitable,” Claybrook said.
Medical office yields
Weighted average occupancy for medical office space rose from 90.4% in 2009 to 92.3% in 2017, according to data from real estate firm JLL. Medical office returns offer a 2% premium over the broader office sector and are more than double the 10-year Treasury yield, according to JLL. That will likely continue as the aging population requires more care.

Catching the world’s attention

The trends have stoked interest from foreign buyers, including China and Japan, who will continue to seek operation and care-delivery expertise in a variety of subsectors, according to PricewaterhouseCoopers’ latest US Health Services Deals Insight report. More global interest is directed toward medical office properties, which could boost a prime seller’s market for healthcare organizations looking to offload their real estate, experts said.While institutional investors like pension funds or insurance companies in Asia, Canada and the Middle East have been surveying the medical office sector for some time, that interest has only just recently translated to more deals, Beebe said.


“We have seen a noticeable increase in interest from foreign investors in the U.S. healthcare real estate market,” Beebe said, adding that foreign investors have been behind the scenes of medical office deals packaged with major U.S. health systems and real estate investment trusts. They have also invested directly or acquired major equity stakes.Most of the interest is stemming from the Asia-Pacific region, at 21%, followed by 16% in Europe, the Middle East and Africa, and the Americas at 15%, according to CBRE’s Global Investor Intentions Survey.
“What healthcare investors like is the stickiness of tenancy,” said Christopher Bodnar, vice chairman of CBRE Healthcare Capital Markets. “In general, foreign investors are looking to diversify and the U.S. is still considered a safe haven, especially when you consider the geopolitical risks in the other parts of the world.”
Trailing 12-month medical office transaction volume decreased to just less than $12 billion in the second quarter of 2018 but didn’t stray far from the 10-year high of $14.2 billion, according to CBRE.

Medical office and total healthcare real estate deals
The real estate investment trust Welltower, for example, recently paid $1.25 billion for 55 medical office and outpatient facilities owned by CNL Healthcare Properties. Most of the 3.3 million square feet of Class A post-acute facilities and specialty hospitals across metro areas of 16 states are affiliated with major health systems. “Now is a great time to be selling medical office buildings,” Calk said.Still, there are three major hurdles to foreign investors eying medical office properties and senior housing facilities—size of the assets, use and sale restrictions, and relationships, Bodnar said. It requires a lot of manpower to acquire the critical mass of facilities needed to move the needle; a 40,000-square-foot medical office just isn’t going to cut it, he said.
These deals also require relationships and trust with major stakeholders, Bodnar said. “We have seen Chinese firms that are looking at real estate ownership as a possible entry point into partnerships with larger specialty practices,” he said.

Copious capital

Many large players in healthcare are flush with capital, which is driving expansion, mergers and acquisitionsShedding real estate can be attractive to providers that need capital and want to offload maintenance duties as they put more resources into patient care. But cash-rich health systems are not selling their real estate by and large, said Mindy Berman, managing director of capital markets at JLL.
Despite the burden of technology, labor and pharmaceutical costs, providers are increasingly self-developing new facilities with good access to capital and low borrowing rates, especially for highly rated and high-performing health systems, she said.
“Last year was the first year where there were no meaningful monetizations—it goes back to access to capital,” Berman said, adding that she typically sees about two a year.
The continued strengthening of credit continues to drive a lot of merger-and-acquisition activity and construction, CBRE’s Bodnar said.
Many health systems have exercised their right of first refusal, which gives a potentially interested party the right to buy a property before the seller fields any other offers. This is likely an outcome of the low cost of capital, HRE Cap’s Beebe said.

Hospital construction starts
Despite the momentum around medical office space, the silver tsunami of baby boomers is poised to boost demand for hospitals as well. The push for more micro-hospitalsfeaturing smaller footprints and post-acute facilities, as well as local requirements like seismic upgrades required in California, are driving the current $21.4 billion of new hospital construction, according to JLL.Nearly 38 million square feet of hospital space was under construction in 2018, JLL’s analysis of Revista data shows. That was up from 25.9 million in 2017, 32.5 million in 2016, 27.5 million in 2015 and 21.4 million in 2014.
Since the financial crisis, health systems’ access to capital across the spectrum has virtually been unlimited, said Jeffrey Sahrbeck, a managing director at healthcare financial advisory firm Ponder & Co. This will continue to drive M&A and construction activity, he said.
“Hospitals have been building beds and spending on brick and mortar in advance of baby boomers,” Sahrbeck said.

Court Blocks San Fran Statute Requiring Warning Labels On Sugary Drinks

In an 11-0 vote, a federal appeals panel yesterday ruled against a San Francisco ordinance that would require beverage marketers to devote 20% of their display advertisements for sugary beverages to a warning that the drinks increase the risks for obesity, diabetes and tooth decay.
The ruling by the Ninth U.S. Circuit Court of Appeals in San Francisco granted a preliminary injunction preventing the law, which was passed by the city’s board of supervisors in 2015, from taking effect. The judges said the warnings would “offend plaintiffs’ First Amendment rights by chilling protected speech.”
A three-judge panel of the circuit court blocked the law in 2017. The entire 11-judge panel agreed last year to rehear the case.


Throwing a bone to health advocates, “the judges wrote on Thursday that the city ‘may be commended for aiming to address serious and growing public health problems.’ But they agreed that beverage companies were likely to suffer irreparable harm if the law went into effect because the warnings would drown out the ads’ main messages,” the AP’s Christopher Weber and Sudhin Thanawala report.
“This decision is solely about the size of the warning label,” said John Coté, a spokesman for the city attorney’s office. “The court found that 20% is too large, but suggested 10% would be sufficient,” reports Dominic Fracassa for the San Francisco Chronicle.
“The court did not say whether the 10% size was valid or invalid, but reiterated that the city had not justified the 20% requirement,” Fracassa observes.
“We’re evaluating our next steps in light of this decision. But make no mistake — we’re committed to protecting the health of San Francisco residents by allowing them to get factual information,” Coté said.
But “the court also determined the city’s warning that consumption of sugary drinks can lead to obesity and other diseases wasn’t based on established fact — citing statements by the Food and Drug Administration that sugars are ‘generally recognized as safe’ when not consumed to excess,” Jim Carlton points out for the Wall Street Journal.
“The American Beverage Association, which represents Coca-Cola, PepsiCo and others, joined retail and advertising organizations to argue in court that the ordinance should be blocked,”  Samuel Chamberlain reports for FoxNews.com
“‘We are pleased with this ruling, which affirms there are more appropriate ways to help people manage their overall sugar consumption than through mandatory and misleading messages,’ the beverage association said in a statement. It added that it hopes to work with public health groups in San Francisco on helping residents make informed decisions about their diets,” Chamberlain adds.
“The San Francisco ordinance is part of a national effort to curb consumption of soft drinks and other high-calorie beverages that medical experts have said are largely to blame for an epidemic of childhood obesity,” Reuters’ Tina Bellon writes.
“Over the past years, many U.S. localities have imposed taxes on sugary beverages, adding a surcharge of up to 1.75 cents per ounce (29 milliliters). At that rate, the cost of a typical 12-ounce can of soda would rise by 21 cents. The beverage industry has opposed the measures, saying they hit poor and working-class families and small businesses the hardest,” Bellon adds.
“One health advocacy group said that it was ‘disappointed that consumers will not benefit from the sensible warnings proposed by San Francisco,’” Richard Gonzales reports for NPR.
“We hope that cities, counties, and state legislatures continue to enact a wide range of policies to combat soda-related disease,” said the Center for Science in the Public Interest in a statement. “Taxes on sugary drinks were shown in Berkeley, Philadelphia, and Mexico to reduce consumption of these beverages. Many communities are requiring restaurants to offer healthier drinks with kids’ meals. Soda and other sugary drinks should be rare and served in reasonable portions — and should not be the default drinks that their manufacturers want them to be.”

Drug-Coated Balloons Superior After 5 Years in Peripheral Artery Disease

Five-year results of the IN.PACT trials in the U.S. and Europe show that drug-coated balloon angioplasty is superior to plain balloon angioplasty in treating patients with femoropopliteal disease, researchers reported here.
Freedom from clinically driven target vessel revascularization was achieved by 74.5% of the patients who were assigned to receive the IN.PACT Admiral paclitaxel coated balloon after 5 years of follow-up compared with 65.3% of patients who were treated with percutaneous transluminal angioplasty – or plain old balloon angioplasty (POBA), (P=0.0196), said Gary Ansel, MD, of OhioHealth in Columbus.
In his oral “Hot Topics” presentation at the 2019 International Symposium on Endovascular Therapy, Ansel said the results “support drug-coated balloon angioplasty as a first-line strategy for the treatment of femoropopliteal disease.”
He described the results as “the first independently adjudicated, blinded randomized trial to demonstrate superior effectiveness of a drug-coated balloon through 5 years.”
The 5-year assessment criteria was used to determine the percentage of patients who were diagnosed with clinically driven target vessel revascularization as adjudicated by an independent clinical events committee who were blinded to the assigned treated patients, based on a re-intervention at the target lesion due to symptoms of a drop of ankle brachial index of at least 20% greater than 0.15 when compared with baseline ankle brachial index.
Ansel and colleagues also demonstrated that the use of the balloon device was safe — i.e., there were no device-related deaths in either arm of the trial. The IN.PACT SFA 1 (conducted in Europe) and the IN.PACT SFA II (conducted in the U.S.) enrolled 331 patients, assigning 220 to treatment with the drug-coated balloon and 111 to percutaneous transluminal angioplasty.
One patient in the drug-coated balloon group had a major target limb amputation due to femoropopliteal disease.
Ansel reported that 70.7% of the patients in the drug-coated balloon groups experienced the primary composite for safety compared with 59.8% of the patients receiving plain balloon angioplasty, but that difference was not statistically significant (P=0.156).
He also discussed outcomes based on the dose of paclitaxel used in the trial, and noted that there was no difference in cumulative dose among patients who died during the trial while on the drug-coated device and those who survived and among those who were lost to follow-up: “We saw no relationship between paclitaxel dose and mortality rate,” he said.
The trial was not powered for mortality, he added. To do that, Ansel said, would require thousands of participants and would not be feasible. “We would never get a trial done,” he said.
He and his co-authors observed a 2.2% rate of thrombosis in the patients assigned to receive the drug-coated balloons compared with a rate of 4.8% for patients treated with POBA.
“This is a very robust dataset,” Ansel said. “And it is a very well-randomized trial with no differences between groups.” He noted that most trials of drug-coated balloons in the setting of peripheral artery disease have a maximum follow-up of 3 years. Only the IN.PACT series have been longer, out to 4 or 5 years, he said.
Ansel also pointed out that the trial utilized an independent and blinded core laboratory, an independent clinical events committee, and an independent safety monitoring board.
The patients included in the trial were approximately 68 years; about 66% were men; about 37% were current smokers; and their Rutherford Class was similar – with more than 55% of the patients diagnosed in Rutherford Class 3, and another 38% diagnosed as Rutherford Class 2. The lesion length was about nine centimeters, and calcifications were observed in 59% of the patients, Ansel said.
Fedor Lurie, MD, of the Jobst Vascular Institute in Toledo, Ohio, called the results “convincing.”
“They pretty much confirm what we are doing in our practice,” he said. “IN.PACT will not change our practice, because we already favor the use of drug-coated balloons in treating these patients. This trial does not compare different types of drug-coated balloons; it just shows that a drug-coated balloon may be better in the long-term than a POBA.
“The science in this study is good,” Lurie continued. “But in real practice one still has to determine which treatment is best for an individual patient. Saying that a drug-coated balloon is better than POBA in every patient would be the wrong conclusion.”
Lurie, a vascular surgeon, said that in some cases a surgical treatment might also be advised, but it all depends on the condition and desires of the patient.
The IN.PACT trials are sponsored by Medtronic.
Ansel disclosed relevant relationships with Abbott Vascular, Boston Scientific, CR Bard, SurModics, W.L. Gore, and Medtronic.
Lurie disclosed no relevant relationships with industry.

Living With Roommates

If you’re like most young men leaving the nest for the first time, you probably won’t have enough money to live all by yourself. To save money, you’ll very likely have to bunk with a roommate or two to cut down on living costs. While roommates can save you money (and provide camaraderie and companionship), they can pose many challenges. Any time you put two people with different backgrounds and lifestyles together under one roof, there’s bound to be conflict and awkward social moments.
Learning how to effectively manage the roommate relationship is an essential skill for every young man to have. Not only will it make living with roommates during your bachelor years easier, it also prepares you in many ways for when you settle down and start a family of your own.
Below we provide some tips on how to make living with roommates as drama-free as possible. The advice is based on my personal experience of living with dozens of roommates when I was single, many of whom came from completely different cultures than me.
vintage college roommates in dorm reading goofing off
Establish ground rules from the get-go. A friend of mine who left home a year earlier than me summed up this guideline thusly: “Establish rules before you need them.” Don’t wait until someone forgets to pay their share of the rent to figure out what happens when someone doesn’t pay the rent. Neither should you wait until the night before a big final to have the discussion about your roommate’s proclivity for blasting his TV at 2 AM in the morning.
The best thing you can do to get along with your roommate is to sit down with him the first day you move in (if you’re in the dorms) or before you sign a lease (if you’re getting an apartment) to discuss the rules of the apartment/dorm. Don’t make this conversation combative. Don’t be defensive and uptight. You want everyone to be as open and frank as possible. You can say something like, “Just so we’re on the same page and so we can avoid any conflicts in the future, can we lay down some ground rules for the apartment?”
What sort of rules should you establish? Here’s a list of a few questions you might consider bringing up in your conversation with your roommate:
  • When should everyone pay their share of the rent and utility bills?
  • Who cleans what and when?  Also discuss the consequences if people don’t do their chores.
  • What are the rules on dishes? Do dirty dishes get put in the dishwasher right away or can you leave them in the sink? Who unloads the dishes?
  • Is smoking inside allowed?
  • What are everyone’s drinking habits?
  • What sort of expenses will we share? Cleaning supplies? Garbage bags? Toilet paper? Any shared food expenses like coffee and milk?
  • What are the rules on bringing guests over? Can friends crash in the living room? How big of a heads-up should everyone give before having a party or bringing guests over? Do we even need to give a heads-up?
  • What about significant others? Can they spend the night? Can they hang out all day, every day? Can we give them duplicates of our keys? You’ve got to be careful with this one. I’ve seen several roommate relationships go south because a girlfriend slowly turned into a non-paying third tenant. Nip that in the bud from the get-go.
  • Speaking of significant others, if you’re sharing a room with a roommate, you might want to establish some sort of “Do Not Disturb” signal. It will save you from some awkward walk-ins.
  • What are the rules on morning and nighttime noise levels?
  • Are pets allowed?
  • What temperature are we going to keep the thermostat set at? (You’d be surprised how contentious this issue can be with roommates.)
  • Have everyone share whether they’re neat freaks or slobs. It’s best to know from the outset so you can manage expectations about what constitutes a clean apartment.
A lot of roommate conflict boils down to a mismatch of expectations. Roommates expect each other to be mind-readers, and to live up to expectations that they’ve never actually verbalized, but simply expect the other guy to magically know and adhere to. When the expectations aren’t met, resentment follows. By sitting down together before you move in, you’ll know what to expect. For whatever psychological reason, even when someone doesn’t meet your standards, if you already know that they won’t, you won’t get bent out of shape about it.
By the way, I know some will feel resistant to the idea of drawing up ground rules, feeling like you’re young and want to keep things loose and that because you’re buddies, things will just naturally work out. Maybe they will, maybe they won’t. Think of the ground rules as friendship insurance — getting a policy isn’t the most pleasant task, and maybe you won’t need it, but if you do, it can keep your friendships intact and make the whole experience smoother and more enjoyable.
Be flexible and willing to compromise (but stand firm on your deal-breakers).  During your conversation about ground rules, you and your roommates will inevitably run into disagreements. Be flexible and work to compromise in order to accommodate each other’s differing lifestyles. For example, if you’re a night owl and your roommate is not, you should be willing to keep the noise down after he goes to bed, and he should in turn try to get ready quietly in the morning when you’re still snoozing. If there are some things that are deal-breakers for you, don’t be afraid to stand your ground. So if you don’t want any smoking in the house, say so. If your roommate isn’t willing to adjust to your request, find a new place or roommate.
Follow the Golden Rule. The key to managing roommate relationships is be mutually respectful and considerate of one another. You will be well served by following the Golden Rule.  If you don’t like walking into your living room to unexpectedly find a stranger sacked out on the couch, don’t invite friends over without giving your roommate a heads-up; don’t touch your roommate’s stuff without asking permission first; don’t leave your dirty dishes in the common area. You get the idea.
Have a weekly sync-up meeting. One activity that I found immensely useful in managing and preventing roommate conflicts is having a weekly meeting to sync up with each other. At this meeting you can discuss bills that need to be paid and chores that need to be done. It’s also a good time to let your roommate know about guests that are coming over in the coming week, so they have a heads-up.
The sync-up meeting is a good time to bring up and resolve any issues that are causing friction between roommates. Again, don’t be combative when you bring up concerns. Just tell your roommate what’s been bothering you and ask what the two of you can do to resolve the issue.
I’d also use this time to ask my roommate if there’s anything I can do to help him out that week. For example, if I knew that he was working overtime to finish a school paper, I’d ask if there were any chores or errands I could help out with that week. My roommates would do the same for me when I was getting bogged down.
Another nice feature about the weekly sync-up meeting is that it carries over nicely to married life. Kate and I do something similar in our own relationship. It’s a practice that has definitely contributed to our success in both our marriage and our business.
vintage college roommates bunk beds pajamas laughing
There will be conflict. Address it calmly and directly instead of avoiding it.  Conflict and disagreements are a normal part of any relationship, be it in a marriage or with a roommate. So don’t be surprised if you and your roommate don’t get along all the time. Unfortunately, many young people handle conflict by simply acting like it doesn’t exist or hoping that the conflict will magically resolve itself. Managing conflict like this will only turn small issues into big ones. Don’t avoid conflict. Don’t leave each other passive aggressive notes. Instead, rip off that band-aid and understand that “pain now is better than pain deferred.” So if you notice that your roommate is slacking off on his chores or is stealing borrowing your food, bring it up as soon as you can. Don’t let the conflict fester until it blows up like a puss-filled boil.
Understand you don’t have to be best friends with your roommate. One mistake I’ve seen many young people make when entering roommate relationships for the first time is having unreasonably high-expectations about the relationship. They expect that they’ll be best buddies with their roommates and do everything together and never get in fights. Their roommate, on the other hand, prefers to have his space and spend time with his own friends. This mismatch in expectations can cause friction in the relationship from the get-go.
To prevent this mismatch of expectations, go in understanding that you and your roommate might not be best buds, but merely roommates who respect each other. While you should certainly invite your roommate out to a party or a ballgame, don’t get offended if he declines. That’s his prerogative.
Even if you’re rooming with your best friend from high school, understand that just because you’re good friends doesn’t mean you’ll naturally be good roommates. I’ve seen the most volatile roommate fights between people who were once best friends. The problem usually stems from poor expectation management. Best buds naively assume that they’ll get along without establishing ground rules or having weekly sync-up meetings. But they don’t. Don’t skip those steps if you’re moving in with a good friend.
Friendships can also deteriorate if you rely on each other for all your social and emotional needs. Even if you’re two manly peas in a pod, don’t spend all your time with each other. Make other friends, find different interests, and do things separately sometimes.
Use Google Docs and Google Calendars to manage everything. During my roommate days, the only tool we had to manage shared expenses and chores was a whiteboard. My roommates and I would post rent due dates and the chores list for the week. And of course, the whiteboard was used occasionally for scribbling passive aggressive notes about some grievance.
Take a tip from Apartment Therapy and upgrade from the humble whiteboard to the Cloud by using shared Google documents and calendars to manage your roommate experience:
  • Create a Google spreadsheet to manage rent and other shared expenses.
  • Another spreadsheet can be used to keep track of chores and whether they’ve been done.
  • Create and share a Google Calendar just for your roommates so you keep everyone abreast of when guests are coming over or dates for parties. You can also put rent and utility due dates on the calendar and have Google send everyone an email reminder when the date rolls around.
  • Use a shared Google write document to share random notes.
If your roomies don’t use Google, you’ll have to convince them to sign up to take advantage of this system.

I Can’t Stand My Roommate. What Can I Do?

Despite doing your darnedest to make it work, your relationship with your roommate has reached a point that you can’t imagine living another day with him. What can you do?
If you’re living in a dorm, go talk to your RA. They might be able to help you make a room switch. I had a friend in college who decided to get assigned a random dorm roommate for the “experience.” Little did she know that the roommate assigned to her would turn out to be certifiably crazy. After a few weeks of trying to make the relationship work, my friend asked for a new dorm room. She got one with little trouble.
If you’re living in an apartment, getting rid of a bad roommate or moving out is a bit trickier because of the lease agreement. Unless you have enough money to pay for the months remaining in your lease agreement, plus an early termination fee, moving out might not be an option. You could always evict your roommate, but that process can take time and makes an already awkward situation even awkwarder.  The eviction process is a bit complex for this post, so I might revisit it later in a future post if there’s any interest.
Unless your apartment roommate is not paying their share of the rent or is conducting illegal activities in your apartment, your best bet is to wait until the lease is up and go your separate ways. It will be a learning experience for sure.