Sunday, August 4, 2019
Walmart Workers’ New Security Threat Is Active Shooters, Not Shoplifters
Walmart Inc., whose stores act as a community gathering place in many U.S. towns, encounters thousands of crimes every year on its property, including thefts and homicides.
But the retail giant has never before experienced the kind of carnage left by a mass shooting at one of its stores in El Paso, Texas, this weekend.
After the Saturday shooting in El Paso, where a lone gunman killed at least 20 people, some Walmart workers expressed concerns in online forums about their safety and how prepared their own store was for such an attack.
“I have to be cognizant of it. What’s my game plan if something does go down?” Alexis Rodriguez, a 21-year-old Walmart cashier at a store in Morristown, Tenn., said Sunday morning in an interview. There isn’t security at the entrance to his store, Mr. Rodriquez said. “It’s just an associate. They check receipts” to stop shoplifters, he said.
On social media platforms Walmart workers posted a picture of the company’s yellow spark logo overlaid with a black ribbon, and some workers said they plan to add a black band to their nametags to honor those killed. Many said they are afraid to head to work.
“Its terrifying knowing I could be killed just coming to work or my friends and family killed for shopping here,” said one person posting in the Walmart group on Reddit.
“I am not aware of another shooting with this impact” at a Walmart, one executive said. The company’s response is being managed by Jason Jackson, the executive responsible for the retailer’s global crisis operations, according to a person familiar with the matter. A former Arkansas state trooper, Mr. Jackson has worked at Walmart since 2004, according to LinkedIn.
Walmart said no workers were killed and two were injured in the shooting. The company is the country’s largest private employer with around 1.5 million U.S. staff.
Locations that are designed to be open to the public, such as supermarkets and shopping centers, are vulnerable to such violent attacks, but many businesses are taking steps to limit the potential carnage by training staff how to protect themselves and speed police response times.
“Anyone can walk in anywhere and start shooting,” said Jesus M. Villahermosa Jr., who runs security consulting firm Crisis Reality Training Inc. and whose own son’s school in Tacoma, Wash., was the scene of a shooting.
Mr. Villahermosa said there is only so much retailers can do. Many are reluctant to add invasive security checks near building entrances because that could make it more difficult for shoppers to quickly enter and exit a store, one reason he said many retailers have focused on training in the event a shooting does happen. “If I can’t stop something from happening, then I better have a plan when it does,” Mr. Villahermosa said.
In 2015, Walmart, the world’s biggest retailer by revenue, introduced computer-based active shooter training for store employees and, in 2017, started requiring workers to take the sessions once a quarter. Much of Walmart’s visible security efforts, including the staff who greet shoppers at store entrances, are focused on preventing shoplifting.
Behind the scenes Walmart uses an emergency operations center in its Bentonville, Ark., headquarters to coordinate with law enforcement to stop more serious incidents, including active shooters, said a former executive familiar with the systems. Staff includes former law enforcement, forensic experts and others.
In high-crime areas, Walmart sometimes hires security contractors or off-duty police officers to patrol stores. It has its own shoplifting-prevention staff in all locations.
In the wake of traumatic store events, Walmart provides counselors on location for workers and other services. The retailer turned off the music played in all stores Saturday, a Walmart spokesman said, but would resume playing music Sunday after reviewing the playlist for insensitive content.
The company is one of the nation’s biggest sellers of rifles and shotguns, though it stopped selling handguns in the 1990s and has put in new restrictions in recent years after several deadly mass shootings. It stopped selling assault-style weapons in 2015, such as the AK-style semiautomatic rifle that police say the El Paso gunman allegedly used.
In early 2018, Walmart took a public stance on gun violence. Days after a mass shooting left 17 dead at a high school in Parkland, Fla., the company said it would restrict gun and ammunition sales to those 21 and older.
Saturday’s rampage was the second shooting at a Walmart in a week. On Tuesday, in Mississippi, a Walmart employee who had been suspended last weekend shot and killed two other workers in the store, the Walmart spokesman said.
“I can’t believe I’m sending a note like this twice in one week,” Walmart Chief Executive Doug McMillon said in an Instagram post on Saturday evening. “My heart aches for the community in El Paso, especially the associates and customers at store 2201 and the families of the victims of today’s tragedy. I’m praying for them and I hope you will join me.”
Mr. Villahermosa, who spent three decades in law enforcement in the Tacoma area, said his own training company is busier than it has ever been because people tired of waiting for a “magic button” to solve the nation’s gun violence are now focused on how to survive a potential attack. “While we’re waiting for a solution, we better have a plan,” he said.
Notable Insider Buys: AbbVie, Bristol-Myers
- Insider buying can be an encouraging signal for potential investors.
- Insiders were buying shares last week in the wake of earnings reports.
- Two big drugmakers saw sizable insider purchases in the past week.
Conventional wisdom says that insiders and 10% owners really only buy shares of a company for one reason — they believe the stock price will rise and they want to profit from it. So insider buying can be an encouraging signal for potential investors, particularly with markets near all-time highs.
Below is a look at a few notable insider purchases reported in the past week.
AbbVie
Last week, an AbbVie Inc ABBV 0.71% director and an executive acquired 95,000 shares altogether of this pharmaceutical company. At prices ranging from $65.30 to $67.32 per share, those transactions totaled more than $6.30 million. Note also that more than 49,000 shares were purchased by insiders in the previous week.
AbbVie recently posted better than expected second-quarter results and raised its full-year guidance. The shares have pulled back since, more than the broader markets, and ended the past week trading at $65.35. The analysts’ consensus target is $86.00, though the stock has traded as high as $100.23 in the past 52 weeks.
Bristol-Myers
Bristol-Myers Squibb Co. BMY 1.73% also saw a director step up to the buy window. At an average price of $44.72 apiece, the 11,000 shares reportedly acquired last week totaled nearly $492,000. Note that another director bought 5,000 shares back in May, but at a price of more than $47 apiece.
This pharma giant also posted better than expected earnings and raised its fiscal year guidance. Shares ended the past week at $45.99, above the above-mentioned purchase price range. Note that the shares have traded as high as $63.69 in the past 52 weeks, though the analysts’ consensus price target is just $54.50.
Philippines to set aside politics on Sanofi Dengvaxia revival
The Palace will set aside politics and instead consider thegeneral welfare of the public in looking at the possibility of allowing the return of Dengvaxia vaccine to address the resurgence ofdengue cases in the country. “Politics must be set aside when the health of the citizenry is in peril,” presidential spokesman Salvador Panelo said last night.
“In this connection, a possible revival of Dengvaxia for those previously infected with dengue virus does not mean that pending cases against former officials involved in the issues surrounding the vaccine will be rendered moot,” he said. Since there are pending cases in relation of the use of Dengvaxia vaccine, which is made by French firm Sanofithat allegedly caused deaths to some beneficiaries of the vaccine, Panelo said the Palace will leave the matter to the courts of law.
Panelo assured the public that the administration will not sit idly by and expect that a health concern will be resolved without any action on its part. “We have always acted with the best interest and welfare of the Filipinos in mind.
We will do the same in this case,” he said. If ever the Palace would allow the revival of the use of the Dengvaxia vaccine,Panelo said the government would abide by the World Health Organization (WHO)’s standards on the anti-dengue vaccine.
“The government is open to any form or method that will lessen the rising cases of dengue in the country, which may include the possible re-use of the anti-dengue vaccine called Dengvaxia,” he said. Panelo explained that the possible revival of the use of the vaccine must be done with utmost caution by considering the opinion of the WHO and other medical experts.
“Nothing is final yet but we vow that we will not repeat the mistakes of the past, where Dengvaxia was allegedly misused and mishandled in aid of political election with haste,” he said. The government will consider the protocol set by the WHO that for countries considering said vaccination as part of their dengue control program, a pre-vaccination screening strategy is recommended, Panelo said.
“If Dengvaxia is proven effective to those who already had dengue in the past, then its application to these individuals will surely cause the decline of the overall number of cases of dengue which plague the residents of this country,”he said. Dengvaxia task force
The Department of Health (DOH) has created a National Dengvaxia Task Force to effectively monitor those vaccinated with the anti-dengue vaccine in four regions, an official said yesterday.
According to DOH regional director for Calabarzon and Task Force chairman Eduardo Janairo, DOH Secretary Francisco Duque III created the group three weeks ago to consolidate all of the records of the Dengvaxia recipients so they can provide “similar services and activities, support and assistance” for all the vaccinees. “We need to harmonize all our efforts.
Basically, what we have been doing in Calabarzon will be replicated in three other regions where the vaccination program was implemented,” he noted in an interview, referring to Central Luzon, National Capital Region and Central Visayas. In Calabarzon, Janairo has organized a tracking system to identify and monitor regularly all of the children given the vaccine in the region.
The region had conducted various meetings with the vaccinees’ parents and came up with a referral system to health care facilities so that their medical needs are immediately provided for. Janairo said through the task force, the DOH intends to establish “a whole of government and whole of society management team to oversee the implementation of activities for more equitable provision of services for all the regions concern.
” In 2016, the DOH launched the Dengvaxia immunization program, implemented by former secretary Janette Garin initially in Calabarzon, NCR and Central Luzon. Itwas expanded to Central Visayas as requested by its congressional representative.
But in November 2017, Duque ordered the vaccination stopped after its manufacturer Sanofi had admitted that Dengvaxia can lead to severe dengue if given to those who have not had dengue in the past. Around 833,000 children were given the vaccine in public elementary schools and Janairo assured the public thatthe task force will be looking for those vaccinated in private clinics.
“It is equally important to recommend funding for the purpose of establishing a research agenda to find out if there really is a correlation between the Dengvaxia vaccine and the reported deaths allegedly caused by the vaccine because as of now, no one can say whether there is a connection,” he added. The DOH has been asking Congress to earmark the P1.5 billion refunded by Sanofi for the vaccinees but legislators have not acted on this.
Sen. Richard Gordon said that doctors who testified for French drugmaker Sanofiare the same people now pushing for the use of Dengvaxia, including Garin.
Gordon also noted that government authorities should not hastily reintroduce Dengvaxia to Filipinos and they should meticulously study each case. He said Singapore is using Dengvaxia but under the supervision of a doctor, unlike what the DOH did.
Garin has asked the Duterte administration to revive the Dengvaxia vaccination program, saying the vaccine would have prevented the dengue outbreak in some provinces. Garin said the vaccination program, which was launched while she was health chief, intended to cut dengue-related hospitalization by 80 percent and to reduce the severe cases by 93 percent.
“If the weight of findings show that there is benefit using Dengvaxia against dengue, then certainly the government should consider it,” Panelo said.
E-cigarettes, Vaping Devices Can Help You Quit Smoking
Worldwide, one-billion people smoke cigarettes. Physicians, educators, health advocates, and governments have attempted to increase cessation and reduce cigarette uptake through taxation, labeling changes, marketing campaigns, and innumerable other efforts, all with very little impact. Yearly, less than 1% of smokers quit.
I completed my medical training in rural Indiana where 22% of the county’s population smoked cigarettes. I know a tremendous amount about Chantix, Nicoderm, nicotine gum, bupropion, hypnosis, counseling, free resources … I have done handstands (metaphorically) trying to unlock the box that would help me help people quit. In my thirteen years as a primary care physician and forty-three years as a daughter of a smoker, I have had minimal to no success in aiding my patients and loved ones in cessation. This is not for a lack of trying, a lack of training nor a lack of time. The vast majority of people who I care for who smoke state they have no desire to quit.
In the United States, the dialogue around cigarette smoking has largely been distilled to: “Cigarettes are bad for you. Quit.” Or “Smoking will kill you … Quit.” The majority of physician groups discuss prevention and cessation, but none discuss transition.
Our modern approach to smoking cessation is akin to telling a person who is one-hundred pounds overweight that they must lose one hundred pounds. This all-or-nothing approach, while academically correct, does not accommodate gradual modifications in human behavior that may ultimately lead to sustained behavioral change. It also flies in the face of accepted practices of motivational interviewing. Motivational interviewing is a strategy utilized by physicians, counselors, and even parents to help people work through uncertainty and commit to change (Miller, 1983).
Offering two behavioral options: continue or quit, leaves little room for transition.
Four years ago, one of my lovely patients with a long-term smoking habit looked at me and said – “Dr. G, I don’t think I’ll ever quit. Asking me to give this up is like asking me to walk away from a best friend. Through my life the only thing that’s always been there for me is a cigarette.” While I reminded this patient that, generally, best friends don’t kill us slowly, her statement struck a chord. I really, truly, had no understanding of just how important, and addictive, cigarettes are.
If I could bottle nicotine and safely prescribe it, I would. As a biochemical substance it works like the best combination of medications we have for anxiety, ADHD, panic attacks, depression, and movement disorders all at the same time. It is a brilliant chemical. In today’s crazy, uncertain, unsettled, insanely busy, and aggravating times I understand how nicotine can feel like a best friend. Unfortunately, for all that it ‘improves’, nicotine dramatically impacts the human cardiovascular system and increases the risk of early death from stroke and heart attack. In the balance of benefits vs. harms, nicotine has a lot of harms.
Nicotine is not the whole story of cigarettes, however. The products of combustion from a traditional cigarette are divided into gas and particulate phases. Biochemistry was never my favorite subject, but let me summarize the US Surgeon General’s Report: “Chemistry and Toxicology of Cigarette Smoke and Biomarkers of Exposure and Harm”:
The result of burning a cigarette means inhaling nail polish remover, Mr. Clean, Vics Vaporub, some of my old trainer’s hand wax parrafin, and a whole lot of stuff that is basically like pesticide mixed with embalming fluid.
The products of combustion of a cigarette are horribly harmful.
Incremental change – as with the weight loss metaphor encouraging that even a reduction of 25 pounds is a marked health improvement – until recently did not exist as part of our dialogue about smoking cessation. E-cigarettes, vaping devices, nicotine substitutes, and new nicotine delivery systems such as heat-not-burn tobacco products offer the possibility of a gradual reduction in the health impact of smoking while a person works toward full cessation. They offer the option for the US health care system, and the physicians within it, to rethink our dialogue around motivational change for our smokers.
The United Kingdom’s National Health Service states, “[e-cigarettes] … aren’t completely risk free, but they carry a small fraction of the risk of cigarettes… While nicotine is the addictive substance in cigarettes… [a]lmost all of the harm from smoking comes from the thousands of chemicals contained in tobacco smoke, many of which are toxic. Nicotine replacement therapy has been widely used for many years to help people to stop smoking and is a safe form of treatment.” The UK is a potentially powerful model for U.S.-based health professionals in expanding the range and efficacy of tools for people who want to stop smoking — and, at least as powerful, for potentially increasing the number of people who are willing to try.
US physicians and health organizations may struggle with a dialogue around nicotine alternatives. When I first considered thinking about smoking not as one thing but as nicotine plus products of combustion, the absolutist in me wanted to call ‘BS’.
People must quit smoking. Period.
Endorsing alternative nicotine sources as a path to cessation gets rid of the clear all-or-nothing “smoking is bad” messaging. The pragmatist in me, however, the day-to-day, do-the-very-best-I-can family physician, the physician who in 13 years has maybe had 1% of my smoking population quit smoking, sees tremendous brilliance in this frameshift. If I can’t help people quit all of the way…can I help them quit part way? Does shifting towards the road of cessation move people through the hardest first part of change?
Leading a conversation that looks towards cessation as a matter of incremental change differs from the long-held culture of saying that smoking is deleterious for health and quitting is the only option. The absolutism of that strategy towards cessation has been and remains woefully ineffective. For patients who can’t or won’t quit, is a dialogue of “if you can’t or won’t quit, will you switch” a transition toward improved health? Is continuing a harmful habit that can be modified to be less harmful, better than no change at all? As a physician and daughter of a smoker, I think it is.
Julie K. Gunther, MD, FAAFP is a member of Clinicians for Tobacco Control – an informal, physician-led group of health professionals dedicated to giving the patients we treat the tools they need to stop smoking.
Separating Fact from Fiction About Short-Term Medical Insurance Plans
The urban myth. The tall tale. Sometimes a story sounds so good, rings so true, well, it just has to be accurate. But, it is not.
As a cancer survivor, I am here to say such is the myth of short-term medical as “junk” insurance.
Recently a federal judge hinted that he would not overturn the Trump administration rule to limit short-term medical plans to three months, citing a lack of evidence that it has harmed consumers. He is correct.
For more than 30 years I have been involved in the short-term medical (STM) market, along with other types of niche insurance: as an agent, as a company executive, as an advocate for change and as a consumer myself. Millions of people need temporary insurance coverage – for all kinds of reasons. Evidence suggests that there are at least 10 niche markets for short-term medical, each influenced by circumstances and timing.
Based on my experience, about 750,000 to 1 million people are enrolled in STM plans. The market may be returning to its normal size because of new rules put out by the Trump administration. But remember, STM plans are not ‘permanent’ health insurance and never have been.
But let’s understand that the very nature of ‘permanent’ has changed in the new gig economy. More than 50 million people work multiple part-time jobs. Gig workers are more mobile. They often have gaps in employment, and their income tends to fluctuate. People who were otherwise uninsured are buying health insurance, and, yes, sometimes it is an STM plan.
Let’s also look at the data. Since April 2018, my organization has paid $61,000 in claims for an insured’s atrial fibrillation, $86,000 for an insured’s lung cancer treatment, and $206,000 for a 26-year-olds invasive cancer diagnosis, just to outline a few cases. Each month we help more than 5,000 members save an average of 40 percent on prescription drugs costs, and have paid out nearly $300,000 in Rx claims for the first quarter of 2019 alone.* Are these paid claims by ‘junk’ insurance meaningless to insureds who were not subject to catastrophic medical debt? One would assume not.
With that, let me debunk ten “myths” about short-term medical plans, and end with one truth:
Myth 1: You can’t enroll in an STM plan if you have ever been sick.
Not true. I am a colon cancer survivor and have heart stents and was recently temporarily enrolled in a STM plan when I moved from Minnesota to Arizona in the Fall of 2017. True, most STM plans have limitations for medical treatment received in the last one to five years, depending on the state.
Myth 2: The existence of STM plans may raise the cost of insurance for those enrolled in ACA plans.
As the old Wendy’s commercial stated: “Where’s the Beef?” There is no fact-based evidence that says the existence of STM plans raise the cost of insurance.
Myth 3: STM plans are the reason that there was a slight downturn in people enrolled in Obamacare plans.
False. The “culprits” include growth in faith-based – health sharing ministries – plans, which are exempt from insurance regulation, the high cost of ACA plans for those not subsidy eligible, , the increase in the number of workers covered by small and large employer insurance plans. The economy is good, and unemployment is low, which leads to fewer people seeking insurance in the individual market.
Myth 4: STM plans must be bad because big insurance companies don’t offer them.
Not true. The largest health insurer in the world offers STM plans, as do several Blue Cross organizations. In many states – and particularly in rural areas – there is a clear lack of choice and options in ACA. STM is a temporary safety net.
Myth 5: Most people can’t be approved for these plans because of pre-existing conditions.
False. Public data by eHealth and other companies suggest nearly 9 of 10 who apply are approved.
Myth 6: Only young people are enrolled in STM plans.
At Pivot Health, the fastest growing segment of our customers are those over age 60. Those not eligible for Obamacare subsidies, have few good choices, especially for those over age 60. How many 64-year-olds are most interested in unlimited lifetime benefits when they are a year from Medicare?
Myth 7: Consumers complain about STM plans way more than other insurance.
The National Association of Insurance Commissioners publishes information about all types of insurance companies and complaint ratios. We have found that there is one complaint for every 3,000 members.* Carriers who underwrite STM plans fare no better or worse than the entire insurance industry.
Myth 8: People are better off being uninsured than paying for an STM.
Some say that if you don’t have any insurance, hospitals and doctors will still provide care while the cost is shifted to others and a consumer would have to spend down their assets and go on Medicaid. Is that really an American solution?
Myth 9: Only STM plans cancel policies because of consumer fraud.
Any material misrepresentation or outright fraud can result in a consumer having their insurance canceled. This is true for life insurance, auto insurance, and for the plans made available at healthcare.gov.
Myth 10: Insurance agents who sell STM make huge profits.
On average, an insurance broker is paid about 50% less when selling an STM plan vs. an ACA plan.
STM provides real solutions to those who have a temporary need. Here is the the truth: one size won’t ever fit all and the demand for tailored, consumer-directed insurance solutions will accelerate as America transitions to a “gig” economy.
STM is not junk insurance. It is gig insurance that meet the needs of a changing economy, for some people, some of the time.
*Based on Q1 claims data provided by Pivot Health.
Jeff Smedsrud is co-founder and chief executive officer of Pivot Health, He has started and led several insurance companies and been active in public policy discussions about health care reform.
Fix Patents, Not Prices, to Solve America’s Prescription Problem
Sen. Kamala Harris (D-CA), a frontrunner in the Democratic nominating contest for president, recently announced her plan, titled “People over Profit,” to solve the nation’s ongoing crisis regarding the ever-rising prices of pharmaceutical drugs.
The provision courting the most national attention and controversy is its proposed hard cap on prescription drug prices. This cap would be set by the Department of Health and Human Services (HHS), and prescription drug companies that raise prices faster than inflation or higher than prices in comparable nations, such as Japan and Germany, would find themselves capped.
Rather than directly and clearly addressing the causes of these high prices, such as high levels of patent abuse and a lack of generic alternatives, this plan disregards the structural and policy causes of high pharmaceutical costs for a quick and simple fix.
Patent Problems
Patent abuse and a regulatory environment hostile to innovative alternatives, such as biosimilars, have led to a pharmaceutical drug pricing scheme in the United States that protects the interests of a handful of high-profit drug producers at the expense of both consumers and competitors.
The classic case one must consider to see the negative effects of the current patent scheme is the problem of insulin in the United States. A study released in January by the Health Care Cost Institute found that from 2012-2016, US insulin costs per patient nearly doubled from roughly $2,864 in 2012 to $5,705 in 2016.
The patent protection afforded to these pharmaceutical giants protects their monopoly power and their cartelization of insulin production.
Seeing that insulin itself is unpatented and that there are three largescale competitors producing it, this steep and near lockstep rise in price between competitors is perplexing. This problem of “parallel pricing,” as its commonly called, ought to be unsustainable in a free market. However, the patent protection afforded to these pharmaceutical giants protects their monopoly power and their cartelization of insulin production.
A report released in 2018 by the Initiative for Medicines Access and Knowledge found that the companies producing the 12 highest-grossing drugs in the US had applied for a combined total of 1,498 patents in 2017, looking to guarantee themselves each an average of 38 additional years of competition-blocking patent protection.
This government-granted shield leads to the establishment and protection of a small, high-profit group of corporations that can raise pharmaceutical prices in a tit-for-tat type of game that the normal American will always find himself losing.
Looking Forward to Reform
Japan and many European nations, the very examples Harris’s plan points to, have successfully prevented the quagmire of continuously rising prices by succeeding where the United States’ health care and pharmaceutical system has failed.
In 2017, the European Commission released a report on the impact of biosimilar drugs within European Economic Area (EEA) countries that found the introduction of these competitors decreased prices and increased market access for those who needed them.
Biosimilars are pharmaceutical alternatives that are effectively an identical copy of existing drugs. According to the FDA, biosimilars only contain “differences…in clinically inactive components” of the reference drug. Capping the price of drugs without fixing the root problem will only lead to fewer Americans having access to the lifesaving drugs they need.
While biosimilars face lower production costs thanks to their ability to skip costly clinical trials, the FDA had only approved 17 biosimilars as of January 2019.
A lack of actual competition and government protection of its most guilty parties has led the pharmaceutical market in the United States to be over-patented and over-priced. Capping the price of drugs without tearing out the root of the problem will only lead to fewer Americans having access to the lifesaving drugs they need.
These regulatory barriers to increased competition within the pharmaceutical market remain major drivers of the problem of affordable drugs in the United States. If Sen. Harris and others are serious about looking to Japan and Europe as examples for the United States’s approach to solving this issue, adopting a skeptical eye toward the current patent scheme and the corporate welfare it provides is the first step.
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