Unregulated sales of insulin common on Craigslist

Unregulated and deeply discounted sales of insulin are common on Craigslist, a new study finds.

During a two-week period, researchers turned up 327 ads from private parties selling insulin at a fraction of the retail price, according to a report in JAMA Internal Medicine.

“The take home message from this study is that patients (with diabetes) should not have to go to Craigslist to find affordable insulin,” said coauthor, Dr. Jennifer Goldstein of ChristianaCare Hospitalist Partners in Newark, Delaware and The Value Institute at Christiana Care. “We have a duty to provide more viable options. There has to be a better way than patients going out on their own and seeking out potentially harmful products.”

The idea for the study was sparked by a newspaper story about a person who purchased insulin on Craigslist, Goldstein said. “I couldn’t believe it and started looking into it on my own,” she added. “I was surprised at the number of ads I found. I wanted to provide a snapshot of what was going on. It’s alarming.”

Craigslist did not respond to a request for comment, but prescription medications are on the site’s list of prohibited items.

Goldstein and colleagues scoured Craigslist ads in June 2019 looking for three prescription medical products: insulin, the asthma drug albuterol, and Epipens, the devices for administering allergy medications in emergencies.

The team was particularly worried about the ads for the potentially life-saving insulin. “There is no way to know what you are purchasing, the potency of it or whether it’s been contaminated,” Goldstein said.

There are also concerns about how the drug has been stored and the conditions under which it will be shipped, Goldstein said. “Insulin is very sensitive to extremes in temperature,” she added.

Goldstein’s team searched all the cities in each state listed on Craigslist between June 12 and June 24. They found no ads for Epipens, 105 ads for albuterol and 327 ads for insulin. Surprisingly, the advertised price for albuterol inhalers was nearly twice the retail price. In contrast, the average price for analog insulin was about a tenth of the retail price, $30.24 versus $372.30.

Some sellers said they didn’t want to waste the medications for which they had no use, some said they were selling because they needed the money for co-pays on newer medications, some said they were selling because they had recently changed medications.

For those who cannot afford the insulin they’ve been prescribed, there is an over-the-counter insulin that can be purchased at Walmart for about $25 a vial, Goldstein said. But patients would need to speak with their doctors because it doesn’t act in exactly the same way as the prescription products, she said.

Goldstein knows the effects of high priced insulin on patients. “I have taken care of many patients who came into the hospital in diabetic crisis because they could not afford their insulin,” she said.

It’s a shame patients feel they need to resort to this kind of measure, said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

“Patients need medications like insulin to survive, but these medications, which were easily available in the past, have become unaffordable,” Wu said in an email. “So now, desperate patients are seeking medications in online marketplaces that are unregulated and unmonitored.”

“This study reflects the disgraceful situation patients are in today,” Wu said.

SOURCE: bit.ly/2WsOgXZ JAMA Internal Medicine, online February 17, 2020.

https://www.reuters.com/article/us-health-medication-black-market/unregulated-sales-of-insulin-common-on-craigslist-idUSKBN20B1M0

Rise in coronavirus infections prompts Japan to limit public crowds

Japan canceled the emperor’s birthday celebrations next week as it moved on Monday to limit crowds to contain the spread of the coronavirus, and said it will close the Tokyo Marathon to all but elite professional runners.

The widening fallout of the virus outbreak, which began in China in December and has already killed over 1,700 people, is damaging output and tourism in Japan, which is preparing to host the Olympic Games from late July.

A further spread of the virus in Japan, which last week reported its first fatality from the disease, could undermine growth and potentially push the country into recession, analysts say.

Citing “circumstances”, the Imperial Household Agency said it would cancel Emperor Naruhito’s public birthday address on Feb. 23, his first since his coronation last year. The event regularly attracts tens of thousands of people to the inner grounds of the Imperial Palace in the heart of Tokyo.

The last time the emperor’s birthday celebration was canceled was 1996, amid a hostage crisis at the Japanese embassy in Peru.

Organizers of the Tokyo Marathon, one of the world’s biggest such races, said the 38,000 general participants who signed up for the March 1 race will not be allowed to compete.

“We cannot continue to launch the event within the scale we originally anticipated,” the organizers said in a statement.

Instead, the event will be limited to top-level competitors. A total of 176 elite runners and 30 elite wheelchair athletes are registered for the race.

Shares of some of the marathon’s sponsors fell. Seiko Holdings (8050.T), the maker of watches and clocks, slid 3.5%, as did shoe and sportswear maker ASICS Corp (7936.T). The broader Tokyo market .TOPX was little changed.

The marathon is not the only international sporting event in Japan the virus has affected: The FIBA Asia Cup 2021 postponed a qualifying basketball game between Japan and China, originally scheduled to be held near Tokyo this week.

INFECTIONS SPREAD

An additional 99 people on a cruise ship docked in the Japanese port of Yokohama were confirmed on Monday to be infected with the virus, a day after 70 were confirmed to have the virus, bringing the total number of infections aboard the Diamond Princess to 454.

The United States evacuated hundreds of citizens from the ship early on Monday, with other countries preparing to do the same for their citizens on the luxury cruise, which was struck by the virus earlier this month.

A Japanese health ministry staff member helping to test passengers has also contracted the virus, the ministry said.

Infections have also been spreading on land, where 59 cases have been confirmed including one woman who died last week.

A hospital outside Tokyo said it would stop admitting new patients after one of its staff tested positive for the virus.

The hospital in Sagamihara, 50km (31 miles) west of Tokyo, said a nurse was infected after treating an inpatient who died of the disease this month.

On Monday morning, a fifth government-chartered flight carrying 65 Japanese arrived in Tokyo from Wuhan, China, the epicenter of the outbreak, bringing the total number repatriated to Japan from the city to 763, NHK said.

Companies are stepping up measures to prevent the spread of the virus as a growing number of cases have been reported in people who have neither visited China nor have had direct contact with people arriving from there.

Nippon Telegraph and Telephone Corp (9432.T), one of Japan’s biggest companies, said it was urging its roughly 200,000 group-wide employees to work from home or stagger their commutes.

On Friday, NTT Data Corp (9613.T) said a contract employee who worked at one of its buildings was confirmed as infected. The company has ordered 14 workers who were in close contact with that person to work at home, it said.

https://www.reuters.com/article/us-china-health-japan/rise-in-coronavirus-infections-prompts-japan-to-limit-public-crowds-idUSKBN20B05Y

Chinese doctors use plasma therapy on coronavirus; WHO: ‘very valid’ approach

Doctors in Shanghai are using infusions of blood plasma from people who have recovered from the coronavirus to treat those still battling the infection, reporting some encouraging preliminary results, a Chinese professor said on Monday.

A top emergency expert at the World Health Organization (WHO) said later that using convalescent plasma was a “very valid” approach to test, but that it was important to get the timing right to maximize the boost to a patient’s immunity.

The coronavirus epidemic is believed to have originated in a seafood market in the central city of Wuhan, capital of Hubei province, and has so far killed 1,770 people and infected more than 70,000 in mainland China.

China’s financial hub of Shanghai on Monday had 332 infected cases, one of whom died in recent weeks. Lu Hongzhou, professor and co-director of the Shanghai Public Health Clinical Centre, said that 184 cases were still hospitalized, including 166 mild cases, while 18 were in serious and critical conditions.

He said the hospital had set up a special clinic to administer plasma therapy and was selecting patients who were willing to donate. The blood would be screened to check if he or she had other diseases like hepatitis B or C, he added.

“We are positive that this method can be very effective in our patients,” he said.

There are no fully licensed treatments or vaccines against the new coronavirus, and the process of developing and testing drugs can take many months and even years.

‘VERY IMPORTANT AREA’

Convalescent plasma has been proven “effective and life-saving” against other infectious diseases, including rabies and diphtheria, Dr. Mike Ryan, head of WHO’s health emergencies program, told reporters in Geneva.

“It is a very important area to pursue,” Ryan said.

“Because what hyperimmune globulin does is it concentrates the antibodies in a recovered patient. You are essentially giving the new victim’s immune system a boost of antibodies to hopefully get them through the very difficult phase.

“So it must be given at the right time, because it mops up the virus in the system, and it just gives the new patient’s immune system a vital push at the time it needs it. But it has to be carefully timed and it’s not always successful.”

Ryan added: “So it is a very important area of discovery, and I believe they are starting trials on that in China. But it is a very valid way to explore therapeutics, especially when we don’t have vaccines and we don’t have specific antivirals.”

As well as using plasma therapies, the Chinese doctors are also trying antiviral drugs licensed for use against other infections to see if they might help.

Scientists are testing two antiviral drugs and preliminary results are due in weeks, while the head of a Wuhan hospital had said plasma infusions from recovered patients had shown some encouraging preliminary results.

https://www.reuters.com/article/us-china-health-hospital/chinese-doctors-using-plasma-therapy-on-coronavirus-who-says-very-valid-approach-idUSKBN20B1M6

Incomplete and inadequate: Data lacking for seniors looking for assisted living

As of today, the youngest of the nearly 70 million baby boomers is 55; the oldest is 74. Within the next decade, millions of them will need long-term care. Many will remain in their homes, with family or “drop-in” caregiver services lending a hand. Some will move in with relatives. Those who are most dependent on care might choose nursing homes. A diverse and expanding older population is looking for help.

For more than a decade, “assisted living” residences grew faster than any other segment of the long-term care industry. Typically more home-like than a full-care nursing facility, assisted living is often favored by people who are generally independent, but still need support with daily activities. In general, providers offer fewer medical services, though many provide health and memory care for residents with Alzheimer’s disease and other types of dementia.

We and our colleagues track the ever-changing circumstances of long-term care in the U.S. As we study policies and practices, we have observed that the expansion of assisted living is clearly a game-changer, creating new challenges in the industry. Many states have increased assisted living regulation in recent years. Some consumer advocates have called for nursing-home style federal rules, though others oppose this, saying assisted living should remain flexible enough to serve residents with a range of needs, from personal care only to end-of-life comfort.

To better understand how consumers make choices when shopping for an assisted living residence, we conducted an examination of health service websites in every state.

Our goal: to find out how much information the states provide to the public about assisted living.

What we found

Unlike nursing homes, which are regulated by the federal government, the states oversee assisted living; they define what constitutes an assisted living residence, establish licensing requirements, and set quality standards.

Data from the states on assisted living is provided free to the public. All licensed residences are listed. While private search services might help consumers sort through options, it’s not clear how complete—or objective—they are. Some services exist primarily for marketing purposes; they collect fees from the residences they list.

Using criteria formulated from prior research, along with information provided by some states, we examined 39 key elements of each website. Those elements included the size of the facility, cost, license status, the insurance it accepts, and any special services offered, such as memory care. We also looked at each website’s usability—the ease in finding critical information.

Another group of researchers conducted a similar study in 2005. In some areas, our findings showed notable improvement. In the earlier study, only about 15% of the websites provided reports of state-required quality inspections. We found 70% now post them.

Substantial gaps remain, however. Only about one-fourth of states divulged the type of payment accepted by their residences. Although assisted living costs vary considerably from place to place, only two states disclosed what a customer would be charged. Knowing the accessibility of care personnel is critical, but again, just two states had any data about the availability of staff.

More than two-thirds of states didn’t say whether their residences offered memory care. That’s difficult to understand; many people with Alzheimer’s or dementia prefer assisted living over nursing homes. In those states where details were given, the facts were disconcerting: More than 20% of older Floridians live in rural counties with no access to memory care.

State websites difficult to navigate

Overall, the websites were not user-friendly. Although most of the basics were relatively easy to find, extensive searching was required for details about individual residences. Sometimes, it wasn’t even clear which state agency was responsible for assisted living oversight.

Still, there were bright spots, mostly in states with significant elderly populations: California listed inspection updates. Florida itemized activities offered in each residence. Arizona posted plain-language summaries of inspection results, even cataloging the fines levied on the facilities for regulatory breaches. But commendable practices were exceptions. At a minimum, more specifics are needed on quality, costs and essential services like memory care. And all state websites should provide inspection results, including details about fines or penalties.

Granted, improving the information on the websites might require new or revised state regulations. Some states, for instance, conduct inspections only once every two years; this limits the availability of new inspection reports. A minority of states impose specific staffing regulations, which explains the lack of staffing data available.

But more and more people are choosing assisted living. The government is now funding many residences to provide care for low-income disabled citizens. Their needs—and vulnerability – are significant, enough for states to reassess their roles in protecting assisted living residents. Adding accurate and detailed content to their websites would be a great first step.

True, the state websites are better than they were 15 years ago. But they are less than what they should be. Many of the elderly, the disabled, and the families who love them require more to make appropriate choices. When navigating the internet, the principle of “buyer beware” should not be the driver.

https://medicalxpress.com/news/2020-02-incomplete-inadequate-lacking-seniors.html

Beijing to fast-track new mask factory in virus fight

The Chinese capital of Beijing will set up a new mask factory within just six days to meet soaring demand for protective gear in the wake of the coronavirus outbreak, the official Xinhua news agency said on Monday.

The factory, to be converted from an industrial building by China Construction First Group, will be able to turn out 250,000 masks each day, it said, adding that work began on Monday and was set to be completed by Saturday.

The rapid pace and makeshift nature of the plant mirror measures taken in the virus epicenter of Wuhan, in the central province of Hubei, where buildings have been converted to treat infected patients, or hospitals built from scratch, in days.

Producers of masks and other protective equipment around the world have been unable to meet demand in the wake of the outbreak, which has killed more than 1,700 people in China.

Last month, CMmask, a Chinese mask maker that supplies 30% of the domestic market, said daily orders for 5 million masks were more than 10 times its usual level.

https://www.reuters.com/article/us-china-health-masks/beijing-to-fast-track-new-mask-factory-in-virus-fight-idUSKBN20B0WX