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newstfionline · 7 years

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Retirees flock to Latin America to live an upper-class lifestyle on $1,500 a month

By Jim Wyss, Miami Herald, June 3, 2017

CUENCA, ECUADOR--To casual visitors, this colonial town in southern Ecuador looks like it was torn from the pages of history. With its cobbled streets, soaring cathedrals and bustling markets, it exudes a lazy, old world charm.

But Cuenca is also on the cutting edge of a very modern trend: providing a safe haven for U.S. retirees who have found themselves unwilling--or unable--to live out their golden years at home.

The growing wave of expat seniors is not only upending notions about retirement in the hemisphere but reshaping the face of communities throughout the Americas. And the trend is expected to grow as waves of baby boomers exit the workforce ill-prepared for retirement.

There’s no accurate way to measure the phenomenon, but the Social Security Administration was sending payments to 380,000 retired U.S. workers living abroad in 2014--up 50 percent from a decade ago.

In the Americas, records show that seniors are flocking to Canada, Mexico, Colombia, the Dominican Republic and Ecuador.

Best known for the Galapagos and providing asylum in its London embassy to WikiLeaks founder Julian Assange, Ecuador is home to 2,850 retirees receiving benefits, according to the U.S. government. But that number doesn’t tell the full picture. The city of Cuenca recently conducted a census that found its municipality alone was home to almost 10,000 foreign retirees, most of them Americans from Texas and Florida.

On a recent weekday, Susan and Michael Herron were having a long, lazy breakfast by the side of the Tomebamba River that cuts through the city. Both in their 70s, they have the lean look of people whose principal mode of transportation is walking--and a sense of adventure usually found in people half their age.

They had previously “retired” in Central Florida, Georgia, Alaska, South Carolina and Panama before finally settling on Ecuador--because it was beautiful and cheap.

“We could have survived [financially] in the United States if we had moved to a more rural area,” said Susan, 71, a semi-retired property manager. “But we wanted to take this chance while we were still healthy enough to be able to do it.”

In Cuenca, a city of about 350,000 people, they’ve found robust public transportation, an extensive museum network, solid healthcare and markets bursting with fresh fruits and produce. It’s a place where their two-bedroom, two-and-a-half bath apartment costs less than $400 a month. They’ve found that for about $1,500 a month, they can live a solidly upper-class lifestyle, dining out frequently and traveling.

“In the United States, we couldn’t afford to go anywhere,” Susan explained. “We were having to stay home.”

Countries across the hemisphere are trying to woo U.S. retirees--and their pensions. Mexico, Panama, Nicaragua and Costa Rica, among others, try to make it as easy as possible for seniors to set up shop.

But city officials say Cuenca is something of an accidental hotspot.

“Cuenca never wanted to attract retirees,” said Ana Paulina Crespo, the director of international relations for the municipality. “In fact, we’re facing lots of problems over how to deal with a phenomenon that we aren’t responsible for creating.”

The city is trying to combat local fears that the retirees are both driving up land prices and bleeding the public healthcare system, she said. And the language barrier has become a source of local irritation. Some restaurants and even neighborhoods seem like English-only spaces.

“Cuencanos are feeling like strangers in their own city,” she said.

Starting in about 2009, Cuenca became a viral sensation on retirement websites. International Living, an influential publication, ranked it the top expat retirement site several years running. As newly arrived retirees began blogging, there was a snowball effect.

“The internet has changed everything,” said Dan Prescher, a senior editor at International Living who recently moved from Ecuador to Mexico to be closer to his family in the United States. “Now you can talk to expats who are living the life in real time. It has lowered the research bar for those who are thinking about it.”

A full 73 percent of the retirees in Cuenca, according to the city’s survey, said they found out about the city via “best of” rankings online.

But the city owes some of its popularity to an economic crisis--and the socialist policies of a president with a penchant for bashing the United States.

In 1999, Ecuador suffered a financial and banking meltdown that forced millions to go to the United States and Europe looking for jobs. Now many of them are coming home--often speaking perfect English and with degrees from internationally-recognized universities.

President Rafael Correa, who stepped down last month, also poured the nation’s oil wealth into hospitals, roads and infrastructure that have made the country rich with public services.

U.S. retirees who used to be slaves to their automobiles rave about the 12-cent bus rides (with the senior discount) and free symphonies.

Doris Soliz, a ruling-party congresswoman who represents this part of Ecuador, said it’s ironic that U.S. citizens steeped in capitalist values are attracted to a country that has embraced socialism.

“We’re a city that’s become a destination for older adults to enjoy their retirement years precisely because of all of our public services,” she said. “The public transportation, the public health, it’s all part of the quality of life.”

There are drawbacks to life abroad, of course. Some seniors said they felt isolated amid the language and cultural barriers, and felt that they had to be on guard from being fleeced by local merchants who saw them as walking ATMs.

If there is a real driving force for retirees, it’s healthcare. Although the Trump administration has said it will leave Medicare untouched, its desire to scrap the Affordable Care Act amid rising premiums has created anxiety among seniors, said Prescher with International Living.

“Look at what retirees [in the U.S.] are facing,” he said. “They have a fixed income, maybe their investments haven’t been doing that well and now nobody knows what public healthcare will look like in the United States.”

“In the face of that … if you can live in a place where you can cut your cost of living in half while getting access to high quality healthcare, you have to think seriously about it,” he added.

James Skalski, a 74-year-old semi-retired architect and builder from Minneapolis, credits the city’s quality but quirky medical establishment for turning his life around. When he arrived here three years ago, he was 20 pounds overweight, had high blood pressure and was running from a family history of heart disease.

“In the United States, all they would do for you is give you drugs,” he said. Here, a holistic doctor worked with him for six months, using a regimen of nutrition, chelation therapy and meditation that Sakalski said reversed all that. Price tag: $1,600.

“Just last month, I had to go to the dentist for inflamed gums, and the dentist was using state-of-the-art X-ray equipment made in Germany,” he said. The X-ray, antibiotics and dentist visit ran him less than $30. He encouraged a friend to travel from Alaska for dental work. With flights and all, it was still cheaper.

“It was a real eye opener,” he said. “For a guy like me who’s not a millionaire, this all makes sense.”

Cuenca’s survey of retirees found that most were either paying for healthcare out-of-pocket or had private healthcare. But some are reliant on Ecuador’s public healthcare system. Foreigners only need to pay into the system for three months before they have access to full benefits.

Because Medicare doesn’t cover most costs abroad, the Herrons, for example, were paying $84 a month to belong to the public healthcare system. When Michael, a 76-year-old retired IT worker-turned-novelist, recently ended up in the emergency room for a cardiac issue, the total bill was $133. In the past, the same procedure in the United States had been billed to his insurance company at $186,000.

Crespo, the city official, said the retirees are pumping money into the economy, but there are growing concerns over how they might be affecting the healthcare system.

“We’ve heard about cases where someone night need brain or heart surgery that might cost $300,000 in the United States and they have the operation here for $300 because they had paid into the system for three months,” she said. “The price differences are abysmal.”

Congresswoman Soliz said the legislature is planning on doing a comprehensive study of how foreign retirees might be straining public resources.

But city officials are also aware that retirement spots can fall out of fashion. Crespo wondered if the election of Trump and his harsh anti-Latino rhetoric could shift the balance.

“We don’t know if people are going to go back to the United States because of Trump or go somewhere else, like Europe,” she said. “There’s so much friction with Latinos right now [in U.S. political rhetoric] that we don’t know what might happen.”

The Herrons say they’ve tried to isolate themselves from the U.S. political news by not having a television. And while they say they have no desire to return to the United States, they’re open to continuing their retirement adventure in some other country.

But for the moment, they’re still enjoying the little details of laid-back Latin American living.

“We keep pinching ourselves,” Susan said. “We can have a two hour lunch and not be rushed out of the restaurant.”

#Ecuador #Cuenca #expats in Ecuador #retirees in Ecuador

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stephenmccull · 4 years

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Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients

The decision came out of the blue. “Your husband isn’t going to get any better, so we can’t continue services,” an occupational therapist told Deloise “Del” Holloway in early November. “Medicare isn’t going to pay for it.”

The therapist handed Del a notice explaining why the home health agency she represented was terminating care within 48 hours. “All teaching complete,” it concluded. “No further hands on skilled care. Wife states she knows how to perform exercises.”

That came as a shock. In May 2017, at age 57, Anthony Holloway was diagnosed with ALS (amyotrophic lateral sclerosis): The Frederick, Maryland, man can’t walk, get out of bed or breathe on his own (he’s on a ventilator). He can’t use the toilet, bathe or dress himself. Therapists had been helping Anthony maintain his strength, to the extent possible, for two years.

“It’s totally inhumane to do something like this,” Del said. “I can’t verbalize how angry it makes you.”

Why the abrupt termination? SpiriTrust Lutheran, which provides senior services in Pennsylvania and Maryland, said it could not comment on the situation because of privacy laws. “In every client situation SpiriTrust Lutheran is committed to insuring the safety and well-being of the individual,” wrote Crystal Hull, vice president of communications, in an email.

But its decision comes as home health agencies across the country are grappling with a significant change as of Jan. 1 in how Medicare pays for services. (Managed-care-style Medicare Advantage plans have their own rules and are not affected.)

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Agencies are responding aggressively, according to multiple interviews. They are cutting physical, occupational and speech therapy for patients. They are firing therapists. And they are suggesting that Medicare no longer covers certain services and terminating services altogether for some longtime, severely ill patients.

Altogether, about 12,000 home care agencies (most of them for-profit) provided care to 3.4 million Medicare beneficiaries in 2017, the most recent year for which data is available.

To qualify for services, a person must be homebound and in need of intermittent skilled care (less than eight hours a day) from nurses or therapists.

Previously, Medicare’s home health rates reflected the amount of therapy delivered: More visits meant higher payments. Now, therapy isn’t explicitly factored into Medicare’s reimbursement system, known as the Patient-Driven Groupings Model (PDGM).

Instead, payments are based on a patient’s underlying diagnosis, the presence of other complicating medical conditions, the extent to which the patient is impaired, whether he or she is referred for services after a hospitalization or a stay in a rehabilitation center (payments are higher for people discharged from institutions) and the timing of services (payments are higher for the first 30 days and lower thereafter).

Agencies now have a stronger financial incentive to serve patients who need short-term therapy after a stay in the hospital or a rehabilitation facility, said Kathleen Holt, associate director of the Center for Medicare Advocacy. Also attractive will be patients who need nursing care for complex conditions such as post-surgical wounds.

At the same time, there are fewer incentives to serve patients who need extensive physical, occupational and speech therapy.

The new system encourages a “holistic” assessment of patients’ needs, and there’s convincing evidence that home health agencies sometimes provided too much therapy under Medicare’s previous system, said Jason Falvey, a postdoctoral research fellow in the geriatrics division at Yale School of Medicine. Between 2000 and 2016, Medicare home health therapy services soared 112%, according to the most recent data published by the Medicare Payment Advisory Commission.

But the risk now is that too little therapy will be offered, Falvey said.

“We are very concerned about that potential,” said Kara Gainer, director of regulatory affairs for the American Physical Therapy Association.

Early reports from the field substantiate reason for concern.

Del (right) and Anthony Holloway, with family friend Veral Jackson(Courtesy of Anthony Holloway)

Last fall, the National Association for Home Care and Hospice asked 1,500 agencies how practices would change under PDGM. One-third said “categorically, across the board, we’re going to reduce our therapy services,” said William Dombi, the association’s president.

Dombi said his group has advised agencies that these cuts “may not be a good move” medically (patients might deteriorate without therapy and end up in the emergency room or the hospital) or “from a business perspective.” (If more patients end up worse off and going to emergency rooms or are hospitalized, that will reflect poorly on agencies and may affect referrals.)

The American Occupational Therapy Association is also surveying members. Based on 135 responses to date, occupational therapists and assistants are being laid off, asked to decrease the number of visits to clients and directed to provide services for less than 30 days, said Sharmila Sandhu, vice president of regulatory affairs.

In an email, a spokesman for the Centers for Medicare & Medicaid Services said the federal agency is “monitoring the implementation of the PDGM, including therapy service provision, at the national, regional, state, and agency level.” (A similar system for skilled nursing facilities that provide rehabilitation was implemented in October.)

“We do not expect home health agencies to under-supply care or services; reduce the number of visits in response to payment; or inappropriately discharge a patient receiving Medicare home health services as these would be violations of [Medicare] conditions of participation,” the spokesman wrote.

Yet that appears to be happening.

Carrie Madigan, an occupational therapist who worked for Kindred at Home in Omaha, Nebraska, said she was laid off in November as the company — the largest U.S. home health provider — cut therapy positions nationwide. Her agency lost four occupational therapists and three physical therapists last year as it implemented layoffs and cut back on therapy visits in anticipation of PDGM, she said.

A company spokesperson wrote in an email that Kindred at Home doesn’t discuss staffing decisions. The person maintained that its “focus always has been, and will remain, on providing the right care at the right time for our patients.”

Several large agencies said they had prepared extensively for PDGM. The Visiting Nurse Service of New York has trained coaches to work with Medicare home health patients and is bringing remote monitoring equipment into people’s homes to track their progress, said Susan Northover, senior vice president of patient care services. The agency provided home health services to more than 30,000 Medicare beneficiaries in and around New York City last year.

Under PDGM, there are 432 ways of classifying patients. For each, the group is recommending “the amount of time we think a patient should be receiving care,” based on extensive analysis of historical data, Northover said. “I absolutely see no change in how we will provide therapy going forward.”

Encompass Health of Dallas serves about 45,000 home health patients in 33 states, most of them covered by Medicare. It’s using an artificial intelligence tool to predict what kind of services, and how many, patients will need. “We’ve been able to eliminate some wasted visits” and become more efficient, said Bud Langham, chief strategy and innovation officer.

Langham said he was disturbed by reports he was hearing that “agencies are taking a very draconian approach to PDGM.”

“That’s dangerous, and it’s going to lead to worse outcomes,” he said.

In Frederick, Maryland, the Holloways have struggled since SpiriTrust terminated Anthony’s services Nov. 11. Four other agencies rejected Anthony as a patient. Without help stretching his limbs and strengthening his core muscles, he’s in more pain and has four new bedsores on his backside.

“He’s developing scoliosis, and he’s slumping in his wheelchair,” Del said. “And he can’t get comfortable at night. We spend hours trying to reposition him so he’s able to sleep.”

Before his services were cut off, Anthony had been getting three hours of physical therapy, two hours of occupational therapy, one hour of speech therapy per week, plus a visit every other week from a registered nurse.

In an email, Hull of SpiriTrust wrote that “individualized plans of care are developed specific to the needs of each client” and that “PDGM did not influence any decision made specific to this particular client’s plan of care.”

Before retiring in 2016 because of ill health, Anthony was chief of police for the U.S. Bureau of Engraving and Printing. “It seems to me nobody cares about what’s happening to me,” he told me. “It makes me feel terrible — awful, less than human.”

Several times, health care providers have suggested that Anthony move to a nursing home, Del said.

“He’d have to go to a ventilator facility, and there’s only one in my area, and everyone in it was really old and drugged when I visited,” she said. “How can he live in a place like that when he can’t use his arms or hands or operate a call button?”

There is a glimmer of hope. A few days before I spoke with the couple, a fifth home care agency said it would initiate services: two hours each of physical and occupational therapy, one hour of speech therapy and one hour for a home health aide every week.

“I’m relieved, but I also feel I’m walking on eggshells,” Del said, “since they can terminate you at any time.”

Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients published first on https://smartdrinkingweb.weebly.com/

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dinafbrownil · 4 years

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Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients

“It’s totally inhumane to do something like this,” Del said. “I can’t verbalize how angry it makes you.”

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Altogether, about 12,000 home care agencies (most of them for-profit) provided care to 3.4 million Medicare beneficiaries in 2017, the most recent year for which data is available.

To qualify for services, a person must be homebound and in need of intermittent skilled care (less than eight hours a day) from nurses or therapists.

At the same time, there are fewer incentives to serve patients who need extensive physical, occupational and speech therapy.

But the risk now is that too little therapy will be offered, Falvey said.

“We are very concerned about that potential,” said Kara Gainer, director of regulatory affairs for the American Physical Therapy Association.

Early reports from the field substantiate reason for concern.

Del (right) and Anthony Holloway, with family friend Veral Jackson(Courtesy of Anthony Holloway)

Yet that appears to be happening.

Langham said he was disturbed by reports he was hearing that “agencies are taking a very draconian approach to PDGM.”

“That’s dangerous, and it’s going to lead to worse outcomes,” he said.

“He’s developing scoliosis, and he’s slumping in his wheelchair,” Del said. “And he can’t get comfortable at night. We spend hours trying to reposition him so he’s able to sleep.”

Several times, health care providers have suggested that Anthony move to a nursing home, Del said.

“I’m relieved, but I also feel I’m walking on eggshells,” Del said, “since they can terminate you at any time.”

from Updates By Dina https://khn.org/news/why-home-health-care-is-suddenly-harder-to-come-by-for-medicare-patients/

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gordonwilliamsweb · 4 years

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Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients

“It’s totally inhumane to do something like this,” Del said. “I can’t verbalize how angry it makes you.”

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Please confirm your email address below:

Altogether, about 12,000 home care agencies (most of them for-profit) provided care to 3.4 million Medicare beneficiaries in 2017, the most recent year for which data is available.

To qualify for services, a person must be homebound and in need of intermittent skilled care (less than eight hours a day) from nurses or therapists.

At the same time, there are fewer incentives to serve patients who need extensive physical, occupational and speech therapy.

But the risk now is that too little therapy will be offered, Falvey said.

“We are very concerned about that potential,” said Kara Gainer, director of regulatory affairs for the American Physical Therapy Association.

Early reports from the field substantiate reason for concern.

Del (right) and Anthony Holloway, with family friend Veral Jackson(Courtesy of Anthony Holloway)

Yet that appears to be happening.

Langham said he was disturbed by reports he was hearing that “agencies are taking a very draconian approach to PDGM.”

“That’s dangerous, and it’s going to lead to worse outcomes,” he said.

“He’s developing scoliosis, and he’s slumping in his wheelchair,” Del said. “And he can’t get comfortable at night. We spend hours trying to reposition him so he’s able to sleep.”

Several times, health care providers have suggested that Anthony move to a nursing home, Del said.

“I’m relieved, but I also feel I’m walking on eggshells,” Del said, “since they can terminate you at any time.”

Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients published first on https://nootropicspowdersupplier.tumblr.com/

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pixlposts · 6 years

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Top Stories of 2017

Workplace culture finally get its due importance

2017 was the year when workplace culture, got the due attention. It started with Susan Fowler’s blogpost detailing workplace harassment at Uber. But ultimately resulted in a much bigger discussion about Silicon Valley treated its employees and was backed by many more people coming forward about the severity of the problem in the valley. We also saw positive results of the widespread attention that this story gained. Employees were fired, VCs began doing the due dilligence on harassment and we actually saw funding being withheld from a popular online trivia game because of the workplace culture. This is in many ways the most profound story of 2017.

iPhone X begins era of proactive authentication

Perhaps the most exciting part of the iPhone X, is it’s camera sensor tray (popularly called the notch). While the entire phone feels like a rethinking of the iPhone. FaceID is more interesting than it seems. Current authentication systems (even the image recognition features on other phones) have felt like reactive authentication systems where you need to perform a certain step to authenticate yourself. It’s what I like to call a “Hey, it’s me!” Authentication system, where a user is supposed to do something to tell the phone that it’s him. With iPhone X’s FaceID, this system moves to a more proactive authentication system, where the phone performs a check automatically, more like the phone saying “Hey! It’s you!” to unlock certain functionality of the phone.

Such functionality, makes using the phone more efficient, and to the owner of the phone blurs the lines between locked and unlocked states and eases more of the pain points of an authentication system. While this isn’t perfectly proactive yet, for example, iOS still requires the user to press a physical button while authenticating purchases, it’s bound to improve in speed and performance over time, and is what excites me most about the iPhone X.

Back to Pro for Apple’s lineup

This year saw Apple moving back to more professional grade computers for their product lineups. Earlier this year, Apple announced that they’re in the process of making a new Mac Pro. A rethink of the cylendrical pro that many professional users were hoping to see an update for. Apple also released an iMac Pro, that had the casing of an all in one computer with the feisty internals of a professional grade machine. While the Mac Pro would offer more flexibility, it’s not hard to overlook the fact that a lot of professional applications would find the iMac Pro to be a valid pro-machine. Apple’s renewed focus towards professional macs encourages it’s loyal but off-late angsty professional user base which’d have otherwise switched to PC in search for more lucrative machines that could actually run their heavy duty applications.

Apple’s focus towards professional computers wasn’t just restricted towards macs though. They also released two new iPad Pro devices, for the professional iOS users. These devices boasted of new technology (including Promotion displays that offer a really high-end touch screen experience, and faster chipsets) and were supported by a new completely revamped iOS for the iPad, making the iPad suitable for doing professional work like audio editing, writing and publishing, graphic designing, and photo editing. With apps like Affinity Photo, Scrivener, Ferrite, Linea and Procreate helping the iPad users to build their workflows around the touch-device.

Rise of the the Amazon Echo-System

Starting with CES where Amazon’s Alexa based speakers and devices were present everywhere, Amazon’s Alexa announced a proud dominance in the category of the smart home assistants. The year saw Amazon pushing its echo efforts even further, by launching more echo devices (including one that featured a screen to provide visual feedback) and expanding in more countries. With an expanded product range that starts at a dirt cheap price point, Amazon’s Alexa attracted a lot of skill makers, that strengthened the platform further and created a pretty booming eco-system of skills (similar to apps on your phone) that had Audio interfaces.

Almost as a testament to Amazon’s year of dominance, the company possibly enjoyed a very healthy holiday quarter with Amazon’s Alexa assistant app being one of the most searched and trending apps on the App Store. 2017 is the year when Amazon’s echo reached new heights compelling the competition to catch up to them.

Apple’s QA practices questioned

While Apple probably had a great year financially and in terms of the new devices it sold. 2017 was the year when Apple’s Quality Assurance was questioned, scrutinised and its lapses exposed to the world at large. It began in July with the accidental firmware upload of the HomePod which revealed quite a lot of details of their upcoming iPhone, a first of sorts, and just a few weeks later in a more deliberate attempt to sabotage the company’s surprise, someone released the links to the gold master software for iOS11. These slips and mistakes raise questions as to how Apple handles the security of their beta software and as to how such a situation occurred in the first place. The fact that Apple hadn’t put checks in place prior to the leaks was telling.

But that wasn’t all. Soon after iOS 11 released users witnessed another quality assurance hiccup from the tech giant, where their new calculator app failed to display correct results when the buttons were tapped quickly. But the larger issues came to light a few weeks later when first Apple had to patch a terrible root access bug that granted administrative access to anyone without the need of a password, and then followed by a date bug that crashed the springboard for some iOS users when notifications appeared on a certain date.

These quality issues affect Apple more than any other company. For a brand that’s built on quality, and has a user base that trusts Apple to do the right thing and offer a quality experience, these hiccups give the company’s reputation a severe dent.

Windows XP users “WannaCry”

Who uses Windows XP anymore? Turns out, a lot of people. Especially, in critical enterprise industries. In an industry such as that, it’d be a shame it the computers were held hostage as it’d disrupt many services. The problem was is increased if the users aren’t too tech savvy either. This is exactly what happened to users affected by the WannaCry ransomeware. The WannaCry ransomware cryptoworm encrypted the user’s data and demanded ransom payments in Bitcoin.

The ransomware affected primarily those computers which had not been updated for a while and ran unsupported versions of Windows. The impact was widespread, affecting various Hospitals and medical equipment, the ransomware also affected car manufacturers which were still relaying on older systems for condition monitoring and CAD simulations. Various banks and government offices were also affected.

Possibly the most significant malware attack of recent times, it was also a lessson for most organisations to keep updating their systems and not ignore critical security updates.

The Uber Fiasco

What began as an ambitious year for Uber with their self driving fleet of cars beginning to start on-road testing, quickly turned into a nightmare that began with Susan Fowler’s allegations on a petty and toxic work culture, followed by lawsuits that claimed that a Uber exec stole trade secrets from Waymo (Alphabet’s self driving car firm) and then followed by further allegations over a botched up lawsuit in India. But that’s not it, Uber’s unethical practices to get data on customers and drivers were also exposed. With the entire scenario turning into an uncontrollable mess, founder and CEO Travis Kelanick was fired. And Dara Kusroshahi appointed.

But Uber’s troubles didn’t seem to end there. In fact, even as late as November, it was discovered that Uber faced a massive security breach earlier in 2016, and they tried to cover it up by making deals with the ransomers. Uber admitted its fault in that case. But it’s also indicative of the fact that Uber’s 2017 fiasco may just be the tip of a larger ice berg.

Switch’s Hit

Nintendo’s latest console Nintendo Switch launched amidst a lot of excitement, the company has been reeling for a while now and desperately needed a lifeline to save them. Nintendo’s Switch did just that, bringing the company out of a slump and proving that Nintendo was still capable of making really good casual gaming hardware, even in the age of devices like the iPad.

With a mix of fun new games and old classics, bundled with modern hardware technology (including some really cool haptics), the Nintendo Switch is definitely an exciting package, and something that compels me a complete non-gamer to just try out the device, which everyone’s talking about. Switch’s success is a welcome sign of relief for Nintendo and da breath of fresh fair in the gadget space that’s becoming increasingly crowded by monotonous ‘smart’ appliances.

Return of “Nokia”

An aquisiton of Withings earlier this year, made Nokia (now a company owned by HMD Global of Finland) an instant big player in the digital health and fitness space with multiple smart health and fitness devices coming under the banner of the Nokia brand.

Closely following on the heals of the smart acquisition, HMD the parent company for Nokia, introduced their slew of Android smartphones into the market and reignited the Nokia brand. And what’s more, the devices themselves weren’t just cheap Android phones (as most of the phones in that price range are) but they were actually, well designed robust smartphones, that showed that great care was put into the making the hardware for those phones. HMD’s Nokia reboot stayed true to the brand’s name.

It’ll be interesting to see Nokia’s progress in the next few years.

Neutral Internet receives severe blows

Earlier this month, the FCC, now headed by Ajit Pai, decided to repeal several limitations put in place by the previous administration to provide telecom and internet service providers with more freedom on how to shape their internet offering. One of the most significant changes was the allowing of Fast and Slow Lanes for internet access, and the allowance for offering only a limited selection of websites to the users. Bascially, blowing away all the restrictions that ensured a free and open internet for everyone.

By repealing net neutrality laws, Pai’s not only given control to ISPs and Telecom to provide internet services with greater freedom, but armed these giants with weapons that’d allow them to prevent the rise and profileration of upcoming internet services that may harm their own competition. For example, Time Warner would be more inclined to give more bandwidth and faster access to something like HBO Go instead of say, Netflix Or any other streaming service.

One can only hope that the such ammendments are carefully scrutinised and possibly overruled as they hardly benefit users in the long run.

#topstories #year in review

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galialay · 7 years

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FUCKING STOP.

Do you want to know? Why we suck as a nation compared to a majority of the world? Do you want to know why I'm a nihilist and hate America and just can't fucking care about much of anything happening in America anymore? WHY WE ARE ANGRY. ABOUT. EVERYTHING. ABOUT. AMERICA. RIGHT NOW?? Watch this video. Listen. Just *fucking* listen. http://u.pw/2kKmeZq?s=p Then come back and read the rest of this rant if you still don't understand. This isn't a funny post. This isn't a polite post. This isn't isn't a argument post; because there is no argument here. This is the wake-up post of cold hard facts. She is an adult (one of you guys older than us "millenials snowflakes") and went to try to find the deepest statistics, the core statistics of why our system is failing us in education, and succeeded by asking the kids who grew up in this system in this last 20 years who actually left America to seek education abroad. Not the students coming here to study, but our own students leaving America - all over the world and asked them. You can't argue her stats, her facts, the fucking reality of the situation behind your political and religious warfare distractions. We need to change our education system. It's not working the way the world around us needs it to work. We need to take a more ancient-Greek-meets-modern-hippie philosophic approach to education. Teaching children about the world, business stuff and science stuff. How science and math can create new exciting things and by understanding it more deeply than "Repeat this equation and solve it idetical to how the book solves it. Just like your great-grandchildren grandma did in 1950, before technology changed dramtically." (Like writing code for technology! Or building new technology! Or curing disease forever!), How to grow food or plants and sustain the natural environment while adopting new business fields to expand our use of replenishable resources instead of pollution emitting/waste producing measures to fuel our world and save the natural ecosysyems. And humane stuff like how to work face to face with people as well as to politely interact online (Our world is fast moving to long online hours and we are barbarically awful online - the same way bullies worked in 1950 onward.), how to make friends, how to treat animals and each other with kindness, How to give generously without giving all of what you have (aka, sharing within reason, aka we need to help bring our education and health care up to actual modern standards: universal tax-paid, government unified healthcare, and naturalistic globally-standardized learning graded with the PISA test), and to appreciate artists and the amazing way they decorate our world and bring stories to film and videogames to life, how to show empathy not apathy, how to be kind not seek revenge, how to be spiritual not Religious®, and that everyone is a human being capable of evil and good equally and we all deserve and equal start in life not this "every man of himself when it comes to basic necessities for life ahaha fuck you poor people" crap going on. If we're not evil assholes murdering, raping, touching kids and other people inappropriately, and other actual morally wrong stuff (or you know those thing you call the 10 Commandments, aka the "golden rule", not "Whose genitals don't match what I think their face indicates they should have?" Or "Who's having sex with someone or in some way I personally don't think they should be due solely to my personal religious beliefs." Or "Whose way of life / skin color is so different from mine that I'm too scared to learn more about them? I'll just kill them before they all end up killing me, because some of them were bad. But my bad guys are ok bad guys. It's different. You wouldn't understand.") Not fighting over religious name brands, political brand names, who's fucking who, who's dating who, who's cheating now, who's dead now, sports name brands, celebrity name brands, etc., and just paying attention to the actual world. Realize we live mostly in poverty standards while earning "minimum wage". Minimum wage means minimum wage necessary to live above the poverty line, not "how little can I legally get away with paying someone for the most work I can get out of them?". $7.75 would be great for 1950. It's a joke in 2017. People are dying in large numbers just because we can't breathe the air, we can't drink the water, the food is killing us, mass varieties of plants and animals are going extinct, your kids can't afford what was considered poverty in the 1950s because minimum wage never rose enough to match inflation of market prices due to new and better tech avilability and vatiety provided by foreign countries. We literally cannot work hard enough to live and the education system is so bad we can't keep up with the technology provided by foreign countries! And you wonder why we're mentally and physically sick and angry all the time? You can't figure out what's wrong? Wake up. Get on board. We need better education, healthcare, food, water, air, and interaction. Aren't you all exhausted from the warring yet? Can't you just try to think for yourself and seek furtheeing knowledge and not just agreeing with what your chosen brand loyalties want you to think and buy because it's easier and doesn't hurt in the short term? It doesn't hurt for long, promise. All it takes is always asking why and finding the core facts, not assuming you know what's what just because you're bigger, older, went to a "better" school, or whatever your issue is with asking and learning even as an adult. What does hurt for long is kids and all kinds of people all around the world killing themselves, hurting themselves and others because we aren't properly equipped to help the mind get better like we can the body when sick. Imagine the strides we could make if we stopped donating to Brand Names and have directly to organizations not charities* and supported STEM & natural education and medical advances. As long as we're failing our future this badly compared to other countries we once called outdated and primal, I can't give an honest care about America's political or religious battle. I'm sick of people believing it's ok to kill based on petty differences. I don't support America and the government it elected. I support the people. (*Google it. Susan G Coleman and PETA take charity donations as salary and fail to give results. They're just brand names now to sell merchandise and pocket the profit. They havent helped donate, instwad they use it to sue other breast cancer or animal charities for rights. Donate to local farmers markets, local hospitals, and local food drives, safety shelters, schools, small businesses, EMS, police, and homeless shelters instead.)

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dinafbrownil · 5 years

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A Million-Dollar Marketing Juggernaut Pushes 3D Mammograms

When Dr. Worta McCaskill-Stevens made an appointment for a mammogram last year, she expected a simple breast cancer screening ― not a heavy-handed sales pitch.

A receptionist asked if she wanted a free upgrade to a “3D mammogram,” or tomosynthesis.

“She said there’s a new approach and it’s much better, and it finds all cancer,” said McCaskill-Stevens, who declined the offer.

A short time later, a technician asked again: Was the patient sure she didn’t want 3D?

Upselling customers on high-tech breast cancer screenings is just one way the 3D mammography industry aggressively promotes its product.

A KHN investigation found that manufacturers, hospitals, doctors and some patient advocates have put their marketing muscle ― and millions of dollars ― behind 3D mammograms. The juggernaut has left many women feeling pressured to undergo screenings, which, according to the U.S. Preventive Services Task Force, haven’t been shown to be more effective than traditional mammograms.

“There’s a lot of money to be made,” said Dr. Steven Woloshin, director of the Center for Medicine and Media at The Dartmouth Institute for Health Policy and Clinical Practice, who published a study in January showing that the health care industry spends $30 billion a year on marketing.

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KHN’s investigation shows that industry money has shaped policy, public opinion and patient care around 3D by:

Paying influential doctors. In the past six years, 3D equipment manufacturers ― including Hologic, GE Healthcare, Siemens Medical Solutions USA and Fujifilm Medical Systems USA ― have paid doctors and teaching hospitals more than $240 million, including more than $9.2 million related to 3D mammograms, according to a KHN analysis of the Medicare Open Payments database. Just over half of that money was related to research; other payments covered speaking fees, consulting, travel, meals or drinks. The database shows that influential journal articles ― those cited hundreds of times by other researchers ― were written by doctors with financial ties to the 3D industry.

Marketing directly to consumers. Manufacturers have urged women to demand “the better mammogram,” using celebrity spokeswomen such as breast cancer survivor Sheryl Crow. Manufacturers spent $14 million to market 3D screening over the past four years, not including spending on social media, according to Kantar Media, which tracks the advertising industry.

Lobbying state lawmakers. Private insurers in 16 states are now legally required to cover 3D screenings, along with Medicaid programs in 36 states and Washington, D.C. Officials at Hologic, the leading manufacturer, told KHN that about 95% of insured women have coverage for tomosynthesis.

Funding experts and advocates. Hologic has given educational grants to the American Society of Breast Surgeons, a medical association that recently recommended 3D mammograms as its preferred screening method, according to the group’s website. Hologic declined to reveal amounts. Hologic also has funded patient advocates such as the Black Women’s Health Imperative, which lobbies for access to 3D mammograms.

Enthusiasm for 3D has sparked a medical technology arms race, with hospitals and radiology practices competing to offer the newest equipment. Patients have caught the fever, too. When rural hospitals can’t afford 3D machines, foundations often pitch in to raise money. More than 63% of mammography facilities offer 3D screenings, first approved for sale in 2011.

Taxpayers write the check for many 3D screenings, which add about $50 to the cost of a typical mammogram. Medicare, which began paying for 3D exams in 2015, spent an additional $230 million on breast cancer screenings within the first three years of coverage. By 2017, nearly half the mammograms paid for by the federal program were 3D, according to a KHN analysis of federal data.

Hologic’s Peter Valenti said the company’s marketing is educational. His company is a “for-profit organization, but our premise is to try to improve the health care for women globally,” said Valenti, president of Hologic’s breast and skeletal health solutions division.

The debate over 3D mammograms illustrates the tension in the medical community over how much research companies should do before commercializing new products. In a statement, officials at Hologic said it would be “irresponsible and unethical” to withhold technology that detects more breast cancers, given that definitive clinical trials can take many years.

On average, 3D screenings may slightly increase cancer detection rates, finding about one extra breast tumor for every 1,000 U.S. women screened, according to a 2018 analysis in the Journal of the National Cancer Institute. Most studies also show that 3D screenings cause fewer “false alarms,” in which women are called back for procedures they don’t need, said Dr. Susan Harvey, a Hologic vice president.

Yet newer tech isn’t necessarily better ― and it can cause harm, said Dr. Otis Brawley, a professor at John Hopkins University. “It’s unethical to push a product before you know it helps people,” he said.

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A Fuzzy Picture

As a senior researcher at the National Cancer Institute, McCaskill-Stevens didn’t need a glossy brochure to learn about 3D mammograms. She helped design a $100 million federally funded study of 165,000 women, which will measure whether women are helped or hurt by 3D testing. The study, now recruiting patients, will follow the women for five years.

“Can we say that 3D is better?” asked McCaskill-Stevens. “We don’t know.”

The American Cancer Society, Susan G. Komen and the U.S. Preventive Services Task Force also say there isn’t yet enough evidence to advise women on 3D mammograms.

When the Food and Drug Administration approved the first 3D mammography system, made by Hologic, the agency required the technology to be safe and effective at finding breast cancer ― not at improving survival.

“The companies do the minimal research needed to get FDA approval, and that usually means no meaningful evidence of how it helps patients,” said Diana Zuckerman, president of the National Center for Health Research.

Valenti said Hologic presented strong evidence to the FDA. “The data was overwhelming that 3D was a superior mammogram,” Valenti said.

Describing a breast exam as 3D may conjure up images of holograms or virtual reality. In fact, tomosynthesis is closer to a mini-CT scan.

Although all mammograms use X-rays, conventional 2D screenings provide two views of each breast, one from top to bottom and one from the side. 3D screenings take pictures from multiple angles, producing dozens or hundreds of images, and take only a few seconds longer.

Yet some studies suggest that 3D mammograms are less accurate than 2D.

A 2016 study in The Lancet Oncology found that women screened with 3D mammograms had more false alarms. A randomized trial of 29,000 women published in The Lancet in June showed that 3D detected no more breast tumors than 2D mammograms did.

And, like all mammograms, the 3D version carries risks. Older 3D systems expose women to twice as much radiation as a 2D mammogram, although those levels are still considered safe, said Diana Miglioretti, a biostatistics professor at the University of California-Davis School of Medicine.

Valenti said the newest 3D systems provide about the same radiation dose as 2D.

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Diagnosing more cancers doesn’t necessarily help women, Brawley said. That’s because not all breast tumors are life-threatening; some grow so slowly that women would live just as long if they ignored them ― or never even knew they were there. Finding these tumors often leads women to undergo treatments they don’t need.

A 2017 study estimated 1 in 3 women with breast cancer detected by a mammogram are treated unnecessarily. It’s possible 3D mammograms make that problem worse, by finding even more small, slow-growing breast tumors than 2D, said Dr. Alex Krist, vice chairman of the preventive services task force, an expert panel that issues health advice. By steering women toward 3D mammograms before all the evidence is in, “we could potentially hurt women,” Krist said.

Some experts worry that patients, who tend to overestimate their risk of dying from breast cancer, are acting out of fear when they choose treatment.

“If there was ever an audience susceptible to direct-to-consumer advertising, it’s women afraid of breast cancer,” Zuckerman said.

Some proponents of 3D mammograms imply that women who opt for 2D are taking a risk.

Dr. Liane Philpotts, chief of breast imaging at Yale School of Medicine, championed a 2016 Connecticut bill to mandate insurance coverage for 3D screenings. “When I look at a 2D mammogram now, I don’t know how we read them with any degree of confidence,” Philpotts said in a letter of support. “They seem grossly inadequate.”

Philpotts’ letter did not mention she has worked as a consultant for Hologic, which paid her $13,500 from 2013 to 2018, mostly for research, according to Open Payments. In an interview, Philpotts said her work for Hologic has not influenced her medical advice. “[Tomosynthesis is] just so much better for patients,” she said. “I feel very passionately about it.”

Dr. Linda Greer, a community radiologist in Phoenix, has said she was “shocked” by how many more tumors were detected with 3D than 2D. In a 2013 interview, she told Everyday Health, “We got scared about what we were missing for so many years” with 2D mammograms. Greer has accepted more than $305,000 from makers of mammography machines, including $222,000 related to 3D products, according to the Open Payments database.

Greer noted she maintains her intellectual independence by writing her own presentations, even if Hologic pays for her travel. “I don’t think I could be bought,” she said.

Building A Brand

The first question many women have about 3D mammograms is: Are they less painful?

In ads, Hologic claims its 3D device was less painful for 93% of women. But that claim comes from a small, company-funded study that hasn’t been formally reviewed by outside experts, Zuckerman noted. Given the limited data provided in the study, it’s possible the findings were the result of chance, said Zuckerman, who called the ads “very misleading.”

Valenti said peer review is important in studies about cancer detection or false alarms. But when it relates to “general patient satisfaction or patient preference, those are data that we get in other ways,” he said. “Plenty of [doctors] have the [3D] system now and you can get feedback from them. “

While screenings may not generate a lot of income, they can attract patients who need other, more profitable hospital procedures.

“Anytime you diagnose more tumors, you can treat more tumors,” said Amitabh Chandra, director of health policy research at Harvard University’s John F. Kennedy School of Government

Changing The Law

For years, women who wanted a 3D screening had to pay an extra $50 to $100 out-of-pocket.

Valenti said Hologic wanted more women to have access to the technology. So Hologic launched a public campaign ― with a website, paid celebrity tweets and billboards ― to pressure private insurers to cover 3D.

Hospitals and radiology practices ― who stand to benefit from an expanded pool of paying customers ― are also fierce advocates for insurance coverage.

In 2017, a doctor at New York’s Memorial Sloan Kettering Cancer Center asked a local assemblywoman to introduce a bill mandating insurance coverage for 3D screenings.

In a statement, an official at Memorial Sloan Kettering said the hospital supported the bill to improve patient care. “Our patients deserved the most optimal screening available,” said Dr. Elizabeth Morris, chief of the hospital’s breast imaging service.

Supporters of 3D mammograms also rallied around an insurance mandate in Texas in 2017. Registered supporters included HCA Healthcare, a for-profit chain that manages 185 hospitals, and the Black Women’s Health Imperative. That group also testified before an FDA panel in 2010 to advocate approving Hologic’s device.

Linda Goler Blount, the group’s president and CEO, said the organization was advocating for early detection long before its partnership with Hologic began in 2016.

“If you’re low-income, you’re much less likely to get 3D mammography than if you’re upper-income,” Blount said.

Blount noted that her group remains “independent and free to speak our mind.”

Paying Doctors

Dr. Stephen Rose has been an especially active advocate for 3D screenings.

Rose, a radiologist, testified on behalf of the Texas insurance bill twice. The practice where Rose works, Solis Mammography, put out press releases in favor of the legislation. In 2010, Rose testified in favor of 3D screenings at an FDA advisory panel.

In the past six years, he has received $317,000 from companies that manufacture mammogram machines, including more than $50,000 related to specific 3D products, according to the Open Payments database. Twelve percent of Rose’s 3D-related payments were related to research.

Rose said industry money hasn’t influenced him. “I can tell you it had zero impact,” Rose said.

In 2014, Rose co-wrote an influential paper that described the benefits of 3D mammograms.

Collectively, Rose and 12 of his co-authors accepted more than $1 million from the four leading manufacturers of 3D equipment over the past six years, including $589,000 related to 3D products, according to a KHN analysis of Open Payments data. In addition, Hologic contributed $855,000 to research in which many of these authors took leading roles.

Valenti said Hologic doesn’t expect anything in return for the payments: “We let the product and the doctor speak for themselves.”

A Web Of Relationships

The American Society of Breast Surgeons, lists Hologic as a corporate partner. In May, the society recommended 3D mammograms as its preferred screening method.

“There is no connection between the society’s educational grants and statement development,” said Sharon Grutman, a society spokeswoman.

Fran Visco, president of the National Breast Cancer Coalition, has advocated for women for decades. But she said she’s at a loss for a solution to curtail industry influence in medicine.

“It’s incredibly troubling,” said Visco, a breast cancer survivor. “Everyone has a different stake in all this, and it all seems to be tied to financial gain.”

KHN data editor Elizabeth Lucas contributed to this report.

from Updates By Dina https://khn.org/news/a-million-dollar-marketing-juggernaut-pushes-3d-mammograms/

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