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Perfect your plank, exercise to banish back pain

Planks are God’s gift to people with low back pain, which is the third most expensive medical condition in the United States. More than $57 billion a year is spent on low back pain, behind only diabetes and heart conditions.

The key to planks is they strengthen the core muscles — the muscles in the front, the six-pack that everyone wants — and the back at the same time.

If you don’t do them right, planks can actually hurt. Here’s how to do planks better:

  • Stay firm. The idea of a plank is like a plank of wood. You don’t want to be a wilting flower.
  • Don’t sag. You should feel some lift in your butt as you contract your core muscles.
  • But don’t pike, either! Keep your hips in line with your shoulders.
  • Relax your shoulders. People tend to be too tense in the shoulders and scrunch up. Be sure your shoulder blades are wide on your back.
  • Keep your hands and forearms aligned with your shoulders.
  • Relax your hands. Don’t grip your fingers.
  • Put your forearms on the ground for a somewhat easier plank. Do a full push-up position to increase difficulty.

 

I recommend 3 minutes of planks a day to give yourself a better life: One minute center, one minute on each side. But you can start with 30 seconds, and you can try it with bent knees like an assisted push-up.

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A Better Plank 0:27

For TG Therapeutics, off-label use a double-edged sword, doctor says

Reni Benjamin of Raymond James maintains a Strong Buy rating on TG Therapeutics Inc TGTX 1.44% after hosting an investor meeting with Charles Farber, a notable physician at the Summit Medical Group.

Benjamin noted Farber’s practice treats approximately 80 patients per week who suffer from chronic lymphocytic leukemia, of which up to 12 are being treated with TG Therapeutics’ ibrutinib.

The doctor also said that among new patients recently diagnosed with CLL, one-third need treatment right away, one-third will likely be treated anywhere from one to 10 years down the road and the remaining one-third don’t receive any treatment.

Among the patients who require therapy, Farber does not think there is a mandatory guideline in terms of which regimen needs to be prescribed since every patient is different.

Double-Edged Sword

Farber told the analyst he prefers not to prescribe a patient with an off-label therapy, as this creates a risk of not being reimbursed for an oncology drug.

Benjamin believes Farber’s comments are likely shared across the community setting and should be viewed as a “double-edged sword.” On one hand, physicians wouldn’t “substitute rituximab or Gazyva for TG-1101 if the TG-1101/ibrutinib combination were to be approved in relapsed/refractory high-risk CLL,” which is a clear positive for TG Therapeutics. On the other hand, “If the combination is approved in
the r/r setting, it is unlikely to be used in the front-line setting unless the company is able to secure a very broad label” — something which is unlikely.

The Winning Combination

Farber indicated that if TG-1101 plus ibrutinib is approved for high-risk CLL patients he would “certainly” give the combination instead of ibrutinib monotherapy given a superior greater overall response rate based on the Phase III GENUINE results.

Finally, Farber argued for his preferences of the combo, especially if it gets a broader label to include all patients, although the analyst believes this is “not likely.”

http://bit.ly/2oWq1nq

As IPO market dries up, panel urges change in class action rules

The status of “public company” is expensive. Between forfeiture of sovereignty, vulnerability to class actions and millions of dollars in fees to ensure regulatory compliance, the whole package is increasingly unbecoming.

And the Committee on Capital Markets Regulation worries the lacking appeal may have significant economic impact.

Shrinking Public Markets

Last year recorded the lowest IPO equity capital in a decade. The $24 billion raised by 111 IPOs in 2016 barely registered beside the nearly $100 billion raised by 290 IPOs in 2014.

Not only that, but the continued trend of delisting lengthened a steady, 20-year decline in market population. Today’s cohort is slimmer than that of the early 1980s, which leaves investors with limited opportunity to diversify portfolios.

The Rise Of The Private Market

Meanwhile, as the public markets contract, the private markets are expanding, with the number of billion-dollar startups nearly tripling between 2013 and 2016. Concurrently, investors are shifting funds to the startup scene. Private Reg D offerings raised more than 4.5 times the amount accrued among IPOs in 2016 to sustain a nearly decade-long trend of private equity capital outpacing public capital.

Slim pickings in the public market may have something to do with it.

“There are fewer public companies out there, and they’re decreasing, so where are investors going to go?” Hal Scott, CCMR director and Harvard University law professor, told Benzinga. “They’re going to go to the part of the market that’s expanding and where there are increased opportunities for investment, which is the private market.”

He added that the cost burden of public companies also limits returns, which may deter investors.

Effects Of Privatization

Ultimately, the effect of a weak IPO market is stunted economic growth.

“If you look at the source of economic growth in this country, it’s largely because startups and the success of these startups,” Scott said, looking at the likes of Alphabet Inc GOOG 0.18% GOOGL 0.13% and Amazon.com, Inc. AMZN 0.39%.

Small businesses, bolstered by venture capital, can grow into corporations with significant economic influence, and he said this process of maturation is the true source of long-term economic growth in the United States. But startups without venture capital don’t make it very far, and the promise of an eventual IPO is what attracts those seeds.

“A very important element in the ability of these startups to attract venture capital is that the people investing in these companies see a payoff in the future from their investments, and that payoff has traditionally been an exit into the public market where they get a high multiple on what they originally invested,” Scott said. “So, when you take that possibility away, the natural impact of that is to reduce the incentives to invest and venture, and that all has a negative drag on economic growth.”

Consequences also manifest in the American household, where retail investors suffer a financial disadvantage.

“One problem with an increasingly private market is that U.S. retail investors do not have an effective way to directly invest in these young and exciting companies, including Uber and Airbnb,” John Gulliver, CCMR executive director of research, said in a press release.

Legal And Regulatory Changes

The CCMR said amending class action regulation to limit the legal risks of public companies may reverse the trends and heighten the appeal of going public. Scott said the rate of securities class actions is rising toward a rate similar but “not quite as bad” as the pre-Sarbanes-Oxley years, and private companies are wary of suffering both financial and reputational damage from these lawsuits.

The legal concerns not only disincentivize domestic companies from listing on U.S. exchanges but foreign companies, as well. The factor has prompted the rapid expansion of more loosely regulated international markets, such as that of China.

“I can tell you one big difference — there’s no securities class actions any place else in the world,” Scott said. “That’s a huge difference. I think also if you looked at the rest of the world you would find much less granularity about disclosure requirements. You would probably find in general that the pressure on short-term performance is probably somewhat less on other public markets around the world. But I think that the securities class action is a total difference and it probably plays a major role in those public markets being more dynamic than ours.”

Regulatory changes could then prove a major game-changer for U.S. markets and the greater economy. The committee specifically recommended that the U.S. Securities and Exchange Commission allow shareholders to decide on a company-by-company basis whether to permit securities class actions.

http://bit.ly/2oC8cXx

For Earth Day this year, let’s remember the alarmists

Today is the 47th annual Earth Day. On this day, it is worth reflecting on how completely, totally wrong environmental alarmists often are. Few things tell us more about the environmental movement—where it’s been and, more importantly, where it is now—than its dismal track record in the predictive department.

Case in point: Paul Ehrlich, who is as close to a rock star as you’re apt to find among environmentalists. Ehrlich is most famous for his 1968 book “The Population Bomb,” in which he famously predicted that, during the 1970s and 1980s, humanity would suffer mass famine and starvation due to overpopulation. “At this late date,” Ehrlich wrote, “nothing can prevent a substantial increase in the world death rate.”

Spoiler alert: Ehrlich was wrong—so wrong, in fact, that not only did his doomsday predictions fail to materialize, but the exact opposite happened. Readers who were alive during the 1970s and 80s will recall that there was plenty to eat, there was no mass die-off, everything worked out fine, and humanity’s lot continued to improve as it had throughout the rest of the 20th century.

Ehrlich Is Still Making Incorrect Doomsday Predictions

This kind of humiliating embarrassment would be enough to cow even the proudest of men—unless that man is an environmentalist, of course. Incredibly, as NewsBuster’s Tim Graham pointed out this week, Ehrlich was still making his doomsday predictions in 1989—well after the point when it was clear his previous predictions had been utter failures. Ehrlich claimed that, during the 1990s, “We’re going to see massive extinction;” he theorized that rising ocean waters meant “we could expect to lose all of Florida, Washington D.C., and the Los Angeles basin.”

Another spoiler: none of this happened. I visited Florida several times in the 1990s; it was not underwater. I visited Los Angeles shortly after the turn of the century; it, too, was fully above ground. Washington D.C., alas, remains as un-inundated as ever.

For Paul Ehrlich, unfortunately, twice-humiliated does not mean twice- or even once-chastened. Just a few years ago he was predicting that human beings would have to resort to cannibalism to cope with the coming famine. He also claims that “The Population Bomb” was “much too optimistic;” this was a book, mind you, that predicted hundreds of millions of deaths that ended up not happening.

This Earth Day, Rest Assured That Ehrlich Is Wrong

You might imagine that such unprofessional behavior and a miserable track record would render a man unfit for professional scientific society, and that he would be looked upon by his colleagues (if he had any) as “that guy who keeps predicting the end of the world and who keeps being wrong.” Not so: Ehrlich is a well-esteemed professor at Stanford, as well as the president of that university’s Center for Conservation Biology.

A man continually makes outlandishly fake predictions and beclowns himself on the global scientific stage: in what socio-scientific subculture could such a man find any purchase? The answer: environmentalism.

This Earth Day, consider reflecting on the bizarre dichotomy of (a) Paul Ehrlich’s mortifying history of predictive failures regarding the environment, and (b) his continued relevance in the field of environmental studies. Reflect on what that tells you about the environmental movement as a whole, particularly its hysterical climate change wing. And then consider the possibility that you can safely ignore the hysterics and simply live your life without worrying that Tampa, Florida is going to be washed away sometime over the next few decades.

http://bit.ly/2pa5Raa

Kaiser Permanente CEO: Over half of members’ doctor visits virtual

Kaiser Permanente members annually have more than 100 million encounters with company physicians, 52% of which are now virtual visits, Kaiser Permanente CEO Bernard Tyson told a Nashville luncheon audience Friday.

That transition from physical to virtual visits has been enabled by Kaiser Permanente’s aggressive spending on information technology, Tyson said at a Nashville Health Care Council presentation.

IT accounts for about 25% of the health system’s $3.8 billion annual capital spend. That’s about 6% of the $71 billion in revenue that Oakland, Calif.-based Kaiser Permanente generates annually, making it the nation’s largest integrated health system.

Members like the convenience of being able to get minor ailments looked at or get test results outside the doctor’s office, Tyson said.

It works for Kaiser Permanente, too. Fully 95% of its 11.7 million members are covered on a capitated basis, meaning that Kaiser Permanente is paid a monthly member fee to take care of a patient’s full range of healthcare needs. As a result, Kaiser Permanente physicians don’t have the same worries as other practitioners about getting paid for virtual visits.

Tyson, who was questioned by former U.S. Senator Dr. Bill Frist, said the move to virtual doctor visits reflected a new consumerism that Kaiser Permanente is endeavoring to keep up with daily.

The old fee-for-service system of healthcare was built around episodic care, in which people only entered into the system when hurt or sick, Tyson said. “The ‘fix me’ system,” he said.

Kaiser Permanente’s approach is to help keep members well by promoting healthy eating, assisting schools and encouraging preventative check-ups, Tyson said.

“We’re reimagining medical care,” he said.

Tyson, a perennial member of Modern Healthcare’s list of the most influential people in healthcare, was named this week to the 2017 Time 100, its annual list of 100 most influential people in the world.

For example, Kaiser Permanente is experimenting with what Tyson called mega-health centers, which are as much community assets and medical facilities. He said they are being constructed with fruit counters, exercise rooms and walking paths.

Tyson said he saw more and more care gravitating to the home and away from the hospital and physician office as technology allows for inexpensive tele-visits, accurate patient monitoring and convenient interaction.

Tyson said that he has attended two meetings at the White House with President Donald Trump to talk about continuing the progress started by the Affordable Care Act and to talk about care for veterans.

A big supporter of ACA, Tyson said he hoped the administration would maintain insurance for the 24 million newly insured and that healthcare executives need to make their voices heard on the important debate happening in Washington.

Frist said President Trump remains short-handed with just 24 of the top 500 administration posts currently filled vs. 150 positions filled by President Barack Obama during the first 100 days of his administration.

Tyson said that healthcare leaders can and must have an influence on the replacement of the ACA. “That’s why we have to be at the table,” he said.

http://bit.ly/2oU4pbl

Ore. eyes ending Medicaid expansion to shore up state budget

Democratic lawmakers in Oregon are considering ending the state’s Medicaid expansion in an effort to address a $1.6 billion budget shortfall.

The state’s Ways and Means committee, which includes both senators and representatives, suggested cutting Medicaid expansion in an effort to curb Oregon’s $1.6 billion budget deficit.

“We are simply laying out possibilities for how the state may deal with the stark realities of a projected $1.6 billion deficit,” Rep. Nancy Nathanson, co-chair of the Ways and Means committee said in an email.

Ending Medicaid expansion, which has led to 350,000 people gaining coverage, would save the state $256 million over the next two years.

The Affordable Care Act fully funded Medicaid expansion though the end of 2016, but now the state will foot an increasing share of the costs. The federal match rate falls to 95% in 2017, 94% in 2018, 93% in 2019, and then 90% in 2020 and beyond.

Cutting Medicaid expansion is just one of several possibilities set forward by Ways and Means.

Democrat Gov. Kate Brown said she is hopeful an alternative can be found to avoid this and other proposed cuts on the list. If enacted, they collectively “would put our most vulnerable children and families even more at risk than they are now,” Brown said in an email via a spokesman. “This is unacceptable.”

Hospitals have benefited greatly from Medicaid expansion as they’ve seen uncompensated care costs drop from $1.3 billion in 2013 to $315 million in 2015 according to state data.

“No one knows better than hospitals the positive impact that Medicaid expansion had on the health of Oregonians,” Andy Davidson, president and CEO of the Oregon Hospital Association said in a statement, “We stand firm in our belief that we all must lean in to ensure that we preserve that access and coverage.”

To that end, the association has committed to working with lawmakers to come up with alternative sources of funding so that expansion won’t have to end. He did not provide any specific proposals.

Nathanson said that she and her fellow lawmakers have been working with hospitals and other providers for months to find solutions to fill the hole in Oregon’s budget, but none have been found yet.

“This discussion document is based only on the funds we have available right now,” Nathanson said.

Lawmakers have until July to finalize a budget.

http://bit.ly/2pTDSwd

We may not stop all terror attacks but can train citizens to survive them

The recent attacks in Westminster and Stockholm have highlighted the need for greater public vigilance. Not only in order to prevent attacks in the first place, but also to understand how to react once an attack is underway.

A key part of this is what the security industry refers to as “situational awareness” and it’s an effective tool for those trained how to use it properly.

However, situational awareness requires an understanding of what is normal in order that a baseline can be established and anomalies can be identified.

In both Westminster and Stockholm vehicles were used as weapons. People expect to see vehicles on our streets, so how do we tell the difference between those going about their normal business and those with malicious intent? After all, those who would do us harm rely on the fact that they are able to blend in in order to carry out their attacks.

Therefore, it’s the small pre-event indicators we need to be aware of, the change in engine pitch, the screech of tyres or the sound of people shouting. Unfortunately, most people are not attuned to such warning signs, not just because they haven’t been trained, but simply because they wander around in their own world, or are too busy concentrating on their phone rather than what’s going on around them.

In Britain we are blessed with having the best police and security services in the world. But in order for them to be able to do their job effectively, they need the public’s help.

Surely then, it’s time for the government to establish a national programme to sensitise, train and mobilise the community to play a bigger part to prevent, and deal with a terrorist attack. A call to action for everyone to unite and safeguard our way of life.

With Islamic State strongholds in places like Mosul beginning to fall, more and more jihadi fighters will return to Britain. The majority will be intercepted, but a few will slip through the net and that’s why we need something beyond the existing initiatives like Project Griffin, ACT (Action Counters Terrorism) and Run, Hide, Tell.

A soldier stands guard on the roof of a ruined church in Qaraqosh Iraq
Isil is on the back foot in Iraq and Syria, but will lash out abroad CREDIT: CHRISTOPHE SIMON/AFP/GETTY IMAGES

We need to provide the public with the skills and training to enable them to spot the tell tale signs of suspicious activities or behaviour within their neighbourhoods. Including signs of radicalisation and identifying those who support violence and are sympathetic to terrorists and their causes.

How to recognise suspicious articles, behaviour and vehicles and how to provide an accurate description of these to the police. It should also provide a process of things to do after a terror attack in order that communities can work together during a time of difficulty and adversity.

The response to a terror attack and what people can do to protect themselves and their fellow citizens is critical in countering the current threat.

Those who are even considering involvement in plots against this country should be under no illusion that they have nowhere to hide and that they will not be shielded by their communities. In fact, quite the opposite.

We should also be teaching our citizens the first aid skills necessary to treat injuries by using commonly available items and proactively encouraging them to sign up to a Community Emergency Preparedness Programme, where they can learn more advanced medical skills, including dealing with fractures, burns, bleeding, patient immobilisation and CPR, as well as casualty evacuation. Having an app or aide-memoire is no replacement for hands-on training.

 

So, does this all sound a bit too far fetched and difficult to implement? Not at all. Singapore rolled out this very programme last September and made it available to all it’s citizens.

It’s called SG Secure and it has allowed Singapore to take a huge step forward in combatting the threat posed by terrorism by creating a trained and aware population. Surely any initiative which equips citizens with lifesaving skills has to be encouraged and given the risks we currently face, this will certainly make the terrorists job much harder.

Any such programme will always have supporters and detractors, but where national security is concerned, we all have a part to play.

Singapore is being proactive in its approach to counter-terrorism and in doing so is giving its citizens a chance to make a difference in their communities by making them a tangible asset in the national security tool kit. It’s time we did the same.

http://bit.ly/2oBCmKG

US joins lawsuit against UnitedHealth

An eight-year-old lawsuit brought against America’s largest health insurer just got a big boost from the Trump administration.

Late last month, lawyers for the Department of Justice joined a suit against UnitedHealthcare that accuses the insurance giant of defrauding Medicare of hundreds of millions of dollars.

“This is a very big development and sends a strong signal that the Trump administration is very serious when it comes to fighting fraud in the health care arena,” Patrick Burns, of Taxpayers Against Fraud in Washington, tells Kaiser Health News.

The suit was originally filed in 2009 by James Swoben, a former employee of SCAN Health Plan, which in 2012 agreed to pay $320 million in a settlement with the Justice Department over allegations that it was fleecing Medicare Advantage by submitting inaccurate diagnosis codes that resulted in larger reimbursements.

Swoben and the federal government aren’t the only ones dogging UnitedHealth. One of its former executives launched a similar suit in 2011 accusing the company of defrauding taxpayers. DOJ is now seeking to combine that suit with Swoben’s.

Investigations by journalists and government auditors in recent years have uncovered evidence of significant Medicare fraud by both insurers and providers.

The Center for Public Integrity reported on numerous instances of risk-score abuse by insurers in 2014 and alleged that insurers had “muzzled” investigation by Congress and regulators through influence-peddling.

Agencies have been aware of massive overpayments for years, the reporting argued, but they were reluctant to go public with their findings due to embarrassment and industry pressure.

In 2013, for instance, the Centers for Medicare and Medicaid Services estimated that 9.5 percent of the payments made to Medicare Advantage plans were improper. But the agency balked at implementing a proposed regulation in the following year to require insurers to report any improper payment they have received for a patient.

“The government isn’t in the best light when there’s that high an error rate,” health care attorney Thomas Hill said at the time. “They are reluctant to expose that to the world.”

In 2015, a federal audit that was published appeared to confirm the worst fears about Medicare Advantage. It concluded that the federal government had overpaid for half of all of the patients enrolled in UnitedHealth’s Medicare Advantage plan.

http://bit.ly/2p9M6Qb