Posts Tagged ‘overuse’

iPhones and Children Are a Toxic Pair, Say Two Big Apple Investors

January 8, 2018

Two activist shareholders want Apple to develop tools and research effects on young people of smartphone overuse and addiction

Teens took a group selfie with a smartphone in New York’s Times Square on Dec. 1.
Teens took a group selfie with a smartphone in New York’s Times Square on Dec. 1. PHOTO: DREW ANGERER/GETTY IMAGES

The iPhone has made Apple Inc. and Wall Street hundreds of billions of dollars. Now some big shareholders are asking at what cost, in an unusual campaign to make the company more socially responsible.

A leading activist investor and a pension fund are saying the smartphone maker needs to respond to what some see as a growing public-health crisis of youth phone addiction.

Jana Partners LLC and the California State Teachers’ Retirement System, or Calstrs, which control about $2 billion of Apple shares, sent a letter to Apple on Saturday urging it to develop new software tools that would help parents control and limit phone use more easily and to study the impact of overuse on mental health.

The Apple push is a preamble to a new several-billion-dollar fund Jana is seeking to raise this year to target companies it believes can be better corporate citizens. It is the first instance of a big Wall Street activist seeking to profit from the kind of social-responsibility campaign typically associated with a small fringe of investors.

Adding splash, rock star Sting and his wife, Trudie Styler, will be on an advisory board along with Sister Patricia A. Daly, a nun who successfully fought Exxon Mobil Corp. over environmental disclosures, and Robert Eccles, an expert on sustainable investing.

The Apple campaign would be unusual for an activist like Jana, which normally urges companies to make financial changes. But the investors believe that Apple’s highflying stock could be hurt in coming decades if it faces a backlash and that proactive moves could generate goodwill and keep consumers loyal to Apple brands.

“Apple can play a defining role in signaling to the industry that paying special attention to the health and development of the next generation is both good business and the right thing to do,” the shareholders wrote in the letter, a copy of which was reviewed by The Wall Street Journal. “There is a developing consensus around the world including Silicon Valley that the potential long-term consequences of new technologies need to be factored in at the outset, and no company can outsource that responsibility.”

Obsessive teenage smartphone usage has sparked a debate among academics, parents and even the people who helped create the iPhone.

Two teenage boys use smartphones in Vail, Colo., in June 2017.
Two teenage boys use smartphones in Vail, Colo., in June 2017. PHOTO: ROBERT ALEXANDER/GETTY IMAGES

Some have raised concerns about increased rates in teen depression and suicide and worry that phones are replacing old-fashioned human interaction. It is part of a broader re-evaluation of the effects on society of technology companies such as Google and Amazon.com Inc. and social-media companies like Facebook Inc. and Snap chat owner Snap Inc., which are facing questions about their reach into everyday life.

Apple hasn’t offered any public guidance to parents on how to manage children’s smartphone use or taken a position on at what age they should begin using iPhones.

Apple and its rivals point to features that give parents some measure of control. Apple, for instance, gives parents the ability to choose which apps, content and services their children can access.

The basic idea behind socially responsible investing is that good corporate citizenship can also be good business. Big investors and banks, including TPG, UBS Group AG and Goldman Sachs Group Inc. are making bets on socially responsible companies, boosting what they see as good actors and avoiding bad ones.

Big-name activists increasingly view bad environmental, social or governance policies as red flags. Jana plans to go further, putting its typical tools to work to drive change that may not immediately pay off.

Apple is an ambitious first target: The combined Jana-Calstrs stake is relatively small given Apple’s nearly $900 billion market value. Still, in recent years Apple has twice faced activists demanding it pare its cash holdings, and both times the company ceded some ground.

Chief Executive Tim Cook has led Apple’s efforts to be a more socially responsible company, for instance on environmental and immigration issues, and said in an interview with the New York Times last year that Apple has a “moral responsibility” to help the U.S. economy.

Apple has shown willingness to use software to address potentially negative consequences of phone usage. Amid rising concerns about distracted driving, the company last year updated its software with a “do not disturb while driving” feature, which enables the iPhone to detect when someone is behind the wheel and automatically silence notifications.

The iPhone is the backbone of a business that generated $48.35 billion in profit in fiscal 2017. It helped turn Apple into the world’s largest publicly listed company by market value, and anticipation of strong sales of its latest model, the iPhone X, helped its stock rise 50% in the past year. Apple phones made up 43% of U.S. smartphones in use in 2016, according to comScore , and an estimated 86 million Americans over age 13 own an iPhone.

Jana and Calstrs are working with Jean M. Twenge of San Diego State University, who chronicled the problem of what she has dubbed the “iGen” in a book that was previewed in a widely discussed article in the Atlantic magazine last fall, and with Michael Rich of Harvard Medical School and Boston Children’s Hospital, known as “the mediatrician” for his work on the impact of media on children.

The investors believe both the content and the amount of time spent on phones need to be tailored to youths, and they are raising concern about the public-health effects of failing to act. They point to research from Ms. Twenge and others about a “growing body of evidence” of “unintentional negative side effects,” including studies showing concerns from teachers. That is one reason Calstrs was eager to support the campaign, according to the letter.

The group wants Apple to help find solutions to questions like what is optimal usage and to be at the forefront of the industry’s response—before regulators or consumers potentially force it to act.

The investors say Apple should make it easier and more intuitive for parents to set up usage limits, which could head off any future moves to proscribe smartphones.

The question is “How can we apply the same kind of public-health science to this that we do to, say, nutrition?” Dr. Rich said in an interview. “We aren’t going to tell you never go to Mickey D’s, but we are going to tell you what a Big Mac will do and what broccoli will do.”

Write to David Benoit at david.benoit@wsj.com

Appeared in the January 8, 2018, print edition as ‘Investors Prod Apple On Child iPhone Use.’

https://www.wsj.com/articles/iphones-and-children-are-a-toxic-pair-say-two-big-apple-investors-1515358834

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New Push to Stop Overuse of Antibiotics in Nursing Homes

October 12, 2015

Up to 75% of prescriptions are incorrect as heath officials open a new front in war on overuse

 
A nurse cares for an elderly woman in a nursing home. Photo: Doctor Stock/Getty Images

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By Betsy McKay
The Wall Street Journal

A new front is emerging in the war on the overuse of antibiotics: the nursing home.

Health officials and health-care executives, concerned by a rise in dangerous drug-resistant infections, are turning more attention to nursing homes, where antibiotics are some of the most frequently prescribed medications. They have concentrated over the past several years on curbing misuse of antibiotics in hospitals.

Up to 70% of nursing home residents receive one or more courses of antibiotics every year for urinary tract infections, pneumonia, cellulitis and other suspected conditions, according to researchers. Yet up to 75% of those prescriptions are given incorrectly—either unnecessarily or the prescription is for the wrong drug, dose or duration, the Centers for Disease Control and Prevention says.

One of the biggest culprits, researchers say: misdiagnosed urinary tract infections. Only a quarter to a third of people in nursing homes who are diagnosed have actual symptoms, according to several studies. Most have only vague symptoms like confusion or bacteria in their urine that aren’t actually causing an infection, says David Nace, director of long-term care and flu programs at the University of Pittsburgh. UTIs are “the poster child of inappropriate antibiotic use,” he says.

Ghinwa Dumyati, an infectious disease physician in the Center for Community Health at the University of Rochester Medical Center. ‘In hospitals over the past decade there have been a lot of programs put in place to improve the use of antibiotics, but the same has not really happened broadly in the nursing home,’ she says. 
Ghinwa Dumyati, an infectious disease physician in the Center for Community Health at the University of Rochester Medical Center. ‘In hospitals over the past decade there have been a lot of programs put in place to improve the use of antibiotics, but the same has not really happened broadly in the nursing home,’ she says. Photo: J. Adam Fenster/University of Rochester

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Such practices spawn the spread of drug-resistant bacteria that can be particularly harmful to the elderly and are very difficult if not impossible to treat, researchers say. They can also lead to drug interaction problems or diarrhea from Clostridium difficile—a common complication in long-term care facilities that can be deadly for people over age 65, says Ghinwa Dumyati, an infectious disease physician in the Center for Community Health at the University of Rochester Medical Center.

Curbing antibiotic overuse is a particularly tall order for nursing homes. Doctors can be reluctant to hold off on prescribing medications because patients are frail, and they sometimes have milder fevers or other symptoms that differ from those in younger adults. Many patients also suffer from dementia or other forms of cognitive impairment and can’t tell nurses or doctors what their exact symptoms are.

On top of that, turnover in nursing home staff is high, and antibiotics are frequently prescribed by clinicians who haven’t seen the patients, geriatricians say. At many nursing homes, nurses evaluate patients and consult with off-site medical staff for prescriptions.

“A lot of the decision-making is done remotely by phone,” says Christopher Crnich, an infectious disease specialist at the University of Wisconsin School of Medicine and Public Health who studies antibiotic use and drug-resistant infections in long-term care facilities.

The government and professional groups are taking action. Calling nursing homes the “next frontier” for antibiotic resistance, the Centers for Medicare & Medicaid Services recently proposed new requirements for facilities to track and curb unnecessary use of antibiotics. In September, the CDC issued guidelines to help nursing homes implement such practices.

 

Diane Kane, the chief medical officer for St. Ann’s Community, a not-for-profit health-care system in Rochester, N.Y. ‘Every opportunity I get I am always talking about this to our nursing staff,’ she says of the misdiagnosis of urinary tract infections. 
Diane Kane, the chief medical officer for St. Ann’s Community, a not-for-profit health-care system in Rochester, N.Y. ‘Every opportunity I get I am always talking about this to our nursing staff,’ she says of the misdiagnosis of urinary tract infections. Photo: St. Ann\’s Community

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To comply, geriatricians say they will have to dispel a myth—widespread among doctors, nurses, patients and families—that confusion alone or even a fall signals a possible urinary tract infection, says Diane Kane, chief medical officer for St. Ann’s Community, a not-for-profit health-care system in Rochester, N.Y. Doctors often order urine tests for such patients which come back positive because about 50% of women and 25% of men in nursing homes have bacteria in their urine, says Dr. Crnich. But the bacteria don’t automatically indicate an infection, he says. Bacteria can develop in the urinary tract due to immune system, hormonal, and other changes in aging people, experts say.

Instead, patients should be checked for actual UTI symptoms such as fever, pelvic pain, incontinence or urgency to urinate, and urine tests should be done only on those with UTI symptoms, according to guidelines and campaigns issued in recent years by several professional societies.Others with symptoms of concern should be observed, geriatricians say.

Patients with the most bizarre symptoms are diagnosed with UTIs, says Robin Jump, assistant professor of medicine at Case Western Reserve University and an infectious-disease physician at a veterans hospital in Cleveland. One patient who had bad dreams was treated twice with antibiotics after positive urine tests, she says.

Dr. Jump and other infectious-disease colleagues helped a 160-bed VA long-term care facility reduce use of antibiotics by 30% over 18 months by coaching staff to evaluate patients more carefully for UTIs and other steps, she says.

Genesis HealthCare Corp., which operates more than 500 skilled nursing centers in 34 states, is developing a campaign, set to launch next year, to reduce overdiagnosis of UTIs. It will include clinical education for doctors and nurses, brochures, meetings with families and other initiatives, says JoAnne Reifsnyder, senior vice president of clinical operations and chief nursing officer.

The Kennett Square, Pa., company says it has also increased its roster of full-time providers and trains them to avoid UTI overdiagnosis.

In Rochester, Dr. Dumyati is working with three nursing homes as part of a larger effort to reduce C. difficile infections in the overall community. Over the first six months of 2014, 66% of patients who were treated for UTIs at those facilities had no UTI symptoms. One, part of health-care system St. Ann’s Community, took 227 urine cultures during the third quarter of 2014, or 76 on average a month, Dr. Dumyati says. This past July and August, after months of educating staff, urine cultures were down to a monthly average of 44, she says.

Dr. Kane has helped Dr. Dumyati lead the charge to reduce antibiotic overuse. A passionate critic of UTI overdiagnosis, she says Dr. Dumyati’s data and her voice as an infectious disease specialist have helped. The data were “eye opening,” Dr. Kane says. “When you have dementia, you’re going to have good days and you’re going to have bad days. When you have dementia and you have a bad day, please don’t send a urine, because it’s going to be positive.”

When his 91 year-old mother, Clarinda, started acting confused recently, John Kirkman says friends and relatives told him it was probably a urinary tract infection. They said, “You just have your doctor prescribe an antibiotic and it takes care of it,” he recalls.

Mr. Kirkman, a retired Xerox Corp. field engineer, got a test kit, which gave mixed results. Dr. Kane told him emphatically when she visited Clarinda in her assisted living facility at St. Ann’s that confusion alone did not indicate a UTI. “She said if a person has a urinary tract infection they are in pain,” he said. “It’s not confusion. It is serious pain.”

http://www.wsj.com/articles/new-push-to-stop-overuse-of-antibiotics-in-nursing-homes-1444654881