Current Events in May 2013

There are all kinds of ways to save fuel and make cars more efficient. While long-term solutions may lie with electric vehicles and other radically different technology, automakers left to their own devices tend to apply smaller fixes that amount to perfecting existing drivetrains.

A telling contrast is seen in two recent announcements -- one by Volkswagen, which says it is developing a 10-speed duel-clutch transmission to improve mileage -- and the other by Toyota, which says it will begin selling fuel-cell vehicles by 2015, with a price between $50,000 and $100,000.

In the Volkswagen announcement, CEO Martin Winterkorn said the dual-clutch 10-speed transmission will be the company's primary focus for the mid- and long-term, along with diesel engines and plug-in hybrids.

"Among the alternative drive systems, plug-in hybrids in particular offer great potential," Winterkorn said at the Vienna Motor Symposium last week. Winterkorn emphasised that existing internal combustion engines still offer a lot of potential.

"Since the year 2000, we've reduced the fuel consumption of our TDI and TSI engines by more than 30 per cent. I'm convinced that by 2020 we can achieve further increases in efficiency of around 15 per cent," he said.

Fuel cell cars

On the other end of the spectrum, Toyota says it expects to have fuel-cell-powered cars ready for sale by 2015 for less than $100,000 -- about 1/20th of what it cost just a few years ago to build a fuel cell prototype.

Chris Hostetter, group vice president of strategic planning for Toyota Motor Sales U.S.A., said it's likely the fuel cell vehicles will cost around $50,000. The cars will initially be sold in California and in other states covered by the California Air Resources Board mandate.

However, like plug-in hybrids, adoption of fuel cell cars may be hampered by a lack of refueling stations. California is planning to build about 30 hydrogen stations statewide. New York also has tentative plans to build at least a few such stations.

There are 36 stations approved by the California Air Resources Board (CARB) but only a handful are in operation. 

CARB has decreed that by mid-century, 87% of cars on the road will need to be full Zero-Emission Vehicles (ZEVs). "This will place California on a path to reducing greenhouse gas emissions by 80% by 2050, a goal adopted by many nations and believed necessary to stabilize climate temperature," according to CARB. 

Toyota's current fleet of 100 fuel cell test vehicles, based on the Highlander crossover, have a range of about 440 miles. The cars to be sold in 2015 will be more the size of a Prius and should have a greater range.

Researchers at UC San Francisco (UCSF) and Baystate Medical Center in Massachusetts have found that that Prozac and other selective serotonin reuptake inhibitors (SSRIs) can cause all types of problems when taken close to surgery.

The researchers came to this conclusion after examining over 530,000 medical records of patients who underwent surgery in the U.S. between the years of 2006 and 2008.

The 2012 AGS Beers Criteria showed SSRIs were potentially harmful for some seniors because they caused fall and balance issues.

More evidence found

Andrew D. Auerbach, MD, MPH, a professor of medicine at UCSF and lead author of the research, said past studies showed small signs of SSRIs being potentially harmful.

“There have been small studies that suggested there was a problem, but it has never been well-proven,” said Auerbach. “With this huge data set, we feel confident in saying that SSRIs are associated with about a 10% increased risk for these adverse outcomes.”

Auerbach and his team said if taken around the time of a surgery, SSRIs could cause hospital readmission, bleeding, transfusion and death.

Furthermore, the research team said many patients taking SSRIs already have conditions that could cause surgeries to go wrong, like chronic pulmonary disease, rapid weight gain and depression, so they took that into consideration.

Some factors eliminated

Some of the patients reviewed in the study were prescribed SSRIs for the first time, which Auerbach thought might be a contributor to some surgeries going wrong. But after looking closer, he said that argument didn't hold up. 

To make sure SSRIs actually did increase the chances of bleeding, transfusions and death during surgeries, researchers looked at patients who were on the antidepressant and patients who were not. Afterwards, they still found the same higher risk.

Auerbach said further research needs to be done involving actual patients on SSRIs at the time of surgery. For this current study only past medical records were used.

“A prospective observational study, in which patients are randomly assigned to take SSRIs around the time of surgery is still needed,” he said.

Autism link?

Surgery patients aren’t the only ones who might face potential harm from taking SSRIs. A new report out of Sweden indicates the antidepressant could cause autism in newborn babies too.

‘In utero exposure to both selective serotonin reuptake inhibitors and nonselective monoamine reuptake inhibitors (tricyclic antidepressants) was associated with an increase risk of autism spectrum disorders, particularly without intellectual disability,” wrote the researchers.

After looking at the medical records of women during the early stages of pregnancy, researchers discovered the potential link between the antidepressant drug and autism.

The new evidence adds weight to concerns raised by a 2011 study in California, in which researchers also found that SSRI use in pregnancy was associated with increased risks of autism in the exposed children.  Furthermore, they showed that the association was with the SSRI use and not depression (that is, the depression-only group did not have an increased risk of autism.)  

Both studies found about a three-fold (or 300%) increased risk. 

“Future, larger studies, with access to both diagnostic and treatment data at multiple stages of pregnancy may help disentangle the role of maternal depression and the individual drugs used to treat it in the risk of autism spectrum disorder,” the Swedish researchers wrote.

An application approved by the U.S. Food and Drug Administration (FDA) would make Plan B One-Step (active ingredient levonorgestrel) for use without a prescription by women 15 years of age and older.

The application was submitted by Teva Women’s Health, Inc. after FDA rejected the company's 2011 bid to make Plan B One-Step available over-the-counter for all females of reproductive age.

The product will now be labeled “not for sale to those under 15 years of age *proof of age required, not for sale where age cannot be verified.” The package will contain a product code prompting a cashier to request and verify the customer’s age. A customer who cannot provide age verification will not be able to purchase the product. In addition, Teva has arranged to have a security tag placed on all product cartons to prevent theft.

The product will be available in retail outlets with an onsite pharmacy, where it generally will be available in the family planning or female health aisles, and will be available for sale during the retailer’s normal operating hours whether the pharmacy is open or closed.

'Emergency contraceptive'

Plan B One-Step is described as an emergency contraceptive intended to reduce the possibility of pregnancy following unprotected sexual intercourse -- if another form of birth control (e.g., condom) was not used or failed. Plan B One-Step is a single-dose pill (1.5 mg tablet) that is most effective in decreasing the possibility of unwanted pregnancy if taken immediately or within 3 days after unprotected sexual intercourse.

Plan B One-Step will not stop a pregnancy when a woman is already pregnant, according to FDA, and there is no medical evidence that the product will harm a developing fetus.

“Research has shown that access to emergency contraceptive products has the potential to further decrease the rate of unintended pregnancies in the United States,” said FDA Commissioner Margaret A. Hamburg, M.D. “The data reviewed by the agency demonstrated that women 15 years of age and older were able to understand how Plan B One-Step works, how to use it properly, and that it does not prevent the transmission of a sexually transmitted disease.”

'Horrific' decision

Georgia Right to Life (GRL) thinks the decision is misguided.

“Adults are denied unlimited access to certain over-the-counter cold remedies,” said President GRL Dan Becker. “Now we’re going to allow children under the age of 17 to purchase a hormone that might kill a pre-born baby and/or cause serious damage such as blood clots, high blood pressure or stroke to the child.”

Even more shocking, he said, is the fact that school nurses can’t even give students an aspirin without parental consent. "Allowing girls under 17 accesses to this pill is horrific; it demonstrates a total disregard for innocent life and all parents,” he concluded.

Use study cited

Teva says a use study shows that women age 15 and older understood that the product was not for routine use and would not protect them against sexually-transmitted diseases, establishing that Plan B One-Step could be used properly within this age group without the intervention of a health care provider.

The company has indicated that it plans to educate consumers, pharmacy staff and health care professionals about the product’s new status. It has also indicated a willingness to conduct an audit of the age verification practices after the product is approved to ensure that the age limitation is being followed.  

When you're planning a summer vacation, it's important to make out a budget. Too many consumers fail to plan their spending and, when they return, are faced with more debt.

But having the right credit card can help. It can help you not only save money, but actually get some money back.

Odysseas Papadimitriou, CEO of CardHub, breaks down summer travel cards into three categories; those that have good initial reward bonuses, those that have good ongoing rewards programs and those that have the best 0% financing offers. The right card can add up to actual money.

“Consumers, by signing up for the right offer, can get $400 statement credit or $500 toward travel expenses by spending what they would normally spend on their credit card during the first three months,” Papadimitriou said.

Real money

Take the Chase Sapphire Preferred Card, for example. By spending at least $3,000 during the first three months your account is open will give you a 40,000-point rewards bonus, which can be redeemed for $500 in travel accommodations booked through Chase’s Ultimate Rewards program or a $400 statement credit.

That's right. Instead of stockpiling those airline miles that you never seem to be able to use, you can trade them in for cash.

“It doesn't get much better than that,” Papadimitriou said.

The Chase Sapphire card does not charge an annual fee the first year but there's a $95 fee each year after that.

Another solid choice is the Barclaycard Arrival World MasterCard. Spend just $1,000 during the first 90 days to claim the card’s 40,000-mile rewards bonus, which is redeemable for a $400 statement credit you can use to pay any travel-related charge. It also waives its $89 annual fee the first year.

Hilton HHonors Surpass Credit Card and the Club Carlson Premier Rewards Card also provide general upfront bonuses. With the latter you get 50,000 bonus points with your first purchase and 35,000 additional points for spending at least $2,500 within 90 days. Those 85,000 points can get you up to 18 free hotel nights, depending on the category of hotel you select and the number of consecutive nights you book.

Long-term value

Other cards, like the Capital OneVenture Card, can provide long-term value. It offers the miles equivalent of 2% cash back across all purchases as long as you redeem them for travel-related purchases.

Also in that category, the Blue Cash Preferred from American Express offers 6% cash back on groceries, 3% on gas and department store purchases, and 1% on everything else, making it a great card for everyday spending as well as road trips. It carries a $75 annual fee but you get a $150 initial rewards bonus for spending at least $1,000 during the first three months.

If you think that you might need several months to pay for your summer vacation, putting everything on a 0% interest card might save some money. Among the most attractive cards in this category, Papadimitriou says, is the Slate Card from Chase. Transferring existing debt to this card before using it to pay for your trip offers two distinct advantages. There's no balance transfer fee and it comes with a 15-month interest-free introductory period.

“I’m a big fan of the Island Approach, which entails using a different credit card for different types of transactions in order to amass the best possible collection of terms, but that’s certainly not for everyone,” Papadimitriou said. “Many consumers instead value the simplicity of having a single credit card in their wallets. But if you go that route, getting the right card for your needs becomes even more important. In other words, you should only get a rewards card if you always pay your bill in full and a travel rewards card if you embark on numerous trips each year.”

Another bit of advice if you are traveling outside the U.S. Papadimitriou says always pay your bill in the native currency. Most foreign businesses will let you pay for credit card purchases in dollars, but usually charge a fee to do the conversion.

You rarely hear a conversation about the cost of healthcare without the subject of "frivolous" malpractice payouts coming up. But just how much of a drain on healthcare resources are they?

Even though such payments sometimes make big headlines, Johns Hopkins researchers suggest they don't amount to that much when looking at the big picture.

The researchers, who reviewed malpractice payouts over $1 million, say those payments added up to roughly $1.4 billion a year -- far less than 1% of U.S. national medical expenditures.

"The notion that frivolous claims are routinely resulting in $100 million payouts is not true," says study leader Marty Makary, M.D., M.P.H., an associate professor of surgery and health policy at the Johns Hopkins University School of Medicine. "The real problem is that far too many tests and procedures are being performed in the name of defensive medicine, as physicians fear they could be sued if they don't order them. That costs upwards of $60 billion a year. It is not the payouts that are bankrupting the system -- it's the fear of them."

Big payments for a reason

Payouts over $1 million -- called catastrophic claims -- are more likely to occur when a patient who is killed or injured is under the age of 1; develops quadriplegia, brain damage or the need for lifelong care as a result of the malpractice; or when the claim results from a problem related to anesthesia, the researchers found in a study published online in the Journal for Healthcare Quality.

Makary and his colleagues reviewed nationwide medical malpractice claims using the National Practitioner Data Bank, an electronic repository of all malpractice settlements or judgments since 1986. They looked at data from 2004 to 2010, choosing a 2004 start date because that is when data regarding the age and gender of patients and severity of injury became available for the first time.

The information includes only payments made on behalf of individual providers, not hospitals or other corporations, meaning the number of payouts may be underestimated by 20 percent, Makary says.

Over that period, 77,621 claims were paid, with catastrophic claims making up 7.9% (6,130 payouts). The seven-year nationwide total of catastrophic payouts was $9.8 billion, representing 36.2% of the $27 billion worth of total claims paid over that time period.

Diagnosis-related claims

The most common charges associated with a catastrophic payout were diagnosis-related (34.2%), obstetrics-related (21.8%) and surgery-related (17.8%) events. Errors in diagnosis showed twice the odds of a catastrophic payout compared with equipment- or product-related errors and were associated with a roughly $83,000 larger payment.

The age of the physician was unrelated to the likelihood of a claim, suggesting inexperience is not necessarily a factor. But 37% of catastrophic payouts involved a physician with a previous claim in the database. The largest payout in the study was $31 million.

Defensive medicine

Makary says the data suggest that the focus of legal reform efforts should be on doctor protections aimed at reducing defensive medicine rather than the creation of malpractice caps.

He says his findings argue for more research to determine what interventions might prevent the type of errors that result in catastrophic payouts, with the overall goal of improving patient safety and reducing costs at the same time.

But real cost reductions, he says, will come from reducing the overuse of diagnostic tests and procedures.

A somewhat disappointing April jobs number from ADP, which uses actual payroll data to measure the change in total nonfarm private employment each month.

According to the April ADP National Employment Report, private sector employment increased by 119,000 jobs from. This after just 131,000 job gains in March -- a figure that was revised lower from an initial report of 158,000.

The report measures the change in total nonfarm private employment each month on a seasonally-adjusted basis. The March report, which put job gains at 158,000, was revised downward to 131,000.

“Job growth appears to be slowing in response to very significant fiscal headwinds, said Mark Zandi, chief economist of Moody’s Analytics, which collaborates on the report with ADP. “Tax increases and government spending cuts are beginning to hit the job market. Job growth has slowed across all industries and most significantly among companies that employ between 20 and 499 workers.”

Job categories

Employment by companies that produce goods rose by just 6,000 jobs in April -- the slowest pace of growth in seven months. Though it accounted for most of the weakness in goods production job growth in March, construction growth picked up in April, adding 15,000 jobs.

Manufacturers, meanwhile, lost 10,000 jobs in April -- the first decline in three months and the largest since September 2012.

In the services sector, 113,000 jobs were created -- the weakest pace of growth in seven months. Among the service industries, trade/transportation/utilities had the largest gain with 29,000 jobs, followed by professional/business services with 20,000 jobs and financial activities, which added 7,000 jobs.

Looking ahead

The ADP report comes just two days ahead of the Labor Department's release of the April employment figures.

Economists surveyed by Briefing.com are forecasting creation of 135,000 jobs, while the market expectation is for 166,000. The market looks for the unemployment rate to remain at 7.6%, while Briefing sees an uptick to 7.7%

Sega may need to up its game if it wants to avoid being sued by its customers. A class action lawsuit alleges Sega wimped out in its "Aliens: Colonial Marines," putting out a product that brought yawns from its users.

Lead plaintiff Damion Perrine says in a federal court suit that the game is far inferior to the promos and ads that induced him to buy it. The suit seeks damages for false advertising, breach of warranties, fraud in the inducement, negligent misrepresentation and consumer law violations.

The class would cover everyone in the United States who bought the game on or before Feb. 12 this year, Courthouse News Service reported.

Perrine calls it a "classic bait-and-switch" and says the actual game is nothing like the "actual gameplay" demonstrations that portrayed a cutting-edge video game with very specific features.

Perrine noted that reviewers who saw the promos and demonstrations praised the game, saying it was robust, exciting and filled with scenes that closely resembled the 1986 James Cameron film "Aliens," which was a sequel to the 1979 film "Alien." 

But when the game was released in February, at a cost of $50 to $100, reviewers pounced on it, noting the disaparity between the promos and demonstrations and the actual product.

Perrine insists his criticisms are not minor. He says consumers like himself had expected to be able to essentially step into the role of one of the Aliens characters, or perhaps even become one of the aliens, ugly reptilian creatures with exceptionally sharp teeth, very bad breath and a disagreeable disposition.

Perrine seeks damages and punitive damages, restitution, disgorgement, and an injunction. He is represented by attorney Sean Reis of Santa Margarita, Calif.

If you transfer money internationally, you can be a little more confident that it'll get were it's supposed to go.

The Consumer Financial Protection Bureau (CFPB) has revised a rule that new protections. According to the agency, revisions are intended to preserve the new consumer protections provided under the rule while facilitating industry’s compliance with the rule.

The rule will take effect on October 28, 2013.

“We are dedicated to protecting consumers who send money abroad and to preserving their access to these services,” said CFPB Director Richard Cordray. The revisions, he says, will maintain “crucial new consumer protections while facilitating compliance for providers of remittance transfers.”

'Comprehensive consumer protection'

The remittance rule creates a “comprehensive consumer protection” regime for remittance transfers sent by consumers in the United States to individuals and businesses in foreign countries. Under the rule, remittance transfer providers will be required to disclose certain fees and taxes, as well as the exchange rate that will apply to the transfer. It also provides consumers with error resolution and cancellation rights.

The new rule finalizes changes first proposed on December 31, 2012, and builds on a final rule on international money transfers that was published by the CFPB on February 7, 2012 and supplemented on August 20, 2012.

The final rule contains the following changes:

• Disclosure of institution fees and foreign taxes: Remittance transfer providers must disclose certain fees, such as a provider’s own fees and those charged by an agent of the provider or intermediary institution. The requirement that providers disclose foreign taxes or, if that institution is not the provider’s agent, fees imposed by a recipient institution for receiving transfers into an account has been made optional. Providers must include, where applicable, a disclaimer that these fees and taxes may apply.
• Errors from incorrect account information: Under the final rule, when funds are deposited into the wrong account because the sender provided an incorrect account number or routing number and certain other conditions are satisfied, the provider would be required to attempt to recover the funds but would not bear the cost of funds that cannot be recovered.

The revisions, according to CFPB, are designed to preserve market competition and consumers’ access to remittance transfer services and to facilitate implementation of and compliance with the rule’s requirements, while maintaining the rule’s new consumer protections and ensuring that those protections can be effectively delivered to consumers.

The complete money transfer rule will take effect on October 28, 2013. The CFPB says the added time will allow entities that provide remittance transfers plenty of time to adapt to the changes.

The final rule is available here. 

The October 1 start of registration for the Affordable Care Act (ACA), also known as Obamacare, is closing in fast. Reacting to criticism from both Democrats and Republicans that Obama Administration planners are behind the curve, there are new efforts to explain how the law works and make signing up easier.

The latest step is a major overhaul of the forms consumers will use to shop for health benefits at a health exchange and receive a subsidy. The original form was 21 pages long and packed with insurance industry jargon. The new form, introduced by the Department of Health and Human Services (HSS), is only four pages long, not counting the page of instructions.

Information to provide

The form, to be used by a single person seeking a subsidy to help pay for benefits, requests:

• Name, address, phone, email
• Preferred language
• Date of birth
• Race/ethnic origin
• Income
• Health conditions
• Employment/income
• Current health coverage

You then mail a printed copy of the application to the health insurance marketplace and wait for a representative to contact you. If things go smoothly, that contact will come in a timely manner. But some are worried the system won't work that way.

Train wreck?

Sen. Max Baucus (D-Mont.), an architect of the ACA, worried aloud recently that implementation of the new health law “could be a train wreck.” Even President Obama, at a news conference, acknowledged it won't be easy.

“The challenge in setting up a market-based system, basically an online marketplace where you can go on and sign up and figure out what kind of insurance you can afford and figuring out how to get the subsidies, that's still a big complicated piece of business,” Obama said.

“And when you're doing it nationwide, relatively fast, and you've got half of Congress who is determined to try to block implementation and not adequately funding implementation, and then you've got a number of Republican governors who know that it's bad politics for them to try to implement this effectively, when you have that kind of situation, that makes it harder,” he said.

California prepares

In California, state officials have released a new guide that explains how ACA will change the insurance marketplace. The California Association of Health Plans (CAHP) says the biggest change will be in the individual market, where some small businesses and individuals purchase coverage.

The officials concede that, while residents will get more comprehensive benefits, many will pay more than they are paying now.

"The ACA will provide a host of benefits for Californians, from expanded coverage to federal subsidies," said Patrick Johnston, president and CEO of the CAHP. "However, premiums will still rise for some individuals. Lower out-of-pocket expenses, more comprehensive benefits and the elimination of annual and lifetime limits will ultimately help offset those increased premiums."

If you are receiving health benefits through your employer, these changes won't affect you. The individual market will work with people who currently have no insurance – and consumers who are currently paying for an individual policy – to find the best deal. In California, that's estimated to be less than six percent of the population.