TIME Innovation

Five Best Ideas of the Day: November 24

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. A bipartisan plan in North Carolina shrunk prison population and cut costs while the crime rate continued to fall. Can it serve as a model for other states?

By the Justice Center at the Council of State Governments

2. In international development, the massively scaleable transformative idea is usually too good to be true.

By Michael Hobbes in the New Republic

3. Net Neutrality could have a big impact on the future of healthcare, from telemedicine to electronic medical records.

By Darius Tahir in Modern Healthcare

4. Today’s renewable energy technologies won’t save us from climate change. We need new ideas.

By Ross Koningstein & David Fork in IEEE Spectrum

5. We must understand and counter the major trends fueling the ranks of Islamic radicals.

By Maha Yahya in the National Interest

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME

Your Pharmacist Called. You Owe $1.3 trillion

A new report predicts that drug spending will shoot up 30% by 2018

Here’s a shocker: global spending on drugs is going up. Way up.

A new report from IMS Institute for Healthcare Informatics projects the world will shell out $1.3 trillion for medications in 2018, a 30% increase over the figure in 2013.

The proliferation of new, pricey specialty medications like Sovaldi, Gilead’s $84,000 Hepatitis C wonder drug, has something to do with this spending increase, particularly in developed markets, but so does an aging population and increased accessibility of healthcare around the globe.

Take the U.S., the world’s largest drug market, where spending is forecast to rise 11.7% in 2014. New innovative treatments— particularly for cancer, diabetes, and autoimmune disorders—are one bigger driver for this, but so is Obamacare, which has expanded the number of individuals receiving medical care. (The spending increase in the U.S. this year was particularly dramatic because of the small number of drugs that went off patent. Also, the $1.3 trillion figure does not reflect the impact of rebates and discounts, pricing adjustments that are increasingly common in the modern health care landscape.)

A growing middle class and the adoption of universal healthcare is fueling drug spending in other parts of the world. Generics, rather than branded drugs, dominate these markets: IMS predicts spending on pain medication, the largest category of drugs in developing marketing, will increase roughly 10% annually. (IMS pegs the compound annual growth rate at between 8% and 11%.)

The rise in drug spending isn’t inexorable. The research firm points out that France and Spain are likely to see drug spending decrease, thanks in part to cost containment efforts.

The world is in a relative sweet spot for drug innovation. Whisked along by the FDA’s new breakthrough drug designations, the number of launches of novel medications will remain high in the coming years, IMS says. That’s particularly true in oncology. Cancer drugs account for 30% of the world’s pharmaceutical pipeline, and sales are expected to top $100 billion in 2018, largely because of breakthrough immunotherapy treatments.

This article originally appeared on Fortune.com

MONEY Health Care

You Won’t Believe Your Employer Can Ask You These Personal Health Questions

Office lamps pointed at pill bottle interrogation-style
Sarina Finkelstein (photo illustration); OsakaWayne Studios (pill bottle); David Malan/Getty Images (office lamps)

When you sign up for health coverage this year, your employer might ask you for a lot of details about your health and your habits. The goal: Cut the cost of your care.

This year, one third of employers will ask workers who enroll in the company health plan to complete a questionnaire about their health, according to the Kaiser Family Foundation. That’s up from 24% of firms last year. The questionnaires, often called a “health risk assessment,” are even more common at big companies; more than half of employers with 200-plus employees offer them.

And as more companies look to control health-care costs with programs aimed at making workers healthier, the stakes for sharing personal details about your health are getting higher.

Last year, Penn State faced a backlash for a questionnaire that, among other things, asked female employees about their pregnancy plans. Workers who refused to fill it out had to pay an extra $100 a month. Penn State later suspended the program.

If you’ve never seen one of these assessments before, here’s what to expect, what happens to the information you provide, and what your rights are.

What kinds of questions can my employer ask?

The questionnaires are crafted to identify current behaviors that may cause costly health problems in the future, says Jillian Fagan of Wellsource, a technology company that creates health risk assessments. Wellsource’s questionnaires cover a long list of topics, including weight and height, chronic illnesses, treatments you’re getting, your willingness to make lifestyle changes, tobacco use, physical activity, diet, alcohol consumption, cancer screenings, hearing and vision impairment, flu vaccinations, stress levels, and depressive symptoms.

Questionnaire writers have leeway about how to pose the questions. For example, Fagan says employers usually don’t want to explicitly ask if you’re depressed. Instead, you might be asked questions like, do you have a social group? Are you married? Do you feel like you’re getting the support you need? How many alcoholic drinks do you consume every week?

You may also be asked about your outlook for the future, how much time you have to relax, your energy level, and whether you’re satisfied with your work-life balance, Fagan says. Wellsource develops its questions based on scientific research and includes links its the underlying medical literature.

Is there anything my employer can’t ask?

Inquiring about your parents’ health would probably violate the Genetic Information Nondiscrimination Act, which prohibits employers from collecting genetic information, says Maureen Maly, employee benefits and executive compensation attorney at Faegre Baker Daniels. A family history of breast cancer, say, could indicate a genetic predisposition.

“Once upon a time, it would get into some questions about family medical history,” says Maly. “Most of these questionnaires will not ask that—and they will usually have a warning saying, ‘Don’t volunteer any information.'”

Can my boss see my answers?

Generally, no. Under HIPAA, the Americans with Disabilities Act, and state privacy laws, employers are prohibited from using health risk assessments for any reason other than for wellness programs, says employee benefits attorney Todd Martin.

Keep in mind that often your employer already has information on your health. If your health plan is self-funded and self-administered—meaning your employer pays the claims directly rather than contracting with an insurer or third party—someone in your office gets your health claims. Your employer is legally bound to maintain a firewall, secure your private information, segregate it from other employment files, and limit staff access, Martin says. Health risk assessments aren’t much different.

And besides, seeing that information could expose the company to a lawsuit if you’re fired or disciplined. “Most employers don’t want to see that information as much as employees don’t want to give it to them,” says Fagan of Wellsource.

So employers usually hire a third party to administer the questionnaires. If that’s a medical provider, that firm is subject to additional privacy rules, says Martin.

That’s really personal! Why is my employer asking me all that?

The goal is to give you a picture of your health and suggest how to do better, Fagan says. “Health risk assessments show you where you’re going to be in five years,” Fagan says. “If we notice that you don’t work out, you’re eating lots of sugar, and your diet is not so great, if you continue down this road, you’re going to have tons of health problems in the years to come.”

Of course, there’s something in it for your employer too—potential cost savings if you stay healthy.

How can knowing more about my health save my boss money?

More than half of large firms surveyed say that they see wellness initiatives as one of the most effective tactics for controlling health-care costs, according to the National Business Group on Health. Such programs can include weight-loss and smoking cessation classes, nutritional counseling, gym discounts, and lifestyle coaching.

With a summary of the answers employees gave on the questionnaires in hand, a company can see, for example, that a lot of workers are struggling to quit smoking (but not who those employees are), which can help it decide whether or not to offer a smoking cessation class (a common perk). To date, however, the research on the effectiveness of wellness programs is mixed.

What’s more, Jennifer Bard, professor at the Texas Tech University School of Law, says she has serious concerns about the privacy risks associated with wellness initiatives.

“It’s not clear how those risks translate into future health,” Bard says. “There isn’t enough information to say that somebody with a particular blood pressure or cholesterol reading or weight is going to have a specific problem. It’s one thing to diagnose someone who is sick, but the science of risk is not as well-developed.”

What else can come of sharing health information?

Your employer can set health-related goals for you. For example, if you’re overweight, your employer can offer a financial incentive for you to lower your BMI. As part of the Affordable Care Act, those financial incentives can be worth 30% of the total cost of plan costs, up from 20% before health reform.

That kind of outcomes-based wellness program is subject to a strict set of rules, Martin says. If your doctor says that you are unable to achieve the goal, your employer has to offer another way for you to earn the incentive.

Outcomes-based wellness programs are growing but not yet widespread. And only 7% of employers say that employees with health risks must complete some kind of wellness program or face a penalty, according to Kaiser.

“The restrictions have made a number of employers want to stay away from outcomes-based programs and focus on the participation-based programs like the health risk assessment,” says Martin.

Can my employer force me to fill out a questionnaire?

Probably not. Only 3% of large firms that offer questionnaires require employees to fill them out, according to Kaiser.

But health assessments, medical screenings, and wellness programs are still a legal gray area.

The Department of Labor says employers can require workers complete a health risk assessment before enrolling in a company health plan, so long as the employer doesn’t deny benefits or change premiums based on the information.

But the Equal Employment Opportunity Commission recently sued three employers on the grounds that their mandatory wellness programs violated anti-discrimination statutes. The EEOC has sued Honeywell over its wellness program, even though the company says it’s voluntary. But employees and spouses who refuse to participate in health screenings face up to $4,000 in financial penalties, which, the EEOC contends, effectively makes the program mandatory.

“It’s helpful for people to know that this is unresolved,” says Bard, the Texas Tech University law professor. “These kinds of wellness programs with a bite, with a financial consequence, are relatively new. Everyone is watching the EEOC lawsuits very carefully.”

That said, if the wellness program is mandatory, you might have little choice. “In my opinion, anyone who chooses not to comply puts themselves at risk for being a test case,” Bard says.

My employer says it’s voluntary. Why should I fill it out?

Health risk assessments are a benefit, says Fiona Gathright, president of Wellness Corporate Solutions, a third-party vendor that administers wellness programs for employers. “We’re trying to help people manage their health, and we’re trying to help people live longer,” Gathright says. “Answer the questions as honestly as you can. If we uncover that you have a risk, we’re going to you help you a manage that risk.”

Still not convinced? More than half of large firms sweeten the deal with some kind of financial incentive, according to Kaiser; 36% of those firms offer a financial incentive worth more than $500.

I’m still uncomfortable with this. What should I do?

Carefully read the disclosures, which usually contain information about who will see your answers and in what form, says Fagan. And ask your own questions

First, who is doing the assessment? An outside vendor, especially one that’s also a medical provider, is best. How is sensitive personal information protected from data breaches?

Second, what information gets back to the employer? Only you should see your individual results. If your employer will see aggregated responses, how big is the sample size? Is there any way you could be identified—say, if you’re the only obese employee at a small firm? There may be rules against reporting results from small groups.

Finally, ask how your employer intends to use the questionnaire. Know ahead of time if you’re just getting information about your health risks—or if you’re laying the groundwork for an outcomes-based wellness program that will ask you to make big changes.

Related

MONEY Health Care

The 7 Biggest Health Problems Americans Face—And Who is Profiting

Bottles of prescription medicine in cabinet
Kim Karpeles—Getty Images/age fotostock

Here are the most-prescribed drugs in America.

Americans include two health-related issues among the 10 most important problems facing the U.S., according to a recent Gallup survey. Healthcare in general ranked fourth on the list, with Ebola coming in at no. 8. But is Ebola really among the biggest health problems for Americans? Not when we look at the chances of actually being infected.

So, what are the actual biggest health problems that Americans face? One way to answer this question is to look at what drugs are prescribed the most. Here are the seven top health problems based on the most-prescribed drugs in the U.S., according to Medscape’s analysis of data provided by IMS Health.

1. Hypothyroidism

AbbVie’s ABBVIE INC. ABBV 0.9403% Synthroid ranks at the top of the list of most-prescribed drugs. Synthroid is used to treat hypothyroidism, a condition caused by an underactive thyroid gland.

The American Thyroid Association estimates that 2%-3% of Americans have pronounced hypothyroidism, while 10%-15% have a mild version of the disease. Hypothyroidism occurs more frequently in women, especially women over age 60. Around half of Americans with the condition don’t realize that they have hypothyroidism.

2. High cholesterol and high triglycerides

Coming in at a close second on the list is AstraZeneca’s ASTRAZENECA PLC AZN 0.3394% Crestor. The drug is used to help control high cholesterol and high triglyceride levels.

According to the American Heart Association, nearly 99 million Americans age 20 and over have high cholesterol. Elevated cholesterol levels are one of the major risk factors for heart attacks and strokes. The problem is that you won’t know if you have high cholesterol unless you get tested — and around one in three Americans haven’t had their cholesterol levels checked in the last five years.

3. Heartburn and gastroesophageal reflux disease

AstraZeneca also claims the third most prescribed drug in the nation — Nexium. The “purple pill” helps treat hearburn and gastroesophageal reflux disease, or GERD, also commonly referred to as acid reflux.

Around 20% of Americans have GERD, according to the American Society for Gastrointestinal Endoscopy. A lot of people take over-the-counter medications, but that’s not enough for many others. Medscape reported that over 18.6 million prescriptions of Nexium were filled between July 2013 and June 2014.

4. Breathing disorders

The next two highly prescribed drugs treat breathing disorders. GlaxoSmithKline’s GLAXOSMITHKLINE PLC GSK 0.5186% Ventolin HFA is used by asthma patients, while the company’s Advair Diskus treats asthma and chronic obstructive pulmonary disease, or COPD.

More than 25 million Americans have asthma. Around 7 million of these patients are children. Meanwhile, COPD, which includes chronic bronchitis and emphysema, ranks as the third-leading cause of death in the U.S.

5. High blood pressure

Novartis NOVARTIS AG NVS 0.5471% claims the next top-prescribed drug with Diovan. The drug treats high blood pressure by relaxing and widening blood vessels, thereby allowing blood to flow more readily.

Around one-third of American adults have high blood pressure. Many don’t know that they are affected, because the condition doesn’t usually manifest symptoms for a long time. However, high blood pressure can eventually lead to other serious health issues, including heart and kidney problems.

6. Diabetes

Several highly prescribed drugs combat diabetes, with Sanofi’s SANOFI S.A. SNY 0.9234% Lantus Solostar taking the top spot for the condition. Lantus Solostar is a long-acting basal insulin that is used for type 1 and type 2 diabetes mellitus.

According to the National Diabetes Statistics Report released in June 2014, 29.1 million Americans had diabetes in 2012. That’s a big jump from just two years earlier, when 25.8 million Americans had the disease. Diabetes ranks as the seventh leading cause of death in the U.S.

7. Depression and anxiety

Eli Lilly’s ELI LILLY & CO. LLY 0.7031% Cymbalta fell just below Lantus Solostar in number of prescriptions. Cymbalta is the leading treatment for depression and generalized anxiety disorder.

The Anxiety and Depression Association of America estimates that 14.8 million Americans ages 18 and older suffer from a major depressive disorder each year. Around 3.3 million have persistent depressive disorder, a form of depression that lasts for two or more years. Generalized anxiety disorder affects around 6.8 million adults in the U.S.

Common thread for common diseases

One thing that stands out about several of these common diseases affecting millions of Americans is that many people have one or more of these conditions — but don’t know it. This underscores the importance of getting a checkup on a regular basis.

Regardless of what the Gallup survey found, the odds of you getting Ebola are very low. On the other hand, the chances of you or someone in your family already having one of these seven conditions could be higher than you might think. Perhaps the truly biggest healthcare challenge facing Americans is knowing the status of their own health.

TIME reproductive rights

6 Myths About Abortion

Katha Pollitt is the author of the recently published Pro: Reclaiming Abortion Rights.

The anti-abortion side of the debate has created fiction from fact

1. The Bible forbids abortion.

It shouldn’t matter what the Bible says about abortion. The United States is not a theocracy. Still, given the certitude of abortion opponents that abortion violates God’s Word, it might come as a surprise that neither the Old Testament nor the New mentions abortion—not one word.

It’s not that the Old Testament is reticent about women’s bodies, either. Menstruation gets a lot of attention. So do child- birth, infertility, sexual desire, prostitution (death penalty), infidelity (more death penalty), and rape (if the woman is within earshot of others and doesn’t cry out . . . death penalty). How can it be that the authors (or Author) set down what should happen to a woman who seeks to help her husband in a fight by grabbing the other man’s testicles (her hand should be cut off) but did not feel abortion deserved so much as a word? Given the penalties for nonmarital sex and being a rape victim, it’s hard to believe that women never needed desperately to end a pregnancy, and that there was no folk knowledge of how to do so, as there was in other ancient cultures. Midwives would have known how to induce a miscarriage.

A passage often cited by abortion opponents is Exodus 21:22–23:

If people are fighting and hit a pregnant woman and she gives birth prematurely but there is no serious injury, the offender must be fined whatever the woman’s husband demands and the court allows. But if there is serious injury, you are to take life for life . . .

Contemporary abortion opponents interpret this passage as distinguishing between causing a premature birth (fine) versus causing a miscarriage (death penalty), which is indeed what most modern translations suggest. Unfortunately for abortion opponents, at least one thousand years of rabbinical scholarship say the fine is for causing a miscarriage and the death penalty is for causing the death of the pregnant woman. If anti-abortion exegetes are only now finding in this rather obscure passage evidence for an absolute biblical ban on abortion, you have to wonder why no one read it that way before. The Talmud permits abortion under certain circumstances, in fact requires it if the woman’s life is at stake.

The New Testament was a second chance for God to make himself clear about abortion. Jesus had some strong views of marriage and sex—he considered the Jewish divorce laws too lenient, disapproved of stoning adulteresses, and did not shrink from healing a woman who had “an issue” (vaginal bleeding of some sort) that had lasted twelve years and would have made her an outcast among Jews. But he said nothing about abortion. Neither did Saint Paul, or the other New Testament authors, or any of the later authors whose words were interpolated into the original texts.

2. Women are coerced into having abortions.

Abortion opponents claim girls and women are frequently forced or bullied into terminating wanted pregnancies. That 64% of women “feel pressured to abort” is a claim that shows up over and over. As the journalist Robin Marty was the first to report, the 64% statistic comes from a 2004 article in Medical Science Monitor, “Induced Abortion and Traumatic Stress: A Preliminary Comparison of American and Russian Women” by Vincent M. Rue, Priscilla K. Coleman, James J. Rue, and David C. Reardon. But David Reardon is a major anti-abortion activist, tireless promoter of “post-abortion syndrome,” a condition rejected by the American Psychological Association, and director of the anti-abortion Elliot Institute. (According to its Web site, the name was “picked from a baby names book” because it sounds both friendly and academic.) His PhD in biomedical ethics comes from Pacific Western University, an unaccredited correspondence school. Medical Science Monitor, an online journal, has published other spurious research, for example, papers defending the discredited vaccine-autism connection. In 2012 it was exposed as one of a circle of journals that agreed to inflate their citation rankings by citing one another.

There are a number of problems with the paper in question, which was actually not about coercion but a comparison of post-abortion trauma in American and Russian women. Its sample was tiny (217 Americans), self-selected, far more white and middle-class than the general population of women who’ve had abortions, plus the women were reporting on abortions a decade earlier. Half thought abortion was wrong; only 40 per- cent thought women should have a right to it. Thirty percent said they had “health complications” after the abortion, which could mean anything. (According to the Guttmacher Institute, only .05 percent of first trimester abortions have complications “that might require hospital care.”) Interestingly, the American women, though not the Russian women, reported staggering amounts of violence and trauma in their lives before the abortion.

How common is it for a woman to be pushed into an abortion she doesn’t want? In a 2005 Guttmacher Institute survey, 1,209 women were asked their reasons for choosing abortion. Fourteen percent cited “husband or partner wants me to have an abortion” and 6 percent cited “parents want me to have an abortion.” (Interestingly, both these answers were down from a similar survey in 1987, when 24 percent of women mentioned the wishes of husbands/partners and 8 percent mentioned those of parents.) But when asked to name the single most important reason, less than 0.5 percent each cited the wishes of husband/partner or parents.

3. Abortion is dangerous.

Anti-abortion literature is full of stories about women gravely injured or even killed in clinics. Such places exist: A woman died in Kermit Gosnell’s Philadelphia clinic, some were injured, and all received inferior care. Steven Brigham has been in legal trouble in several states. Such doctors stay in business because they are cheap, they are in the neighborhood, they perform abortions later than the law allows, and they zero in on low-income patients who, sadly, are used to being treated badly by people in authority. No doubt there are other inferior clinics out there. But only in abortion care do the few bad providers taint all the others—and taint them so much that opponents can pass laws that would virtually shut down the entire field in the name of patient safety.

And yet, abortion is remarkably safe. The CDC reports that from 2003 to 2009, the most recent period for which it has figures, the national mortality rate was .67 deaths per 100,000 abortions. In 2009, a total of eight women died due to abortion. Tragic as that is, compare it with fatal reactions to penicillin, which occur in 1 case per 50–100,000 courses. And what about Viagra? According to the Association of Reproductive Health Professionals, it has a death rate of 5 per 100,000 prescriptions. But you don’t find legislators calling for a ban on Viagra.

Really, though, there is only one directly relevant comparison of risk with respect to abortion, and that is pregnancy and childbirth. The death rate for that is 8.8 women per 100,000. Continuing a pregnancy is 12 to 14 times as potentially fatal as ending it. (And maternal mortality rate is rising in the US even as it is falling around the world.) Curiously, no one suggests that obstetricians be compelled to read pregnant women scripts about the dangers that lie ahead before sending them home for 24 hours to think about whether they wish to proceed.

4. There are too many abortions.

Sometimes what people mean when they say there are too many abortions is that we need to help girls and women take charge of their sexuality and have more options in life. According to the Guttmacher Institute, in 2011 abortion declined by 13 percent from 2008, mostly because of better access to birth control and to longer-acting birth control methods like the IUD. That is very good news.

But often what people mean is that women are too casual about sex and contraception. When Naomi Wolf writes about her friends’ it-was-such- good-Chardonnay abortions, she is saying women get pregnant by accident because they are hedonistic and shallow. It is difficult to come down hard on abortion as immoral, to insist that the ideal number of abortions is zero, as Will Saletan maintains, without blaming the individual woman who got herself into a fix and now wants to do a bad thing to get out of it.

5. Abortion is racist.

In February 2011, a three-story-high billboard popped up in New York City. Featuring an adorable little black girl in a sweet pink dress, it pro- claimed, “The Most Dangerous Place for an African American Is in the Womb.” The previous year, billboards in Atlanta showed a little black boy with the slogan “Black Children Are an Endangered Species.” The brainchild of Life Always, a Texas anti-abortion group, these signs, and similar ones around the country comparing abortion to slavery, aroused so much indignation from black women that they were quickly taken down. But the charge that abortion is racist is commonplace in the pro-life movement.

If the womb is the most dangerous place for an African American, that makes black women, the victims of racism, the real racists. Put like that it doesn’t make much sense. The metaphor ignores the subjectivity of black women; once again, a woman is a vessel, a place—in this case a hostile place. Imagery of abortion as slavery or genocide allows abortion opponents to posture as anti-racists without having to learn anything about the lives of black women or lift a finger to rectify the enormous and ongoing legacy of slavery and segregation. Just shame black women into giving birth to more children than they feel they can safely bear or care for, and all will be well.

6. Abortion opponents would never punish women.

That’s what they always say: Women are abortion’s “other victim.” Only the providers should be charged with a crime. That view would come as news to the many countries where women are in prison for ending their pregnancies.

Right now, putting women on trial for abortion sounds far- fetched, I admit. There’s little heart for it in the ranks of the pro-life movement. But the groundwork is being laid. Women have been arrested for self-abortion in several states, although few have been convicted. Many have been arrested and some imprisoned for drug use or other behavior during pregnancy, even when no bad outcome occurred, and even when the law was clearly designed for some other purpose (to protect living children from meth labs, for example). For decades the anti-abortion movement has striven to enshrine in law the view that the embryo and fetus are persons. They won passage of the federal Unborn Victims of Violence Act, which made causing the death of embryos and fetuses a separate crime from the harm caused to the pregnant woman, and versions of that law in many states. In the spring of 2014, despite strenuous objections from women’s groups and medical organizations, the Tennessee state legislature passed with bipartisan support, and the moderate Republican governor signed, a bill that would subject to criminal penalties of up to fifteen years in prison drug- using women who had a poor pregnancy outcome.

As abortion becomes restricted, and the embryo and fetus are regarded as legal persons in more and more areas of the law, it becomes increasingly difficult to say why a pregnant woman’s conduct during pregnancy should not be subject to legal scrutiny.

 

Katha Pollitt, the author of Virginity or Death! and Learning to Drive, is a poet, essayist, and columnist for The Nation. She has won the National Book Critics Award for her first collection of poems, Antarctic Traveler, and two National Magazine Awards—for Essays and Criticism, and Columns and Commentary. She lives in New York City.

Excerpted from Pro: Reclaiming Abortion Rights by Katha Pollitt, published by Picador. Copyright © 2014 by Katha Pollitt. All rights reserved.

Read next: Dear Fellow Conservatives: Want Fewer Abortions? Tolerate Birth Control

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

Ebola: World Bank Chief Calls for Health Workers in West Africa

World Bank President Dr. Jim Kim speaks to reporters in Washington about Ebola on Oct. 24 Michael Bonfigli—The Christian Science Monitor

Says thousands needed to stop the spread of Ebola

The global health community needs “thousands” more health-care workers in West Africa to tame the Ebola virus epidemic that has so far killed nearly 5,000 people, the president of the World Bank told reporters Friday.

Dr. Jim Yong Kim, chief of the international financial institution, said a lack of trained medical personnel in Guinea, Liberia and Sierra Leone is one of the main challenges hampering the international effort to control an outbreak that has ravaged three West African countries and risks spreading to its neighbors.

Kim said the global community has stepped up its response to Ebola, but conceded that the World Bank, like other international organizations, was late to recognize the severity of the epidemic. The spread of the virus in the three stricken nations at the heart of the epidemic has left healthcare workers in triage mode. As a result, they are often unable to use “the ideal techniques” for combating an epidemic, such as contact tracing—the process of identifying and isolating the contacts of infected patients.

“We are now on a war footing,” Kim said, “but it took us a long time to get there.”

Kim said that international organizations have ratcheted up levels of support to West Africa after a sluggish start, but said more must be done. “We’ve got to get beyond these sort of nihilists notions that nothing can be done,” he said. The World Bank has pumped $400 million into West Africa to fight Ebola.

Kim praised Dr. Craig Spencer, the physician who was diagnosed with Ebola Thursday night in New York City. Spencer contracted the virus while treating Ebola patients in Guinea as a volunteer for the international organization Doctors Without Borders, or Medicins Sans Frontieres.

“Dr. Spencer is a hero,” Kim said, urging more doctors to follow his lead and fight the epidemic at its source. He added that both the patient and city officials executed a textbook response to Spencer’s symptoms.

Kim said he hoped that the cases in Dallas and New York would help open the eyes of the world to a disease gutting large swaths of West Africa and prompt the global community to spring into action more quickly in the future. “I think this is a wakeup call,” he said, pausing slightly. “I hope this is a wakeup call.”

TIME Healthcare

Need Your Flu Shot? Just Call an Uber

Uber Taxi App In Madrid
Pablo Blazquez Dominguez—Getty Images

The one-day program is available in three U.S. cities

Uber on Thursday launched a one-day pilot program to deliver free flu shots and flu prevention packs in three major U.S. cities.

The UberHEALTH service will be available only Thursday in Boston, New York and Washington, D.C., between 10 a.m. and 3 p.m. ET, according to Uber’s blog. The service can be requested while ordering a ride on the Uber app, after which a registered nurse will administer flu shots and distribute materials for up to 10 people at no additional cost.

The free flu shot service, which is a partner project with Vaccine Finder, is only the latest of Uber’s limited time specials. Uber has previously rolled out delivery services for air conditioners and diapers, and even its own Optimus Prime.

 

TIME Healthcare

The CDC’s New Tests Can More Quickly Check for Enterovirus

CDC Chief Dr. Thomas Frieden Updates Media On Dallas Ebola Response
Exterior of the Center for Disease Control (CDC) headquarters Jessica McGowan—Getty Images

Tests that took weeks will now take only days

The testing process for a common enterovirus known to cause reparatory illness is getting streamlined.

The Centers for Disease Control and Prevention (CDC) has developed a faster test for EV-D68, a strain of enterovirus that has sent hundreds of children to the hospital, particularly affecting those with asthma.

“CDC has received substantially more specimens for enterovirus lab testing than usual this year, due to the large outbreak of EV-D68 and related hospitalizations,” said Anne Schuchat, MD, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases, in a statement Tuesday. “When rare or uncommon viruses suddenly begin causing severe illness, CDC works quickly to develop diagnostic tests to enhance our response and investigations. This new lab test will reduce what would normally take several weeks to get results to a few days.”

The faster enterovirus testing will help the CDC track the recent outbreak of EV-D68, which began over the summer and appears to be continuing through the fall as children across the country return to school.

 

TIME medicine

FDA Approves Combined Hepatitis Drug

Harvoni
Harvoni, the first single medication to treat hepatitis C, was recently approved by the FDA. Gilead Sciences

Harvoni is the third hepatitis C drug approved in the past year

The Food and Drug Administration approved the first single medication to treat hepatitis C on Friday, green-lighting one pill in the place of multiple treatments. The new drug, Harvoni, is the third hepatitis C drug approved in the past year.

“With the development and approval of new treatments for hepatitis C virus, we are changing the treatment paradigm for Americans living with the disease,” said FDA official Edward Cox.

Harvoni, developed by Gilead Sciences, will be the first hepatitis drug to require a pill only once daily. A full 12-week treatment will cost $94,500, less than existing treatments, Reuters reports.

TIME Walmart

Why Walmart Workers Losing Healthcare Might Not Be Bad

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Ironies abound

Talk about irony. In the same week that Walmart announced employees who work less than 30 hours will be losing their health care coverage, the company also announced that it’d be getting deeper into the business of selling insurance, making it easier for customers to price shop for insurance in stores. In some ways, this mirrors Walmart’s overall business model—keep prices down for consumers, but keep wages and benefits for employees low too.

Ironically, under the rules of Obamacare, it’s possible that those part time employees will get a better deal on health care exchanges, thanks to subsidies that help lower income workers buy insurance. It’s all part of the new landscape created by the Affordable Care Act. As Obamacare turns one year old, Joe Nocera and I discussed how it’s changed healthcare, business, and the economy, on WNYC’s Money Talking.

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