May 11, 2007 (CIDRAP News) – The city of Edmonton, Alta., recently announced that it was stockpiling an herbal supplement in the hope of boosting the immunity of police, firefighters, and other essential workers during an influenza pandemic.By buying a ginseng product from CV Technologies, Inc., a company based in Edmonton, the city has become the first in North America to add an herbal supplement to its pandemic stockpile, according to media reports.The supplement, COLD-fX, is a proprietary extract of North American ginseng that contains what the company calls unique polysaccharide components. It is Canada’s top-selling over-the-counter cold and flu remedy, according to an Apr 23 company press release. Warren Michaels, CV Technologies’ vice president of media relations, told CIDRAP News the company launched COLD-fX in the United States in October 2006 and that sales have been modest.City says decision took timeBob Black, Edmonton’s director of emergency preparedness, said in the CV Technologies press release that COLD-fX is another tool the city can use for pandemic preparedness. “There are so many unknowns in planning for a possible pandemic that anything we can do to be prepared makes sense,” he said. “We need to take every reasonable precaution to help our emergency personnel stay on the job, so they can help others.”The stockpile will be used to treat 5,000 key city employees, such as police, firefighters, paramedics, and waste disposal workers. It consists of 600,000 pills, an 8-week supply, according to an Apr 25 report by the Toronto Globe and Mail.CV Technologies, which pitched the stockpiling idea to Edmonton’s pandemic planners, said it would split the $250,000 cost of the program with the city as part of the company’s social responsibility program. Black told CIDRAP News that the agreement stipulates that Edmonton will pay $30,000 up front to secure access to a stockpile of COLD-fX and will be required to pay its remaining share only if and when the city needs the remedy in a pandemic setting.The product has a 5-year shelf life, but the company said it would make sure the city has access to a fresh supply regardless of when it uses the stockpile.Jacqueline Shan, PhD, DSc, CV Technologies’ chief executive officer and chief scientific officer, said that in a pandemic, “COLD-fX may help provide additional protection to front line workers by enhancing their immune systems” until an effective vaccine becomes available.Black said the city spent more than a year considering if it should stockpile COLD-fX. Senior officials and an epidemiologist from the city’s occupational health and safety office were involved in the discussions. “It wasn’t a spur-of-the-moment decision. On the balance, it seemed like a prudent thing to do” he said.Emergency preparedness officials are faced with tough questions about whether workers, particularly those in health and public safety jobs, like paramedics, firefighters, and police, will come to work during a pandemic, Black said. Having an herbal remedy on hand that might boost immunity could potentially make employees feel more confident about showing up for work, he said.Canadian health officials may have a heightened sensitivity about protecting workers during a public health emergency because of their experience with SARS (severe acute respiratory syndrome) in 2003, Black said. A final report on the outbreak that was issued in January faulted hospital officials for not doing more to protect their workers; nine hospital workers in Toronto contracted SARS while caring for critically ill patients.Studies suggest possible benefitsSome randomized, double-blind, placebo-controlled studies have suggested that COLD-fX can help people reduce their number of colds and the duration and severity of symptoms.Two controlled trials were described in one report in the January 2004 issue of the Journal of the American Geriatrics Society. The researchers evaluated the effect of COLD-fX on the number of laboratory-confirmed acute respiratory illnesses in 198 nursing home and assisted-living residents (average ages, 83.5 and 81) in the 2000 and 2000-01 flu seasons.Ninety percent of the subjects had received the influenza vaccine. Half received a 200-mg COLD-fX tablet twice a day, while the others received placebo tablets.Investigators found that more people in the placebo group (9 of 101 subjects) than in the treatment group (1 of 97 subjects) were diagnosed with flu or respiratory syncytial virus. They calculated that the overall risk was reduced by 89% in the treatment group and concluded that COLD-fX was a safe, well-tolerated, and potentially effective treatment for preventing acute respiratory illnesses.During the 2003-04 cold and flu season, another research group, headed by Gerald N. Predy of the regional public health agency based in Edmonton, studied whether the ginseng supplement could prevent colds in a group of 323 Edmonton adults aged 18 to 85 who had not received seasonal flu vaccination. Their findings appeared in the October 2005 issue of the Canadian Medical Association Journal (CMAJ).The volunteers, who had a history of at least two colds the previous season, randomly received two COLD-fX capsules or a placebo daily for 4 months. Colds were verified by a symptom scoring system and graded on a 4-point severity scale.Researchers found that those who took COLD-fX had fewer colds and the colds they did have were milder and less persistent. The authors concluded that the treatment appeared to reduce the number of recurrent colds by almost 13%, the severity of colds by 15.4%, and the average duration of colds by 2.4 days.In a commentary published in the same issue of CMAJ, Ronald B. Turner, MD, professor of pediatrics at the University of Virginia School of Medicine in Charlottesville, wrote that problems with natural remedy studies typically include a lack of information about the active ingredients they contain, lack of a clear understanding of the mechanism of action, and lot-to-lot variability in the products. However, he said the COLD-fX was standardized to reduce such variability.Turner wrote that it was not clear how the effects of North American ginseng relate to viral respiratory infections. “Enhancement of interferon-gamma activity might be expected to reduce the severity of symptoms, but enhancement of the elaboration of inflammatory cytokines might be expected to increase the severity,” he wrote.Few rigorous, reproducible studies have shown either conventional or alternative cold treatments to be beneficial, Turner wrote. Further studies involving well-characterized and standardized ginseng preparations were needed to confirm the results of the CMAJ study, he stated.Public health experts weigh inPaula Steib, communications director for the Association of State and Territorial Health Officials (ASTHO) in Washington, DC, told CIDRAP News in an e-mail that it’s not surprising to see a metropolitan area like Edmonton stockpile a natural remedy. Canada, along with Australia, Britain, and other European countries, has a long tradition of using homeopathic and herbal remedies, which are available in pharmacies and often prescribed by physicians, she said.”The situation is very different in the US where most homeopathic and herbal remedies are scoffed at by the medical establishment,” Steib said. “ASTHO is unaware of any state that is stockpiling remedies that are not part of the CDC’s strategic national stockpile program.”Jeffrey Duchin, MD, chief of communicable disease control for Seattle King County Public Health in Washington, said Edmonton’s plan to stockpile COLD-fX for its essential employees sounded interesting, but he said it was unclear from the studies whether the remedy would be of value.”It appears safe and inexpensive, but it shows how little else people feel they have to turn to,” he said.Communities that consider adding an alternative remedy to their stockpiles should weigh the costs and benefits, Duchin said. If they have met other stockpiling needs, such as having adequate supplies of oseltamivir (Tamiflu) and personal protective equipment, and still have money left in their pandemic preparedness budgets, then it might be reasonable to consider adding something extra, he said.Black said the city has increased its supplies of personal protective equipment and other items its employees would need and noted that other public health functions, including stockpiling vaccines and antivirals, are handled by the province and its health authorities.NIH says ginseng may have potentialThe CMAJ study caught the attention of the US National Institutes of Health (NIH), which in September 2006 included it in its annual bibliography of significant advances in dietary supplement research. “These findings suggest that North American ginseng may be an attractive natural prophylactic for upper respiratory tract infections,” the NIH said. “Additional studies are needed to confirm these findings.”In January, the Nutrition Action Health Letter, a publication of the Center for Science in the Public Interest, a health advocacy group, included COLD-fX in a review of eight popular over-the-counter cold remedies. The publication said that more studies are needed to confirm that COLD-fX can shorten or prevent colds or flu. “Even so, COLD-fX is the only remedy we found with any evidence that it might improve your chances of getting through the cold and flu season without coming down with something,” the article said.Michaels said CV Technologies doesn’t want to overstate COLD-fX’s potential in a pandemic situation, but he said the company believes the product has merit and is a legitimate candidate for incorporation into pandemic plans.The company is exploring the possibility of applying for US Food and Drug Administration approval to market COLD-fX specifically as a preventive for colds and is conducting a phase 3 clinical trial for that purpose. The company also recently launched a trial to see if COLD-fX improves the immunity of healthcare workers and is investigating the precise biochemical pathways by which the product affects the immune system, according to information on the company’s Web site.See also:McElhaney JE, Gravenstein S, Cole SK, et al. A placebo controlled trial of a proprietary extract of North American ginseng (CVT-E002) to prevent acute respiratory illness in institutionalized older adults. J Am Geriatr Soc 2004 Jan;52(1):13-9 [Abstract]Predy GN, Goel V, Lovlin R, et al. Efficacy of an extract of North American ginseng containing poly-furanosyl-pyranosyl-saccharides for preventing upper respiratory tract infections: a randomized controlled trial. CMAJ 2005 Oct;173(9):1043-8 [Full text]Turner B. Studies of “natural” remedies for the common cold: pitfalls and pratfalls. (Commentary) CMAJ 2005 Oct 25;173(9):1051-2 [Full text]CV Technologies news releaseSARS Commission final reporthttp://www.ontla.on.ca/library/repository/mon/16000/268478.pdfNIH press releasehttp://www.nih.gov/news/pr/sep2006/od-21.htmNIH bibliographies of dietary supplement research advanceshttp://ods.od.nih.gov/Research/Annual_Bibliographies.aspxSchardt D. Un-catching colds: do popular remedies work? Nutrition Action Healthletter 2007 Jan/Feb;8-11 [Full text]
Share StumbleUpon SBC Magazine Issue 10: Kaizen Gaming rebrand and focus for William Hill CEO August 25, 2020 The happenstance of bet365 and Sky Betting & Gaming (SBG) releasing results on consecutive days earlier this week rammed home an important message about the dominance of the market leaders in the UK online scene.The numbers were mightily impressive. Total net revenues from the gambling business at bet365 comfortably sailed past the £2bn barrier, up a huge 39 percent on the previous year, and with operating profits totalling £503.9m. Amounts wagered was up 27 percent and active customers rose 35 percent.SBG released scarcely less impressive numbers with group revenue up 38 percent to £516m and total customers rising 31 percent to 2.6 million. EBITDA was up 38 percent to £146m.The figures put to the sword the notion that the UK online gambling market has been exhibiting signs of a marked slowdown in the growth rate. Between them, bet365 and SBG are the UK market leaders – the first is estimated to earn circa 25 percent of its total revenues from the UK while SBG’s results, for now, consist wholly of UK earnings. By comparison, William Hill said its first-half online net revenue rose 5 percent for the period while Ladbrokes Coral said pro-forma revenues rose 14 percent in constant currency terms, though this includes the revenues from Australia and Italy. In UK sportsbook terms alone, the company said UK stakes were up 10 percent year-on-year. Meanwhile, at Paddy Power Betfair the recent third-quarter trading statement said that online revenues in Europe (largely UK) were down 3 percent due to tough comparatives with last year (when the Euros were still taking place) and a deteriorating margin.What would appear to be the gulf in performance (and increasingly scale) between the market leaders and the rest of the notional top five or ten operators in the UK throws up some interesting questions about the structure of the market and of the individual constituents.“There are four things these two have in common,” says Paul Leyland, lead partner at gambling consultancy Regulus Partners. “They are held privately, they are UK-based, they have clearly identified a customer segment that they aim at and none of them have been involved in (large-scale) M&A. The key is that none of their competition have all four of these factors in their favour. Some have none.”Football focusMoreover, these factors are likely to remain in place for some time to come. Bet365 is owned by the Coates family while SBG is under the stewardship of private equity house CVC, meaning the managements of both are more focused on the long-term, without the pressure of pleasing shareholders and the short-termism that comes with it.The UK base is important, meanwhile, not for the specifics of geography but because what having a single base brings in terms of cohesion. Both Stoke (bet365) and Leeds (SBG) have become centres of gaming excellence and each have welded together well-rewarded and highly motivated employees.Then there is the clear target audience. It is notable, for instance, that each is highly connected to and visible alongside the English football and while they may be aiming at slightly differing segments within the huge audience for football, they are equally focused and defined.“They know who their customers are,” says Leyland. “You can target them properly. The bigger operators who go for every segment tend to tick every box and miss every target.”The last point, meanwhile, could yet have even greater relevancy in the months ahead. Much of the focus in the sector at present has been about the potential for further M&A in the sector – and this despite the paucity of evidence that the last spate of buyouts and unions have been successful.The jury is still very much out on Paddy Power Betfair, for instance, where new chief executive Peter Jackson aims to complete the job left behind by departing boss and merger architect Breon Corcoran. The evidence of the success of Sportsbet in Australia, relatively free from any merger backwash, in comparison with the still integrating and transitional mothership points to how much M&A can handicap a business.The only cloud on the horizon for either SBG or bet365 comes with the threat of Chancellor Philip Hammond potentially raising gross profits tax in the upcoming budget, potentially to help mitigate the loss of taxes should the ongoing triennial review consultation process end with a £2 maximum stake (and the loss in tax revenues that would come with it).But if the net result of the end of the review process is – as many have suggested – another bout of corporate activity, then bet365 and SBG might yet see a silver lining as the consummation of further deals once again distracts the competition from the real task at hand of trying to close the gap at the top.Football as a key driver for betting firms will be discussed at next year’s Betting on Football conference (20-23 March) at Stamford Bridge. 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“This is sending us into a tailspin,” said county Supervisor Zev Yaroslavsky. “We believe this will adversely affect our county annually to the tune of $200 million. It will contribute to a degradation of public health, and it’s something that we’re going to fight very hard.” The Bush administration has long sought to limit Medicaid payments to public hospitals, but Congress in 2005 beat back legislation that would have imposed caps. This year, however, the administration changed tactics and moved to reduce about $5 billion in spending over the next five years by using a series of regulatory changes. Lawmakers from 42 states that depend heavily on such payments, however – including California, Illinois and New York – have been fighting back hard. “A cutoff of the funds would work a real hardship on those hospitals,” said Sen. Richard Durbin, D-Ill., who led the fight to preserve the money by inserting a one-year moratorium on the new Medicaid rule in the $124 billion war supplemental. That measure, however, also included a controversial timeline for pulling U.S. troops out of Iraq. Bush this week called a deadline “irresponsible” and vetoed the bill. While new negotiations are in the works, domestic issues like hospital funding have fallen into the background as congressional leaders debate benchmarks and other ways to monitor progress in Iraq. Durbin said Friday he was uncertain whether the hospital protection will stay in. The funding reduction would hit five hospitals in Los Angeles County: Martin Luther King Jr.-Harbor Hospital, Rancho Los Amigos National Rehabilitation Center, Olive View-UCLA Medical Center, Los Angeles County-USC Medical Center and Harbor-UCLA Medical Center. Yaroslavsky said the reduction would wipe out money Los Angeles County takes in from a 2002 ballot proposal that raised property taxes to generate about $180 million for trauma and emergency services. He also noted the county had not accounted for the possibility of losing the money when it determined its budget for the coming year. “It is money we have not assumed we’re going to lose,” he said. “We would have been foolish to make plans based on the worst-case scenario. We would have had to close hospitals.” At the same time, Yaroslavsky predicted, hospitals will have to shut their doors if Congress can’t protect the funding. “The ripple effect it will have on the private hospitals is quantifiable,” he said. “All the patients will have to go somewhere, and they’ll flood the private hospitals.” [email protected] (202) 662-8731160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set! Los Angeles County hospitals could become the newest victims in the ongoing battle between Democrats and the Bush administration over the Iraq war. Tucked into the war spending bill that President George W. Bush vetoed this week was a key domestic provision blocking the government from slashing $500 million in annual Medicaid payments to California’s public hospitals. With Congress and the White House now back at the bargaining table, health advocates said they worry hospitals will be overlooked in the high-stakes negotiations over management of the war. If the provision is dropped, it will mean a $200 million annual hit to Los Angeles County that officials said could force some hospitals to shut their emergency-room doors.