Why not take this as the golden opportunity to introduce polymer currency notes of Rs500 and Rs1,000 in a single move?
Every now and then couriers and "mules" are caught carrying fake Indian currency notes. However, quantity and frequency have increased recently, as per reports appearing in the press. Investigations by various related agencies have come to the sad conclusion that these originate from Pakistan. Supplies via Nepal and Bangladesh were regular; this was increased due to the presence of large Indian expatriate population in the Gulf. Now reports indicate that Cambodia (Kampuchea) is one more point of distribution from where the fake currency finds its way to India.
Therefore the present move by the Reserve Bank of India (RBI) to replace the old currency notes minted before 2005 has to be viewed from different angles. First is the fear that "foreign hands", especially Pakistan, can cause havoc by pushing the supplies of these fake Indian currency notes in circulation that may be designed to be supplied to groups which can create problems before elections that are due in May.
Secondly, the genuine reason is to reduce the replacement cost of currency notes, which do not have a long shelf life; at best these last for four to five years, as compared to polymer notes, which are practically permanent and not easily copied or made. Counterfeiting polymer currency note is just not possible, as countries like Australia, the pioneer, has not reported any case so far. Besides, replacement costs are nil.
The world treasuries are reported to be printing about 150 billion bank notes every year to replace the old, worn out and torn notes, at an estimated cost of $10 billion, and it is not always practical carry metallic coins, which are also in circulation, side by side, but for smaller denominations. Technically, the reason for shorter life span of the paper currency notes has been attributed to human sebum, the oily, waxy substance secreted by the sebaceous glands that prevents hair and skin from drying out! Two researches in the US—Nabin M Lawandy and Andrei Smuk of Solaris Nanosciences Corporation—found out that the frequently handled currency notes become grimy due to human sebum! When they carried out further studies, they came up with a supercritical CO2 which acts both like a gas and a liquid commonly used for "cleaning" applications! This will take further research and trials before it can become functional on a large scale!
Anyway, RBI has announced the procedures to be followed for replacement of old currencies (pre 2005) from 1st April onwards, till 30th June, simply by contacting the individual bankers where one has the account.
After 1st July, there are no restrictions on lower values, where one has the account, but upto 10 notes of Rs500 and Rs1,000 denominations and exchange them for new notes. In case of other banks, if one should carry more than 10 note of Rs500 and Rs1,000 denominations, they need to produce ID and residence proof from 1st July onwards. In case of doubt, banks can be contacted for assistance.
The RBI has given the assurance that this move is not intended to or aimed at demonetising the currency, and actually being done to replace the old (pre 2005) which were easily counterfeit able. The new notes are more difficult to counterfeit according to RBI. Though the BJP party called this move as "anti-poor" and as a gimmick of the finance ministry, stating that people who have no bank accounts will be hard hit, RBI officials confirmed that this was done to protect the public and that there is no need to panic because of the proposed introduction of new currency notes.
All said and done, and taking full face value of the reasons given by RBI for this new notes, why not take this as the golden opportunity to introduce polymer currency notes of Rs500 and Rs1,000 in a single dramatic move? Such move will kill several birds in one stone! Elections are around the corner and fake currencies from across the border is bound to be flooded to cause havoc, and this can be avoided by this single major move - or at least, reduced to a great extent!
(AK Ramdas has worked with the Engineering Export Promotion Council of the ministry of commerce. He was also associated with various committees of the Council. His international career took him to places like Beirut, Kuwait and Dubai at a time when these were small trading outposts; and later to the US.)
In its effort to crack down on weight-loss scams, the US FTC earlier this month released a gut check’’ guide for the media to help advertising managers spot scam ads and make sure they aren’t published or aired
Fraudsters count on consumers thinking that an ad for a product or service must be legitimate when they see it on their favorite media site or in their local paper, the agency noted.
Said the FTC to the media:
Accuracy is your company’s stock in trade. Why sully your good name by being known as a publication or station that promotes rip-offs.
This is certainly an issue that resonates with readers. Just as the FTC was releasing its guide, TINA.org received a complaint from a reader about a newspaper in Arkansas that was printing ads for companies he said were selling suspect products. One such ad was for collectible coins from the World Reserve Monetary Exchange that has an “F” rating from the BBB.
Reader Larry K. told TINA.org:
My main concern is that the newspaper owes its readers at least a minimum inquiry of the accuracy of ads and especially of full-page ads. It only took me five minutes to Google these companies and their products to find numerous complaints, lawsuits and “F’ ratings by the BBBs. Newspapers owe their readers at least that much effort.
Larry said he tried to contact the advertising executives at the paper, the Arkansas Democrat-Gazette, and also complained to the Arkansas Attorney General. But he got nowhere on the issue. I tried to contact the advertising manager as well, several times. But no one from the paper got back to me.
Other media representatives say it’s a complicated issue, bound up in First Amendment issues, court rulings and the individual advertising policies of various media outlets.
Court rulings have stipulated that media outlets aren’t responsible for the content of ads unless they provide some kind of endorsement for the product or service itself. In fact some states have regulations that expressly state that media outlets aren’t responsible for the content of ads unless media staff had knowledge beforehand that the ads were false. That means that the more a newspaper does to vet an ad, the more responsibility it has to not run it if it’s deceptive. Said another way, the less they do to vet an ad, the less liable they are.
Paul Boyle, senior vice president of public policy for the Newspaper Association of America, told me that while the association works with the FTC to educate its members about false and deceptive ads, advertisers themselves have the ultimate responsibility for what they sell and how they sell it.
Newspaper advertising people are not doctors…Are they capable of making a determination of whether or not a claim is accurate or not in regards to the way it is phrased and (its) health effect? That is why we firmly believe the responsibility is on the advertiser and not the media.
The National Association of Broadcasters had a similar view. Dennis Wharton, who is its executive vice president, said:
You can’t expect every broadcaster in America – and there is something like 16,000—to have teams of researchers checking the scientific claims of every product…At some point you have to trust your listeners or viewers to have a truth meter embedded in their brain if an ad sounds too over the top…
Full disclosure: I am a member of the media and have worked for small and large newspapers, each with its own standards for ads. I know in this age of declining revenues and small staffs it can be tough for media outlets to vet all ads and even more so, turn income away. Still, I agree with the FTC. A media outlet’s reputation is on the line.
In a recent follow-up email, Larry said the Arkansas paper finally stopped running at least one ad that he was upset about. That ad was for a “free” telephone for seniors that actually ends up costing $97 after activation fees. He said the paper stopped running the ad after a local television station did a story about the ad and the company, Brilliant Built Technologies, which also has an “F” rating from the BBB.
So, readers, if you’ve been scammed by an advertisement, contact the media outlet and let them know. Tell them you will stop watching their station or paying for their newspaper. That’ll get their attention. And of course, let us know too. Because that’s exactly what we do here at TINA.org. We vet ads for accuracy.
(Fran Silverman, editor of TINA, believes in the watchdog role of journalists who can empower and inform consumers through news and education.)
After an adviser is accused of taking kickbacks, the US National Quality Forum launches a review of its widely used patient safety guidelines
When the team of patient safety experts volunteering for the National Quality Forum met in 2009, it was no exaggeration to say lives were on the line. The dozen committee members were updating “safe practice” guidelines that are taken as gospel by the nation’s hospitals, where mistakes and preventable complications cause hundreds of thousands of patient deaths a year.
Dr. Chuck Denham, one of the country’s most visible advocates for patient safety, co-chaired the session. Denham resembles a trim version of Dr. Phil but talks faster, lacing his speech with a mix of self-help and business jargon. Though he lacked the deep research credentials of some others on the panel, Denham had more than made up for it with evangelistic zeal, including a featured role in a patient safety documentary with the actor Dennis Quaid.
A transcript of the meeting shows that when discussion turned to preventing hospital infections, Denham twice brought up a study that endorsed a particular formula for antiseptic skin cleansers. What the committee didn’t know: A business run by Denham had contracts worth $11.6 million from a company whose market-leading product, ChloraPrep, used that same formula.
Earlier this month, the U.S. Justice Department settled a $40 million whistleblower lawsuit with CareFusion, the maker of ChloraPrep. The case claimed the money paid to Denham's business was a kickback to get him to manipulate the National Quality Forum's standards and boost sales of the drug.
Denham has called the allegation “blatantly false.” But the case has shaken the patient safety world, prompting speculation about a star figure’s motives and questions about the inner workings of the Quality Forum, whose guidelines are regarded as the gold standard for best health care practices.
The Quality Forum has said it halted dealings with Denham in 2010 and took steps to insulate its guidelines from commercial influence. Officials from the organization said they were confident that none of the guidelines was corrupted to favor the company that was paying Denham.
But two high-profile members of the committee told ProPublica they believe the process was compromised, resulting in an unintended endorsement of ChloraPrep. And a review by ProPublica found that the group’s final 2010 guidelines, currently in effect, still recommend the ChloraPrep formula.
Asked about the discrepancy last week, the Quality Forum said it was launching a new review of all the recommendations listed in its 2010 “Safe Practices for Better Healthcare” report.
Also in response to questions from ProPublica, the Quality Forum divulged that Denham’s nonprofit was one of its contributors, and that in 2007 and 2008 it received $485,000 in donations from a foundation affiliated with Cardinal Health, a company that spun off CareFusion in 2009.
The committee members who spoke to ProPublica said they were surprised to see the formulation specific to ChloraPrep in the 2010 guidelines. The transcript of the committee’s discussion in 2009 shows that Denham suggested the panel endorse the formula, but no final agreement to recommend it.
Dr. Patrick Romano, a professor and researcher at the University of California, Davis School of Medicine, said the recommendation “is likely to reflect improper commercial influence.”
Both Romano and Dr. Peter Pronovost, who leads a patient safety institute at Johns Hopkins Medicine, said they had been unaware of Denham’s financial ties with CareFusion. Quality Forum officials said Denham never reported them, nor did he mention them during the 2009 meeting when members were asked to disclose their financial relationships, the transcript shows.
“He clearly lied,” Dr. Christine Cassel, the Quality Forum’s president and CEO told ProPublica. “He just didn’t say anything about any of his business relationships.”
Cashing In On Patient Safety
As the medical community comes to grips with the persistent problem of patient harm, companies are selling solutions. Although many groups recommend best practices, an endorsement by the Quality Forum can mean riches.
Created in 1999 at the behest of a presidential commission, the Washington, D.C.-based nonprofit takes private donations and collects fees from members, including consumer groups, health plans and medical providers.
Five years ago, the federal government hired the Quality Forum to endorse measures to show whether health care spending is achieving value for patients and taxpayers. The contract has since grown substantially and by 2012 made up nearly three-fourths of the organization’s $26 million in revenue.
The Quality Forum’s standards are widely adopted. The report produced by the committee Denham co-chaired included recommendations for best practices in 34 areas of care.
Denham is not a practicing doctor. He runs both the Texas Medical Institute of Technology, an Austin nonprofit that focuses on patient safety research, and a for-profit company called Health Care Concepts that figured in the whistleblower case. He’s known in patient safety circles for his fervent motivational speaking and appearances with Quaid, whose infant twins nearly died from a medication error.
Between 2006 and 2009, Denham’s nonprofit donated $725,000 to the Quality Forum. The group and Denham had a five-year contract, but the Quality Forum declined to provide a copy or explain the terms, saying only that it was ended three years early, in 2010, after concerns about Denham emerged.
In a response to questions from ProPublica, Denham attorney Larry Gondelman said the Quality Forum signed off on all the recommendations that appeared in the final 2010 Safe Practices report.
According to Gondelman, Denham’s nonprofit was obligated to provide financial and staff support for Quality Forum projects, including evidence-based medicine reviews, hosting webinars and creating multimedia presentations about the safe practice recommendations.
Denham declined an interview request. He said in a separate statement that the $11.6 million came via two contracts in 2008 with Cardinal Health to develop performance models and software to help reduce infections. CareFusion was a subsidiary of Cardinal Health at the time.
The 2010 film with Quaid, “Chasing Zero,” was made and promoted by Denham’s nonprofit and partially funded by CareFusion. The film features interviews with prominent patient safety experts, including Janet Corrigan, former chief executive officer at the Quality Forum.
ChloraPrep is not named in the film, but in one scene it is being applied while an expert talks about its ability to prevent surgical-site infections. According to Denham’s website, a copy of “Chasing Zero” was to be sent to every hospital in the country.
CareFusion officials declined to comment for this story. The Justice Department case, filed in U.S. District Court in Kansas, accused CareFusion for marketing ChloraPrep for off-label uses. Documents in the case describe the antiseptic as the No. 1 drug in its class in 2010 with sales of $193 million. The government alleged that the money paid to Denham's company was part of an effort to boost sales and included financing in a study published in the New England Journal of Medicine.
The January 2010 study, whose authors all reported ties to Cardinal Health, found that ChloraPrep — a combination of 2 percent chlorhexidinegluconate with isopropyl alcohol — reduced the risk of surgical site infection by 41 percent compared to a common alternative.
Company promotional materials went on to portray the finding as a 41 percent reduction in infections, and a 41 percent reduction in costs, the Justice Department said in court papers.
The 2 Percent Solution
At the safe practices committee session on Aug. 19, 2009, Denham twice appears to reference the New England Journal of Medicine study, the meeting transcript shows. Although he did not cite the study or ChloraPrep by name, Denham remarked that research to be published soon in a “major journal” would show the effectiveness of the 2 percent chlorhexidine antiseptic.
Pronovost said it wasn’t necessary to actually identify ChloraPrep because it was well known as the product with the 2 percent chlorhexidine formulation.
The committee members agreed that chlorhexidine was an effective antiseptic – guidelines by the Centers for Disease Control and Prevention (CDC) say so as well. But studies show it also works in other concentrations and combinations.
Discussion turned to recommendations for preventing infections caused by central lines, the thin tubes inserted into a vein to deliver fluids or medications. Dr. Gregg Meyer of Massachusetts General Hospital in Boston, the co-chair of the committee with Denham, brought up the forthcoming study.
“Chuck (Denham) made me aware of it,” Meyer said. He then asked Pronovost, a leading expert on preventing central-line infections, what he thought.
“There has been a systematic review in a number of studies that show chlorhexidine reduces risk by about half,” Pronovost said.
Denham replied that the upcoming study showed a 40 or 50 percent reduction. “The specifics,” he added, “were the 2 percent.”
Pronovost noted that studies have shown other methods also reduce infection rates. “My own recommendation would be to follow the CDC guidelines,” he said.
The 2002 CDC guidelines said a 2 percent chlorhexidine antiseptic is preferred, but that other skin cleansers, such as iodine, can also be used. Newer 2011 CDC guidelines recommend an antiseptic with greater than 0.5 percent chlorhexidine combined with alcohol.
The committee never delved into the merits of the ChloraPrep study or whether one particular concentration of chlorhexidine was better than another, the transcript shows.
In interviews, Pronovost and Romano both said they were uncomfortable with the way the Quality Forum’s panel operated. The process wasn’t as scientifically rigorous as it should have been, they said, and it was hurried, without enough time to carefully review all the evidence.
The transcript shows the committee moving through dozens of complex topics, from improving hand hygiene and decreasing wrong-site surgery, to safety culture, pediatric imaging and infections.
Pronovost said he complained to the Quality Forum about the process and questioned at the time whether he should continue to participate.
“The NQF has a big voice and a lot of credibility,” Pronovost said. “I wanted to make sure that whatever we recommended would truly be beneficial and wise because it would change practice in America — hospitals would do it. I felt we lacked a formal process for revising and grading the evidence of recommendations for these safe practices.”
Ultimately, he decided not to leave the committee because he believed in the Quality Forum and wanted to influence the process, he said. Something might be put into place that doesn’t save lives, he said, or something might be recommended that doesn’t help but uses tremendous resources.
“When you’re doing these things you have to be extremely mindful,” he said.
The committee members were volunteers, Romano said, and some felt burdened with the responsibility of reviewing so much material without the help of the Quality Forum staff. Romano said staffers from Denham’s Texas Medical Institute of Technology performed the committee’s administrative functions, selecting the studies to review and drafting the versions of the guidelines.
“It was all a bit of a mystery to us that Chuck Denham was so generous with his time and his staff time to support this process,” Romano said.
A Competitor Objects
After the meeting, when the committee’s draft report was published in late 2009, a recommendation for preparing surgical sites to prevent infection did not name ChloraPrep but did specify its telltale formula – a 2 percent chlorhexadine and alcohol antiseptic.
That draft recommendation was challenged by 3M, a company that makes a competing product. A scientific review of the evidence by a Quality Forum ad hoc committee found a lack of clear evidence to support one skin prep product over another. As a result, the recommendation to use the ChloraPrep formulation on surgical sites didn’t make it into the final 2010 safe practices report.
On the separate issue of reducing central-line infections, the 2009 draft report endorsed a chlorhexidine antiseptic but did not specify any one concentration – just as the committee decided. Yet the final 2010 report does call for a 2 percent chlorhexidine and alcohol antiseptic like ChloraPrep.
Although Quality Forum officials seemed surprised to learn this last week from ProPublica, the group is listed as a co-host, with Denham’s nonprofit, of a webinar where the 2010 safe practices guidelines for central-line and surgical site infections are presented.
The presentation, posted on the website of Denham’s nonprofit, states that the Quality Forum recommends the ChloraPrep formulation to protect against both central-line and surgical site infections.
CareFusion also cites the Quality Forum’s endorsementin at least one brochure on its website.
Since the financial ties between CareFusion and Denham’s business became public, the Quality Forum heard from “a wide range of people in the community,” spokeswoman Ann Greiner said. That feedback led to the decision to review the entire safe practices process over the next 30 days, she said.
“We’re taking a very affirmative action here,” Greiner said.
Pronovost said the controversy over Dehnam should not call into question all of the Quality Forum’s work. He said the lack of scientific rigor of the safe practices committee reflected Denham’s influence, but the process behind the Quality Forum’s other measures is more robust.
All the same, he said, it raises significant concerns about oversight of the burgeoning quality improvement industry.
“It’s an enormous business,” Pronovost said. “Hundreds of millions or billions of dollars are at stake, but our transparency procedures haven’t matured.”
Editor’s note: ProPublica is investigating health care quality and welcomes your input. Medical providers – help us by completing a brief Provider Questionnaire. Patients can complete ProPublica’s Patient Harm Questionnaire.