AI Can Help Apple Watch Predict High Blood Pressure, Sleep Apnea

The world’s most valuable company crammed a lot into the tablespoon-sized volume of an Apple Watch. There’s GPS, a heart-rate sensor, cellular connectivity, and computing resources that not long ago would have filled a desk-dwelling beige box. The wonder gadget doesn’t have a sphygmomanometer for measuring blood pressure or polysomnographic equipment found in a sleep lab—but thanks to machine learning, it might be able to help with their work.

Research presented at the American Heart Association meeting in Anaheim Monday claims that, when paired with the right machine-learning algorithms, the Apple Watch’s heart-rate sensor and step counter can make a fair prediction of whether a person has high blood pressure or sleep apnea, in which breathing stops and starts repeatedly through the night. Both are common—and commonly undiagnosed—conditions associated with life-threatening problems, including stroke and heart attack.

The new study adds to evidence that the right algorithms might transform the Apple Watch from personal trainer to personal physician. Apple said in September that it is working on a study with Stanford that will test whether the gadget can detect atrial fibrillation, or irregular heartbeat, which can lead to stroke or heart failure. A study independent of Apple presented in May has already suggested the answer is yes. And health insurer Aetna said last week that it is partnering with Apple to give Apple Watches to members to try to reduce health costs.

The Apple Watch’s potential to predict high blood pressure and sleep apnea was revealed by a collaboration between University of California San Francisco and a startup called Cardiogram. The company offers an app for organizing heart-rate data from an Apple Watch, and other devices with heart-rate sensors. UCSF provided data from more than 6,000 Apple Watch users enrolled in a study on mobile health. Cardiogram’s founders drew on their previous experience as Google employees, working on speech recognition for Android phones and the Google Assistant.

Cardiogram’s engineers took the kind of artificial neural networks that Google and others use to turn our speech into text and adapted them to interpret heart-rate and step count data. (Like speech, they are signals that vary over time.) The system, dubbed DeepHeart, is given strings of heart-rate and step data from multiple people, and information about their health conditions. In May, the company and UCSF released results showing that DeepHeart could figure out how to predict atrial fibrillation from a person's Apple Watch data. The study presented Monday shows that with one week of data on a wearer, the algorithms can predict hypertension with roughly 80 percent accuracy, and sleep apnea with about 90 percent accuracy.

Doctors don’t—and probably couldn’t—diagnose high blood pressure or sleep apnea just by eyeballing a week’s worth of data from your smartwatch. They diagnose hypertension by putting that familiar cuff on your arm. Sleep apnea requires a visit to a sleep clinic, or use of home monitoring equipment. So how do Cardiogram’s algorithms make good guesses without directly measuring a person's blood pressure or breathing? We only sort of know.

Breathing, heart rate, and blood pressure are all connected to our autonomic nervous system, which regulates the unconscious bodily functions that keep us alive. Past research has shown how hypertension and sleep apnea alter the dynamics of heart rate. For example, heart rate variability is lower in people with sleep apnea. But Brandon Ballinger, a Cardiogram cofounder, admits that he doesn’t know all the patterns in a person's heart rate that his algorithms use to make predictions. “They’re kind of a foreign form of intelligence,” says Ballinger.

Ballinger says that, with the right testing, that doesn't prevent his alien intelligence from having business potential. Cardiogram’s app for Apple Watch and other devices is free today. But the startup’s business plan is to one day add features that advise a user to be checked for atrial fibrillation, high blood pressure, or sleep apnea. To stay on the right side of the FDA, the app would have to advise a person to get tested, and not suggest the person has a particular condition. Cardiogram would make money by offering to ship the necessary equipment for a home test, and billing a person's health insurer. The app could also provide advice after a diagnosis, or link people to medical practitioners or health coaches, Ballinger says. He predicts some of these features will appear within months.

That plan is plausible, but needs to be proved out. Leslie Saxon, a cardiologist and executive director of the Center for Body Computing at the University of Southern California, says the idea of inferring conditions indirectly from heart rate and step counts needs more testing. “The study is seeing a correlation and that’s important to know, but the value is still unproven for medicine,” she says. Saxon also notes that the Apple Watch's heart data varies in accuracy depending on how a person wears the device. Cardiogram says it has more research underway, and expects accuracy to improve. There are now about 30,000 people enrolled in Cardiogram's study with UCSF.

That’s big for a medical study—and perhaps a reflection of people’s readiness for wearables like the Apple Watch to act as medical advisers. Saxon says studies at USC have shown that patients eagerly engage with apps capable of medical-grade measurements. If people are properly educated about what they can do alone, their health care is better managed as a result, she says. Her center's projects include testing a mobile heart sensor that pairs with a phone or watch made by startup AliveCor. “Patients would much rather self-manage than deal with you, the physician,” says Saxon. “And they’re already on their phone 200 times a day.” If Cardiogram and Saxon are right, medical-grade notifications may soon nestle among those for our Snaps, likes, and texts.

Read more: https://www.wired.com/story/ai-can-help-apple-watch-predict-high-blood-pressure-sleep-apnea/

Purdue Approaches States in Bid to Settle Opioid Claims

Oxycontin maker Purdue Pharma LP is proposing a global settlement in an attempt to end state investigations and lawsuits over the U.S. opioid epidemic, according to people familiar with the talks.

Purdue’s lawyers raised the prospect with several southern-state attorneys general who haven’t sued the company, as they try to gauge interest for a more wide-ranging deal, said four people who asked not to be identified because the talks aren’t public.

Opioid makers are accused of creating a public-health crisis through their marketing of the painkillers. More than a dozen states and about 100 counties and cities have already sued Purdue, other opioid makers and drug distributors, in a strategy echoing the litigation that led to the 1998 $246 billion settlement with Big Tobacco.

“This sounds like the opening bid in settlement talks,’’ said Anthony Sabino, who teaches law at St. John’s University in New York. “It also sounds like they are trying to convince some of these state AG’s that they don’t need to bring their own suits.’’

A group of 41 attorneys general are also investigating how companies like Purdue and other opioid makers marketed and sold prescription opioids. It’s not clear whether Purdue’s lawyers are authorized to speak for other drugmakers facing opioid suits, but the people familiar with the talks say Purdue’s attorneys are looking for a global accord to include all U.S. states’ claims against all manufacturers.

Robert Josephson, a Purdue spokesman, declined to comment on any settlement discussions. The company said earlier that the U.S. Food and Drug Administration approved Oxycontin for use as a painkiller, and approved the safety warnings.

Company officials with J&J, based in New Brunswick, New Jersey; Dublin-based Endo International Plc; Israel-based Teva Pharmaceutical Industries; and Allergan Plc, with headquarters in Parsippany, New Jersey, didn’t immediately return calls for comment on whether they are involved in talks.

Spokesmen for drug distributors Cardinal Health Inc. and AmerisourceBergen Corp. didn’t immediately return calls for comment on whether they are participating. A spokesman for McKesson Corp. declined to comment.

The Lawyer Who Beat Big Tobacco Takes On the Opioid Industry

Opioid makers argue in court filings that states and local governments are barred from suing because opioids are regulated by the FDA. They say judges must defer to the FDA’s finding that the painkillers are safe and effective and that companies such as Purdue properly disclosed addiction risks on warning labels.

States and municipalities disagree, saying that because the FDA doesn’t thoroughly regulate drug marketing there is a basis for suits claiming opioid makers created a public-health crisis with overly aggressive marketing.

Stamford, Connecticut-based Purdue hired Sheila Birnbaum, a veteran mass-tort defense lawyer, to help guide its legal strategy and put together a settlement game plan. She’s a partner with New York’s Quinn Emanuel Urquhart & Sullivan LLP.

Nicknamed the “Queen of Torts,’’ the 76-year-old Birnbaum is skilled at negotiating big-dollar settlements, including the $765 million NFL concussion settlement and an accord settling a suit against Pfizer Inc. over its hormone-replacement drugs. She also oversaw a $2.8 billion fund set up to compensate first responders and residents following the 2001 World Trade Center attacks.

“She’s been the go-to person over the years to come up with sweeping resolutions for mass-tort cases,’’ Carl Tobias, who teaches product-liability law at the University of Richmond in Virginia, said of Birnbaum. Birnbaum’s name is on Purdue court filings; she didn’t respond to a request for comment.

State Lawsuits

Any settlement would likely include cash, along with changes to the company’s manufacturing and marketing practices, the people said. It would resolve only the state claims, they added.

What may make an early settlement offer attractive to states is early access to money to deal with the social costs of the opioid epidemic, Sabino said. “The idea is the states wouldn’t have to go through years of discovery and trials to wind up where they could be right now — at the settlement table,’’ he said.

Governments could use their share of billions in settlement funds to recoup the costs of ramping up policing and drug-treatment programs.

Swain Wood, general counsel for the North Carolina Attorney General Josh Stein, told a group of county officials at a Nov. 15 seminar in Raleigh that his office was negotiating with opioid makers, according to a person who attended the meeting.

Dual-Track

Wood said his office was on a “dual-track,’’ engaging in settlement talks while continuing to investigate opioid makers’ activities in North Carolina, according to the person. He said the settlement proposal offered to North Carolina would resolve only the state’s claims, but could offer an opt-in right for counties, the person said.

Laura Brewer, a spokeswoman for the North Carolina Attorney General’s Office who also attended the Nov. 15 seminar, denied that Wood said his office was negotiating a settlement.

At the meeting, Wood said “our office is vigorously investigating opioid manufacturers and distributors in cooperation with many other state attorneys general,” Brewer said in an emailed statement. “At the same time, we are open to having discussions with these potential defendants to determine what role they can play in helping to resolve this crisis.”

Brewer added that Wood spoke about “multi-state settlements” in general and noted that “an opt-in for counties is one such way a settlement could be done.”

More than 60,000 people died from drug overdoses in 2016, and there was a five-fold increase in overdose deaths involving synthetic opioids — from 3,105 in 2013 to about 20,000 in 2016, according to the Centers for Disease Control.

One Judge

A study in the October 2016 issue of Medical Care Journal put the economic cost of opioid overdose, abuse and dependence at $78.5 billion. Health care accounts for about a third of that cost, while lost productivity in nonfatal cases add another $20 billion, according to the journal published by Wolters Kluwer.

Against a backdrop of early settlement talks, opioid makers are calling for 69 lawsuits pending in 15 federal courts across the U.S. to be gathered before before a single judge, according to court filings. A hearing on the multidistrict litigation request is set for Nov. 30 in St. Louis.

The companies and some plaintiffs’ lawyers are asking that opioid suits filed by states, counties and cities be combined for information exchanges and test trials. The consolidation is intended to save money by streamlining the document exchanges and avoiding duplication.

Drugmakers have suggested collecting the cases in federal court in Chicago while plaintiffs recommended that they be sent anywhere from New Hampshire to opioid-ravaged southern West Virginia, according to court filings. The city of Chicago officials filed one of the first cases against opioid makers in 2014.

The case is In Re: National Prescription Opioid Litigation, MDL NO. 2804, Before the U.S. Judicial Panel on Multidistrict Litigation (Washington).

    Read more: https://www.bloomberg.com/news/articles/2017-11-17/purdue-is-said-to-approach-states-in-bid-to-settle-opioid-claims

    How the Humble Hospital Scrub Became a $10 Billion Business

    The line between symbiosis and mortal combat is a fine one, both in the C-suite and at the cellular level. Michael Singer and Ben Favret thought they had the former when they began making plans for a better, safer line of medical apparel—a super scrub, if you will.

    Singer is chief executive officer of Strategic Partners, a manufacturer that controls an estimated 40 percent of the U.S. market for scrubs. Favret, a former pharmaceutical executive, is founder of Vestagen Protective Technologies, a startup launched in 2009 with the goal of making a bacteria-proof medical uniform.

    “He just seemed interesting, infectious in his enthusiasm,” Singer said of meeting Favret. “And he helped convince me antimicrobial was going to be something in the future.”

    Last month, the men and their respective companies faced each other across a federal courtroom in Los Angeles—each having sued the other. Their fleeting partnership had turned toxic as both accused the other of tearing their respective company apart. Vestagen was making false and illegal promises about its product, Singer alleged. Singer had poached one of Vestagen’s key employees and stole trade secrets, Favret claimed. As the Swift anthem goes, we got bad blood.

    The humble hospital scrub, ever saggy and often scratchy, is never in style—or out of it, for that matter. Rather, it’s beyond sartorial judgment. Instantly recognizable, it’s simply a given for most of America’s 19 million health-care workers, as essential as latex gloves and bitter cantina coffee. At the moment, almost one in seven U.S. workers falls into the scrub-set, a metric that’s expanding quickly as baby boomers fade into their hip-replacement years.

    Make no mistake, apparel seldom seems this easy. In other parts of the clothing business, fortunes are won and lost trying to forecast the fickle fashion trajectories of skinny jeans, retro sneakers, jumpsuits, and leggings. Abercrombie & Fitch is ripping off its logos and rushing to remake the kind of rugged adventure-wear that built its brand 50 years ago, and J. Crew Group has drifted to the brink of solvency as it struggles to find the right mix of rugby shirts and shift dresses. The sturdy scrub, meanwhile, has emerged as one of the safest spots in retail. Like the work-shirts and pants Americans wore back when the country was an industrial behemoth, health-care-wear is very much in demand in the modern service economy.

    If medical apparel were a standalone business, it would be solidly among the world’s top retailers, bigger than EBay, Foot Locker, and Tiffany & Co. Much of those spoils, at the moment, go to Strategic Partners, a business Singer started in 1995 when he bought the scrubs business out of bankruptcy from Cherokee. “The joke at the time was the three bestselling colors were white, white, and white,” he said. He took control of 40 workers posting about $17 million in annual sales.

    Over the years, the company added colors and patterns, moved production to Mexico and later to Asia while gradually building out a closet of brands. It added a studio where it created designs and cut licensing deals so it could put cartoon characters on pediatric scrubs to cheer up sick kids.

    In the early 2000s, Strategic began building web stores for its retail partners, taking the orders and shipping the product directly. Most of the retailers weren’t putting much focus on the internet at the time, and it was a crafty way to box out competing brands. By 2005, the company had almost 500 employees and a deep bench of captive manufacturing partners. Five years later, it acquired the license to make a line of “Dickies” scrubs and added another 30 employees. 

    Around that time, Singer started talking to Vestagen and other startups about antimicrobial treatments. Vestagen, which declined to be interviewed for this story, citing the ongoing legal battle, had developed an “active barrier” to repel fluid from fabric and kill bacteria via an electrical charge.

    Vestagen’s timing was propitious. As it was looking for manufacturing partners, bacterial infections were running rampant in America’s hospitals and clinics. In 2011, patients at acute-care facilities came down with almost 722,000 so-called health-care-associated infections, pneumonia being the most common. Almost one in 10 of those patients died, or about 70,000, according to the Centers for Disease Control & Prevention. Not surprisingly, insurance companies began adding clauses to their coverage so they wouldn’t have to pay hospitals for bacterial outbreaks.

    The simple scrub, meanwhile, was starting to look like a disease vector. The CDC estimates that one in 25 patients currently hospitalized has contracted some kind of infection just by being there. 

    Most of the folks who wear scrubs have to buy their own, despite the fact the job typically requires them, be it a hospital, doctor’s, dentist’s, or veterinarian’s office. Apparel makers can line up discounts and distribution deals, but ultimately the consumer can buy whatever uniform he or she wants, provided it’s the specified color. This little wrinkle in the market, it turns out, presented an opportunity. While lawyers for Singer and Favret fight, a host of startups have discovered there’s a lot of money to be made in this sleepy-yet-lucrative segment. Moving on from mattresses, eyeglasses, razors, and booze delivery, the world’s direct-to-consumer disrupters have discovered scrubs.

    FIGS was launched in 2013, offering antimicrobial, wrinkle-free uniforms in a range of flattering designs, solely through its own web store. Founder Trina Spear said she warmed to the idea at investment firm Blackstone Group, where she said she worked on a financing deal for Strategic Partners. In the financial reports, Spear said she noticed a staid company with margins around 40 percent. 

    FIGS co-founder Trina Spear says her company is the first to take a fashion approach to scrubs.
    Source: FIGS

    “It’s a massive industry that no one knows about and no one talks about,” she said. “It’s been around for about 100 years with zero change and zero innovation.” Her company sold out of its first batch in 23 days and has struggled to keep up with demand. Now FIGS has spread into lab coats, “underscrubs” (read: T-shirts), and hoodies. 

    About a year later, Jaanuu hit the market with a similar approach, launched by Shaan Sethi, a private-equity investor, and his pediatrician sister, Dr. Neela Sethi Young. Sethi said he was most encouraged by what he called a broken retail channel. Hundreds of different stores were selling scrubs, each store packed with a motley jumble of competing brands. 

    “You’d go to a hospital and see 50 or 60 nurses in 50 or 60 different brands,” he explained. “I had this idea in the back of my mind around this concept of trading up.” Spear, at FIGS, is less diplomatic. “Honestly, it’s hard for me to call them brands,” she said. “Everyone is getting thrown a hodge-podge of crap.”

    Naturally, all this rankles Singer at Strategic, which is now owned by New Mountain Capital, a private-equity firm. The U.S. scrubs market is far smaller than his new rivals let on, he warned, and his designers have decades of experience developing more fashionable treatments. “I bristle a little when I hear Jaanuu and FIGS say these are just commodity products,” he said.

    A post shared by FIGS (@wearfigs) on

    It’s hard, however, to find a brand evangelist in American hospitals—the field remains wide open. No label seems to have captured the kind of devotion Nike has among athletes or Lululemon enjoys with yogis. In just two years as a technologist measuring brain activity at the University of Iowa hospital, Mandie Wagner has purchased a closet full of scrubs. She said the Dickies are kind of itchy, the Cherokee brand doesn’t fit very well, and the Grey’s Anatomy scrubs collect pet hair. Her go-to, at the moment, is Cherokee’s Infinity, a higher-end brand made by Strategic, although she is keen to try FIGS and Jaanuu. 

    So far, the best feature Wagner has found isn’t having to think about what to wear: “It makes my morning easier,” she said. Wagner’s colleague Wendy Sebetka hasn’t settled on a brand, either. “Even though I buy the same styles, they all seem to fit a little differently,” she said. “And everything I have purchased online I have had to return, which is a pain.”

    It still isn’t clear how much of the segment has been swiped by FIGS, Jaanuu, and other new entrants. Both companies declined to detail revenue. FIGS now has 35 employees and increased sales 17-fold in the past two years. It has raised $10 million from investors in two different rounds. Of the customers it’s won, more than half are ordering apparel from the company every month. “We believe we can take over the whole industry,” Spear proclaimed. “That’s our goal.”

    Jaanuu, meanwhile, has 50 employees and $7.6 million in venture funding. The company expects to triple revenue this year, thanks in part to a new line of plus-size scrubs and footwear. Its average order is $120—and when orders come, they come in clusters. When a customer buys in a small town in, say, North Dakota, a flurry of other orders pop up in the same location.

    “You have to remember, this isn’t Nasty Gal going after Forever 21,” Sethi said. “We’re going after a really, really sleepy market.”

    Jaanuu’s plus-size line has quickly accounted for 10 percent of its business.
    Source: Jaanuu

    In the long run, Singer likes his odds of staying on top. His company now has almost 600 employees and last year sold $300 million worth of scrubs in the U.S. Working with Dow Chemical, it began selling an antimicrobial scrub in 2014 and a version with a fluid barrier a year later.

    And despite the simplicity of the product, a scrubs empire requires a complex supply chain. At any given time, Strategic has about 85,000 items, across a range of brands, colors, and prints, and in a spectrum of sizes for both women and men.

    “There aren’t necessarily high barriers to entry, but there are high barriers to scale,” Singer said. “There’s styling complexities. There’s sourcing complexities. There’s long, long lead times and you have to manage all of this inventory as you go.”

    Back in the courtroom in Los Angeles, Vestagen’s allegations of stolen trade secrets were rejected. The jury, however, dismissed Strategic’s assertion that Vestagen had made false advertising claims. Vestagen promptly declared victory and announced another $9.5 million in financing. “We always believed that this lawsuit brought by SPI, a company many times the size of Vestagen, was being pursued in an attempt to stifle an emerging competitor,” Chief Executive Officer Bill Bold said in a statement. Strategic, meanwhile, asked the judge to set aside the jury’s findings.

    While keeping an eye on the litigation, Singer is still pushing to expand Strategic’s already big footprint. The company is seeing brisk demand for Careisma, a brand it launched last year with actress Sofia Vergara. In 27 years of business, Strategic has seen sales decline only once, in the aftermath of the financial crisis. Singer said he doesn’t expect 2017 to be a second.

    (Corrects spelling of Sofia Vergara’s name in last paragraph.)

      Read more: http://www.bloomberg.com/news/articles/2017-10-26/there-s-a-10-billion-fight-to-keep-you-from-dying-in-the-hospital

      GE’s New CEO Vows Sweeping Change After Unacceptable Report

      General Electric Co.’s new boss promised “sweeping change” as he delivered a brutal assessment of the 125-year-old manufacturer.

      Results for the latest quarter are “completely unacceptable,” Chief Executive Officer John Flannery told investors on Friday as he slashed the profit forecast and pledged to unload $20 billion of GE businesses. “We need to make some major changes with urgency and a depth of purpose.”

      Flannery, who took over Jeffrey Immelt’s longtime post less than three months ago, is plotting a dramatic overhaul at the maker of jet engines and ultrasound machines. Already, he has welcomed a representative of activist investor Trian Fund Management to GE’s board and announced major management changes. He’s seeking deeper cost cuts and investors are bracing to see if GE cuts its dividend for only the second time since the Great Depression.

      “Everything is on the table,” Flannery said on a conference call to discuss quarterly earnings. “Things will not stay the same at GE.”

      The new CEO, who will detail his plans to reshape the Boston-based company at an investor meeting Nov. 13, is grappling with challenges from poor cash flows to slumping power-generation markets. GE is mired in one of the deepest slides in the company’s history and is the worst performer by far in the Dow Jones Industrial Average this year.

      Flannery said he sees a path to recovery — and the comments registered with investors. After falling the most intraday in two years in early trading, the shares began erasing losses during the conference call and eventually turned slightly positive. GE rose 1.1 percent to close at $23.83 in New York.

      “We have fundamentally good franchises,” Flannery said in a telephone interview. “There’s a lot of work to do, but we know what the issues are. They’re fixable.”

      Profit Miss

      Adjusted earnings this year are expected to be $1.05 to $1.10 a share, down from a previous range of $1.60 to $1.70 a share, GE said in a statement. Analysts had anticipated $1.54 a share, according to the average of estimates compiled by Bloomberg.

      GE reported a decline in adjusted profit to 29 cents a share for the third quarter, falling well short of the 50-cent average of analysts’ estimates compiled by Bloomberg. GE hasn’t missed estimates by more than half a cent in over nine years.

      Earnings were hurt by restructuring and impairment charges, as well as a sharp decline in profit at the power-generation division.

      GE cut $500 million in costs during the quarter, bringing the 2017 total to $1.2 billion, which the company said is ahead of its original plans.

      “This is a light-speed version of transformation,” said Nicholas Heymann, an analyst with William Blair & Co. “This is a really compressed process.”

      Industrial operating cash flow, a major focus for investors, was $1.7 billion in the quarter, excluding deal taxes and pension plan funding, GE said.

      The company reduced its industrial-cash-flow forecast to $7 billion after previously saying it could top $12 billion.

      GE’s liquidity came under scrutiny after the company reported negative $1.6 billion in industrial operating cash flow in the first quarter, about $1 billion worse than the company had anticipated. The measure rebounded modestly in the second quarter.

      Division Sales

      Sales fell 3.5 percent in GE Power, the world’s largest maker of gas turbines, as profit plummeted by more than half.

      There were some bright spots. GE Aviation, which is boosting production on a new jet engine, increased revenue 8.1 percent. The health-care division, which Flannery led before being picked to succeed Immelt, boosted sales 5.4 percent.

      Flannery announced several top management changes this month, including naming a new chief financial officer. Jamie Miller, the current head of the GE Transportation unit, will assume the CFO role from Jeff Bornstein in the coming weeks.

      The new CEO also became chairman this month — earlier than planned — after the surprise retirement of Immelt, who had been slated to stay until year-end.

      Gadfly: GE’s dumpster fire is bad news for dividend

      The appointment of Ed Garden, a founding partner of Trian, to GE’s board this month marked a victory for the activist firm, which had pledged to hold management accountable. Trian, co-founded by Nelson Peltz, became one of GE’s largest shareholders when it took a $2.5 billion stake in 2015.

      Investors are bracing for a possible dividend cut. Though GE has said the payout remains a top priority, a dividend reduction has already been priced into the stock, Susquehanna derivative strategist Chris Jacobson said in a note.

      After Friday’s results, it is “increasingly likely some cut is coming” to the dividend, Robert McCarthy, an analyst at Stifel Financial Corp., said in a note.

        Read more: http://www.bloomberg.com/news/articles/2017-10-20/ge-cuts-2017-profit-forecast-as-new-ceo-battles-deepening-slump

        Worried About Robots Taking Your Job? Learn Spreadsheets

        Musing on the future of the economy earlier this year, Bill Gates warned of smart machines replacing human workers and suggested a tax on robots. A new study of how technology is changing American jobs suggests workers are most immediately challenged by more common technology that Gates himself bears much responsibility for, such as Microsoft Office.

        The new study from the Brookings Institution used government data on work tasks to track how use of digital tools changed in a wide range of occupations between 2002 and 2016. Use of digital technology, such as computers and spreadsheets, became more important to occupations of all kinds. But the most dramatic changes were felt in jobs traditionally least reliant on technology skills—think of home health aides and truck mechanics using computers to diagnose problems or record their work.

        The Brookings’ study created a “digitalization” score for 545 occupations covering 90 percent of the economy, using government survey data that asks workers about their knowledge of computers, and how much they use them. In 2002, 56 percent of jobs scored low on Brookings’ digitalization scale; by 2016, only 30 percent did. Nearly two-thirds of new jobs created since 2010 required high or medium digital skills, the report says. That shift is problematic given America’s long-established deficit in basic digital skills, such as familiarity with spreadsheets or other workplace software, where US workers score well below other those from other advanced economies.

        Share of US jobs by degree of digital content. Source: Brookings Institution

        HOTLITTLEPOTATO

        Overall, the Brookings report suggests the window of opportunity for workers without basic digital skills or a college degree is closing. “With the availability of jobs that require no to very low digital skills dwindling, economic inclusion is now contingent on digital readiness among workers,” says Mark Muro, a senior fellow at Brookings who led the study. “While tech empowers it also polarizes.” He recommends that companies, government officials, and educational groups invest in programs that train workers in basic digital workplace tools.

        That diagnosis and proposed remedy stand in contrast to two common prescriptions for how to help the US economy adapt to technological change. Gates and many other tech executives suggest new government programs to support workers displaced by a coming generation of smart robots. In recent years there has been a swell of support, including from the Obama administration, for programs that teach people to code.

        The new Brookings data suggests the US faces a more immediate, and perhaps less glamorous task. “Coding for all is not quite the right model,” says Muro. “It’s less sexy, but we need much broader exposure and mastery of humbler, everyday software.” Maybe not everyone needs to be a code slinger, but word processing and enterprise packages like Salesforce are hard to avoid.

        Google CEO Sundar Pichai made a similar argument last month, when he launched a $1 billion educational program focused on helping workers skill up in workplace technology. Google employees will offer training in cities around the US. Naturally, they’ll highlight products such as GSuite, Google’s competitor to Microsoft office.

        The digital-skills crunch has been a long time brewing. Erik Brynjolfsson, director of the MIT Initiative on the Digital Economy, says that IT’s impact on US businesses surged in the mid-to-late ’90s—not coincidentally around the same time US median wages began to stagnate. In 1996, President Clinton announced a “national mission” to make all US children technologically literate by 21st Century. The Brookings report shows there is still a way to go. “We could have done a lot better,” says Brynjolfsson.

        Brynjolfsson echoes Muro’s call for better educational efforts to widen the pool of workers with basic digital skills. He also says society’s poor track record at adjusting to the digital age shows we should be starting now to prepare workers for the next big shift, in which machines become capable of many tasks now done by humans. He recommends that, in addition to productivity software and coding skills, workers should be encouraged to develop their creativity and emotional intelligence—faculties believed to be among the toughest for software to acquire.

        Jason Kloth, CEO of Ascend Indiana, an industry-led group that tries to improve workforce skills, generally agrees with Brynjolfsson’s long-term predictions that advanced automation will challenge workers of all kinds. But his organization has more immediate concerns. “We need to close the gap between demand and supply in the labor market today,” he says.

        Ascend has collaborated with Brookings on research on workplace skills. The Indianapolis group’s initiative includes programs that help companies identify or create educational programs for workers. Kloth says he feels there’s more at stake than just the fortunes of local companies and workers. “I think that growing income inequality manifests in social and political unrest,” Kloth says. Spreadsheet training could—maybe should—be a political issue.

        Read more: https://www.wired.com/story/worried-about-robots-taking-your-job-learn-spreadsheets/

        Coming Soon to Washington: An Anti-Trump Hotel for Liberals

        The first thing you’ll see when you walk into Eaton Workshop, a hotel opening in late spring 2018 in Washington, is a custom-commissioned video art installation by AJ Schnack, shown on a series of vintage-style television screens. All day long, it’ll broadcast a montage of footage from the presidential elections of 2012 and 2016 that’s built around one pointed question: How did our country get where it is today?

        It’s not a subtle statement, and it’s not meant to be.

        In Trump’s Washington, Eaton is planting a clear flag as a haven for Democrats. It’s the world’s first politically motivated hotel, the flagship for a global brand that’s built around social activism and community engagement. And it comes with a pedigree: As the daughter of Ka Shui Lo, the creator and executive chairman of Hong Kong-based Langham Hospitality Group Ltd., founder Katherine Lo knows a thing or two about luxury hotels and world-class service.

        The Big Idea

        An artist’s rendering of the reception desk of the Eaton.
        Source: Gachot Studios

        Lo firmly believes that hotels ought to be catalysts for good. In a world where we can be conscious consumers—of everything from clothing to food to baby products—she argues there’s a place for conscious hotels, too. This isn’t a revolutionary idea: Already, 1 Hotels has built a small collection of luxury properties entirely around the idea of sustainability, and Shangri-La Hotels & Resorts has made a significant, brand-wide commitment to bolster community programming for disadvantaged children in all of its destinations. It’s one of many five-star brands that have a conscious ethos but choose not to flaunt it.

        Eaton Workshop is different. With a premise that’s built around liberal activism and civic engagement, the brand will weave a liberal philosophy into every aspect of the guest experience, some more obvious than others.

        Among the subtler points is the significance of the company’s name: a nod to the high-end shopping mall of that name in Montreal that captured the fascination of Ka Shui Lo when he fled the Cultural Revolution in China. The mall, says Katherine, was a beacon of freedom to her father—and when she found an archival photo bearing its old motto, “Progress and better living,” the two Eatons became forever intertwined.

        The Washington hotel—which has 209 rooms just north of the National Mall—will be the brand’s flagship, with a second location opening in Hong Kong in 2018 and new constructions set to rise in San Francisco and Seattle no sooner than 2019.

        A Hotel With an Agenda

        The lobby of the Eaton.
        Source: Gachot Studios

        Among the Washington location’s programming signatures will be a sort of TED talk series driven by the liberal agenda, consisting of fireside chats and rooftop lectures that Lo hopes will be free, open to the public, and streamable as Eaton-branded podcasts. Then comes the art program, which—aside from the political statement piece at check-in—will include commissions from at least a half-dozen up-and-coming local artists and a street-facing exhibition window curated in partnership with local museums and institutions. A co-working space will prioritize memberships for progressive startups, activists, and artists, while a wellness program will offer “inner-health-focused treatments” such as Reiki and sound baths, rather than facials and massages. (Some of these features will roll out a few months after the hotel opens.)

        Just as important, partners and staff will be brought on board, both for their skills in the food and beverage worlds and their activist track records. For instance, Lo saw the cocktail director of the famed Columbia Room, Derek Brown, as a perfect fit to be the hotel’s beverage director—not just because he’s won such awards as magazine’s Bartender of the Year but because he “cares deeply about social justice.” To wit, Brown actively champions policies that fight sexual harassment in the bartending industry and acts as chief spirit advisor for the National Archives.  

        Similarly, Lo says that the “amazing life story” of house chef Tim Ma “perfectly expresses our brand ethos.” The Chinese-American culinary up-and-comer was an engineer at the National Security Agency for years before discovering his true passion in food. At Eaton’s to-be-named restaurant, Ma is planning a menu with a heavy focus on vegetables from an on-site garden.

        A guest who does nothing other than check in, sleep atop Eaton’s organic mattresses, and check out will still have a sense of the hotel’s mission, says Lo. “We plan to have new ideas in the minibar—an activist toolkit, for example, that includes sheets with information to help you call your congresspeople. And if we’d been open during this year’s Women’s March, I could have seen us putting poster boards and markers in the rooms!”

        Political statements such as these will be tailored to each property. In Hong Kong, for instance, Lo says she’d like to replace Bibles in the nightstand drawers with copies of the United Nations Declaration for Human Rights.

        A Place for Thought Leaders (but Not All of Them)

        The library at the Eaton
        Source: Gachot Studios

        Lo understands that Eaton Workshop isn’t for everyone. “Self-selection is definitely one of our strategies,” she says about branding and marketing materials that directly appeal to the “woke” crowd. “We wanted to emphasize that it’s a place for people who are thinking outside the box and want to effect a change in the world,” she says.

        Though she repeatedly talks about fostering a culture of diversity and inclusion, Lo also tells Bloomberg that “the goal isn’t to bring together left and right.” Instead, she wants to create “a diversity of fields and backgrounds as well as gender and ethnicity.” In other words, her hotel should represent the antithesis of the Trump hotel that’s just a few blocks away, offering an intellectual playground to those who may feel marginalized by the current administration’s agenda.

        This is partisan politics playing out on the city’s hotel scene; whether that will hurt or help Lo’s bottom line remains to be seen. But if the Trump Hotel is any indication, Lo may be poised for big success. According to the , the president’s hotel brought in $1.97 million in profits during the first four months of the year, despite business projections that had forecast a loss of $2.1 million.

        “It’s Like a Non-Profit but Better”

        Though her goal is to create a successful, scalable business, Eaton Workshop is not built to pad Lo’s pockets. On the contrary, she sees the entire enterprise as a means to a philanthropic end, and hopes to use the hotel profits to fund community arts initiatives in the brand’s respective destinations. 

        Each location will have a radio station, cinema, and music venue so local talent can produce or showcase work in a state-of-the-art space at low—or no—cost. In Washington, the building’s history as a printing venue has inspired Lo to create a writer’s residency, where investigative reporters can be hosted on site for several months while pursuing important stories.

        Artists will be invited to create short films, podcasts, or other types of content under the emblem of Eaton’s in-house multimedia studio; the results will be available for guests to stream on personal devices, and each piece will feature a clear activist message and a call to action.

        “We’re hoping that our hotel revenues will propel our creative projects,” says Lo, who likens the hotel to “a non-profit, but better.” Still, room rates won’t be extravagant; prices in Washington are likely to hover in the upper $200s. Thankfully, for members of both political parties—who are, no doubt, tired of dropping Benjamins for vodka drinks at the Trump International—the price of a martini should be less radical.

          Read more: http://www.bloomberg.com/news/articles/2017-11-13/coming-soon-to-washington-an-anti-trump-hotel-for-liberals

          Bill Gates announces major donation to advance the fight against Alzheimer’s

          Bill Gates speaks speaks at the Goalkeepers 2017 event on Sept. 20, 2017, in New York City.
          Image: Jamie McCarthy / Getty Images for Bill & Melinda Gates Foundation

          Bill Gates just donated a piece of his fortune to advance the fight against Alzheimer’s disease.

          The philanthropist and Microsoft founder announced in a blog post Monday that he will give $50 million to the Dementia Discovery Fund, a public-private partnership that invests in innovative dementia research. Gates will also donate another $50 million in startups working in Alzheimer’s research.

          Through the Bill and Melinda Gates Foundation, Gates has a long track record of supporting research to eradicate diseases like malaria and polio. But Alzheimer’s disease, which is the most common form of dementia that progressively affects memory and other brain functions, is the first noncommunicable disease he’s fighting.

          The $100 million is his own investment, not his foundation’s. That’s, in part, because it’s personal. 

          “This is something I know a lot about, because men in my family have suffered from Alzheimer’s.”

          “It’s a terrible disease that devastates both those who have it and their loved ones,” Gates wrote in his blog post. “This is something I know a lot about, because men in my family have suffered from Alzheimer’s. I know how awful it is to watch people you love struggle as the disease robs them of their mental capacity, and there is nothing you can do about it. It feels a lot like you’re experiencing a gradual death of the person that you knew.”

          Alzheimer’s disease is the sixth-leading cause of death in the United States, according to the Alzheimer’s Association. An estimated 5.5 million Americans live with Alzheimer’s, and someone new develops the disease every 66 seconds. People of all ages are affected, but 1 in 3 seniors dies with Alzheimer’s or another form of dementia.

          Gates said he spent the last year learning everything he could about Alzheimer’s disease, speaking with researchers, academics, and other industry experts. Those conversations led him to focus on five areas: understanding how the disease unfolds, figuring out how to detect it earlier, funding more innovative and lesser-known drug trials, making it easier for people to enroll in clinical trials, and using data to inform better approaches.

          Gates’ investment in the Dementia Discovery Fund will help support startups as it explores “less mainstream approaches to treating dementia,” he explained.

          “The first Alzheimer’s treatments might not come to fruition for another decade or more, and they will be very expensive at first. Once that day comes, our foundation might look at how we can expand access in poor countries,” Gates wrote, explaining how he might look at the issue beyond his personal investment in the future.

          The announcement is timely, coinciding with National Alzheimer’s Disease Awareness Month in November. The goal of the month is to increase awareness and drive home the fact that as many as 16 million people could live with Alzheimer’s disease by the year 2050.

          “People should be able to enjoy their later years — and we need a breakthrough in Alzheimer’s to fulfill that,” Gates said. “I’m excited to join the fight and can’t wait to see what happens next.”

          Read more: http://mashable.com/2017/11/13/bill-gates-alzheimers-disease-donation/

          United Airlines Halts Flights to New Delhi on Poor Air Quality

          United Airlines temporarily suspended Newark-New Delhi flights due to poor air quality in India’s capital, and said some extra charges will be waived for passengers forced to reschedule.

          “We are monitoring advisories as the region remains under a public health emergency, and are coordinating with respective government agencies,” a United Airlines spokesperson said in response to a Bloomberg query. 

          Other airlines were still flying to the national capital and it was not clear if they will follow United Airlines’ move to suspend flights.

          Chief Minister Arvind Kejriwal, the leader of Delhi, called the capital a “gas chamber” as thick toxic smog continued to envelop the mega-city of around 20 million people on Sunday. The levels of the deadliest, tiny particulate matter — known as PM 2.5, which lodges deep in a person’s lungs — soared to 676 at 2 p.m. local time, according to a U.S. embassy monitor. World Health Organization guidelines suggest levels above 300 are “hazardous.”

          Customers traveling over the next several days should visit the United Airlines website or download the company’s mobile application for updates, the spokesperson said.

          The Coming Storm of Climate Change

            Read more: http://www.bloomberg.com/news/articles/2017-11-12/united-airlines-halts-flights-to-new-delhi-on-poor-air-quality

            GE’s $100 Billion Wipeout Heralds Reckoning for an American Icon

            Few under the age of 30 might remember, but General Electric Co. was once a model of corporate greatness.

            Back in 1999, when Steve Jobs was still fiddling with iMacs, Fortune magazine proclaimed Jack Welch, then GE’s chief executive officer, the best manager of the 20th Century.

            Few people — of whatever age — would lavish such praise on the manufacturer these days.

            GE, that paragon of modern management, has fallen so far that it’s scarcely recognizable. The old GE is dead, undone by an unfortunate mix of missteps and bad luck. The new one now confronts some of the most daunting challenges in the company’s 125-year history.

            The numbers tell the story: This year alone, roughly $100 billion has been wiped off GE’s stock market value. With mounting cash-flow problems at the once-mighty company, even the dividend is at risk of being cut. The last time GE chopped the payout was in the Great Recession — and before that, the Great Depression.

            Read more: Bloomberg Gadfly on GE dividend

            And yet the hit to the collective psyche of generations of investors and managers is incalculable. For decades, GE-think infiltrated boardrooms around the world. Six Sigma quality control, strict performance metrics, management boot camps — all that and more informed the MBAs of the 1970s, ’80s, ’90s and into this century. GE, in turn, seeded corporate America with its executives.

            Anxious Investors

            Now, John Flannery, GE’s new CEO, is struggling to win back the trust of anxious investors. He’s set to detail his turnaround plans on Monday — and has said he’ll consider every option.

            “There’s nothing less than the fate of a once great, great company on the line,” said Thomas O’Boyle, the author of “At Any Cost: Jack Welch, General Electric, and the Pursuit of Profit.” “Some of the fundamental notions about its status as a conglomerate and whether it can succeed in a world of increasing complexity are really being challenged right now.”

            In hindsight, the seeds of this struggle were planted decades ago. Welch expanded and reshaped GE with hundreds of acquisitions and demanded every GE unit be No. 1 or No. 2 in its industry. He also culled low-performers ruthlessly, earning the nickname Neutron Jack. By the time he retired, in 2001, GE’s market value had soared from less than $20 billion to almost $400 billion.

            But all that maneuvering, plus GE’s increasingly complex financial operations, obscured the underlying performance and put the company in peril during the 2008 financial crisis. Welch’s successor, Jeffrey Immelt, soon embarked on a plan to undo much of the House that Jack Built. He would sell NBC and most of the finance operations — two of the businesses that defined Welch’s tenure — along with units such as plastics and home-appliances.

            The moves narrowed GE’s focus, yet it remains a collection of somewhat disparate manufacturing businesses, ranging from jet engines to oilfield equipment.

            Out of Favor

            Unfortunately for GE, that industrial conglomerate model has fallen sharply out of favor on Wall Street. And the rise of activist investors like Nelson Peltz has encouraged companies to try to boost their stock prices however they can, rather than focus on the long term. GE recently welcomed one of Peltz’s partners at Trian Fund Management to the board.

            “The reckoning had to come,” said Jack De Gan, chief investment officer of Harbor Advisory, which has been a GE shareholder for more than 20 years before selling most of the shares in the past few weeks.

            GE’s leaders have long defended the multi-business strategy by pointing to the benefits of sharing technology across product lines — jet engines, for instance, have a lot in common with gas turbines. In an interview with Bloomberg in June, Flannery dismissed concerns about conglomerates, saying investors care more about outcomes.

            “They want growth, they want visibility, they want predictability, they want margin rate,” Flannery said. “And there are a multitude of models to produce that.”

            $20 Billion

            The new CEO has already said he’ll divest at least $20 billion of assets. He’s coming under pressure to do even more.

            “Anything less than a sweeping plan to ‘de-conglomerate’ the portfolio would be viewed as disappointing,” Deane Dray, an analyst with RBC Capital Markets, said this week in a note to clients. The potential moves include unloading its transportation, oil, health-care and lighting operations.

            Read more: Bloomberg Gadfly on a GE Breakup

            To be sure, GE’s issues run deeper than the composition of the company. One of its biggest divisions, power-generation, is in the early stages of a deep market slump — just two years after bulking up with the $10 billion acquisition of Alstom SA’s energy business. GE’s cash flow is light, potentially putting the dividend in jeopardy and driving investors away from the stock.

            Flannery has spoken of the need to change GE’s culture and instill a sense of accountability. He’s reined in excessive spending — on corporate cars and planes, on the new Boston headquarters — and replaced top executives.

            But the sudden changes, combined with Flannery’s relative lack of public reassurances, have spooked investors. In the days after Flannery’s first quarterly earnings as CEO, when he called GE’s performance “completely unacceptable,” the stock fell and fell. And fell some more, closing at the lowest level in five years on Nov. 2.

            The shares slid less than 1 percent to $19.99 on Thursday, bringing the 2017 loss to 37 percent.

            “You think about a company like Kodak. Will GE become that?” said Vijay Govindarajan, a professor at Dartmouth University’s Tuck School of Business who served as GE’s professor-in-residence in 2008 and 2009.

            Some investors may be throwing in the towel, but Govindarajan isn’t giving up. “I will put my bet that GE will weather this and come back,” he said.

              Read more: http://www.bloomberg.com/news/articles/2017-11-10/ge-s-100-billion-wipeout-heralds-reckoning-for-an-american-icon

              Amazon Threat Causes Shakeout in the Health-Care Industry

              Amazon.com Inc. is casting a long shadow over the health-care industry.

              The prospect of the giant Internet retailer entering the business is beginning to cause far-reaching reverberations for a range of companies, roiling the shares of drugstore chains, drug distributors and pharmacy-benefit managers, and potentially precipitating one of the biggest corporate merger deals this year.

              On Thursday, the pressure was plain to see. A report that Amazon had received pharmacy-wholesaler licenses in a dozen states triggered a fast and steep selloff that wounded the likes of McKesson Corp., AmerisourceBergen Corp. and Cardinal Health Inc. And late in the day, shares of Aetna Inc. surged after a report that it was in talks to be taken over by CVS Health Corp.

              Executives in the drug industry say that Amazon could use its expansive online reach and its logistical muscle to threaten companies that ship and sell medicines to consumers and cut pricing deals with drug makers.

              “Size and scale-wise, they can disrupt anywhere they want to disrupt,” said Chip Davis, president of the Association for Accessible Medicines, a trade group for generic medication, in an interview Thursday.

              Competitive Squeeze

              A deal for Aetna could conceivably move CVS further away from the business of brick-and-mortar retail drugstores and deeper in health services such as pharmacy benefits, where it already has a sizable presence.

              Combining Aetna and CVS would create a health-services giant and a bigger competitor for UnitedHealth Group Inc., which is the largest U.S. health insurer and has its own own clinics and a pharmacy-benefits unit.

              The presence of Amazon is already being felt by retailers and companies that sell drugs over the counter. The head of of Bayer AG’s consumer-health business said on a conference call with analysts Thursday that the wider shift to online shopping by U.S. consumers was hurting its business. Erica Mann, the division’s chief, dubbed it the “Amazon effect,” saying buyers are looking for value.

              At the same time, the pecking order in the health-supply chain is beginning to shift.

              Earlier this month, insurance giant Anthem Inc. said it was cutting ties with Express Scripts Holding Co. after a long dispute over pricing and starting its own pharmacy-benefits manager in 2020. A bulked-up CVS and Anthem’s new venture could raise the pressure on Express Scripts, which has touted its independence.

              Any tie-up of Aetna and CVS would follow a pair of failed mergers among health insurers. The deals would have reduced the ranks of big U.S. health insurers from five to three, a prospect that led the Justice Department to oppose both prospective tie-ups.

              If the Aetna deal happened, “CVS would have a dominant position” in the drug-benefits business, said Michael Rea, founder of Rx Savings Solutions, which has an app that helps patients find low cost drugs.

              Pharmacy Threat

              Analysts have speculated that Amazon could soon enter the business of selling prescription drugs, threatening to disrupt retail drugstores, drug wholesalers, and the pharmacy-benefits management business. While Amazon has never publicly commented on what its plans may be, CNBC reported this month that the Internet giant could make a decision about selling drugs online by Thanksgiving. The network didn’t name its sources.

              McKesson slid 5.2 percent at 4 p.m. in New York, while AmerisourceBergen shares fell 4.2 percent and Express Scripts sank 3.7 percent following the report on Amazon’s state licenses by the St. Louis Post-Dispatch.

              Bloomberg News confirmed that Amazon had obtained wholesale-pharmacy licenses in at least 13 states, including Nevada, Idaho, Arizona, North Dakota, Oregon, Alabama, Louisiana, New Jersey, Michigan, Connecticut, New Hampshire, Utah and Iowa. An application is pending in Maine. Some of the licenses were obtained late last year and some this year.

              Amazon declined to comment.

              The licenses could be part of Amazon’s business-to-business sales effort, which would include sales to hospitals, doctor’s offices and dentists. Amazon on Tuesday announced “Business Prime Shipping,” which brings the quick delivery associated with Amazon household orders to workplaces. 

              The Seattle company launched Amazon Business in 2015, offering tractor parts, latex gloves, file folders and millions of other products needed in factories, hospitals, schools and offices. Businesses are shifting their supply shopping online from less-efficient methods such as browsing print catalogs, faxing orders and telephoning sales representatives.

              Online business-to-business sales – a broad category that includes pens and paper for the office as well as lab equipment and parts used in factories — will grow to $1.2 trillion in 2021 from $889 billion this year, according to Forrester Research Inc.

              On a conference call Thursday with analysts, McKesson CEO John H. Hammergren said the wholesaler doesn’t “take the entry of any competitor lightly,” but said the company already has a large online order operation and similar to what Amazon does logistically. “To some extent, we were Amazon before it was cool to be Amazon.”

                Read more: https://www.bloomberg.com/news/articles/2017-10-26/drug-wholesalers-slump-after-amazon-com-obtains-state-licenses