Just who the bloody hell are ya?

 There is this mob, they call themselves The Investors Club.

and who runs it? Kev and Kath do

Kevs credentials are listed below

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The Investors Club, under Kev & Kath's guidance,  are putting pressure on the RBA

The Investment Club says interest rates in Australia are among the highest in the developed world.

The club wants rates to be cut by 2 per cent to bring them into line with countries like New Zealand.

Investors Club president Kevin Young says the RBA has repeatedly breached its own charter.

"On our website we've listed 80 breaches of their own charter," he said.

"They're a completely non-elected group who can destroy our lives. Their crystal ball is flawed."

Speaking of crystal balls

Regular readers of my articles will know that, for a number of years, I have been urging caution about dealing with a so-called "investors club" run by a former bankrupt called Kevin Young who was formerly known as Kevin Sampe.

I believe this "club" is not a club, but a large, well organised property selling outfit which receives large commissions for selling properties that are often over-priced.

It disturbs me that this purported club claims that its services are "free" when, in fact, it is getting as much as six per cent commission from the sellers of properties (often property developers).

Young claims that his "club" has around 200,000 members, however these so-called "members" are mostly just lists of names and contact details. I believe it is misleading to refer to mailing lists as "members".

I believe it is also misleading for this "club" to claim it does not have salespeople when, in fact, it has around 350 people trying to sell property, often through seminars. The fact that salespeople are called "support members" does not change the fact that they are salespeople.

I have received many complaints from investors who have dealt with this "club". I have not publicised all of them, nor, in fact, have I written all there is to write about Mr Young and his selling outfit. More information will appear in my upcoming book, Stitched!.

For many years, Kevin Young has been threatening me with legal action. He has also threatened others who have criticised him and his methods.

Young has now commenced legal action against me for damages and defamation. I am looking forward to defending his claim. I will keep my readers informed as the case proceeds.

In the meantime, however, if you have any information that you feel can assist in my defence, please let me know by contacting me at neilj @jenman.com.au.

Thank you.

Neil Jenman

Neil Jenman is on this site

What the heck, its only munny

TAX NATION

Business Council of Australia looked at corporate taxes with some interesting data on mining;

 The significant difference in other business Taxes Borne by the energy and mining industry groups is partly explained by the different treatment of petroleum  resource rent tax ($1,401m) and extraction royalties ($2,194m). Under the Total Tax Contribution framework, petroleum resource rent tax is included as a tax whereas extraction royalties are not treated as a tax. (Refer “Survey for the Business Council of Australia and the Corporate Tax Association”)

Taxes Borne and Taxes Collected as a percentage of turnover
 

Taxes Borne and Taxes Collected as a percentage of turnover is a useful measure of what a company contributes to government tax receipts, having regard to their size as measured by turnover.
 

The median of total taxes to turnover of the survey participants was 11.7% in 2006 and 13.3% in 2005. Figure 7.3 shows the range of total Taxes Borne and Taxes Collected across survey participants.
This same data is consolidated by industry in Figure 7.4.
 

Taxes Collected are negative for the mining industry group because as major exporters survey participants reported a significant GST refund which more than offset other Taxes Collected

Texan Tai Chi

Chinese Students and Scholars Association of Texas University advises

Student Health Service requirement is

Once a Tuberculin skin test is positive or history of BCG, students should have a QuantiFeron-TB gold test.

According to their website Texas A&M University has 38,000-plus undergraduates and more than 9,000 graduate students and they require that new entries from at risk countries are to be tested for TB.

Chicago outbreak

From the Daily Herald;

The health department plans on screening 200 homeless people every two months for tuberculosis, starting Wednesday with a screening at Hesed House, 659 S. River St. The federal government is kicking in more than $184,000 in grant money passed on by the Illinois Department of Public Health to assist the county in battling the outbreak. However, that won't be enough to cover the costs of the blood tests, X-rays and quarantine housing needed to diagnose and treat people who have contracted the infection.

Has to be better than a poke in the eye with the proverbial burnt stick?

Our new ABC

well, sort of..

MP3 here.

Website www.pendulum.com.



HT Peter Martin

Ned the Bear gets an iPad

Ned comes from Darwin

American Association for Clinical Chemistry

From their website

AACC is an international scientific/medical society of clinical laboratory professionals, physicians, research scientists and other individuals involved with clinical chemistry and related disciplines. Founded in 1948, the society has 10,000 members and is headquartered in Washington, DC.

I didn't fully realise that the AACC was behind Lab Tests Online,  which apparently

attracts more than one million visitors a month

Anyway, AACC are currently running the QFT story

Interferon-g Release Assays Out-Perform Tuberculin Skin Tests in Detecting Active TB

Of note, they also say

The researchers also found that there was a lower frequency of indeterminate results among individuals tested with QuantiFERON-Gold In-Tube in comparison to T-Spot.TB, regardless of whether the patient was immunocompetent or immunocompromised.

Unlevelling the playing field

The Minerals Council outline their objections to tax reform

1. The industry must be taxed at a rate that is internationally competitive.
2. Investors in the industry should not be taxed retrospectively on their investments.
3. One tax rate for all resources is not workable because different minerals have very different profitability and face different tax rates globally.

On points 1 and 3 it would appear that the mining industry want to be taxed differently to other Australian businesses - in essence they are asking to be subsidised by the taxpayer.

TB testing ramps up down under

From Medicare; whilst QFT testing ranges between 40% to 60% of the total TB testing in general has taken off - a lot of testing in Victoria.

UPDATE: in my enthusiasm I double dipped the data - here is the corrected version.

In His Humble Opinion

Dennis Shanahan in the Murdoch rag

The Rudd government, incredibly, has lost the fight over the RSPT. A Labor government has been unable to win popular support, or the policy argument, for lifting taxes on wealthy and prosperous mining companies that were actually receptive to the idea they would have to pay more for the privilege of digging up natural, non-renewable resources.

Thats not what the polls say;

Q. The Government has proposed a resources super profits tax‐ which is a 40% tax on the large profits of mining companies ‐ in order to fund a reduction in company tax, assistance for small business and an increase in superannuation. Do you support or oppose this tax?

Mining the archives

The Minerals Council has released this chart in support of their argument;

Shouldnt it be more like this?

The Minerals Council claim that

The Government is today continuing to misrepresent the minerals industry’s contribution to Australia

One could be forgiven for doubting their claim

Playing both ends for the middle

In a letter to BHP shareholders the chairman advised

"Any reform must only apply to new investments: not to existing investments,"

and that the proposed RSPT would

"seriously threaten Australia's competitiveness, jeopardise future investments and adversely affect the future wealth and standard of living of all Australians,"

OK, but how many new projects are BHP considering?

3.11 A report provided to the Western Australian Government by Evans & Peck in August 2004 indicated that there may be few, if any, economically viable deposits in the Pilbara that have not already been identified. BHPBIO notes that currently there are no proven17 iron ore deposits in the Pilbara apart from those held by BHPBIO and RTIO/HD

3.12 The 2004 Evans & Peck report also indicated that 85% of the identified iron ore resources in the Pilbara were controlled by BHPBIO or RTIO, with HD and FMG holding 10%, and other suppliers holding the remaining 5%.

It would appear that for the big miners resources are known and finite and the risk that the RSPT would hamper new mine development would be minimal, if at all.

Playing to the peanut gallery

Opposition spokesman Andrew Robb responds to a paper published by the NBER by saying that

It’s a very shonky piece of work, it’s amateur hour,’ 

‘Some young bloke’s done his best but it’s a joke.’

And that, in a nutshell, is the oppositions considered response.

So what is the NBER?

The NBER is the nation's leading nonprofit economic research organization. Sixteen of the 31 American Nobel Prize winners in Economics and six of the past Chairmen of the President's Council of Economic Advisers have been researchers at the NBER. The more than 1,000 professors of economics and business now teaching at colleges and universities in North America who are NBER researchers are the leading scholars in their fields. These Bureau associates concentrate on four types of empirical research: developing new statistical measurements, estimating quantitative models of economic behavior, assessing the economic effects of public policies, and projecting the effects of alternative policy proposals.

And who is co author Douglas Shackelford?

Douglas Shackelford is the Meade H. Willis Distinguished Professor of Taxation and director of the UNC Tax Center. His research and teaching address taxes and business strategy.

Current areas of interest include the effects of shareholder taxes on equity prices, the taxation of multinationals and the disclosure of corporate tax information. He has published widely in accounting, economics and finance journals.

Dr. Shackelford is a research associate in public economics at the National Bureau of Economic Research in Cambridge, Mass. He has held visiting faculty positions at Stanford University and Universiteit Maastricht in the Netherlands.

A CPA, he was a senior tax consultant with Arthur Andersen in Boston and Greensboro from 1981-85.

He received his PhD from the University of Michigan and his BS from UNC-Chapel Hill.

And who is Andrew Robb? - a politician

Who do you believe and who do you trust?

Once the oil leak in the Gulf of Mexico, from the well known as Deepwater Horizon, was established the owners of the well BP originally estimated the leakage at 1,000 bbl/day. NOAA and other govt bodies disagreed saying that it was more like 5,000 bbl/day, which BP accepted. BP refused requests from scientists to use sophisticated instruments to gain a more accurate picture

“The answer is no to that,” a BP spokesman, Tom Mueller, said on Saturday. “We’re not going to take any extra efforts now to calculate flow there at this point. It’s not relevant to the response effort, and it might even detract from the response effort.”

Undeterred associate professor of mechanical engineering Steven Wereley analysed videotape of the seafloor plume using a technique called particle image velocimetry and concluded that the leak was more like 70,000 bbl/day. As they said, it wasnt rocket science - all they needed to know was the diameter of the hole and the flow rate and apply basic geometry. So why all the ducking and weaving?

Questions remain why it's taken this long for evidence of a much bigger spill to come to light. The calculations above are elementary and could have been undertaken as soon as BP obtained pictures of the leak.

Perhaps the executives of BP, Halliburton and Transocean are innocent of all technical details and maybe even of elementary geometry. (It would have been interesting if at the Senate hearing where each of them blamed the other two they were asked the formula for a cylinder and its relevance to the size of the spill.)

But even if we excuse the executives' lack of technical knowledge, it's very hard to believe that the smart engineers who work for them didn't have a good feel for the extent of the leak early on. If they did, why didn't they speak up?

People are becoming angry at the way this multinational miner has been allowed to run rough shod over national interests

“We’ ve got to stop relying on BP, we need transparency not cover-up . . . we need our best oceanographers on the site. BP has been blocking people, saying we’ve got it under control, and as we know they don’t. They’re running a misinformation campaign.

Said House of Rep Edward J Markey

"It's obvious they are trying to limit information to protect their economic liability,"

.."BP has mismanaged this entire incident from day one," he said. "They should not be trusted."

And another one gearing up for QFT

It's all here

WASHINGTON STATE TUBERCULOSIS SERVICES MANUAL

LABORATORY SERVICES 

UPDATED 04/01/10

List of Labs in Washington State who handle QFT;

1. Evergreen Hospital, 12040 NE 128th St, Kirkland, WA 98034
2. PACLAB Redmond Patient Service Center, 8301 161st St. NE, Suite 104, Redmond, WA 98052
3. PACLAB Woodinville Patient Service Center, 17000 140th Ave NE, Suite E102, Woodinville, WA 98072
4. PACLAB Canyon Park Patient Service Center, 1909 214th St SE, Suite 120, Bothell, WA 98021
5. Clinical Laboratory, 413 Lilly Road NE, Olympia, WA 98506
6. Spokane Regional Health District Laboratory, 1101 W. College Ave, Spokane, WA 99201
7. Tacoma General Hospital, 315 Martin Luther King, Jr Way, Tacoma, WA 98405
8. TriCities Laboratory (Kennewick, WA), 7131 West Grandridge Blvd., Kennewick, WA 99336

Do we need a simpler tax system?

This graph would indicate that at present Australia's taxation laws require the average person to seek professional assistance

Ready for the CDC guidelines..

..in Louisville

Fighting that revolving door

Commentator Robert Gottliebsen observes

Bankers are also losing confidence in governments.

18 months ago it was the banks that failed to inspire confidence

The failure of Washington Mutual – the largest bank failure in US history by a very large measure – demonstrates that the US financial system, and probably the global system, is now balanced on a knife edge

and it was the banks own lack of confidence that necessitated government support

global central banks have become the liquidity providers of first resort because private banks and sovereign funds are not letting their cash out of their sight.

It was the banks and capital markets that failed, not governments. As Roger Montgomery points out, much of this is hindsight

The people pointing out worries about China today are those that said the banks would rise to $100 before the GFC hit. One of the easiest things to observe in the markets is that predictions of a change in direction are far more frequent than they are accurate. And anyone can explain what has happened, but few seem to be able to look far enough ahead to be positioned well.

More on costs

Studies into cost effectiveness of latent TB diagnostics are gathering momentum; Albert Nienhaus puts forward his case (full letter below fold)

The higher the progression rate, the bigger the increase in costs for untreated contacts. As this rate is higher in TST-based screenings, IGRA-only strategies will become the most cost-effective. 

Solid Gold

Santa Clara Valley Health & Hospital System

The QFT is a test that replaces the TB skin test and is identified by the CDC Bioterrorism Reference Lab as the new gold standard for TB skin testing.

Thats what I call Gold

Much ado about SFA

Miners in Australia are running around saying that the sky will fall in if the govt brings in a resource rent tax on profits (with offsets for royalties, company tax and exploration costs). The IMF put their contribution into perspective

KPMG Econtech produced a report on the tax saying that

Overall, total GDP is 0.7 per cent higher than would otherwise be the case, made up of contributions of 0.3 per cent from the company tax cut and 0.4 per cent from the changes to resource taxation.  The cut in the company tax rate stimulates investment across the whole economy, leading to higher production reflected in the gain of 0.3 per cent in non-mining GDP.

I guess what has irked some company executives, with their own share portfolios, is that

a resource rent tax, collects only a portion of above normal profits, maintaining the incentive to invest, while effecting a transfer from industry shareholders to taxpayers.

It is unfortunate that calculated long terms gains are being stymied by perceptions of short term pain and conflicts of interest

In the mining industry, removing and reducing inefficient taxes leads to gains in activity.  Specifically, effectively abolishing crude oil excise and resource royalties enhances incentives, leading to a gain in mining production of 5.7 per cent, which is boosted to 6.6 per cent when the company tax cut is also taken into account.

Message from the Top

From the Robert Koch Institute, the German Federal Institute centre for infectious disease control and part of the Federal Ministry of Health; their April 2010 Bulletin

Zur Diagnose einer latenten tuberkulösen Infektion stellen Interferon-Gamma-Release-Assays (IGRA) aufgrund ihrer weit überlegenen Spezifität gegenüber dem Tuberkulinhauttest (THT) einen deutlichen Fortschritt dar

For the diagnosis of a latent tuberculosis infection use interferon gamma release Assays (IGRA) due to their far superior specificity as opposed to the the tuberculin skin test (TST) a clear Progress. 

This was apparently in response to the WHO Global plan to stop TB "2006 - 2015" which contains the following;

OBJECTIVE 2: Development and evaluation of a portfolio of new diagnostic tools and demonstration of impact

Identification of latent TB infection at risk of progression
Conceptualization and development initiation of test for risk of disease progression in a suitable platform based on best candidates
Introduction of at least one product for point of care use by 2012

Quick, call the fire brigade, Get QFT is on Fire!

Latest additions;

Quest Diagnostics-CHANTILLY
Quest Diagnostics-DAYTON
Quest Diagnostics-HORSHAM
Quest Diagnostics-HOUSTON
Quest Diagnostics-LAS VEGAS
Quest Diagnostics-SACRAMENTO
Quest Diagnostics-SAN JUAN
Quest Diagnostics-ST. LOUIS
Quest Diagnostics-Specialty Laboratory
Quest Diagnostics-TAMPA
Quest Diagnostics-WALLINGFORD
Quest Diagnostics-WEST HILLS
Quest Diagnostics-WOOD DALE
Seattle & King Country Public Health Laboratory

Thanks Dr Daz

Policy makers battle with policy breakers.

Over in Norway they are testing migrants for TB and what was the result?

Just 1% of the study group received treatment for latent tuberculosis and with a long time delay. The reason for this may be organizational factors affecting follow-up and referral and specialists not following current guidelines.

So they did a study on it

Public health efforts to increase awareness about TB transmission, its diversity in manifestations, and its progression from latent to active disease, may decrease patient delay. An increased awareness among health professionals about typical and atypical symptoms of TB, aspects of the patient’s history, and being aware and sensitive to patients’ own interpretation of symptoms may reduce diagnostic delay in the health services.

The problem then is how do policy makers ensure that stakeholders are properly informed without incurring additional horrendous expense? Blogger, Facebook, MySpace, YouTube or Twitter are now considered to be legitimate communication tools of government.

Mea culpa from a banker

President of the Federal Reserve Bank of Minneapolis, Narayana R. Kocherlakota, writes that

I believe that during the last financial crisis, macroeconomists (and I include myself among them) failed the country, and indeed the world. 

He then points to the current debate

According to the media, the defining struggle of macroeconomics is between people: those who like government and those who don’t. 

We can see parallels in Australia, in wanting to simplify and make more efficient the tax system the government are met with a barrage of outrage from a multitude of sources. Kocherlakota explains the dilemma

the defining struggle in macroeconomics is between people and technology. Macroeconomists try to determine the answers to questions about entire economies. These questions really concern the outcomes of large-scale experiments, but there is no sensible way to perform such experiments in national or global laboratories. Instead, macroeconomists must conduct their experiments inside economic models that are highly stylized and simplified versions of reality. I will show that macroeconomists always leave many possibly important features of the world out of their models.

Kocherlakota identifies the problem

Macroeconomists have failed to communicate their new discoveries and understanding to policymakers or to the world. Indeed, I often think that macroeconomists have failed to even communicate successfully with fellow economists.

In this regard he is entirely correct, progress and reform should not be hampered by lack of cognition. Clearly governments and policy makers also have a duty to properly sell their policy and not leave the public to the mercy of lobbyists.

Heads we win, tails you lose

Apparently Goldman Sachs have set a new record

Goldman Sachs Group Inc.’s traders made money every single day of the first quarter, a feat the firm has never accomplished before.

It is not as if such feats are new, there have been many other instances of either abnormally high or unusually consistent returns.

Maintaining a share price is important to many company executives - they don't want their margin calls to be triggered - and some (see below) can wield enormous influence with government and it's regulators

MacBank's code red

As the tsunami engulfing global markets in September 2008 crashed into Lehman Bros, a besieged Macquarie Group wasted little time swinging into action.

Under attack from short selling hedge funds and with its share price plunging by half, Macquarie launched a concerted lobbying effort with the government and regulators.

Documents obtained by BusinessDay under freedom of information laws reveal the haste and well-targeted strategy Macquarie employed as the maelstrom of the global financial crisis rocked banks around the world.

Macquarie's efforts appear to have been brutally efficient. Within days ASIC would impose a ban on the short selling of financial stocks - an investment strategy used to make money by punting on a share price falling further - that would halt the precipitous plummet of the bank's shares.

The old 1-2

AMERICAN THORACIC SOCIETY 2010 INTERNATIONAL CONFERENCE

New Orleans, Louisiana - May 14-19, 2010

Listed under  

Controversies in Pulmonary Infection: Challenging Conventional Wisdom

Interferron Release Assays Should replace the Tuberculin Test for the Diagnosis of Latent Tuberculosis Infection: PRO: NW Schluger, MD, New York, NY.

Interferron Release Assays Should replace the Tuberculin Test for the Diagnosis of Latent Tuberculosis Infection: CON: KUJ Dheda, MD, PHD, Cape Town, South

plus there is a heap of other stuff on IGRAs and latent TB, agenda here

Pitchforking forecasters

Peter Martin looks back at commentary arising from the May 2009 Budget

RICHARDSON: "Some of those growth assumptions are optimistic"

KOHLER: "A colossal turnaround that they’re forecasting which I don't think is credible at all"

BRISSENDEN: "The optimistic growth figures are are going to underpin the Government's argument about returning to surplus"

and Ken Henry's later observations

If the Government had waited for the recession to hit our shores before tackling it — and there are some who consider that this is precisely what they should have done — then you wouldn't have had anything like last week's document to confuse you. Things would have been much simpler.

It wasnt that long ago that everybody was forecasting a recession

AUSTRALIA is heading towards recession in 2009, according to a survey that has succesfully picked the last three economic downturns.

Despite billions in economic stimulus, continued slow growth in December points to a likely recession, economists said.

The monthly Westpac-Melbourne Institute leading index predicts the likely pace of economic activity for the next three to nine months.

and then by July Westpac had changed their tune

Surprise surge in Consumer Sentiment....
...Westpac Chief Economist, Bill Evans, commented, "This is unquestionably a stunning result.

This hasnt stopped the Murdoch rag churning out more tosh

THIS prime ministership, this budget and this election are all coming down to belief.

Do you believe Kevin Rudd? Do you believe the budget will return to surplus in 2012?

Yes, who do you believe - at least he has left the punting to the experts

.
The last word has to be that of the study Are Some Forecasters Really Better Than Others?

Results suggests limited evidence for the idea that the best forecasters are actually innately better than others, though there is evidence that a relatively small group of forecasters perform very poorly.

Efficient Market Hypothesis?

News that Liberal party frontbencher Peter Dutton bought BHP shares 2 days after the announcement of the Resource Rental Tax has had pundits a-twittering. Joshua Gans takes a wry look at the scenario

One view is that he doesn’t believe the tax will harm BHP and, indeed, that the market has over-reacted to it. That gives us to potential hypocrisy line — you can’t attack the tax for harming mining companies at the same time as buying stock — but also a lack of belief in markets line — the markets don’t know how to evaluate these things as well as Dutton. Both beliefs are revealed by this story.

The alternative is that Dutton knows that the tax won’t actually be put in place. This requires a ‘being ahead of the market’ belief on the part of Dutton again, but this time he may actually know more than the market on this. Specifically, he may have information that others do not possess that the tax is likely to be blocked and so BHP shares are under-valued. Of course, this might just be a guess on his part in which case he doesn’t think the markets are working properly again.

So which is it? Markets don’t work properly or extra information that the market does not have, or both? Or, maybe these investments are not made with very much thought.

21 hours a week

These guys are playing my tune - where do I sign up?

Moving towards much shorter hours of paid work offers a new route out of the multiple crises we face today. Many of us are consuming well beyond our economic means and well beyond the limits of the natural environment, yet in ways that fail to improve our well-being – and meanwhile many others suffer poverty and hunger. Continuing economic growth in high-income countries will make it impossible to achieve urgent carbon reduction targets. Widening inequalities, a failing global economy, critically depleted natural resources and accelerating climate change pose grave threats to the future of human civilisation.

Twenty-one hours is close to the average that people of working age in Britain spend in paid work and just a little more than the average spent in unpaid work. Experiments with shorter working hours suggest that they can be popular where conditions are stable and pay is favourable, and that a new standard of 21 hours could be consistent with the dynamics of a decarbonised economy.

There is nothing natural or inevitable about what’s considered ‘normal’ today. Time, like work, has become commodified – a recent legacy of industrial capitalism. Yet the logic of industrial time is out of step with today’s conditions, where instant communications and mobile technologies bring new risks and pressures, as well as opportunities. The challenge is to break the power of the old industrial clock without adding new pressures, and to free up time to live sustainable lives.

QFT takes another bite out of the Big Apple

New York health plan provider announces

Amida Care now has available, only through Bendiner & Schlesinger Labs Inc., the QuantiFERON-TB Gold IT blood test for the detection of TB under test number 2064

Amida Care cover a wide territory

* 150 Primary Care Providers (PCPs)
* 6000 Specialists
* 130 Case Managers
* 1000 Behavioral Health Providers
* 400 Ancillary Service Providers
* 19 Hospitals Across 3 Boroughs  

OK, so who are  Bendiner & Schlesinger Labs Inc?

one of America's oldest, most experienced clinical laboratories

They must be doing OK, their new factory is over 1.8 acres in size

2004 - Relocated to a new 80,000 square foot facility at 140 58th Street, Brooklyn, NY.

Queue jumping

There is no doubt that the CDC is slower than a wet week, or a month of Sundays, which might be why Columbia have taken the  initiative;

 7. TB Screening: (must be within 6 months of deadline date)
a. PPD(unless previously positive). Indicate date placed, date read, and millimeters of induration; receipt of BCG is not a contraindication to placing a PPD

OR
b. Quantiferon Gold or TB Spot (preferred in those who have received BCG)

Double, double toil and trouble; Fire burn, and cauldron bubble.

Like the witches of Macbeth, Cellestis shareholders (some) periodically gather to grumble eg

We are now at about the 9th anniversary of CST listing and I have held since then. I no longer have any huge expectations for this stock but will not sell simply because I have held for so long. No one could have expected the resistance to move away from TST to be as strong as it is. IMO the next two profit reports will be critical in determining if CST is ever going to reach its full potential.

Thankfully reason prevails

I think it simplistic to suggest that the last 9 years have all been about moving from TST to Quantiferon;

I would rather say that the past 9 years have been one long marketing exercise, with the product marketed being the QFT-CMI. Specifically regarding TB, the QFT-TB was approved and launched and whilst it held many benefits they proved not sufficient to generate meaningful sales. So the ppd was replaced with two TB specific antigens in QFT-TB Gold, approval was obtained and whilst sales improved the time constraint for processing proved to be a negative. Further refinements were made; the process time was extended and antigens precoated in provided tubes and QFT-GIT was introduced and approval obtained.

A major factor in this process has been the time taken to obtain approvals. No point in complaining about it, it is a fact of life and affects all health industry participants. However, delay is not all bad - it has allowed sufficient time for many independent studies to be undertaken and these studies present a strong argument for further approvals and guidelines and also act as a powerful marketing tool. In addition the delays have added value to those approvals and could act as a disincentive to any future competitors, should there be any.

It must be pointed out that the testing, trialling and subsequent analysis have been undertaken by bodies independent of the company and at no cost to the company.

In addition the lengthy approval process has the effect of increasing the protection of the intellectual property.

When considering the size and complexity of the global TB industry it could be said that for Cellestis the last 9 years have been one of submitting and gaining approvals.

Importantly, whilst the testing and approval process has been underway the sales have been sufficient to make the company profitable. Only now has QFT-GIT been approved for sale around the world (lets not talk about the CDC) and only now can sales be properly generated.

Incidentally, a medical specialist friend of mine was recently telling me of a medical presentation he had attended where the subject was an 8 year old girl. He says that the clinician said

and we did a Quantiferon

This was significant, they didn't say that they were testing for TB or that they were going to use a new blood test or interferon gamma assay; just the word "Quantiferon" was sufficient to convey the message. For me that represents a "tipping point"

Spain - 2010 consensus statement

From Archivos de Bronconeumologia

Extract from the abstract;

Treatment control is one of the most important activities in TB management. The Tuberculin Skin Test (TST) is positive in TB infection when >/=5mm, and Interferon-Gamma Release Assays (IGRA) are recommended in combination with TT

 This is an update from their 2008 guidelines (ex Pai)

In Spain, the 2008 Society of Pulmonology and Thoracic Surgery (SEPAR) Guidelines recommend the TST, followed by an IFN-γ test for:
1) the immunocompromised and children with negative TSTs; and
2) TST-positive persons with a history of BCG vaccination.

Action man

After pedalling from Sydney to Melbourne our prime-minister-to-be Tony Abbott was pedalling a different line, this time he was busy telling schoolkids in Adelaide that

it was warmer "at the time of Julius Caesar and Jesus of Nazareth" than now.

This raise more questions than answers; does he mean Adelaide is now warmer, or the Middle East, or Adelaide is warmer than the Middle East?

Kiddies in Adelaide are probably wondering how long ago Julius Caesar came to Adelaide, especially as Adelaide did not exist until 1836, or so the records would have us believe.

Here is another record that some politicians choose to disregard.

Be afraid, very afraid

doc-gt points us into the direction of a big lawsuit for wrongful diagnosis of TB

TB lawsuit will cost Ramsey County millions

Seems as if the whole prison is going to get some cash by way of a botched up TB diagnosis, latent TB get between $44,300 and $54,300 and active TB are to get $250,000 plus another $250,000 if there are complications.

Plus there is another $14M lawsuit pending.

Inmates and former inmates who test negative for TB will receive no benefits.

Yeah well, that will never happen if you keep using the TST

Correction, it was the failure to detect the active TB that became the trigger. Be that as it may, the skin test (or blood test) is still the recommended test for TB.

Footnote 1; it appears that payment for damages is to be made by the taxpayer as the county has a "self-insurance fund."

Footnote 2;  forrest has done some digging and found records indicating that Ramsey County are to take the work away from their Public Health Department and engage the services of Multicare Associates.

QFT costs in Japan

More from the 2009 IGRA symposium; an extract from Cost effectiveness of IGRAs assays in Japan presented by Akiko Kowada, MD, PhD; Director, Department of Health Service, Katsushika City; Public Health Center, Tokyo, Japan.

It would appear that following a +TST with a QFT is more expensive than QFT alone.

QuantiFERON - Worth the Cost

Just out on the google machine;

The advantages of the quantiferon gold assay have prompted me to switch my patients on immunosuppressive therapies to baseline and annual quantiferon gold screenings. This has been good for both me and my patients. First of all, I don’t need to pursue so many positive TB test results, due to the test’s specificity and greater convenience. As for my patients, the single trip to the lab for blood drawing rather than two visits to the physician’s office is truly appreciated.

This is an exciting new development in my practice, allowing for enhanced accuracy and convenience for patients, and reduced hassles for everyone. Do consider checking with the labs that you use about whether this test is available to your patients, and if so, I strongly recommend that you consider using it for your patient monitoring. As we strive for more optimum care of our psoriasis patients we also need to figure out how to monitor patients efficiently and successfully. This step has made the process better for all.  

Dr. Van Voorhees is Associate Professor, University of Pennsylvania Health System and Director of its Psoriasis and Phototherapy Treatment Center.

International Journal of Tuberculosis and Lung Disease 2010 - QuantiFERON

Transcripts, including Q and A's, of the 2009 Dubrovnik IGRA symposium have been published in the May 2010 issue of International Journal of Tuberculosis and Lung Disease, available here. 

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Clearly we need a new more precise test to identify LTBI. To be of value, that new test must minimize unnecessary and costly additional testing and treatment of false-positives. Ideally, it should also reduce the number of false-negatives. The inherent problem is that we have no gold standard for identifying the infected.

As long as we continue to compare new diagnostic products to the TST, our progress will be very limited. Even though we are more comfortable with the PPD, we need to put it, with the horse, out to pasture and move on. We need to focus on the new test, not the old

2009—Is there still a role for the tuberculin skin test? What history has taught us

John A Sbarbaro, MD, MPH, FCCP
Professor of Medicine & Preventive Medicine, 

University of Colorado, School of Medicine, Denver, CO, USA

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IGRAs are a significant advance because of their high specificity and operational advantages. They are powerful epidemiology tools. Leadership and advocacy are keys in implementation.
When advocating the use of IGRAs, it is important to focus on the potential benefit to patients and society. Start-up funding remains the biggest obstacle, but the real question is: ‘Is TB control worth it to society?’ Be creative, apply for grants. In the USA, our generally passive TB control culture may be the largest obstacle. It will not be hard to prove to providers the value of switching to the IGRAs, as they understand the shortcomings of the TST.

and in the questions;

Q: I would like to see more information on the use of QFT and acceptance of preventive therapy.
A: Our staff is really excited about this, and they can see the difference in patient acceptance.

IGRAs in public health practice: overcoming obstacles to implementation

Masae Kawamura, MD
Director, TB Control Section, San Francisco, Department of Public Health, 

Francis J. Curry National Tuberculosis Center, 

University of California, San Francisco, CA, USA

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A common factor of all these examples is that IGRA was used for all the investigations due to decisions by the incident management team that the IGRAs provide a more practical and efficient approach to handling large numbers of exposed persons.

and in questions;

Q: Our result rates for contacts and staff are better and the staff certainly happier with QFTs. How about in London?
A: In large incidents, the IGRAs are a lot easier and more efficient. The problem is in very young children, where the results are less reliable and obtaining blood from very young children may be more difficult.

Implementing IGRAs in the UK: constraints and opportunities

Ibrahim Abubakar, MBBS, PhD, FFPH
Head of Section/Consultant Epidemiologist, Tuberculosis Section, 

HPA Centre for Infections, Colindale, London, UK

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I could do it for less

Perhaps English is not their first language;

technically contribute to developing EU adapted guidance on the use of interferon gamma assays for the identification of latent TB infection and diagnosis of active TB disease

With a budget of 35,000 euros I could cobble something reasonable together, I reckon

Nearly all mothers have 'em

Oh dear

T-Spot TB was evaluated in South Korea, abstract here and full text here. From the abstract

The sensitivity deduced from group 1 and specificity deduced from group 4 of T-SPOT.TB test were 96.4% and 72.6%, respectively

Group 4 are "healthy volunteers without TB history"; I'll let the pictures tell the full story

Lets get it right the first time

This is how they are doing it in Germany, they call it an Ablaufschema vorsorge which sounds the right stuff.

Taking a gamble on the markets

As global markets slip on a sickly mixture of soap and grease its worth perusing testimony by Professor James Galbraith before the Subcommittee on Crime on the role that fraud has played in the financial crisis;

I write to you from a disgraced profession. Economic theory, as widely taught since the 1980s, failed miserably to understand the forces behind the financial crisis. Concepts including “rational expectations,” “market discipline,” and the “efficient markets hypothesis” led economists to argue that speculation would stabilize prices, that sellers would act to protect their reputations, that caveat emptor could be relied on, and that widespread fraud therefore could not occur.

..Ask yourselves: is it possible for mortgage originators, ratings agencies, underwriters, insurers and supervising agencies NOT to have known that the system of housing finance had become infested with fraud? Every statistical indicator of fraudulent practice – growth and profitability – suggests otherwise. Every examination of the record so far suggests otherwise. The very language in use: “liars’ loans,” “ninja loans,” “neutron loans,” and “toxic waste,” tells you that people knew. I have also heard the expression, “IBG,YBG;” the meaning of that bit of code was: “I’ll be gone, you’ll be gone.”

..Either the legal system must do its work. Or the market system cannot be restored. There must be a thorough, transparent, effective, radical cleaning of the financial sector and also of those public officials who failed the public trust. The financiers must be made to feel, in their bones, the power of the law. And the public, which lives by the law, must see very clearly and unambiguously that this is the case.

Interferon-Gamma Release Assay for TB Suggested Before Prescribing Anti-TNF Agents for IBD: Presented at DDW

NEW ORLEANS -- May 5, 2010 -- Patients diagnosed with inflammatory bowel disease (IBD) should undergo sensitive testing for latent tuberculosis (TB) before they begin biologic therapy, researchers suggested here at the Digestive Diseases Week (DDW) 2010.

"We know that the tuberculosis skin test may not be the most sensitive test available, and when you are giving biologic agents that may be immunocompromising we want to make sure these patients are not at risk for the emergence of a serious infection such as tuberculosis," said Kay Greveson, Centre for Gastroenterology, Royal Free Hospital, London, United Kingdom, on May 4.

"Conventional screening involves assessment of risk factors, chest radiograph, and tuberculin skin testing," Greveson said. "This can be difficult to interpret in immunosuppressed subjects. Tuberculosis interferon-gamma assays may detect Mycobacterium tuberculosis infection with greater specificity and possibly sensitivity."

The research team performed a retrospective review of patients with IBD either considered for anti-tumour necrosis factor (TNF) agents or who were already using infliximab and adalimumab and who were assessed for evidence of TB infection with interferon-gamma release assay testing as part of their screening protocol.

Greveson said that 100 patients were tested using interferon-gamma release assays, and 3 patients had positive reactions, while 3 others had indeterminate responses.

Of those with positive reactions, 1 patient had been successfully treated for pulmonary TB and had already been on adalimumab therapy for IBD. After a risk/benefit analysis was performed, the patient remained on treatment. A second patient was treated for latent TB infection prior to starting anti-TNF therapy. The third patient developed a TB infection 44 months into treatment with a TNF agent and after visiting TB-endemic regions in South America.

Two of the 3 patients with indeterminate results had no reaction when they retook the test 2 weeks later. The third patient had another indeterminate test.

"We suggest that large scale evaluation of interferon-gamma release assays as part of a tuberculosis screening strategy prior to anti-TNF agents should be undertaken," Greveson said. "It will be particularly important to include health-economic cost-benefit analyses in low tuberculosis incidence areas."

Digestive Disease Week 2010 is cosponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society for Surgery of the Alimentary Tract (SSAT).

[Presentation title: Screening Patients Initiating Anti-TNF Agents for Mycobacterial Infection Using Interferon-Gamma Release Assays (IGRA): The Experience of a Large Inflammatory Bowel Disease Service. Abstract T1272]

Bags of gas

Recently the Murdoch rag set the dogs loose with this headline

"Mining tax will kill industry"

Peter Martin takes a look at the history of taxing miners

Taxing times

There's no doubt that partisan interests are at play here - is there to be an election somewhere? - take the Mineral Council of Australia submission to the Henry Review

QuantiFERON in New York City

American Thoracic Society 2010 International Conference, May 14-19, 2010 • New Orleans

Link here and here, lots on QFT and this one caught my eye;

Treatment Acceptance And Completion Rates For Latent Tuberculosis Infection After Implementation Of QuantiFERON®-TB Gold, New York City

J. Kessler1, S. Ahuja2, A. Crossa3, T. G. Harris4
1New York, NY, United States of America, 2New York City Department of Health and Mental Hygiene, New York, NY, United States of America, 3New York City Department of Health and Mental Hygeine, New York, United States of America, 4New York City Department of Health and Mental Hygeine, New York, NY, United States of America

Corresponding author's email: jak2182@columbia.edu

Rationale: Treatment of latent tuberculosis infection (LTBI) among high-risk populations is part of the tuberculosis (TB) control strategy in the United States. Use of the tuberculin skin test (TST) for LTBI diagnosis among individuals who received the Bacille Calmette-Guérin (BCG) vaccine is complicated by the cross-reaction of TST antigens with the BCG causing false-positive results which can lead to patient and physician reluctance to initiate LTBI treatment. QuantiFERON®-TB Gold (QFT-G) lacks this cross-reaction. We therefore sought to study the impact of implementing QFT-G testing on LTBI treatment initiation and completion at NYC chest clinics.

Methods: QFT-G results from 10/2006–12/2008 in NYC Bureau of TB Control chest clinics were obtained from the electronic medical record system. Characteristics of patients who did and did not initiate and complete treatment were compared using the Wilcoxon rank-sum (continuous variables) or chi-square (categorical variables) tests and multivariate logistic regression. The proportions of patients who initiated and completed treatment among patients tested with QFT-G were compared to those tested with TST from 10/2004–9/2006

Results: Among 38,450 patients tested with QFT-G, 2368 (6%) tested positive, 35,626 (93%) tested negative, and 456 (1%) had an indeterminate result. Among those who tested QFT-G+, 1197 (51%) initiated treatment; of those, 595 (50%) completed treatment. Among LTBI patients, contacts [72%(122/169) vs. 49%(1075/2199) non-contacts] and foreign-born persons [57%(972/1719) vs. 34%(225/664) US-born] were more likely to initiate treatment (both p<0.0001). In multivariate analysis younger age [adjusted odds ratio (adjOR)=0.96, 95% confidence interval(CI)=0.95-0.96], foreign-birth (adjOR=1.87, 95%CI=1.47-2.37), and being a contact (adjOR=2.77, 95%CI=1.91-4.03) were associated with initiation. Among treatment initiators, foreign-born persons [57% (558/972) vs. 36% (81/225);p<0.0001], and contacts [(69% (84/122) vs. 52% (555/1075);p=0.0003] were more likely to complete LTBI treatment. In multivariate analysis these factors remained associated with treatment completion (foreign-birth adjOR=1.92, 95%CI=1.35-2.72, contact adjOR=1.75, 95%CI=1.15-2.67). Historically, among patients tested with TST, 19% (6932/37,713) tested positive; 50% (3500/6932) initiated LTBI treatment and 44% (1545/3500) completed treatment. The proportion of patients initiating LTBI treatment did not differ based on test (p=0.961); however, the proportion completing treatment was higher for those tested with QFT-G (p<0.0001).

Conclusions: QFT-G implementation has greatly reduced the number of persons begun on LTBI treatment and appears to have increased completion. Additional studies are needed to determine whether QFT-G use results in a sustained increase in treatment completion and occurs in settings other than NYC TB clinics. The reasons behind the higher completion but not initiation proportions also need to be elucidated.

Pants on fire

Foreign correspondent 'Alexanders' recently said

I have seen a couple of your posts where you talk about the impact of 3G in Japan coming through this half.
I do not think this will have a big impact. There was a lot of negative feeling about 3G in Japan when the first batch of tubes had endotoxin contamination and were recalled. Now the Research Institute of TB in Japan thinks the gel in the tube gets soft in hot weather, breaks off, stimulates the blood cells and gives false positive results. They are openly saying this in Japan.
All of this will delay new customers moving to QFT.

And how does he know all this?

My info comes from a Doc at the Japanese Institute of TB (where many of the QFT studies for the publications were done).

This sort of stuff seems to have rattled the confidence of a few poor souls

Sales are pathetic face it...I see no meaningful sales until at least 12 months post recs...I would not be surprised to see sub $2s again...on what I have just read Ill be considering selling down given the opportunity...

Maybe they both should take up a hobby..

The real deal

In their latest briefing Cellestis describe how useful the Diel meta-analysis is as a marketing tool;

This definitive analysis of all relevant papers has been highlighted to our customers by our sales & marketing team, and those of our commercial partners

It is important to be able to independently verify the performance data

When Clinicians have a test result they want to know how confident they can be in the result in various settings for particular patients.

The meta-analysis also firmly puts to rest various "opinions" floating around

• Highlights the superior performance of QFT over both TST and T-Spot.TB.
• Clarifies the much lower specificity of T-Spot.TB - previously promoted by the manufacturer as 99.9%!
• Demonstrates that the rate of Indeterminate results is lowest with QFT.
• Highlights how medically inappropriate the TST really is, and how valuable QFT is for TB control.

Government failure or public failure - or both

Stop TB USA have just published a report on why the medical community have failed to stop TB

This report assesses how and why the IOM’s tuberculosis elimination plan has not been fully implemented and provides updated action plans to move forward on its recommendations to accelerate progress toward tuberculosis elimination in the United States.

The 2000 IOM report required government to

Accelerate the rate of decline of tuberculosis by increasing efforts at targeted testing and treatment for latent tuberculosis infection

In that regard it is a "fail"

two blood tests are currently licensed in the United States. However, insufficient funding for operational research has led to delays in implementation of these tests, and many public health programs have been unable to cover the additional cost of these tests.

So when it comes to money

Federal funding has not increased to the level recommended by the IOM as necessary to accelerate the elimination of tuberculosis.... All members and partners of Stop TB USA need to mobilize to build the political will to increase the Division’s funding to the full appropriated levels.

It's easy to blame the government however the 2000 IOM report did say that to achieve these goals

social mobilization is necessary to build and sustain political will

which means that the ball is now back in the medical communities court

Stop TB USA and its partners must work together to develop the political will needed to advocate for the development and implementation of new tools needed both domestically and globally to eliminate TB..

To gather political support you need use the media to educate and create public interest in TB elimination

Only an aggressive effort aimed at building political commitment can prevent the elimination of funding for tuberculosis research

QFT in Saudi Arabia

Following on from their guidelines and expert opinion comes this paper from the TB Research Unit, King Faisal Specialist Hospital & Research Centre. Firstly they establish the need

It is clear that tuberculosis in Saudi Arabia is in need for attention. This is supported by the increase in the infection rate 0.6% during 2007 compared to 2006 infection rate.

and how to meet that need

We believe that the first step in improving the control of tuberculosis in Saudi Arabia is to improve and unify the standards of diagnostic services and laboratories responsible for tuberculosis. This paper reviews the current status and suggests possible improvements.

and in more detail

It is essential to screen at least those at high risk for latent TB using most reliable tools. Recently FDA approved two new interferon- gama release assays (IGRAs) which are are now available for the diagnosis of LTBI: the QuantiFERON-TB Gold (Cellestis, Victoria, Australia) and the T-SPOT.TB (Oxford Immunotec, Oxford, UK). Both tests are better than skin test in the specificity and sensitivity to diagnose latent TB. Also they have advantages over the skin test; including ease in performance, no need for second second visit and the test reading is not subjective like skin test. One of these two tests should be implemented to screen most vulnerable groups within the communities to detect latent TB or even catch those whom recently converted to sero-positive [2].
The advantages of these new tests in addition to what was mentioned that they, unlike skin test, do not cross react with other mycobacteria such environmental mycobacteria or do not react with BCG vaccine it self.

Spot the failure

Oxford Immunotec are keen to tell the world of their latest success ie raising more funds

New Leaf Venture Partners (NLV Partners) today announced the closing of the second tranche of a $26 million investment in Oxford Immunotec Ltd., a leading manufacturer and marketer of T cell-based diagnostic tests.

Oxford Immunotec have managed to collect a fair swag of credentialed investors, from their website it appears that Clarus Ventures, Wellington Partners, DFJ Esprit, Dow Chemical, SPARK Ventures and Top Technology Ventures are now to be joined by Kaiser Permanente Ventures and New Leaf Venture Partners. I guess they are all excited by the market potential

In the U.S., there are an estimated 15 million individuals infected with latent TB, and an estimated 17 million tests for latent TB are performed each year

A quick google reveals that Oxford Immunotec have had several successful capital raisings;

2003 --> £2.5M
2005 --> £7M
2007 --> £40M

which totals £49.5M, or $US76M. Combined with the recent raising of $26M giving a Grand Total of $US102M which then begs the question, what is the purpose of all this cash?

...The company will use the funds for the US launch of its T-SPOT.TB tuberculosis blood test.

I guess that at some time you will have to make a return on your investment

We have approval in the EU and in many other countries further afield and we have strong prospects for the use of our patented technology for the diagnosis of other infectious diseases. We are excited to be working with Prelude who is helping us move closer to achieving profitability..

That statement was made in 2005 and when you consider their estimate of the size of the market you have to wonder just how long, if ever, it will take OI to return a profit on the investment.

The anagrams are longer in Massachusetts

Update (April 2010) from the Office of Health and Human Services (EOHHS); not only are they now doing QuantiFERON In Tube they also give special instructions for delivery.

The good thing about QuantiFERON In Tube is that you dont have to worry about what sort of tube you have to buy and use, if it is sodium or lithium heparin or whatever  - the tubes are already supplied and you just follow the colour code

Blood from each patient must be drawn into each of three Quantiferon (QF) blood collection tubes: Nil Control (grey cap), TB Antigen (red cap), and Mitogen Control (purple cap). Specimens collected in any other tubes will be rejected.

Use of QuantiFERON in the developing world.

Posting from the UK on an Australian forum commentator Alexanders gave his two pennyworth on QFT testing in developing countries

I am not sure there will be huge sales in the “poorer countries” as you call them.
Yes, the cost of testing is a big issue (do you want to eat for the next week or do you want to know if you have a TB infection?)
You also have to determine how useful a test for TB infection would be. In many poorer countries (much of India and Africa) the rates of infection are estimated to be over 50%. I cannot see any country running tests that will be positve this often as they would then have to treat all of those that are positive (only test if you are going to treat). Any such country must firstly control active disease properly. Once this has been done they can start to think about latent infection - this will take decades.

Maybe, but WHO see things differently

By 2013 - All countries should have:
* developed a national TB infection control plan
* set up national surveillance of TB disease among health workers
* assessed major health-care facilities and congregate settings for TB infection control
*reported on the implementation of TB infection control.

Bearing all this in mind a hospital in India undertook a study into the prevalence of TB in their HCWs

Our study showed a high prevalence of LTBI even in young nursing trainees.

So which IGRA test did they use?

We have now incorporated the QuantiFERON-TB Gold In Tube (QFT) assay in our cohort study, and after initial technical problems with quality assurance, we have successfully incorporated QFT into our annual testing protocol.

Targetting HCWs was a smart move

With the recent WHO TBIC policy guidance as the reference, Indian healthcare providers (private and public) and the Revised National TB Control Programme (RNTCP) will need to begin implementing at least a minimum package of basic TB infection control measures, and enhance capacity for TBIC at the country level with adequate budget allocation. Medical schools and teaching hospitals, in particular, have to adapt and translate the TBIC policy into concrete action.