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DO WHAT YOU DO BEST WE HANDLE THE REST EXPERT PROVIDER & SPECIALIST NETWORK MANAGEMENT & ADMINISTRATION WE KNOW THE BUSINESS OF HEALTHCARE. With 15 years experience, we re the leading network managers. Use our know-how to your advantage: practice cost studies, tariffs, coding, practice advisory services, funder negotiation, network contracts & access to medical professionals & specialists. We complement our Healthcare services with our Alliance Partners: Glenrand MIB, Citadel, Prosper Financial Services, E2 Solutions. Our track record speaks for itself. Call us. Johannesburg Head Office: Casper Venter PO Box 2127, Cresta, 2118 Tel: 011 340 9000 Fax 011 782 0270 Cape Town: Ernst Ackermann Tel: 021 864 2542 E-mail: healthman@healthman.co.za 2 PAEDIATRIC NEWS

CONTENTS 4 5 6 7 SAPPF News PMG Chairman s report Important services offered by the Paediatrician Management Group Current issues facing the PMG 8 PMG Exco 2012 12 12 13 14 17 26 30 32 Summary of health news: July 2012 National health insurance (NHI) & public health News on HIV/AIDS, TB, malaria, & communicable deseases Doctors, nurses, hospitals & training Medical aids Pharmaceuticals Financial news General news All articles published in Paediatric News have been sourced and approved by SAPPF and PMG. Thetha Media Sales takes no responsibility for any of the content carried in the publication. Advertiser content and supplier editorial is carried as supplied.

IS A LEGAL SHOWDOWN WITH THE HPCSA LOOMING? Yesterday the HPCSA together with SAPPF, SAMA and SADA were asked to appear before the Portfolio Committee on Health in Parliament to discuss the publication and then subsequent withdrawal of the HPCSAs controversial Guideline Tariffs for Medical and Dental Services that had been released on the 7th of August. The cause of the furore was the fact that the HPCSA had used the outdated reimbursement 2006 NHRPL tariff of the BHF with an inflator of 46.66% as its new tariff. The three professional organisations in a rare show of solidarity opposed this announcement, first with a meeting with the Registrar last week on the 14th and then in a follow up meeting with the President of Council, Professor Sam Mokgokong the next day. At that meeting the president agreed to refer the matter to the full Council at its meeting on the 3rd of September and invited the 3 professional organisations to present their objections to the council. However subsequently, despite agreeing to suspend publication of the tariff in the government gazette, it appears that the tariff has not been withdrawn from the HPCSA website, and council is refusing to remove it on the grounds that Professor Mokgokong never promised to do so, despite his offer to suspend the tariff pending further discussions. This is causing confusion with our members and in the view of SAPPF is acting in bad faith. Also and equally unacceptable, is the requirement that the professions restrict their presentations to 10 minutes, a completely inadequate amount of time to engage in a real consultation, and further that the written submissions had to be received by council by the 22nd of August, i. e. yesterday. This is not acceptable and does not seem to be the actions of an organisation truly interested in making an admittedly late attempt to make the process of consultation acceptable to the professions, so what is going on here? When pressed to explain in our meeting with the Registrar on the 14th why the Council had decided to introduce the tariff, Professor Barday explained that Council had been receiving an increasing number of complaints of overcharging from the public and he gave a figure of 246 cases that had been investigated by council this year and in the absence of a tariff guideline it was difficult for council to adjudicate on the matter. When pressed further as to the reason why an outdated 2006 NHRPL was used, he stated that this tariff had not been challenged in the court at the time the government was taken to court by SAPPF and others over the RPL in 2010, and further that the NHRPL rather than the HPCSA s own Ethical Tariff (which was three times higher than the NHRPL), was chosen, because in the council s experience, when the ethical tariff had been used many doctors adopted as their usual tariff! None of this makes sense. Firstly if we contextualise the 246 complaints it becomes abundantly clear that this cannot be the reason. Let us (in order to make the math easy) assume that there were not 246 cases but rather a thousand cases. Then consider the following: Ten thousand doctors (and dentists) providing 10 items of billable service a day (100 000 billable services per day) which becomes 500 000 per week, 2 million per month making it 16 million billable services so far this year-out of which there were 1 000 (actually 246) cases of overcharging investigated this year! This works out at one case every 16 000. Clearly this cannot be the explanation. Turning next to the reason why a NHRPL tariff rather then the HPCSA s own Ethical Tariff at three times the NHRPL was used, the reason stated also does not wash. For years before the HPCSA adopted the old SAMA Tariff (also three times the NHRPL) there were about twenty per cent of doctors who used this tariff - the recommended SAMA tariff, as their legitimate guideline, and there are still about twenty per cent who continue to charge at this rate, although this figure may have started to rise slightly recently but not for the reasons given by Professor Barday. There has been much publicity around the cost studies mandated as part of the RPL process, and these studies indicated quite clearly to the profession what we as doctors should be charging, and it is this knowledge rather than the publication of the Ethical tariff that may have changed the behaviour of some practitioners. So I repeat the question; what is going on here? I believe that the answer lies in the determination of the Minister of Health to push on with his ambition to introduce NHI which cannot be achieve if private sector pricing remains at the level it is currently. It is worth recalling that the original number crunching and estimates of cost done by Sule Calikoglu and Patrick Bond for COSATU in 2008 included a savings of 33% on existing costs, which they calculated could be achieved through the single purchaser model on which the NHI proposals are currently based. Add to this the current crusade by the minister against the high prices in the private sector and I believe we have an answer. South Africa simply cannot afford NHI at current costs. Equally NHI cannot succeed without the participation of the private sector. Clearly if NHI is to become a reality something has got to give and this appears to be it. Once again it is the soft under belly of a disunited profession that offers the greatest opportunity for price reform. How will the profession respond to this latest challenge? Dr Chris Archer CEO 23/08/2012 4 PAEDIATRIC NEWS

PMG CHAIRMAN S REPORT The PMG has for a while felt the need to establish a better means of communicating with our members. We have to date, made good use of emails and our website but it was apparent that some communications did not seem be noted by our members. We are excited over the opportunity to provide content to Paediatric News. This opportunity (together with word of mouth from our members) will promote the PMG brand to non member paediatricians, the pharmaceutical industry and Corporates who may assist with professional services. The present PMG was formed 10 years ago to negotiate with funders and represent the business aspects of private practice paediatrics. In our first 2 years we enrolled 100 members nationally and successfully introduced new billing codes. We would have been able to introduce much more but for various government interventions that made negotiations over fees and coding a legalistic minefield. Despite these barriers, our income has increased significantly since the formation of PMG, due to the focused efforts of our team. Our membership is now at 270 doctors. PMG promotes best practice medicine to its members and our successful national weekend meetings provide opportunities for our members to participate in discussions on optimal management of conditions faced in private practice. This year, we have hosted the Pfizer meeting at Clarens, the Aspen meeting at Fancourt and look forward to a Nestle Nutritional Workshop scheduled for 2-4 November 2012 at Zimbali. The combination of the website, email news flashes, congresses and the expertise of Healthman ensure that our members have access to support for all the stressors of private practice. Challenges we face include motivating our members to control the escalating costs of healthcare by ensuring appropriate use of hospitalisation, investigations and pharmaceuticals. We also face obstacles from funders that initiate one sided payment options that split the profession. These arrangements make it difficult for us to initiate reimbursement options that reward doctors for best practice medicine. We sincerely hope that Paediatric News assists in promoting the vision of PMG to its members and encourages other paediatricians to join our family. We thank the companies that have chosen this medium to communicate with our members and hope that this leads to other possible collaborative efforts. Important services offered by The Paediatrician Management Group for Neonates requiring intensive care from the date of birth up to 28 days after the expected date of full term delivery. At this point Discovery Health pays for this code if you are on the governance project. The code is paid when attached to all ICU codes up to 28 days of life whereas BHF associated funds pay for this code linked to all ICU codes except code 1204. CODES AND BILLING PMG is in constant negotiations with Funders for better remuneration, for possible designated service provider agreements and for peer review processes for Paediatricians. SAPPF (South African Private Practitioners Forum) is the only other specialist group that is working on coding and billing issues. No other group, offering services to Paediatricans, negotiates with funders for a better deal for Paediatricians. Healthman will investigate each and every complaint related to billing and coding and channel the complaint correctly to ensure that an adequate reply or result is attained. If you have any problems with billing, coding or if claims are not being paid then forward this information either to your local PMG Exco member or directly to Healthman. Codes 0205 - can be charged for children from 3 years and younger every day for fluid management regardless of whether the drip was inserted by the Paediatrician. This code may only be charged for once per day. Code 0111 is accepted by all Funders as exclusive to Paediatrics for daily in hospital care. This code can be charged once daily and the increased tariff reflects the fact that children in hospital are seen twice a day by the attending Paediatrician. Code 0019 The descriptor in the SAMA doctors Billing Guide states that this can be used by Paediatricians and neonatologists DISCOVERY HEALTH Discovery is by far the largest Funder in South Africa and we will continue to negotiate with them and to improve the governance project. The Governance project allows for participating doctors to benefit from: Better remuneration for code 0111 The ability to charge code 0019 Payment for code 0149 (after hours code) 5 times per month Participation in this project is voluntary and the project aims to promote high quality cost effective Paediatric practice. The first part of the project is to ensure appropriate 6 PAEDIATRIC NEWS Continued on page 7

admissions. Practises and participating doctors give consent for their practice admission data to be profiled. If the admission rates fall well outside of the norm then the PMG Exco contacts the particular practice so that constructive debate can be entered into to understand the admission policies of the practice. It is important to understand that the Governance project and PMG have nothing at all to do with the payment agreement options such as Premier A, Premier B, Classic Direct and Executive. Participation in these payment options is your own decision and this will be guided by the demographics of your practice. Only the Classic direct option gives remuneration close to that suggested by the Practice Cost Study data. THE VERMONT OXFORD NETWORK VON is an Internationally accepted and acclaimed neonatal database and any hospital in South Africa can join this Database. Each Neonatal Unit is encouraged to join the VON Network because the data allows for each unit to audit their own data and thus improve the quality of neonatal care. The data from each unit is only visible to that unit except in cases where hospital groups have arranged a central data point with VON. The information is then also visible to the managers of the hospital groups. Life Healthcare has recently started such a programme. The Mediclinic group of hospitals does not form part of the one rate that PMG has negotiated for all other South African Hospitals. With the money generated by this project we are able to assist academic and other government hospitals to join the VON network. Thus far Groote Schuur Hospital, Steve Biko and Charlotte Maxeke Hospital have joined. SAPVAC The South African Paediatric Vaccine Action Group was established to design a uniform Paediatric vaccine schedule for use by all doctors and clinic sisters in the private sector. This schedule has been updated whenever changes have occurred in the schedule or when new vaccines are available. The next update will be in 2013. WEBSITE Our website www.paediatrician.co.za is hosted by e2 solutions and funded by ASPEN/GSK. This is the official website of SAPA but the secure section is only accessed by PMG members. You need to register on the site. In the secure section we have facilities for chat rooms and discussion forums, notice boards to pin information, practice information and CPD point registers. OTHER COMMERCIAL OFFERINGS Free online SMS service that can be used for patient communications via the website Free prescription pads the sponsor of this is currently changing so there will be a gap in this service for a few months. Script pads will not be available until the new sponsor and layout has been agreed upon. An agreement with ABSA bank offers members a better rate on credit card transactions. An agreement with Alexander Forbes offers members a better rate on malpractice insurance premiums. Online access to obtain CPD points, as well as online access to view your CPD points Practice advisory services to assist with medical schemes problems, ie, non-payment, reversals, PMB s etc., through the HealthMan offices Helpdesk to assist with general medical schemes queries Online access to various medical journals this is currently under review as we try to secure a provider that will provide a user friendly service and method of access to a selection of Paediatric journals with the option of individual searching. Online Human Resources library with access to standardised employment contracts, procedures for dismissal, legal directives, labour regulations, etc. Prosper Financial Services, an associate company of HealthMan will review and advise on employee benefits, investment planning, PPS and income protection insurance. Earlier this year, NHI and the future of private medical schemes was discussed with special reference to SA s brain drain the quarterly PPS Graduate Professionals Confidence Index had shown that the number of professionals who are confident of remaining in the country has dropped from 84% to 78%. The survey found that professionals were concerned about the feasibility of NHI and that confidence in the future of healthcare in SA dropped 5% to 45%. 38% of professionals supported the principle of improving the healthcare system but believed NHI was not the cure for the ailing health system. In response, the Health Minister Aaron Motsoaledi went on record that he had no intention of harming the private medical scheme industry but yet was very vague about the role that schemes would play under the full NHI environment envisaged in 14 years time. A few months later at the Board of Healthcare Funders (BHF) CURRENT ISSUES FACING THE PMG conference, there was a significant move against the private sector: 1) Minister Motsoaledi attacked the spiralling costs in the private sector and even called for the 2004 Competition Commission s (CC) ruling - which barred medical schemes from negotiating prices with service providers - to be reversed. Minister Motsoaledi also reiterated that the CC ruling of 2004 has made private healthcare unaffordable and that medical schemes could not carry the cost. The CC had ruled that it was uncompetitive for industry bodies to negotiate tariffs and hence schemes were prohibited from entering into collective bargaining arrangements with healthcare providers. Pricing was now governed by the law of the jungle, Motsoaledi said. 2) Anban Pillay of the Department of Health claimed that SA patients were paying up to five times more than patients in other countries for some hospital procedures. According to the Council for Medical Schemes (CMS) 2011 report, hospital costs amounted Continued on page 8 PAEDIATRIC NEWS 7

to R31,1-bn of medical schemes total R84,7-bn expenditure in 2011 R30,8-bn of this amount was paid to private hospitals. 3) Specialists alone claimed R19-bn of the total medical aid scheme expenditure in 2011. According to BHF head of benefit and risk, Rajesh Patel, some specialist categories charged as much as 500% to 700% more than what medical schemes reimbursed. Furthermore Minister Motsoaledi also set his sights on amending Regulation 8 of the Medical Schemes Act, which deals with PMBs. PMBs were introduced into the Medical Schemes Act of 1998 to ensure members of medical scheme members did not run out of benefits for certain conditions. Up to now the payment in full had been the subject of several court rulings significantly the PMG had led the way with both Kara and Puterman rulings forming the foundation for successful appeal cases. Motsoaledi described the judgment in the Gauteng North High Court in 2011 as a terrible ruling that doctors had interpreted to mean anything I charge, which would result in increased health inflation forcing schemes to raise contributions. However, Motsoaledi said it was no matter for the courts; the loophole had to be closed by parliament. At the time of writing this report, the SAPPF is working out a counter-strategy to this line of action it is for this very reason that the PMG remains affiliated to the SAPPF as these issues are best dealt with as a united Specialist Body. On a smaller, more practical level, the PMG has been hard at work in discussions with the Funders as members will recall, certain newsflashes have been sent urging members not to sign DSP agreements ( Bonitas, Fedhealth, Sasolmed) with funders as this action would prejudice future negotiations. From the above, one can see that there are significant and formidable challenges facing the private healthcare sector the PMG remains committed to fighting these for the benefit of all members. PMG Exco 2012 The current PMG exco comprises 8 of your members elected at the meeting in Fancourt in May 2012. All directors are involved in meetings with funders and members and various projects. They are a phone call or e- mail away please check contact details on our website. Yatish Kara, based in Durban is the current chairman. Yatish as been on the exco since 2003. He co-ordinates the activities of the exco, sets up meetings with Funders and Pharma and all projects have to report back to him. He also serves on the exco of SAPPF. Dr Andrew Halkas was chairman of the PMG from 2003 to 2007 and is based in Krugersdorp. He is also serving on the ALLSA exco. He has served on the Exco since 2003. His portfolios include Pharma sponsorships, Peer Review and VON. Dr Allan Puterman is based in Cape Town and is treasurer of the PMG and has been on the exco since 2003. He is also a member of the SAPA exco. Apart from being treasurer, he is also involved with VON and PVAC. Dr Simon Strachan is based in Johannesburg and has been on the PMG Exco since 2005. He is also a member of the SAPA exco and his portfolios are Pharma sponsorship, communication and website. Dr Ashley Wewege is based in Cape Town and has been on the PMG exco since 2010. His portfolios are website, PVAC and Pharma sponsorships. Dr Gerrrit de Villiers is based in Cape Town and has been on the exco since 2010. His portfolios are website and communication. Dr Thesi Reddy has been a member of the exco since 2009. He is based in Durban and he is involved in the Peer Review portfolio. Dr Omolemo Kitchen has been on the exco since 2012 and is currently tasked with PVAC. He is also Gauteng based. So far in 2012 PMG has held 2 CME weekends. The first was in Clarens in March with sponsorship from Pfizer and then the Annual Advancing Paediatrics weekend with Aspen at Fancourt in May. The next exciting event will be held at Zimbali 2-4 November 2012 with Nestlé as the sponsor. These weekends provide PMG members with the chance to create and renew friendships, get up to date with current Paediatric treatment and protocols and discuss important medico-political and legal developments. Attendance by members is given priority over non member s at these weekends and families are encouraged to attend. 8 PAEDIATRIC NEWS

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SUMMARY OF HEALTH NEWS: JULY 2012 The High Cost Of Healthcare And The Elephant In The Room Report on Dr Martin Young s June 27 Politicsweb open letter to Health Minister Dr Aaron Motsoaledi Doctors and specialists are being wrongly singled out for blame. In his letter Dr Young gives an overview of the events that lead to the unhealthy relationship between doctor, patient and medical aids. He ends his letter by summarising the problems: The roots of the present high costs of healthcare are not just based on the economic realities of inflation and technological advance. They lie instead in a broken and flawed relationship between doctors and funders that goes back over forty years. The power of the medical aids has increased, and their attempts to draw doctors into line based on limitation of costs and control have led to a backlash of over servicing and further expenditure, leaving patients more and more out of pocket, not to mention the cost to the economy, and to the morale of doctors who have not bought into this manipulative practice, and whom you place directly in the line of fire. Young s vision for the future of healthcare in SA includes: A system whereby high quality and ethical doctors are treated as such and remunerated properly for their services, without having to consider manipulative business practices by medical aids. The membership of such groups should be on a peer-reviewed basis and according to recognised standards of practice. Medical aids already have the data to support the claims of those who wish to be part of that group. The technology exists to make this possible. So, Minister Motsoaledi, our public health system is admittedly broken. Our private health system is effective, though expensive. Doctors as a body have made historic mistakes that have left us vulnerable in many ways. Big business ambitions, wastage and desire for control of the industry of the medical aid administrators are the elephants in the room, Mr. Minister. Ignore them, or focus undue and unwarranted attention on the doctors you have left, and you will see South Africa get the universal healthcare system your efforts and policy deserve, and not the one the whole of South Africa craves. Source: www.entsociety.co.za NATIONAL HEALTH INSURANCE (NHI) & PUBLIC HEALTH State attacking private healthcare Government is seeking to replace private healthcare with NHI, says Jasson Urbach, executive director of the Free Market Foundation s health policy unit. The Treasury s announcement in March to restrict the availability of gap cover medical insurance and hospital income plans was a systemic attack on private healthcare. Gap insurance came as a result of government restrictions, says Urbach. Source: SAPA, 26 July 2012 Doctors Will Get NHI Pay; NHI Pilot Sites Not Able To Guarantee Payouts The Department of Health (DoH) will guarantee the payment of private general practitioners who work in public clinics in the NHI pilot districts, Health Minister Aaron Motsoaledi told journalists at SAMA s conference. The 10 pilot sites - which cover 20% of SA s population - are being funded by a conditional grant of R1-bn. Motsoaledi reiterated the public healthcare sector needed to be overhauled, the private healthcare sector had to be officially regulated and a medical ombudsman should be appointed. Meanwhile, Business Report reported that the DoH cannot ensure that people using healthcare facilities under the NHI pilot projects will not be left with extra financial liabilities. Source: Business Report, 28 June; Business Day, 6 June: The Times, 6 July; SAPA, 5 July 2012 SA Healthcare Cannot Become Great Overnight According to health economist Prof Di McIntyre, who is also a key NHI advisor to the Health Minister, the starting point of the NHI had to be at the service delivery side, even though more money was needed. An audit of all health facilities in the country is essential for successfully implementing the system. This includes the state of buildings, the need for more facilities, equipment, human resources and drug supply as well as an audit of the skills and qualifications of managers at facilities and providing additional training. The Office of Health Standards Compliance has been established to address and solve problems. McIntyre said the Green Paper did not address the funding of NHI as the Treasury had insisted on taking responsibility. However, it had already missed the April deadline. Source: The Cape Times, 6 July 2012 12 PAEDIATRIC NEWS

NATIONAL HEALTH INSURANCE (NHI) & PUBLIC HEALTH Time for fresh leaders at medicines council The Medicines Control Council s (MCC) purpose is to regulate the use of medicines based on their safety, efficacy and quality, says Nathan Geffen from the Centre for Social Science Research at UCT. However, its reputation for tardiness is legendary. A backlog of thousands of medicines is awaiting its consideration. The MCC s inability to convey useful information to the public is another problem. Its website is poor; and finding out if a particular medicine has been approved, and for what purpose, is very difficult. New legislation provides for a new regulatory authority to replace the MCC. Even with visionary leadership and excellent management, this transition will be hard to carry out successfully. The new Medicines and Related Substances Amendment Bill proposes that all people selling medical devices must be licensed. Manufacturers, wholesalers and distributors also have to hold licences. A new regulatory body, the SA Health Products Regulatory Authority (SAHPRA), which is scheduled to replace the Medicines Control Council (MCC), would be tasked with the licensing responsibilities. Source: Business Day, 12 July 2012 NEWS ON HIV/AIDS, TB, MALARIA & COMMUNICABLE DISEASES Over-the-counter HIV home testing kit; SA stops distribution of Bioline testing kits; ARV use to cut risk of infection; SA saves R5,2bn on ARVs; HIV rate in children plummets; Minister encouraged by public s attitude; Drug resistance emerging; Tentative step towards cure ; US to cut SA s funding for AIDS The US has authorised sales of over- Nowhere is the progress in the fight against AIDS more evident the-counter home than in Africa. Major behaviour testing kits for HIV. The OraQuick In-Home will change and the amazing expansion of life-giving AIDS treatment allow people to obtain a result within 20-40 breathed life and hope into a dying minutes. A positive continent. -David Wilson, World result did not mean a Bank s Global AIDS programme person was definitely director. (24th July) infected with HIV, but that an additional test should be done to confirm the result. A major breakthrough in the war against HIV/AIDS is the prescription of ARVs to high-risk individuals, to be taken a day before and a day after exposure. SA has stopped the distribution of SD Bioline HIV testing kits after reports that they were blacklisted and ruled unreliable by the World Health Organisation The US Food and Drug Administration (FDA) has approved the use of an ARV (tenofovir disproxil) by sexually active HIV-negative men and women to reduce the risk of HIV infection. The latest UNAIDS report revealed that SA saved $640 million (R5,2-bn) on the cost of ARVs since 2011 as the new tender process improved price transparency and boosted competition among suppliers. Meanwhile SA is preparing for a 50% or more cut to funding from the US government for HIV/AIDS programmes over the next five years. The cut is part of a broader shift by the Obama administration, which is scaling down its support for global HIV/AIDS programmes, including the US President s Emergency Plan for AIDS Relief (Pepfar). A spokesperson for Prefar said the best chance at not having the US be the predominant resource motor for HIV treatment and HIV/TB treatment on the planet was to bring others to put their resources to it. US researchers used the chemotherapy drug vorinostat to revive and so unmask latent HIV in the CD4+T cells of eight trial patients. The patients were also on antiretroviral drugs, which stops HIV from multiplying but have to be taken for life. HIV researcher Steven Deeks said the research provided the first evidence that a cure might one day be feasible. The number of children in the world infected with HIV decreased by 26% between 2009 and 2011. More than 90% of the 3,4-m children living with HIV are in sub-saharan Africa. According to the latest figures from the SA Medical Research Council, the mother-to-child transmission of HIV has decreased from 3,5% in 2010 to 2,7% in 2011. The increase in HIV-positive pregnant women with access to highly active antiretroviral therapy has also increased from 33% in 2010 to 43% in 2011. Health Minister Aaron Motsoaledi has welcomed the findings of the third National HIV Communication Survey, which showed South Africans were indeed changing their behaviour to reduce their likelihood of getting HIV as a result of the information they had received According to a study, published in The Lancet, resistance to AIDS drugs is growing in eastern and southern Africa. The mutations were found in strains of HIV-1 that made them There are now 1,7-m South Africans on treatment, making ours the biggest programme of its type in the world, which is quite a turnaround from the days of President Mbeki questioning whether HIV causes AIDS and former Health Minister Manto Tshabalala-Msimang insisting that ARVs were poisonous. Editorial Comment: Business Day, 26 July 2012 resistant to a class of drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs). These are first-option treatments for HIV infection and are also used to prevent transmission of the virus from a pregnant woman to her foetus. Source: The Citizen, 4 July; SAPA, 9, 24 July; Health-e News, 17, 18 July; Business Report, 20 July; The Star, 19 July; Business Day, 20, 25 July; AFP, 25 July 2012 PAEDIATRIC NEWS 13

NEWS ON HIV/AIDS, TB, MALARIA & COMMUNICABLE DISEASES Moulds Associated With Childhood Asthma Three types of mould commonly found in water-damaged homes are strongly linked to the development of asthma in children, a study suggests. US researchers found children were more than twice as likely to be diagnosed with asthma if all three moulds had been present in their homes during infancy. The study of almost 300 children, all of whom had at least one atopic parent, used DNA techniques to analyse 36 moulds from household dust samples collected when children were about eight months old. Children were then evaluated for asthma at age seven using spirometry. Mould had been previously linked to asthma exacerbations, and there was increasing evidence it was also involved in asthma development, according to the study authors. The results are...intriguing and provide impetus to correct residual water problems in the homes of especially high-risk infants, the researchers said. They noted that the three moulds, Aspergillus ochraceus, Aspergillus unguis and Penicillium variabile, were typically found in water-damaged homes. However, it is unclear how common they are in Australia. ProfAdam Jaffe, a paediatric respiratory physician at the University of NSW, said the study was interesting but parents should not be unduly alarmed. It shows an association between damp houses and this type of mould and asthma but it by no means shows definite proof [of causality]. He said parents could take a commonsense approach by clearing any household mould and addressing dampness. But on the basis of this, I wouldn t go and spend a fortune on fixing up your house. Source: Antonio Bradley, www.paediatricsupdate.com.au Specialists pan plans for proton therapy facility; battle for public sector patients with cancer Cancer specialists have poured cold water on the National Research Foundation s (NRF) ambitions to expand its proton therapy cancer treatment capacity at ithemba Labs in Faure, saying it is too costly and in the wrong place. The laboratory has the only proton therapy facility in the southern hemisphere, which is used for treating very small tumours in delicate areas such as the brain, spine and eye. More cancer news is that medicine stock-outs, broken machinery and poor hospital administration are hindering access to treatment that determines whether public sector patients live or die. Considering that SA had the largest health budget in Africa, this was deplorable, said the Cancer Alliance. Source: Business Day, 9 July ; Health-e News Service, 19 July 2012 New TB Drug Combo Could Cut Costs, Recovery A New TB drug combination could cure TB in record time (4 months) and cut treatment costs by 90%. The New Combination 1 (NC1) study at the University of Stellenbosch used two new drugs and one old TB drug in their trials. Their findings are published in the latest Lancet journal. Source: Health-e News Service, 23 July 2012 DOCTORS, NURSES, HOSPITALS & TRAINING Centralisation Of Control For State Hospitals More Foreign Nurses For SA The ANC commission on health policy decided that academic hospitals should be centrally controlled. This would also resolve the problem of referring patients across provincial borders, said Motsoaledi. 1 000 doctors would start training in Cuba later this year. It costs R1,7-m to train a doctor in SA, but a mere R700 000 to train a doctor in Cuba. The commission also recommended that a dedicated NHI fund be established; that the state be a major shareholder in a state-owned pharmacy; and that the primary training of nurses should take place in hospitals, not at universities. The SA Nursing Council and Africa Health Placements agreed to work together to bring more nurses to SA to solve the shortage of nurses, especially in rural areas - served by only 19% of the country s nurses. Source: Media Statement, 17 July; SAPA, 30 June 2012 14 PAEDIATRIC NEWS

NEW His mission: To grow, learn, play. Publicis Wellcare 9345 And avoid the sedative effect of antihistamines Convenient and beneficial for children suffering from SAR** and CIU # 1 Effective in the treatment of chronic idiopathic urticaria* and seasonal allergic rhinitis 1 Favourable tolerability and safety profile 1 Non-sedating 1 S2 42/5.7.1/0339 * in children from 6 months 11 years in children from 2 11 years ** Seasonal Allergic Rhinitis # Chronic Idiopathic Urticaria Suspension Reference: 1. Mansfield LE. Fexofenadine in paediatrics: oral tablets and suspension formulations. Expert Opin Pharmacother 2008;9(2):329-337. S2 TELFAST Suspension. Composition: Contains 6 mg fexofenadine hydrochloride per ml. A 5 ml dose will provide 30 mg of fexofenadine hydrochloride. Preservatives: Propylparaben 0,034 % m/v, butylparaben 0,017 % m/v and disodium edetate 0,150 % m/v. Contains sucrose and xylitol. Reg. No.: 42/5.7.1/0339. For full prescribing information, refer to the registered package insert. sanofi-aventis south africa (pty) ltd. 2 Bond Street, Midrand, South Africa. ZA.FEX.11.11.08

DOCTORS, NURSES, HOSPITALS & TRAINING Babies die due to a lack of facilities; doctors must choose who lives; ICU shock prompts probe plea Wits professor and head of paediatrics at Rahima Moosa Mother and Child Hospital, Prof Keith Bolton, says most government hospital ICUs catering for babies have only half the number of beds they need while private hospitals have ICU beds available all the time. He also said the shortage of ICU beds was largely due to a lack of nurses. Figures from the critical care audit showed that only 26,5% of nurses working in ICUs were trained in intensive care. A 2008 report by the National Perinatal Morbidity and Mortality Committee indicated that every year, about 23 000 newborn babies die in SA, with an additional estimated 20 000 stillbirths. Prof Vic Davies, head of the paediatric intensive care and neonatal unit at Charlotte Maxeke, said one or two children, or infants, are turned away daily from ICUs at the hospital. Paediatricians say 80% of ICUs are dedicated to adults. Meanwhile the Public Protector is investigating the DoH for the shocking treatment of babies and children in its public hospitals. This follows reports on the shortage of beds for critically ill children in ICUs as doctors at several hospitals were forced to play God daily in deciding which children got a bed in an ICU and which were sent to a general ward. A report by SA Institute of Race Relations indicates that there were 1 469 maternal deaths in SA in 2010, while 68 736 pregnancies were terminated in 2010, a decrease from 77 207 in 2009. Source: The Saturday Star, 30 June; The Times, 9, 12 July; Business Day, 16 July The Star, 27 July 2012 Breast milk link to nut allergies Results of a study by the Australian National University, published in the International Journal of Pediatrics, have shown that children who are solely breast-fed in the first six months of life are at increased risk of developing a nut allergy. Parents of more than 15,000 children at 110 schools in Australian Capital Territory were asked to report if their child had a nut allergy, Doctors lose patience as suits spike; doctors are sick and tired A research paper by Prof Michael Pepper of the University of Pretoria s department of immunology, published in SA Journal of Bioethics and Law, reveals that South Africans are fast becoming like Americans when it comes to suing their doctors. In a letter to members last year, the Medical Protection Society, a malpractice insurance and on feeding habits in the first six months of life. The study found the risk of developing a nut allergy was one-and-a-half times higher in children who were only breast-fed in their first six months. But children fed food and fluids other than breast milk were protected against nut allergies. company, said there had been a staggering 550% increase in claims in the previous 10 years. Claims of more than R5-m had increased by 900%, with a number of claims topping the R30-million mark. Obstetricians are most often sued, next are neurosurgeons and spinal surgeons. Contributing to the phenomenon is the new Consumer Protection Act, which brought with it additional liability for doctors. In terms of the act, doctors are liable even for faulty equipment they have no control over. Pepper believes litigation can be avoided if an alternative health dispute resolution Our results contribute to the argument that breast feeding alone does not appear to be protective against nut allergy in children - it may, in fact, be causative of allergy, said study author Marjan Kljakovic when commenting on the findings. Despite breast feeding being recommended as the sole source of nutrition in the first six months of life, an increasing number of studies have implicated breast feeding as a cause of the increasing trend in nut allergy. Peanut allergy accounts for two-thirds of all fatal food-induced allergic reactions, added Kljakovic, a professor at the university s medical school. It is important for us to understand how feeding practices might be playing a part. Source: www.bizcommunity.co.za, 13 July 2012 mechanism is found, and malpractice payouts are capped, as they are in 30 US states. He warned that a consequence of litigation could be defensive medicine - a tendency for doctors to insist on costly diagnostic tests. Although doctors who work for the state are not held personally liable under SA law, claims are instead brought against the DoH. Here, too, the number and quantity of the claims have increased remarkably. Source: City Press, 8 July; The Sunday Times, 22 July 2012 Mismanagement Blamed For Departing Doctors; Discovery Looks To Train More Specialists Universal healthcare coverage in SA is threatened by the rate of the brain drain among doctors, according to Econex director Cobus Venter. He said SA had enough financial capacity to sustain its doctors, while importing foreign doctors was costing the country more. Doctors left because of uncertainty and poor working conditions and not because of financial reasons. Like Dr Motsoaledi, he also ascribed the problem to management rather than a lack of money. Practitioners registered with HPCSA fell from 168 160 last year to 165 371 by the end of March. Meanwhile the Discovery Foundation is considering increasing the funds it awards for the training of medical specialists to help the country deal with a shortage of health professionals. The company committed R150-m in 2006 to train 300 specialists over 10 years. Source: Business Report, 4, 27July 2012 16 PAEDIATRIC NEWS

Eastern Cape Health Not In Crisis; Doctors In Trouble; Staff Shortage Plea Disputed The Eastern Cape health department has denied claims that it is unable to maintain medical equipment at state hospitals in the province. Meanwhile it has been reported that EC health authorities have acted against three doctors who allegedly spoke about the poor state of hospital infrastructure in the province without permission. SA Medical Association said the association fully supported their actions. Meanwhile the head of the EC s health department, Siva Pillay, said the personnel budget had a R800-m shortage. Doctors had legitimate concerns, but the way they had raised it, had been inappropriate, he said. Health Minister Aaron Motsoaledi said at SAMA s annual conference that he had received conflicting reports about the staffing crisis in the EC. He said the issue was less about money than it was about management. Source: SAPA, 30 June, 2 July; Business Day, 6 June 2012 DOCTORS, NURSES, HOSPITALS & TRAINING Gauteng health department settles debt Gauteng s MEC Ntombi Mekgwe, said the health department had paid its debts up to March this year. A plan - that included cost containment measures of R1,6-m. - was put in place. The department would also review existing contracts and tenders, address fraud and corruption, and establish an office for ethics and discipline. Source: SAPA, 7 July 2012 MEDICAL AIDS Medical schemes in SA doubt the success of government s ambitious NHI and believe the provision of healthcare in the country is deteriorating. A PriceWaterhouseCoopers (PwC) survey, titled Strategic and Emerging Issues in the Medical Scheme Industry, shows that schemes believe the NHI alone is not the solution to SA s healthcare problems. The demarcation between health insurance and medical scheme cover and new regulations from the Council for Medical Schemes (CMS), also resulted in negativity. Respondents believed better working conditions and an overhaul of basic resources were needed before NHI could be implemented. Although the majority of them believed that NHI would increase access to healthcare for previously disadvantaged people, they did not foresee it reducing the cost, or resulting in the better use of funds allocated to healthcare. 95% said PMBs paid in full, resulted in excessive benefits being paid by medical schemes to the detriment of members. Schemes also cited managing data and data quality as major technology weaknesses. Most of the respondents think the pending Medical Schemes Amendment Bill will only cause a further regulatory burden. Source: Business Report,4 July; BusinessLIVE, 4 July 2012 DOCTORS FEES NOT UNREASONABLE, SAYS SAPPF The South African Private Practitioner Forum (SAPPF) is dismayed to see the BHF blaming the providers for escalating private medical costs (The Star; Business Report; 5 July, 2012). These allegations are never substantiated by facts, and never include any discussion about the validity of schemes own reimbursement tariff schedules, nor of the impact of medical schemes administration costs on the overall cost of private medical services, says Dr. Chris Archer, CEO of the SAPPF. In most cases the administration and managed care costs of schemes exceed the fees paid to surgical and consulting specialists. SAPPF, together with the private hospitals and emer- gency services, took the DoH to court over their failure to adhere to regulations which should have seen medical scheme benefit tariffs based on provider input costs. In his judgement, Acting Judge Ebersohn reiterated, that professional fees were undervalued. Furthermore the calculations provided by SAPPF consultants HealthMan, (based on extensive surveys of professional practices and submitted to the DoH) suggested that professional fees in some instances required as much as a threefold increase, to enable the recovery of costs and the payment of a salary based on that of a senior consultant in the public service. A study to assess the impact of inflation on benefits revealed that medical scheme benefit should be twice what it currently is for consultation services, and three times its current level for procedures. An independent tariff commission should establish a realistic benchmark, and look into the PMB issue, said Archer. Source: SAPPF Press Release, 10 July 2012 PAEDIATRIC NEWS 17

MEDICAL AIDS Helping Identify One-Year-Olds At Risk For Autism A group of American researchers has found that 31% of children identified as at risk for autism spectrum disorders (ASD) at 12 months received a confirmed diagnosis of ASD by age three years. In addition, 85% of the children found to be at risk for ASD based on results from the First Year Inventory (FYI), a 63-item questionnaire filled out by their parents, had some other developmental disability or concern by age three. The findings were published in Autism: The International Journal of Research & Practice. These results indicate that an overwhelming majority of children who screen positive on the FYI indeed experience some delay in development by age 3 that may warrant early intervention, said Grace Baranek, PhD, Programme for Early Autism, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Identification of children at risk for ASD at 12 months could provide a substantial number of children and their families with access to intervention services months or years before they would otherwise receive a traditional diagnosis, said lead author Lauren Turner- Brown, PhD, Carolina Institute for Developmental Disabilities, Chapel Hill, North Carolina. In the study, parents of 699 children who had completed the FYI when their child was 12 months completed additional screening questionnaires when their child reached age 3. In addition, children who were found to be at risk for ASD based on these measures were invited for in-person diagnostic evaluations. These findings are encouraging and suggest promise in the approach of using parent report of infant behaviours as a tool for identifying 12-month-olds who are at risk for an eventual diagnosis of ASD, said Dr. Turner-Brown. Source: www.pslgroup.com, July 13, 2012 Medical Schemes Welcome Planned Probe Into Costs All but one of 20 medical schemes surveyed by PwC welcome the Competition Commission s proposed investigation into private healthcare costs. The study highlighted healthcare costs as the most pressing concern facing their businesses. Respondents said medical inflation, which was higher than CPI (consumer price index) made healthcare unaffordable. Dr Motsoaledi has said he is intent on regulating private healthcare sector prices to contain Paediatricians Doubt Their Role Obesity Care An Australian study has revealed that only one in five paediatricians feels they can make a difference to an obese child s weight. While most felt confident discussing and assessing obesity, only 18% of paediatricians surveyed were quite confident of actually making a difference. And only two percent were very confident, according to the online survey, which included 166 paediatricians from across Australia. Our data are consistent with qualitative primary care studies showing that clinicians view childhood obesity as an important health issue, yet often feel frustrated and ineffectual, said the researchers, led by Professor Melissa Wake from the Royal Children s Hospital in Melbourne. Contributing factors include patient and family variables, for example, lack of perception of weight as a problem, lack of motivation and difficulty with compliance, a lack of support services and options for referral; the sense that clinicians need to be part of a broader systemic effort to tackle obesity, and the rather low efficacy of clinical intervention in randomised trials. costs and provide certainty to funders - including medical schemes and the state. The government believes the two-tiered healthcare system in SA is not sustainable. However, 60% of the respondents said SA s system was sustainable, although they acknowledged deterioration in healthcare. Primary healthcare had to be revived and pharmaceutical distribution for state-owned facilities should be decentralised. PwC cited regulations and excessive interference by the Council for Medical Schemes as the main challenges facing the industry. Source: Business Day, 4 July 2012 The study also found important gaps in the training received by paediatricians: while 53% had been trained in assessing the complications of obesity, only 37% were trained in managing them. And only 20% knew specific techniques such as motivational interviewing, or teaching behavioural modification. The researchers said the solution to the childhood obesity problem was not clear, since simply giving doctors more training was unlikely to work in isolation. One option was to develop specific algorithms and tool kits for use in consultations, while another was to create new, shared-care models for managing obesity, they said. A third (and not necessarily exclusive) option is to argue that public health measures, rather than physician-directed management, may be the best long-term investment to address the problem of paediatric obesity itself, Professor Wake and colleagues said. Under this scenario, paediatrician training and research would focus on comorbidities that could benefit from skilled medical management (e.g. insulin resistance, obesity-related hypertension), rather than concerted efforts to boost paediatricians role in weight management and lifestyle guidance. Source: David Brill, www.paediatricsupdate.com.au, 26 July 2012 18 PAEDIATRIC NEWS

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MEDICAL AIDS Smart Medicines, Technology Becoming Unaffordable; BHF Lays High Costs At Door Of Provider of new technology that gets funded was paid for by medical schemes and whatever was paid for had to be 100% funded by members, says Dr Jonathan Broomberg, of Discovery Health. This applies not only to super drugs - specialised drugs developed through biological origins, known as biologics - but also new medical procedures, such as keyhole surgery. According to Broomberg, Discovery did not believe that there was a specific need for the Competition Commission to investigate costs, as high costs were generally not a result of collusion between suppliers. Other medical schemes have also warned that contribution rate increases might be worse this year in areas that drove costs in previous years because of the Regulation 8 payment issue. The BHF, which represents about 95% of the schemes, but not Discovery Health, said the high costs of specialists and hospital procedures, and an increase in charging above-scheme rates for PMB s is a combination which will have a severe impact on costs and affordability to schemes and their members. Source: The Star, 19 July; Business Report, 5, 18 July 2012 MEDICLINIC RESPONDS TO CLAIMS BY BHF Mediclinic reacted to an article in Business Report, 5 July, 2012: BHF lays high costs at the door of providers. Mediclinic said it annually negotiates prices with every medical scheme in the country individually and is bound by contract to abide by these fees. Research conducted by MCSA s Health Policy Unit indicates that more medical scheme members are in fact using private hospital services more often than previously, said MCSA CEO, Koert Pretorius. Mediclinic believes that it is critically important to conduct proper research into understanding the dynamics that have resulted in the pattern of cost increases in the private sector. Source: Media Statement: Mediclinic, 9 July 2012 CHALLENGE ON LATE JOINER FEES; SCHEMES DISCRIMINATION CHALLENGED; WARNING AGAINST INTERFERENCE The CMS has requested an urgent meeting with the National Consumer Commission (NCC) after the watchdog called schemes sexist and discriminative. The NCC is taking Fedhealth, Momentum, Medshield and Bonitas (Medscheme s and Bonitas administrator) to the Equality Court for contravening provisions of the Consumer Protection Act. The commission is challenging late joiner penalty fees for people who join schemes after the age of 36 and waiting periods imposed before members get full benefits. The NCC is also challenging them on discriminatory clauses that technically exclude women who fall pregnant before they join the schemes from benefiting from the medical aid, saying it unconstitutional. The medical schemes had clauses stipulating a three-month general waiting period when someone joined and a condition-specified waiting period of up to 12 months Neil Kirby director of healthcare and life sciences law at Werksmans Attorneys says caution should be taken not to interfere too much in the business of medical schemes. The interests of consumers were well protected in the Medical Schemes Act, while the Consumer Protection Act could not do a better job. Health economist, Prof Alex van den Heever described the application as completely absurd. He said he did not understand why the NCC did not discuss its concerns with the medical schemes. Source: Business Report, 23, 24 July; Business Day, 13 July; Sunday Independent, 15 July; FinMail, 27 July 20 PAEDIATRIC NEWS

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MEDICAL AIDS Higher Reading, Maths Scores Among Fitter Boys And Girls Findings presented at the American Psychological Association s recent 120th Annual Convention have revealed that having a healthy heart and lungs may be one of the most important factors for middle school students to make good grades in maths and reading. Cardiorespiratory fitness was the only factor that we consistently found to have an impact on both boys and girls grades on reading and math tests, said study co-author Trent A. Petrie, PhD, professor of psychology and director of the Center for Sport Psychology at the University of North Texas. This provides more evidence that schools need to re-examine any policies that have limited students involvement in physical education classes. The researchers gathered data at five Texas middle schools from 1,211 students, of whom 54 percent were female with an average age of about 12. Overall, the group was 57 percent white. Among the boys, the breakdown was 57.2 percent white, 24.2 percent Mexican-American, 9.1 percent African American, 1.1 percent Asian-American and 1.2 percent American Indian. For the girls, 58.6 percent were white, 23.4 percent were Mexican-American, 9.2 percent were African-American, 2.3 percent Asian-American and 0.6 percent were American Indian. While previous studies have found links between being physically fit and improved academic performance, this study also examined several other potential influences, including self-esteem and social support. It also took into account the students socioeconomic status and their self-reported academic ability, Petrie said. In addition to cardiorespiratory fitness, social support was related to better reading scores among boys, according to the study. It defined social support as reliable help from family and friends to solve problems or deal with emotions. For girls, having a larger body mass index was the only factor other than cardiorespiratory fitness that predicted better reading scores. For boys and girls, cardiorespiratory fitness was the only factor related to their performance on the math tests. The finding that a larger body mass index for girls was related to better performance on the reading exam may seem counterintuitive, however past studies have found being overweight was not as important for understanding boys and girls performances on tests as was their level of physical fitness, Petrie said. From one to five months before the students were to take annual standardized reading and math tests, they answered questions about their level of physical activity, and how they viewed their academic ability, selfesteem and social support. The school district provided information on the students socioeconomic status and reading and math scores at the end of the year. To determine students physical fitness, the researchers worked with physical education teachers to administer a fitness assessment programme widely used in U.S. schools. The programme includes a variety of tests to assess aerobic capacity, muscular strength, muscular endurance, flexibility and body composition. The assessment provides an objective measure of cardiorespiratory fitness through the Progressive Aerobic Cardiovascular Endurance Run, or PACER, and body composition through measuring BMI, the study said. Because this is a longitudinal study, these variables can now be considered risk factors in relation to middle school students performance on math and reading examinations, Petrie said. And that is essential to developing effective programmes to support academic success. Source: www.medicalnewstoday.com, 6 August 2102 Discovery members urge probe into fees; Putting medical schemes on notice; Discovery defends administration fees; Member activism a sign of things to come The activism displayed by members of Discovery Health Medical Scheme (DHMS), when they called for a review of fees paid to administrator Discovery Health, may be a sign of things to come for the health industry, says health economist Alex van den Heever. Blum Khan, CEO of Metropolitan Health, also agreed that consumer activism was the order of the day. Members resolved that the scheme s trustees actively seek to reduce administration fees over the next three years. They asked for a detailed breakdown of the R2,8-bn spent on administration last year, instructed the trustees to commission an independent review of the value for money provided by the administrator, and moved that the potential benefits of regularly placing the administration and managed care contracts of the scheme out for tender in the open market be investigated. DHMS is the biggest open medical scheme on the market, with 2,35- m members last year, and is administered by SA s second-biggest administrator, Discovery Health, a subsidiary of JSE-listed Discovery Holdings. Discovery Health received R3,2-bn in administration and managed care fees from DHMS for the year ended June 30 last year, and R217-m from the other 13 restricted schemes it services. DHMS contributed more than 90% of the administrator s R1,4-bn operating profit. The council s annual report shows DHMS administration fees per beneficiary were the second highest in the country, at R102 per beneficiary per month. But Broomberg argues this is a misleading measure as the industry does not use a standard definition of administration fees. A more accurate yardstick, he says, is the ratio of total non-healthcare expenditure to gross contribution income, which shows DHMS is paying competitive rates. Source: Business Day, 10, 11, 13 July; Editorial Comment; SAPA, 10 July 2012 22 PAEDIATRIC NEWS

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MEDICAL AIDS Pay more for less benefit? The remuneration of medical scheme trustees has risen by as much as 50% in the past financial year. In its annual report last year, the CMS listed the 10 medical schemes that paid the highest trustee compensation. On the list were Liberty Medical Scheme, Spectramed, Medshield, Fedhealth, Bonitas and the Government Employees Medical Scheme (Gems). Source: City Press, 22 July 2012 Medical Aid Policies To Be Reviewed; Medical Aids Fail To Keep Fraud In Check; Clampdown On Fraud According to a KPMG study, code manipulation and claiming for services not given accounted for 76,2% of fraud committed by service providers in the healthcare industry. The report stated collusion between member and service provider was a primary cause for fraud, followed by member apathy, ignorance, and a lenient approach by regulatory bodies. There needs to be a stringent regulatory framework to clamp down on dishonest hospitals, members and medical practitioners, said The Sunday Independent in its Editorial Comment. * Meanwhile Michelle David, a medical scheme specialist at law firm Eversheds, said medical aid fraud amounts to about R15-bn annually; much higher than the estimated R4-bn to R5-bn. She said only a few schemes took part in surveys to determine the extent of fraud. David said a positive element of the NHI plan was that it would be one bank of information preventing the manipulation of information by schemes. By law, medical schemes are not allowed to make a profit, and all money collected from their members should go towards paying claims and administering those claims. In the private sector, healthcare providers are unregulated as far as pricing is concerned. In a 2010 article for Equinet Prof Di Mcintyre of UCT, writes doctors often had a stake in the financial performance of some hospitals through share ownership or other forms of financial relationship. This might encourage higher levels of hospitalisation, longer periods of admission and greater use of expensive diagnostic technology provided in hospitals. Source: Health-e News Service WHY BESTMED LEFT SANLAM Bestmed Medical Scheme expects significant cost savings after reverting back to self-administration after ending its external administration by Sanlam Health (SMH). Bestmed CEO and principal officer Dries la Grange said cost savings and a switch back to its Medware IT system influenced the decision to part with SMH. Bestmed joins six other SA medical schemes that are self-administered and open. Source: The Financial Mail, 20 July 2012 Source: Editorial Comment: The Sunday Independent, 15 July; Business Day, 23 July; Fin24.com, 26 July 2012 Poor Lung Function Associated With Vitamin D Deficiency In Asthmatic Children Vitamin D deficiency is associated with poorer lung function in children with asthma treated with inhaled corticosteroids, a study published in the American Journal of Respiratory and Critical Care Medicine has noted. In our study of 1,024 children with mild to moderate persistent asthma, those who were deficient in vitamin D levels showed less improvement in pre-bronchodilator forced expiratory volume in 1 second after 1 year of treatment with inhaled corticosteroids than children with sufficient levels of vitamin D, said Ann Chen Wu, MD, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts. These results indicate that vitamin D supplementation may enhance the anti-inflammatory properties of corticosteroids in patients with asthma. The study was conducted using data from the Childhood Asthma Management Programme, a multicentre trial of children with asthma aged 5 to 12 years who were randomly assigned to treatment with budesonide, nedocromil or placebo. Vitamin D levels were categorised as deficient ( 20 ng/ml), insufficient (20-30 ng/ml), or sufficient (>30 ng/ml). Among children treated with inhaled corticosteroids, pre-bronchodilator forced expiratory volume in 1 second (FEV1) increased during 12 months of treatment by 24 PAEDIATRIC NEWS Continued on page 26

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MEDICAL AIDS 330 ml in the vitamin D insufficiency group and 290 ml in the vitamin D sufficiency group, but only 140 ml in the vitamin D deficient group. Compared with children who were vitamin D sufficient or insufficient, children who were vitamin D deficient were more likely to be older, be African American, and have a higher body mass index (BMI). Compared with being vitamin D deficient, being vitamin D sufficient or insufficient was associated with a greater change in pre-bronchodilator FEV1over 12 months of treatment after adjustment for age, gender, race, BMI, history of emergency department visits, and season that the vitamin D specimen was drawn. The study had some limitations, including a small sample size of 101 vitamin D deficient children, and the investigators only studied vitamin D levels at 1 time point. Our study is the first to suggest that vitamin D sufficiency in asthmatic children treated with inhaled corticosteroids is associated with improved lung function, said Dr. Wu. Accordingly, vitamin D levels should be monitored in patients with persistent asthma being treated with inhaled corticosteroids. If vitamin D levels are low, supplementation with vitamin D should be considered. Source: www.pslgroup.com, 13 July 2012 PHARMACEUTICALS INFERIOR MEDICINES POSE A MAJOR HEALTH RISK Up to 15% of all drugs tested in African cities and 7% in Indian cities failed basic quality testing, says Roger Bate, author of Phake: The Deadly World of Falsified and Substandard Medicines. A study of malaria drugs found up to 40% of those bought in the two largest West African cities had insufficient active ingredient. If a drug is not made to the highest standards, patients are unlikely to recover and it increases the chance of malaria parasites or TB bacteria developing resistance to the treatment. Some of the drugs might be counterfeits, but many were made by local African, Indian or Chinese companies without the proper oversight of a government drug regulatory authority. Nearly 18% of the WHO-approved Chinese products did not reach required standards. In April, the Indian drug regulator was heavily criticised by the Indian parliament for colluding with drug manufacturers. Source: Business Day, 10 July 2012 India s generic medicine plan a blow to Big Pharma India has put in place a $5,4-bn policy to provide free medicine to its people. The new policy could provide 52% of the population with free drugs by 2017. This is a major disadvantage for global pharmaceuticals like Pfizer, GlaxoSmithKline, Merck and US-based Abbott Laboratories, as they target big growth for branded medicine in emerging economies such as India, where generics account for about 90% of drug sales. Source: Reuters via Business Day, 6 June 2012 Patents on third-line ARVs make prices unaffordable The protection under patents of the newest HIV drugs - thirdline treatments for people who have developed drug resistance - was making ARV treatment unaffordable for middleand low-income countries. Countries in sub-saharan Africa were paying nearly 15 times the price of a first-line treatment, according a report released by Médecins sans Frontières (MSF). The report was titled shows that a drug combination for third-line treatment would cost $2 486 (R20 266) a person a year in the leastdeveloped countries globally and in sub-saharan Africa. Some 80% of all ARVs used in Africa are from India. Source: Business Report, 30 July 2012 26 PAEDIATRIC NEWS

PAEDIATRIC NEWS 27

PHARMACEUTICALS SA urged to follow India on medicines; drug patent war threatens SA healthcare SA s medicine patent laws need strengthening as pharmaceutical firms are evergreening old medicine, thus preventing access to cheaper drugs. When the US granted a patent, SA automatically granted it. Companies often register new patents for old drugs to which minor changes have been made. This allows companies to extend the period in which they can hold a monopoly on a drug. MacDonald Netshitenzhe, chief director of policy and legislation at the Department of Trade and Industry, said a draft policy on intellectual property will soon be available for public comment. According to Treatment Action Campaign (TAC) data, 204 new medicine patents were issued in Brazil between 2003 and 2008 in comparison to SA, where 2 400 patents were issued in one year and about 2 000 of those went to companies from the US and EU. India only grants patents when a drug firm has a new molecule. However, the court battle between pharmaceuticals giant Novartis and the Indian government, could set a dangerous precedent that will impede local access to affordable drugs. SA healthcare NGOs, supported by doctors, lawyers and academics, warned about the impact the lawsuit may have on access to healthcare in SA. Victory for the Novartis case could endanger the supply of cheap generic drugs to developing countries. Novartis has challenged Indian legislation, blocking its application to patent the leukaemia drug Gleevec. Source: Business Report, 12 July; The Mail & Guardian, 13 July 2012 EGG POWDER POSSIBLE CURE FOR ALLERGY Allergies to egg in children can be cured in around a quarter of cases by small daily doses of egg-white powder, a study of children aged five to 11 has found. In the investigation, 28% were able to eat a whole cooked egg without clinical symptoms within two years of beginning oral immunotherapy. And three years after beginning treatment, these children could still eat eggs whenever they pleased, without any adverse events. Oral immunotherapy consisted of eating daily egg white powder, building-up to a maintenance dose of 2g per day (equivalent to around one third of an egg). Oral immunotherapy...represents a highly promising therapeutic intervention for food allergy, researchers wrote Thursday in the New England Journal of Medicine. Currently, children with allergies are advised to avoid eggs outright, but this was challenging and placed a strain on families, they said. The randomised, placebo-controlled trial involved 55 children 40 of whom received immunotherapy. Thirty children (75%) who received immunotherapy could eat 10g of egg-white powder at 22 months without significant symptoms, although only 11 could tolerate a whole egg in a food challenge two months later. This suggested a majority of children had built up at least partial protection against accidental egg exposure, the researchers said. About 15% of the children did not complete treatment due to allergic reactions, although none were classed as severe. Associate Prof Katie Allen, a paediatric allergist at the University of Melbourne, said the study was an exciting first step. It s the first tentative step showing with controlled evidence that immunotherapy has a future, she told Paediatrics Update s sister publication, Australian Doctor. The limitations of the study were its small size, and the fact that some of the children included might have naturally outgrown their allergies, she said. The fact that it is egg is interesting, but most kids grow out of egg allergies. We would want to see this type of study replicated in other food allergens. The study was conducted at five paediatrics departments in the US. Source: Antonio Bradley, www.paediatricsupdate.com.au, 26 July, 2012 28 PAEDIATRIC NEWS

Looking for a performance?...from your ADHD patient 10 /10 ALLOW ADHD CHILDREN TO PERFORM AT THEIR BEST. Rapid onset of action 1 Effective control of ADHD for the school day 2 Improvement of the core symptoms of ADHD 1 Well tolerated 1 RitalinLA 10 Unleashing potential References: 1. Lyseng-Williamson KA, Keating GM. Extended-release Methylphenidate. Drugs 2002;62(15):2251-225. 2. Lopez F, Silva R, Pestreich R, Muniz R. Comparative Efficacy of Two Once Daily Methylphenidate Formulations (Ritalin LATM and Concerta ) and Placebo in Children with Attention Deficit Hyperactivity Disorder Across the School Day. Pediatr Drugs 2003;5(8):545-555. Scheduling status S6 Registration numbers: RITALIN 10 B/1.2/1610. RITALIN LA 10: 44/1.2/0594. RITALIN LA 20: 36/1.2/0186. RITALIN LA 30: 36/1.2/0187. RITALIN LA 40: 36/1.2/0188. Pharmacological classification: A 1.2 Psychoanaleptics (antidepressants). Composition: Tablets containing 10 mg methylphenidate hydrochloride. Modified-release capsules (Ritalin LA) containing 10 mg, 20 mg, 30 mg, 40 mg methylphenidate hydrochloride. Indications: Attention-deficit/hyperactivity disorder (ADHD); narcolepsy (Ritalin 10 tablets only). Dosage: Individual. Maximum daily dose is 60 mg. For children, start with 5 mg once or twice daily and increase in increments of 5-10 mg weekly. For adults the usual daily dose is 20-30 mg. Ritalin LA is for once daily administration. Contraindications: Anxiety and tension states, agitation, tics, tics in siblings, diagnosis or family history of Tourette s syndrome, glaucoma, hyperthyroidism, cardiac arrhythmias, severe angina pectoris, known hypersensitivity to methylphenidate. Precautions/Warnings: In psychotic patients Ritalin may exacerbate behavioural disturbance and thought disorder. It should not to be used to treat severe depression. Chronic abuse can lead to marked tolerance and psychological dependence. Caution in patients with epilepsy or hypertension. Monitor blood count during long-term treatment. Careful supervision during withdrawal. Caution if combined with pressor agents, MAO inhibitors, anticoagulants, anticonvulsants, tricyclic antidepressants, phenylbutazone or guanethidine. Not recommended for children under 6 years of age. Avoid use during pregnancy or breastfeeding. Caution in road traffic/machinery use. Adverse reactions: Very common: nervousness, insomnia, decreased appetite. Common: rash, arrhythmias. Rare: blurred vision, angina pectoris, moderately reduced weight gain and slight growth retardation in children. Very rare: abnormal liver function, cerebral arteritis; blood dyscrasias, thrombocytopenic purpura, exfoliative dermatitis, erythema multiforme, choreoathetoid movements, tics, convulsions, toxic psychosis, hallucinations. Note: Before prescribing please read detailed product information. Novartis South Africa (Pty) Ltd. 72/74 Steel Road, Spartan, Kempton Park, 1619. P.O. Box 92, Isando, 1600. Tel. +27 (11) 929 9111. Fax: +27 (11) 929 2232. Reg. No.: 1946/020671/07. www.novartis.co.za. Customer Support Line 0861 929 929. ZA1208047076/07/2012

PHARMACEUTICALS GSK warns of fake batches of Grandpa headache powders Two batches of Grandpa headache powder have been recalled after manufacturer GlaxoSmithKline (GSK) sent out a warning about counterfeited headache powder being sold to consumers. The group said it was not recalling all the Grand-Pa headache powders, only the cartons of 38-count packages bearing the batch numbers 309339 and 314020. The first batch was released in September 2011 and the second batch in March this year. Source: Business Report, 27 July 2012 No brown envelopes The DoH has issued a notice on proposed amendments to the regulations relating to transparent pricing under the Medicines & Related Substances Act. This implies that from September, companies and individuals involved in underhanded pharmaceutical sales practices could face criminal prosecution. The legislative amendments support the Marketing Code Authority, a voluntary membership watchdog representing nine pharmaceutical and medical device industry organisations. Source: The Financial Mail, 27 July 2012 Better growth seen for branded generic drugs Branded generic medicines (generics marketed under company brand names) are gaining momentum over unbranded and cheaper generics, as brand awareness rises among African consumers. Tinotenda Sachikonye, a healthcare analyst at Frost & Sullivan, said unbranded generics were perceived as low quality by consumers, and companies producing and distributing branded generics would see the most growth. The biggest players in the branded generics sector include the likes of UK-based GlaxoSmithKline. Source: Business Report, 27 July 2012 FINANCIAL NEWS Adcock offers voluntary lay-offs; retrenchments a clear sign all is not well with the economy Adcock Ingram with an estimated staff of 2 000 people in SA, offered a retrenchment package to workers who wished to volunteer. Adcock has had a tough trading period since the withdrawal by the MCC last year of painkillers containing dextropropoxyphene and the loss of an ARV tender worth more than R660-m over two years. Source: Business Day, 3 July 2012 Liberty Medical Scheme rated AA- Liberty Medical Scheme s (LMS) claims paying ability has once again earned the scheme an AArating from Global Credit Rating (GCR), reaffirming its position among the top-performing SA schemes. Source: BusinessLIVE, 10 July 2012 Litha completes Pharmaplan deal Litha Healthcare announced it has concluded its acquisition of Pharmaplan for R590-m. Private equity firm Blackstar said it had halved its stake in Litha to 13,42%. Canadian pharmaceutical group Paladin Labs, bought the shares, which has raised its stake in Litha to 44,52%. Source: Business Day, 4 July 2012 Life Healthcare outpaces rivals Life Healthcare has beaten expectations on its listing in 2010, outpacing rivals Netcare and Mediclinic - largely because it is less encumbered offshore. Netcare spent some R20-bn in buying the General Hospital Group and Mediclinic, nearly as much on its Swiss and Middle Eastern acquisitions. Life recently reported interim earnings up 21%. It recently purchased a minority stake in nine hospitals in India for some R800-m. The difference between Life and the others is that they opted to go into First World situations, where the South Africans ability to add value is limited, says CEO Mike Flemming. Source: Moneyweb via The Citizen, 20 July 2012 30 PAEDIATRIC NEWS

The Trusted IV Immunoglobulin. South Africa s own IVIG Indications Replacement therapy in primary antibody deficiency syndromes Children with congenital AIDS and recurrent infections For immunomodulation in: - Idiopathic Thrombocytopenic Purpura (ITP) - Kawasaki Disease - Guillain Barré Syndrome Allogeneic bone marrow transplantation Available in 4 strengths Polygam 1 g, Polygam 3 g, Polygam 6 g and Polygam 12 g Room temperature storage (below 25 C) Specialised Information Centre: 031 714 6700 (office hours) or 082 895 0056 / 082 870 3705 (after hours) info@nbisa.org.za S4 POLYGAM 1 g, 3 g, 6 g, 12 g (Lyophilised powder for IV infusion). COMPOSITION: 2% (Polygam 1 g) and 3% (Polygam 3 g, 6 g, 12 g) polyvalent human normal immunoglobulin after reconstitution with sodium chloride 0,9% m/v, stabilised with sucrose. REGISTRATION NUMBERS: Polygam 1 g: Z/30.2/367. Polygam 3 g: Z/30.2/368. Polygam 6 g: Z/30.2/369. Polygam 12 g: 29/30.2/511. For full prescribing information refer to the package insert approved by the medicines regulatory authority Company Reg. No. 1994/002044/08. NPO Reg. No. 020-898-NPO. 10 Eden Road, Pinetown, 3610 Private Bag X9043, Pinetown, 3600 Telephone: 031 714 6700 Fax: 031 708 5614 www.nbi-kzn.org.za info@nbisa.org.za 08/12

FINANCIAL NEWS GlaxoSmithKline settles healthcare fraud case GlaxoSmithKline has agreed to plead guilty and pay $3 -bn to settle the largest case of healthcare fraud in US history. The settlement includes $1-bn in criminal fines and $2-bn in civil fines in connection with the sale of the drug company s Paxil, Wellbutrin and Avandia products. The company also agreed to stricter oversight of its sales force by the government to prevent the use of kickbacks or other prohibited practices. ADCOCK BUYS BRANDS OF INDIAN FIRM JSE-listed drug maker Adcock Ingram has acquired the brands of Indian pharmaceutical company Cosme Farma Laboratories for R708-m. It expects the move to enable it to tap into India s rapidly growing private sector pharmaceutical market. Cosme Farma has access to more than 150 000 doctors and distribution capacity in 27 states. Its products include gynaecological, gastro-intestinal and skin medications. Source: Business Day, 11 July 2012 Source: Reuters, 2 July 2012 GENERAL NEWS Smoking draft excessive; draft smoking regulations unconstitutional The draft regulations on smoking in public places and certain outdoor public places are too restrictive, says Tobacco Institute of Southern Africa (Tisa). Tisa has submitted comments to the DoH highlighting certain concerns. Tisa also felt that Health Minister Dr Aaron Motsoaledi had acted beyond his powers. Meanwhile the Law Review Project (LRP) - an independent legal policy institute - said the draft regulations amounted to a direct violation of the constitutional requirement of separation of powers between the executive, legislative and judicial authority. Spokesman, Tebogo Sewapa said they were a draconian intervention against the rights of smokers. Smoking was a vice, not a crime, he said. Source: SAPA-AFP, 2 July; The Cape Times, 12 July 2012 Ascendis Health expands Africa footprint Coast 2 Coast Investments has announced that its healthcare subsidiary Ascendis Health has acquired Avima for nearly R80-m through its subsidiary Efekto Care. The transaction opens up new sales channels into Africa for the Efekto subsidiary. Source: Fin24, 24 July 2012 SA leads cutting-edge surgery; backing for heart valve start-up Poor, rheumatic heart disease patients could soon have a new lease on life due to technology being researched by the University of Cape Town. Prof Peter Zilla, and Prof David Williams - with the assistance of polymer technologist Deon Bezuidenhoudt are pioneering a way of replacing heart valves that does not require open heart surgery. It is expected to sell for under US$1 000 in developing countries, compared with current heart valve prostheses which cost $5 000-$30 000. Source: The Times, 4 July; Financial Mail, 13 July 2012 SA professor sets standard A groundbreaking international initiative by the International Centre for Eye-Care Education will provide eye-care education to more than 640-m people worldwide. It was introduced by Prof. Kevin Naidoo from the University of KwaZulu-Natal, and consists of core teaching and learning units of an optometry degree programme in a downloadable format that enabled educators and students globally to access course notes and presentations by some of the finest optometric educators in the world. Source: The Times, 16 July 2012 32 PAEDIATRIC NEWS

Find the true cause of the allergy The true cause of an allergy symptom can be a mystery. Is it one allergen or, more likely, the total load of several offending allergens that triggers the reaction? ImmunoCAP is a quantitative specific IgE blood test that can help you get a precise answer to your patient s allergen profile with invaluable information when it comes to diagnosis, prognosis and follow-up. Use ImmunoCAP, in conjunction with case history in order to give reliable advice for prescriptions and avoidance recommendations - and consequently improve patient well-being. Allergy blood test - be sure, be safe. Learn more at www.isitallergy.co.za Tel: +27 (11) 792 6790/1/2/3 www.thermoscientific.com/phadia/en-za

Paediatric News is published by Thetha Medical For advertising contact Alex Tschumi on (011) 789 2112 OR alex@thethamedia.co.za For editorial contributions contact Elri Rautenbach on (011) 789 2112 OR elri@thethamedia.co.za 34 PAEDIATRIC NEWS