Plymouth, Michigan-based Esperion is in phase 2 trials of ETC-1002, a once-daily oral drug designed to regulate abnormal lipid and carbohydrate metabolism without many of the side effects associated with other cholesterol-lowering drugs. It’s intended for use in patients with high levels of LDL, or “bad” cholesterol, who are intolerant or resistant to statins, the company says.

Esperion disclosed in a U.S. Securities and Exchange Commission filing that it had raised at least $17 million in equity but announced publicly a $33 million raise led by Longitude Capital. Aisling Capital, Alta Partners, Domain Associates, Arboretum Ventures and Asset Management also participated.

So far, the company says, the drug has demonstrated LDL cholesterol reductions as high as 43 percent with no adverse side effects reported.

The original company was founded in 1998 by Roger Newton, who was part of the team that developed Pfizer’s Lipitor. At the time, Esperion was focused on developing a drug to increase HDL, or “good” cholesterol. The company went public and was acquired by Pfizer in 2008, but as part of its cuts to its Michigan operations in 2007, Pfizer apparently discontinued development of the drug shortly thereafter. Newton, however, wasn’t ready to give up. He licensed back some of the intellectual property and revived the small molecule drug ETC-1002–a different lead candidate than the one the company was previously working on–in 2008.

DETROIT - To reduce costs for insurers, hospitals and patients, Blue Cross Blue Shield of Michigan announced today that its new, pioneering contract with all of Trinity Health 12 hospitals and provides incentives for more efficiencies in the health care industry's long-reigning fee-for-service payment model.

Under the contract's "value-based reimbursement model," hospitals will get a share of the savings achieved in cases where hospitals and physicians have worked together to, among other things, eliminate redundant tests or provide better treatments that prevent return trips to a hospital.

Blues officials and Trinity Health executives said their new arrangement is not specifically required by the Affordable Care Act, which rolls out in full Jan. 1 and encourages similar cost-control programs.

"The current system is best described as fee-for-service without a focus on improved health outcomes," Susan Barkell, a Blue Cross senior vice president, said in a statement. "Insurers pay for most every treatment, no matter how effective. But we don't pay physicians and hospitals for some things that really improve patient health, like proactively contacting people about their follow-up care or medication compliance."

The value-based incentives will immediately take effect at Mercy Health Partners hospitals in western Michigan and Saint Mary's Health Care Grand Rapids. Other Trinity Health hospitals will get them in July, including Saint Joseph Mercy hospitals in the southeastern Michigan and the Ann Arbor area. ___

In Alabama, if you get your health insurance through your employer and you lose your job, you quickly realize there aren't a lot options for purchasing coverage on your own. Blue Cross and Blue Shield of Alabama has had a virtual monopoly in the state since the Great Depression, and today it covers a whopping 89 percent of Alabamians.

In part, Blue Cross and Blue Shield is dominant in Alabama simply because it has been there for so long -- it sold its first policy in 1936 -- and potential newcomers have found it difficult to convince hospitals and doctors to give them favorable prices so they can compete with the entrenched carrier. But it also has to do with Alabamians themselves: On average, residents of the state are poorer and less healthy than other Americans, making them more expensive to cover and thus less attractive customers.

The lack of competition in nearly a dozen states could present problems when the insurance exchanges that are part of the Affordable Care Act launch in October. The exchanges are supposed to give Americans who do not get health insurance from their employers the opportunity to choose from an array of private insurance plans. The idea is to generate competition between insurers that will lead to lower premiums.

Individuals and businesses with up to 100 employees will be able to shop on the exchanges, and people who can’t afford coverage on their own will get government subsidies to help them pay their premiums. About 26 million low-income Americans are expected to receive subsidies to purchase health insurance through the exchanges.

But in states with a dominant insurance carrier, competition and lower prices may not arrive for quite some time.

A recent analysis by the American Medical Association found that a single insurance company held 50 percent or more of the market in nearly 70 percent of local markets nationwide. And in 30 states, a single insurance company covers more than half the people who purchase insurance individually, according to the Robert Wood Johnson Foundation.

The dominance by a single insurance company is particularly pronounced in Alabama, Hawaii, Michigan, Delaware, Alaska, North Dakota, South Carolina, Rhode Island, Wyoming and Nebraska.

In general, multiple insurance companies are eager to compete in states that have a large number of health care providers and a lot of people who can afford to pay premiums. A relatively young and healthy population is also an attraction. In states that don’t have those characteristics, competition can be sparse.

Alabama ranks 45th in the nation in overall health status, and 46th in median household income, according to the United Health Foundation and the U.S. Census Bureau, respectively. Over the decades, a few major insurance carriers have tried to dip their toes into Alabama, but most pulled out after just a few years.

In other states, there are different reasons for the lack of competition. In Wyoming, for example, the problem is that the state has relatively few health care providers and people have to travel long distances to get care.

Wyoming has only 18.7 physicians per 10,000 people, ranking it 47th in the U.S., according to the Kaiser Family Foundation. By comparison, New York has 34.8 physicians per 10,000 people, Maryland has 35.3 and Massachusetts has 39.7. The national average is 25.7. (Kaiser Health News is an editorially independent program of the Foundation.)

Blue Cross Blue Shield of Wyoming dominates the market. Do Wyoming consumers want more choices? "Sure they do," said Tom Hirsig, Wyoming's insurance commissioner. But Hirsig said it's a huge challenge for new carriers to develop provider networks in Wyoming. "My sense right now is that the individual market inside the exchange is not going to be stacked with lots of competition."

A shortage of hospitals is the problem in Rhode Island, where there are just 11 hospitals owned by two companies. Health Insurance Commissioner Christopher Koller said Rhode Islanders would like other options, but he isn't sure they’ll have them when the state’s exchange launches in October.

Big Changes

The vast majority of Americans get health insurance coverage through their employers. Millions of low-income Americans qualify for Medicaid, and seniors can sign up for Medicare. But for people outside of these groups, there are few good options when it comes to health insurance.

Many of these Americans pay high premiums if they are sick or middle-aged -- if they can find coverage at all. They also run the risk of purchasing policies that don't cover certain medical conditions or limit the total dollar amount of claims. That's why so many of them go without insurance altogether.

The health insurance exchanges are designed to change that. The policies that are included on the menu will have a uniform set of benefits and pricing structures that will be easy for people to understand and compare.

In addition, the new health law will make it illegal to deny coverage to people who have pre-existing conditions. It also will a mandate a minimum set of benefits; prohibit lifetime caps on claims; and require insurance companies participating in the exchanges to spend at least 85 percent of their revenue on health care.

The hope is that this new pool of previously uninsured people will attract insurers to enter new markets, creating competition where none exists now. Poor states across the South and West have the largest share of uninsured people, and thus hold the greatest potential for insurers to cash in on the $350 billion the federal government plans to spend over the next 10 years to help low-income people buy insurance.

Furthermore, the exchanges should allow smaller companies and non-profits to market their products more effectively, challenging entrenched incumbents. "When you go online, the Blue of Alabama won't look so much bigger than the next plan," said Andy Hyman of the Robert Wood Johnson Foundation. The exchange is meant to be an "equalizer," Hyman said.

What's Wrong With Monopolies?

Carriers that dominate a particular state often argue that they hold onto their position by keeping prices down. "There are lots of national carriers out there who would provide a product that is less expensive than what is in the market, if they could," said Kim Holland, director of state affairs for the Blue Cross and Blue Shield Association. "We’re not so naïve as to think that if we don't price our products correctly our customers won't find another alternative."

Some economists note that in some cases, a dominant carrier can use its heft to negotiate the best prices with hospitals and then pass along those savings to consumers. In some markets, dominant insurers are akin to utilities, explained Paul Ginsburg, director of the Center for Studying Health System Change. "You don't necessarily need more than one," he said.

Ginsburg said large carriers are likely to get better prices from hospitals and doctors, because providers can’t do without them. "I suspect that consumers have actually benefitted from high [market] concentration. It's really a bigger problem for physicians," he said.

Despite having the least competitive health insurance market in the country, Alabama's individual premium prices compare favorably with neighboring states and are below average for the nation.

But the AMA, which represents doctors, disputes the idea that big insurers always secure the best prices for consumers. They point to national studies showing that when insurance companies merge and acquire smaller companies, their profits go up and so do their premiums.

Exchange Experience

Two states, Massachusetts and Vermont, already have exchanges, and offer a glimpse of what the future might hold.

When Massachusetts launched its exchange in 2007, new players did not immediately burst into the market. One new carrier, Centene Corporation, joined the exchange to offer a limited network of providers for Medicaid beneficiaries. But competition in the individual market remained relatively unchanged.

But Massachusetts already had a relatively competitive market, so existing carriers competed with each other to create new, lower-cost plans in response to market demand -- and pressure from state officials to keep costs down. Despite the emergence of low-cost plans, however, average premium prices have continued to rise.

Earlier this month, Vermont became the first state in the nation to publish preliminary health insurance rates for its exchange. Not unexpectedly, the tiny state of only 626,000 residents did not attract any new insurance companies. And the price of the plans offered on the exchange? They cost about as much as what Vermonters were paying before.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

When donors give blood, the components of that blood most commonly used by hospitals, red blood cells, are refrigerated and stored for up to six weeks, at which point it’s thought that their ability to transport oxygen becomes depleted.

A growing debate, however, has emerged around the age at which blood becomes unsuitable for transfusion. Some research has suggested that the quality of stored blood actually degrades at different rates depending on the donor, sometimes long before the six-week mark.

Blaze Medical Devices is developing a tabletop device and disposable cartridges that hospitals would use to evaluate blood units by the strength of their red blood cell membranes rather than by age alone.

During storage, various biochemical and biomechanical changes occur in red blood cells. Blaze is hoping to capture how those changes have impacted the quality of the cells by measuring mechanical fragility, which the company says is associated with less cell viability and a decreased ability to deliver oxygen to tissue. The device does that, in simple terms, by subjecting a small blood sample to mechanical stress and seeing how the cells hold up. Ideally, that would give hospital blood bank directors a better idea of whether the blood is suitable for transfusion.

According to the U.S. Department of Health and Human Services, 24 million blood components are transfused each year in the U.S. to replace blood lost during surgery or injury, or to supplement inadequate red blood cell amount or function in certain diseases. Although they’re common, transfusions are also linked to rare but serious complications.

Blaze has completed a preclinical study at Mayo Clinic and an initial clinical study at Henry Ford Hospital, and plans to release a research-only version of the device late this year, according to CEO David Weaver. Then, it plans to start commercialization in Europe the following year. In the U.S., the company plans to follow the Class II De Novo pathway for U.S. Food and Drug Administration clearance and projects initial sales will occur in 2015.

Formed in 2006, Blaze makes its home in Ann Arbor, Michigan. It’s been funded thus far by Ann Arbor SPARK, the Michigan Pre-Seed Capital Fund and the Great Lakes Angel Group.

DETROIT - Lois Gridley wasn't feeling well. She had just taken her 10-year-old son to the pediatrician and he had strep throat. She worried she might have it, too.

But she couldn't get an appointment with her primary-care doctor. So Gridley went online to find the nearest CVS pharmacy clinic and got an examination there.

"I didn't want to wait," Gridley, 51, of St. Clair Shores, said this month at the CVS MinuteClinic in Fraser. "My throat was hurting."

As millions of additional patients are expected to gain insurance through the Affordable Care Act in the next few years, drugstore chains are planning to add hundreds of clinics nationally. In metro Detroit, CVS Caremark and Rite Aid have clinics. Other chains may enter the market.

Since the walk-in clinics opened in 2000, an estimated 15 million people have been treated, according to Convenient Care Association, a trade group. By the group's count, there are more than 1,400 of these clinics in 35 states.

A key selling point for customers is convenience: The retail clinics are close to home, open late and on weekends and no appointment is needed. Patients are seen quickly -- and they can pick up over-the-counter and prescription medications at the same time.

A visit to a metro Detroit CVS starts at $79. Rite Aid, the other major pharmacy chain in Michigan, champions a virtual approach, offering time with nurses and doctors via a video link in the store. Nurse time is free; a 10-minute video chat with a doctor costs $45.

Retail clinics are increasing in numbers and are becoming so popular that 13 states -- including neighboring Illinois and Indiana -- have considered legislation to regulate them, according to a National Conference of State Legislatures report.

Attorney Dan Schulte, whose law firm represents the Michigan State Medical Society, said that from a legal perspective, one question is whether there is proper licensing and supervision of the medical staff.

And some doctors have expressed concerns that patients might try to replace family physician visits with trips to the clinic and that sick people might not get the full spectrum of care they need. The American Academy of Family Physicians opposes pharmacy clinics expanding beyond treating minor acute illnesses.

"We are worried about fragmentation of the health care system," said Jeffrey J. Cain, a doctor and president of the group, which represents more than 105,000 U.S. doctors.

A family physician knows his or her patient and their medical histories and can coordinate overall health care, Cain said.

He said the academy also fears health decisions could be made by people motivated by profit and not overall care.

Cain also pointed to a 2010 survey that showed family doctors changing to better compete by offering some of the same conveniences as retail clinics -- same-day scheduling (73%), extended hours (48%) and weekend appointments (31%).

But, even with those changes, there are limits.

"I can't be there 24/7 and my patients use them (retail clinics)," said Dr. Sharon Geimer, an internist and pediatrician who has a practice in Sterling Heights. "They provide quick care, but continuity can be inconsistent."

Sports physicals

The retail clinics also offer services, such as sports physicals, that might be required by schools and recreation leagues.

Earlier this month, CVS announced a deal to be the official provider of physicals for Pop Warner Little Scholars, a national nonprofit with youth football, dance and cheerleading programs.

CVS, which has 640 clinics nationally, offers a dozen clinics in metro Detroit. They are all branded under the name MinuteClinic and staffed by nurse practitioners.

"MinuteClinic is just another option where people can go for help," said May Hang, the company's state practice manager. "You don't have to go to the emergency room for a sinus infection or an earache."

Last year, Hang said, CVS added two clinics in metro Detroit and hopes to add more. Nationally, the Woonsocket, R.I., company said it aims to open 150 clinics this year and continue expanding through 2017 to hit 1,500 clinics.

Limits to care

Still, Hang acknowledged there are limits to the care the clinics can provide. The MinuteClinics don't stitch wounds or mend broken bones, for example. And Hang said patients who visit too often or have chronic illnesses are urged to visit their family doctor.

The clinic, she said, should not replace a physician's care.

Camp Hill, Pa.-based Rite Aid, the other major pharmacy chain in Michigan with clinics, has nine in metro Detroit. They operate under the NowClinic name, and have partnered with OptumHealth, which provides the doctors and nurses. Instead of in-person visits, however, the company offers a virtual clinic in a retail setting. Patients go to a private room, where they talk to a doctor or nurse for about 10 minutes via video or phone.

"It's live, real time; but no doctor or nurse is in the room with you," said Rite Aid spokeswoman Ashley Flower. "It's the first of its kind."

Rite Aid piloted the clinic concept in metro Detroit in 2011. This month, the company added 58 NowClinics in four more markets -- Baltimore, Boston, Philadelphia and Pittsburgh. The company does not take insurance payments, but the visits can be submitted for insurance reimbursements.

Flower said the virtual clinics are not intended to replace a patient's relationship with a primary-care doctor or hospital.

She said: "If someone comes in and says: 'I have chest pains,' we're going to say: 'You need to go to an emergency room.' "

But as demands for health care grow, retail clinic operators could expand services, especially as they partner with large health systems. CVS has an affiliation with the Henry Ford Health System, which it would like to enhance.

Mike Cannon, the store manager of the Fraser CVS, said a retail clinic "doesn't necessarily translate into more retail sales."

But sometimes it does.

Gridley's strep test turned out to be negative -- and the nurse practitioner who examined her suggested she pick up some saline solution and Zyrtec to treat her symptoms.

Her bill was $116: $89 for the exam, $27 for the test. She paid a $15 insurance co-pay with a credit card.

"Since I'm here," said Gridley, seeming relieved by her diagnosis, "I'm going to shop."

How to make the most of your visit

--Keep track of your health care visits, medications and test results.

--Take a written list of questions and symptoms with you.

--Bring your insurance card, and make sure it's up-to-date.

--Take notes for future reference and records.

--Ask about treatment side effects, risks and benefits.

--Share the information with your primary-care physician. ___

The company now plans to focus on its experimental treatment for a heart condition called dilated cardiomyopathy, in which the heart becomes weak and cannot pump blood efficiently.

The company has about 71 employees, according to Thomson Reuters data.

The letter also said Stryker failed to notify the regulator of a product recall, and had been marketing devices without approval.

The FDA acknowledged that Stryker has submitted corrective action plans for the quality and recall issues, Stryker said.

Stryker shares were down about 0.5 percent at $65.90 in premarket trading.

(Reporting by Esha Dey in Bangalore; Editing by Joyjeet Das)

Designed to provide lower back support, the brace has two padded, sensor-embedded straps worn horizontally around the hips and chest, and two vertical straps that go over the shoulders. Between the horizontal straps are actuators connected to the sensors that allow the device to move along with the person wearing it, providing optimal support through a variety of poses.

It’s similar to the idea behind mountain backpacks that strap around the hips, said co-founder and Chief Executive Officer Jorge Sanz-Guerrero Cosulich, which are meant to offload the back by transferring weight directly to the hips. “By doing that, we are reducing the amount of effort that the muscles in the lower back need to put in, and that allows muscles to withstand longer periods of time crouched over.”

Exo Dynamics grew out of the PhD project of Daniel Johnson, now the company’s chief technology officer.  Fellow PhD candidate Sanz-Guerrero, who was in the same medical device research group at University of Michigan, proposed the idea of starting a company to bring the technology to market.

 A year and a half later, Johnson, Sanz-Guerrero and a team of six others are gearing up to launch it to medical professionals this summer. Although the eventual goal is to have it used in patients for prevention and treatment of back pain, the team is starting in a narrower market where Johnson noticed that back strain was really a problem, and where it can be used as an ergonomic aid without 510(k).

 The team plans for its first customers to be interventionalists – medical professionals that perform minimally invasive procedures, like cardiologists, radiologists and some surgeons.

 ”These operations are short, but some do four procedures a day, so they’re stooping over patients for eight hours a day,” Sanz-Guerrero said. “Furthermore, these guys need to wear X-ray shielding vests, which can add 12 pounds to them.”

Once it starts generating some revenue, the company will expand its target market to include dentists, Sanz-Guerrero said. But their movement and positioning is more complex, so the product needs further development.

Meanwhile, the company hopes to simultaneously be making its way through clinical trials so that it can eventually take the device to patients recovering from spine surgeries. The brace has fewer points of contact than a traditional back brace and is readjustable, so it may be more comfortable to wear and allow for more mobility. And, the sensor and electromechanical components open the door for the incorporation of at-home monitoring features. The company is working on seeking IRB approval to conduct clinical trials.

To make that happen, and to launch the product to interventionalists this summer, Sanz-Guerrero said the company is looking to raise $300,000 this year. Being young founders has had its benefits; the startup has gotten most of its $120,000 in funding thus far through the university, competitions like the Michigan Business Challenge, and the National Science Foundation’s I-Corps program.

[Photo courtesy Exo Dynamics LLC]

In announcing that it was buying Chinese orthopedics company Trauson Holdings Company Limited, Kalamazoo, Michigan-based Stryker (NYSE:SYK) is following in the footsteps of medical device heavy weight Medtronic.

Barely four months ago, the Minnesota medical device maker announced that it was buying Kanghui Holdings, which described itself as  a top player in the spine and trauma market in China.

And Thursday, Stryker announced that Hong Kong-based Trauson is a “leading trauma manufacturer in China and a major competitor in the spine segment.”

This is how Stryker’s CEO Kevin Lobo described the deal:

T”he acquisition of a leading player in the Chinese trauma and spine market underscores our commitment to strengthening our presence globally. With its research and development expertise, manufacturing capabilities and strength of its distribution network, Trauson is a compelling opportunity for Stryker to drive growth in China and other emerging markets for years to come.”

That statement hews pretty closely to the message that Medtronic’s Omar Ishrak delivered on his company’s first Chinese acquisition.

“Kanghui represents a significant investment in China, accelerating Medtronic’s overall globalization strategy with an established value segment distribution network and strong R&D and operational capabilities,” Medtronic’s CEO said in September.

Even the money that each agreed to shell out for their Chinese acquisitions is not too far apart. Stryker is paying $764 million in an all cash transaction with the transaction valued at $685 million, net of cash. Medtronic doled out $816 million in cash, though excluding Kanghui’s cash, the transaction was worth $755 million.

These two acquisitions underscore how much the medical device industry is banking on emerging markets for growth. Up until now, the industry has been behind other industries in capitalizing on the opportunity presented by globalization.

2013 might be the year to change all that.

The 75 direct sales force dedicated to boost Stryker’s (NYSE: SYK) foot and ankle business unit had a stellar year in 2012, said CEO Kevin Lobo, to a packed room at the J.P. Morgan Healthcare Conference in San Francisco on Wednesday.

The unit had a 40 percent increase in U.S. sales in the fourth quarter.

“If you think about Stryker, we were just above the ‘other’ category in the foot and ankle business a few years ago,” Lobo said. “Based on Q4 and I haven’t seen Wright Medical’s numbers yet, we are breathing down their necks.”

The unit is a relatively new addition to Stryker’s business units. Lobo said it took a few quarters in the beginning of 2012 to “find our feet” (no pun intended), but in retrospect, it was a smart decision to create a dedicated sales team for the unit.

Now the company has been able to hire sales people away from market leaders like Wright Medical and Arthrex.

“The idea that a sport medicine sales person would come from Wright Medical and Arthrex a few years ago would have been laughable,” Lobo declared.

 Photo Credit: Boxer fron BigStock Photo]

CHICAGO (Reuters) - After his first day working at St Joseph Mercy Ann Arbor hospital's newly created Fungal Outbreak Clinic, Dr David Vandenberg struggled to describe to his boss the enormity of what lay ahead. He settled on a line from the movie Jaws.

"We're going to need a bigger boat," Vandenberg told Dr Lakshmi Halasyamani, chief medical officer of the Michigan hospital, echoing the film's local police chief after he first eyes a 25-foot (7.5-metre) killer shark.

The St Joseph Mercy clinic has been at the front line of the fight against one of the biggest ever U.S. outbreaks of fungal meningitis, a killer infection that has been traced to tainted steroid shots from a Massachusetts pharmacy.

So far, 620 Americans have developed serious infections related to the outbreak, including 367 cases of deadly meningitis, and 39 people have died. Of the 19 U.S. states affected, Michigan has been worst hit, handling more than one third of the total cases in the outbreak.

St Joseph Mercy - a 537-bed Catholic hospital located in Ypsilanti, on the doorstep of the University of Michigan - has treated 169 of the state's 223 cases of infections that can cause meningitis, including 7 people who died.

At one point it was so overrun that 87 of its 537 beds, which are usually occupied by patients with cancer or heart ailments and the like, were occupied by patients with fungal meningitis and related infections.

Dr Tom Chiller, the fungal disease expert at the U.S. Centers for Disease Control and Prevention, who has been overseeing the outbreak, praised the work of the hospital in helping to limit deaths from the outbreak.

"They have been incredibly creative in dealing with these complicated patients," he said.

In all, almost 14,000 people seeking relief from back and joint pain received injections from moldy steroid shots made at the now-bankrupt New England Compounding Center in Massachusetts before they were recalled in late September.

CDC experts initially feared death rates in the 40 to 50 percent range; instead, only about 6 percent of those infected have died, and the CDC credits the creative and dogged efforts of state and local health officials for keeping the death rates so low.

The first wave of the outbreak involved the most severe cases of meningitis - an inflammation of the membranes that cover the brain and spinal cord. But starting in mid-October, patients who had been recovering from meningitis were developing potentially fatal localized infections near the site where contaminated drug was injected to treat back or neck pain.

As they started seeing more cases of these local, secondary infections, the staff at St Joseph's devised a bold plan to screen all patients in their database looking for potential new infections that might have been missed in the first wave.

On December 20, the CDC issued an alert to doctors incorporating some of lessons learned by the efforts of doctors at St Joseph's and other hospitals, calling for increased screening of patients who may be harboring localized infections.

A BEWILDERING FUNGI

Among the patients who developed secondary infections was Bonita Robbins, a 72-year-old retired nurse from Pinckney, Michigan, who received doses of the tainted drug at the Michigan Pain Specialists clinic in the nearby town of Brighton while seeking relief for lower-back pain.

The first shot brought some relief, the second did little to ease her aches, and the third was contaminated. In October, Robbins went to St Joseph's with a severe headache, back pain and pain in her thighs.

She spent 37 days in the hospital taking two kinds of antifungal drugs.

Dr Anurag Malani, an infectious disease specialist treating Robbins, said the challenge with the outbreak was that there was no medical literature to fall back on.

"No one has ever seen anything of this magnitude related to fungal infections, ever," he said.

Chiller said U.S. doctors had never treated meningitis caused by Exserohilum rostratum, the environmental mold causing most of the infections.

"It's just a rare, rare cause of infection." Seeing that mold in the meninges - membranes covering the brain and spinal cord - is "completely new."

Initially, St Joseph's Fungal Outbreak Clinic was started in order to coordinate the care of patients after their discharge, which included overseeing the administration of a complex regime of anti-fungal drugs.

It morphed into something bigger when some of its 53 patients with meningitis started returning with infections near the site in their back or neck where the contaminated drug was injected.

Then came a wave of patients like Robbins, who had been ruled out for meningitis with a spinal tap, but were still complaining of pain near their injection site.

GETTING THE 'BIGGER BOAT'

"When it became obvious that the number of patients would be a much higher percentage than anticipated by the CDC, we expanded our clinic and started enlisting the help of several other hospitals," Vandenberg said.

Many of the patients had spinal abscesses, an infection in the space between the outside covering of the spinal cord and the bones of the spine. Others developed arachnoiditis, an infection of nerves within the spinal canal.

The decision to screen all patients in the hospital database who might have received tainted injections was not taken at the recommendation of the CDC.

"That was our own decision," said Vandenberg, a specialist in internal medicine overseeing the screening effort.

He admitted that the strategy was aggressive, but said that, especially early on, doctors feared the local infections might be precursors to meningitis, making catching them early a potentially life-saving move.

Excluding patients who had already been screened and those who had injections in areas other than the spine, the hospital targeted about 500 patients for MRI scans.

Most so far have had private insurance that covers the screening. For the uninsured, the hospital's Patient Financial Services department has been helping them to apply for financial support.

"We did over 400 MRIs in about a 4-week period," Vandenberg said. The hospital screened so many patients, in fact, that the state of Michigan sent in an emergency mobile MRI unit to help.

Vandenberg got the task of reading stacks of MRI reports, sometimes as many as 30 a day.

So far, about 20 percent of the MRIs have shown up as abnormal, meaning that patients have to come back for surgery and treatment.

Vandenberg makes all of those calls personally. Not all of them go smoothly. He likens the gravity of the conversation - learning you have a potentially deadly new disease that requires months of treatment with risky drugs - to telling someone they have cancer.

After one especially tough call, in which a heart patient feared he would not survive the surgery he would need to clear his infection, Vandenberg cracked.

"I started crying. I probably haven't cried for 15 years."

SIGNS OUTBREAK IS EASING

But at last, after months of onslaught, there are signs the outbreak is easing.

Attendance at the hospital's daily support group has begun to taper off. And since the beginning of December, more than 50 patients with fungal infections have been discharged, while only 20 have been admitted, bringing the total number of fungus-related inpatient to 30.

Vandenberg nevertheless cautions that the outbreak is still far from over.

"Every single day of this screening program, we're finding one or two cases that are abnormal and need to be admitted," he said.

Vandenberg gave the CDC access to the clinic's database so the agency could see how the effort turned out, and this month, the CDC issued the alert to doctors incorporating some of the results of the MRI screening program.

The alert warned that some patients who got tainted injections but did not develop meningitis may still be at risk of localized infections.

And it urged doctors to consider ordering an MRI for all patients who still have pain, even if the pain is similar to what sent them in for treatment in the first place.

Chiller said the United States had not yet reached the end of the outbreak.

"Unfortunately, with fungi, the incubation periods are so long and they can remain indolent. I'm definitely concerned that we're going to continue to see more cases."

(Reporting by Julie Steenhuysen; Editing by Jilian Mincer, Mary Milliken and David Brunnstrom)

Now equipped with U.S. Food and Drug Administration clearance to market its first product, University of Michigan spinoff Tangent Medical Technologies has raised $8.6 million, presumably to take its closed-system IV device to market.

The financing came from nine investors in an equity offering this month, the company said in a U.S. Securities and Exchange Commission document. President and CEO Jeff Williams couldn’t be reached by email today but has said previously that the device would hit the market late this year.

Tangent redesigned the peripheral intravenous catheter system, giving it additional features to make it stay more securely and comfortably on a patient, prevent blood splatters and avoid patient exposure to pathogens. The NovaCath won FDA clearance in September.

The vascular access device market in the United States is poised to grow slowly as healthcare providers increasingly adopt safety PIVCs over traditional ones to prevent needle-stick injuries and patient infections, according to Millennium Research Group. Other closed-system IV systems already on the market include the Nexiva by BD Medical and Introcan Safety by B. Braun.

Tangent, located in Ann Arbor, Michigan, was incorporated in 2010 as a spinoff of the University of Michigan’s Medical Innovation Center.  The three co-founders were fellows at the Medical Innovation Center when they observed issues with traditional catheters and came up with the concept of the NovaCath.

After hiring Williams, who previously led three medical-related companies through exits, last year, it closed a $4.5 million series A from Arboretum Ventures, Flagship Ventures, Osage Ventures and several angel investors. Tangent plans to introduce the product outside of the U.S. in 2013.

 [Photo from Tangent Medical Technologies]

Anti-infection and dermatology drug company NanoBio Corp. raked in $11 million in series C financing from its existing lineup of investors, bringing its total to $130 million, half of which has come from nondilutive sources.

With the funding, the company says it will continue developing its various anti-infection programs and vaccines. Its NanoStat platform is based on high-energy, oil-in-water emulsions that, when applied to the skin or mucous membranes, enter pores and hair shafts to disrupt and kill infectious agents. Unlike current therapies, the company says, its topical treatments are selectively toxic and don’t irritate the skin.

Among the company’s lead topical products are a phase 3 treatment for cold sores/fever blisters and a phase 2 treatment for nail fungus.

“Our topical therapeutic programs continue to show tremendous promise to enable new products that can effectively treat drug-resistant pathogens and avoid the concerning safety risks associated with oral therapies,” said CEO David Peralta in a release.

Peralta took over the top seat at NanoBio earlier this year following the departure of founder James Baker, who left to become a senior vice president at Merck.

The company is also using its nanoemulsion-based technology to develop other anti-infective drugs and intranasal vaccines including a seasonal flu vaccine in phase 2 development.

The Ann Arbor, Michigan company is a spinout of the Center for Biologic Nanotechnology at the University of Michigan. It’s involved in collaborations with Merck, with which it’s developing a vaccine for a serious cause of lung infections called respiratory syncytial virus, and with GlaxoSmithKline, which licensed its cold sore treatment for over-the-counter use.

Here's a multiple-choice question about the big hospital hookup plan unveiled last week by the Beaumont and Henry Ford health systems, which plan to join 10 hospitals and 41,000 employees in a giant not-for-profit marriage.

Is it:

(a.) Scary?

(b.) A necessary survival move?

(c.) An opportunity to forge a medical supersystem with cachet to rival names like Mayo, Johns Hopkins or Cleveland Clinic?

(d.) All of the above?

Let's go with (d.) as the correct answer, for the following reasons:

--Giant mergers are always scary in any industry. Scary to employees who fear they will lose jobs in the name of synergy; scary to competitors; scary to suppliers who fear being squeezed, and scary to consumers who fear being treated like numbers by large institutions and worry they will become specks of dust to an even larger corporate behemoth.

--Survival is indeed Job One in health care today, as pressure intensifies to control per-patient spending by spreading fixed costs across a larger population.

"We have a tsunami coming with Medicare," Henry Ford CEO Nancy Schlichting said of the aging baby boom generation. In other words: How on Earth will we possibly pay those looming bills?

--It's also true that Henry Ford and Beaumont are highly regarded hospitals with national reputations in robotic surgery, heart and vascular services, transplants and quality care. Combining them holds potential to attract more research grants from outfits such as the National Institutes of Health, and to attract more patients from around the world for specialty treatment.

Executives of the two hospital systems were careful last week to sidestep talk of possible facility closings or staff layoffs, but the phrasing of a few of their comments left little doubt that they will be looking for savings, if and when they close a deal by mid-2013.

"In the short run," Schlichting said, "we're not planning the closure of any facilities. Note the preface: "in the short run."

"There is a demand for higher quality at less cost," said Beaumont CEO Gene Michalski. "At less cost" being the key words.

The merger is "an opportunity to make sure we have more efficient model for care," Schlichting added.

We all know what "a more efficient model" means -- careful cost control -- but Schlichting knows that is essential to survival, which makes other things possible.

In an interview earlier this year, after closing a hospital in Warren, Schlichting told me, "I've closed three hospitals in 10 years. But in those same 10 years we doubled our size, doubled our employment. We made tough decisions that we felt were in the interests of the community because the capacity was too large."

Sandy Pierce, chairwoman of the Henry Ford Board of Trustees, talked about "growing" the new entity. But how do you grow by just merging two nonprofit groups, without an infusion of new cash that a for-profit partner might have provided?

"Our draw beyond the state of Michigan will improve dramatically," Pierce said, predicting that the larger scale would help draw more patients from outside Michigan -- and hinting that future acquisitions in other states are possible.

Steve Howard, chairman of Beaumont's Board of Trustees, agreed that out-of-state expansion is possible "down the road."

If all that sounds grandiose for a couple of outfits that are toiling today in a challenging environment, as bond rating agencies have candidly stated, it's not unattainable.

A big reason for confidence is the leadership at Henry Ford and Beaumont, and specifically the presence of Schlichting, 57, a rock star in the health care field, a director of the American Hospital Association and current chairwoman of the Detroit Regional Chamber.

While the Beaumont and Henry Ford leaders said Wednesday that no decisions have been made yet on the future CEO and governance team, Schlichting is a good bet. She's younger than Beaumont CEO Michalski, 64.

And when I asked about her future plans, Schlichting said: "I had given some thought to stepping aside on the 100th anniversary year of Henry Ford Hospital, in 2015. But then this (the Beaumont merger) came along and, well, who knows now?"

(c)2012 the Detroit Free Press

Visit the Detroit Free Press at www.freep.com

Distributed by MCT Information Services

Michigan public health officials have boosted to 119 the cases of infection linked to tainted steroid injections for back pain, and a local doctor says some of those patients are now returning for secondary problems from the injections.

Some health officials had believed they were seeing the end of the cases of fungal meningitis and other infections that have led to seven deaths in Michigan and more than two dozen across the U.S.

Of the 119 infections, 61 cases were of fungal meningitis, and six of those patients died. Fifty-one patients have reported epidural abscesses, which can develop into meningitis; and six cases involved joint infections, said Michigan Department of Community Health spokeswoman Angela Minicuci.

A seventh death involved a patient who died after a stroke following the injection, she said.

But other health officials say that -- even though they originally believed patients were near the end of the average incubation period from the last injections given in Michigan -- secondary infections have them worried that complications will stretch forward for an indefinite period of time.

"If there is a significant fungal load at the site of the infection, the anti-fungal treatments aren't adequate," said Dr. Lakshmi Halasyamani, Chief Medical Officer of Ypsilanti-based St. Joseph Mercy hospitals.

The fungus is relatively common in the environment and is normally harmless, but doctors are now learning what happens when it is injected into the spine, she said.

The last injections were given in the beginning of October in Michigan, just before the U.S. Centers for Disease Control & Prevention identified the source of meningitis cases elsewhere and alerted states that had received shipments of the preservative-free methylprednisolone acetate from the New England Compounding Center in Massachusetts.

Contact Robin Erb: 313-222-2708 or rerb@freepress.com ___

(c)2012 the Detroit Free Press

Visit the Detroit Free Press at www.freep.com

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LOS ANGELES (Reuters) - Your own beating heart may generate enough electricity to power a heart-regulating pacemaker, ending the need for expensive surgeries to replace expiring batteries, according to an early study of an experimental energy-converting device.

Researchers at the Department of Aerospace Engineering at the University of Michigan in Ann Arbor tested an energy-harvesting device that runs on piezoelectricity - the electrical charge generated from motion, according to the study which was released at the annual American Heart Association scientific conference on Sunday.

The approach is a promising technological solution for pacemakers, because they require only small amounts of power to operate, said M. Amin Karami, the study's lead author and a research fellow at the university.

The implanted devices, which send electrical impulses into the heart to help maintain a normal heartbeat, have to be replaced every five to seven years when their batteries run out.

Researchers measured heartbeat-induced vibrations in the chest. They then used a "shaker" to reproduce the vibrations in the laboratory and connected it to a prototype cardiac energy harvester they developed.

Measurements of the prototype's performance, based on a wide range of simulated heartbeats, showed the energy harvester generated more than 10 times the power required by modern pacemakers.

The device is about half the size of batteries now used in pacemakers and includes a self-powering back-up capacitor, Karami said. Researchers hope to integrate their technology into commercial pacemakers.

"What we have proven is that under optimal conditions, this concept is working," Karami said, adding that the next step is to integrate the device into a pacemaker.

The researcher, who presented the study here at a scientific meeting of the American Heart Association, said the technology might one day also power other implantable cardiac devices, such as defibrillators.

The study was funded by the National Institute of Standards and Technology and the National Center for Advancing Translational Sciences.

About 700,000 people worldwide who have heart rhythm disturbances get a pacemaker or defibrillator each year.

In the United States, pacemakers sell for about $5,000, which does not include the cost of surgery, a hospital stay and additional care.

(Reporting By Deena Beasley; Editing by Bernard Orr)

Formerly president of J&J company Ethicon Endo-Surgery and then head of Stryker’s orthopedics unit, Lobo replaced chief financial officer Curt Hartman, who served as interim CEO following the resignation of Stephen MacMillen in February.

According to Lobo, the innovation culture at Stryker has changed dramatically over the past several years as providing clinical and economic evidence for new products has become critical. “We’re starting to broaden our lens from just looking at products to thinking about the overall procedural efficacy, to thinking about the customer experience and the patient experience,” he said. “And we’re starting to collaborate with customers and trying to understand what role can we play in assisting along the continuum of care.”

Stryker is also placing an emphasis on internal collaboration. The makeup of the innovation teams at the company has changed, he noted, from groups of R&D engineers to groups of engineers, plus IT and supply chain personnel and health economists.

In the past, the model was to stay focused on the customer. “We’re now changing that paradigm, realizing that if the capital equipment part of the business collaborates with disposables, the customer can really get a benefit,” he said. “We have health economists on our innovation teams now saying, ‘so if you add this, who’s going to pay for this?’ That wasn’t even a thought five or six years ago.”

And how will these plans for innovation affect Stryker’s business strategy with Lobo at the helm?

Orthopedics, which makes up about half of Stryker’s sales, will remain at the heart of the company. Lobo sees great opportunity for orthopedics in emerging markets, which represent only about 6 percent of the company’s sales today. “We really have to push global growth; it will be part of my agenda without question,” he said.

That doesn’t just mean emerging markets, but also in Europe and other places where sales aren’t as strong as they are in the U.S.

That might also mean snatching up more companies. Over the past few years, Stryker has gone on a bit of an M&A spree, making acquisitions including Israeli stent technology company Surpass Medical, medical device company Concentric Medical, specialty spine company Orthovita, reprocessing/remanufacturing company Ascent Health and the neurovascular division of Boston Scientific Corp.

“We’re going to (look at) a company that has a new procedural approach [...] or something that has high clinical evidence,” Lobo said, noting the purchase of Orthovita as an example of one in which the company was willing to pay a little more for a company with more clinical evidence behind it.

Rather than approaching innovation as adding new features to a product and charging higher prices for those features, Lobo said Stryker is now thinking about how it can make a simpler solution that is easier, more reproducible and more consistent.

“I think we’re going to continue to look at new materials — materials that can last longer and are easier to implant,” he said. “But I think product innovation as a percent of innovation is definitely going to go down, and we’re going to be looking at other areas where we can improve more efficiency and other aspects of the continuum of care.”

[Photo from Stryker]

Catholic Health East in Newtown Square and Trinity Health in Michigan have reached a preliminary agreement to form what management said would be the nation's second-largest Catholic health-care system, the two nonprofits said Wednesday.

If a final agreement is reached, the new organization would have 82 hospitals in 21 states coast to coast.

Catholic Health East's Philadelphia-area hospitals include St. Mary in Langhorne, Our Lady of Lourdes in Camden, and Mercy Fitzgerald in Darby. The region, including Trenton and Wilmington, accounted for 46 percent of Catholic Health East's $4.3 billion in revenue last year.

The systems, which together have more than $13 billion in annual revenue, said they had signed a nonbinding letter of intent with the goal of reaching a definitive agreement next spring.

The deal is further evidence that executives are convinced that health-care providers need to be bigger to survive in a world where they will be responsible for the health of large populations and receive payments based on results of care rather than the amount of care provided.

"Our assumption is that scale will matter going forward," Judith Persichilli, Catholic Health East's president and chief executive, said in an interview. "Scale nationally brings us together with a stronger organization that will allow us to meet the challenges of health-care reform."

Trinity, which had $8.9 billion in revenue the fiscal year ended June 30, is stronger financially, with an operating profit of about 3 percent, compared with about 1 percent for Catholic Health East.

Terri Wareham, a managing director at KaufmanHall, a health-care consulting firm in Skokie, Ill., called the merger a "very powerful and important consolidation."

"This is a clear reflection of what is happening nationally and how health-care providers are trying to deal with health-care reform. This is all about there's not enough money to go around for how care has been provided," said Wareham, who said she has had both systems as clients.

Many details remain to be worked out, but the boards have agreed that John R. Swedish, president and chief executive of Trinity, which is based in Novi, Mich., will retain those positions if the merger is completed. Persichilli will become executive vice president.

No decision has been made on where the new entity's headquarters will be, but Persichilli said, "Our vision is that there will always be an eastern division."

About 500 people work in the Newtown Square headquarters.

According to a Moody's Investors Service report in June, Catholic Health East has been creating a more centralized system to become more efficient. Those efforts are likely to continue. "We will look for economies of scale," Persichilli said.

Catholic Health East, which was founded in 1997 by 12 religious congregations and three health systems, has attempted to improve its financial results by leaving some markets, including Miami, Atlanta, and Carbondale, Pa., where it closed inpatient operations, Moody's said.

A year ago, Catholic Health East also expanded by combining St. Peter's Health Partners in Albany, N.Y., with two other systems to form its largest regional group.

Contact Harold Brubaker at 215-854-4651 or hbrubaker@phillynews.com. ___

(c)2012 The Philadelphia Inquirer

Visit The Philadelphia Inquirer at www.philly.com

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The Perrigo Company (NASDAQ: PRGO) today announced that it has received approval from the U.S. Food and Drug Administration (FDA) for its Abbreviated New Drug Applications (ANDA) to market over-the-counter nicotine polacrilex mini lozenge USP, 2 mg (mint flavor) and 4 mg (mint flavor).

This ANDA approval represents the first approval for mini lozenge products that will be targeted for the store brand market. The mint flavored mini lozenge will be marketed under retailer and wholesalers' store, or own brand labels and is comparable to GlaxoSmithKline's Nicorette® Mini Lozenge. The product is indicated to reduce withdrawal symptoms, including nicotine craving, associated with quitting smoking. "This approval strengthens Perrigo's leading store brand position in smoking cessation products, which also includes coated and uncoated flavored gums and lozenges," said Joseph C. Papa, Perrigo's Chairman, President and Chief Executive Officer. Nicorette® Mini Lozenge is selling at an annual rate estimated at over $30 million at all retail outlets. The product is expected to begin shipping in the next 90 days.

Perrigo Company is a leading global healthcare supplier that develops, manufactures and distributes OTC and generic prescription (Rx) pharmaceuticals, infant formulas, nutritional products, and active pharmaceutical ingredients (API). The Company is the world's largest manufacturer of OTC pharmaceutical products and infant formulas, both for the store brand market. The Company's primary markets and locations of manufacturing and logistics operations are the United States, Israel, Mexico, the United Kingdom and Australia. Visit Perrigo on the Internet (http://www.perrigo.com).

DETROIT — Dan Gilbert is a billionaire entrepreneur, pro sports team owner, and massive real estate investor. He also personally runs employee orientation for new employees of his more than 50 businesses.

In other words, Gilbert is not your average billionaire.

I went to Detroit to find out what’s happening — what’s changing, and what’s growing in Detroit. The answer, to a large degree, is Dan Gilbert. He’s the CEO of Quicken Loans, the majority owner of the Cleveland Cavaliers, and a principal in Detroit Venture Partners, among about 50 other companies.

But perhaps his biggest passion is restoring Detroit to its former status as one of the premier cities in the United States.

In the pursuit of that mission, Gilbert has bought vacant, derelict buildings, and is turning them into modern, vibrant, art-filled offices. He’s moved over 7,000 employees downtown, and offers $20,000 incentives to employees who buy a home in the city. He’s started local accelerators and a venture capital firm, and is investing in local talent and local ideas. He’s galvanized a reverse migration of sorts, starting to re-fill the urban core of downtown Detroit.

And he doesn’t wear a tie.

Quicken Loans, Gilbert’s flagship company, invited me to Detroit after I wrote about the city and — full disclosure — paid my airfare and hotel). I spoke to Gilbert during a break in one of his employee orientation sessions, in an empty room we found just off a casino floor.

His passion is a resurgent downtown Detroit with a vibrant urban life, and he pours his — and much of his companies’ — resources into that mission. But, he’s quick to add while he jokes about “skyscraper sales,” everything he does makes hard business sense.

I asked him about his life, his work, and his mission.

VentureBeat: Born and raised in Detroit, Michigan?

Gilbert: Yeah, born and raised, grew up 3-4 years in the city, and then a couple miles in the suburbs.

VentureBeat: As I’m walking around at Quicken head office, it doesn’t feel like a company … it feels like a mission.

Gilbert: Right … yeah … I would say we’re focused on that, at least as far it concerns Detroit. But we’re still pretty focused on our businesses too … we think it goes hand in hand.

VentureBeat: One of the things I noticed in your offices is design: designed environments, art, color. Talk to me about that.

Gilbert: Well, we think that in the brain economy innovation and creativity are key in developing ideas and creating jobs and wealth … and so we think that we can inspire that kind of thought process in an environment that’s not, well, like this [ he gestures around the generic beige hotel meeting room we're in].

VentureBeat: So I’ve heard that you’re not a traditional CEO, and I’ve seen some of that here — why are you not button-down, tie, etc?

The old and the new in the corporate hallways

Gilbert: Well, I don’t think I grew up that way, first of all, and secondly, I just don’t think it works in today’s world, you know.

I think that all that stuff really symbolizes separation between you and most of the people who work at the company.

I just think that everything is symbolic and who you are determines everything that you do, small moves and big moves, and plus it’s just more comfortable … and more fun.

VentureBeat: In your company manual, you’ve got a list of 27 things you’ve learned in 27 years of professional, working life. What’s the most important one?

Gilbert: Appreciate everything.

VentureBeat: You love sports — you’ve bought a lot of sports teams. Why have you gotten into the sports business?

Gilbert: Well the Cavs became available to us about like seven years ago, sort of quickly and Cleveland was a close-by city and it was just sorta one of those things … it became available, and we were in a fortunate enough position to make the deal happen, and it was an exciting team.

And it led to other things in Ohio with the casinos and the other stuff we’re doing here, so … we’re sort of like a Lake Erie center … Detroit and Cleveland, the flower of the lake, and those are our two home cities and that where 85 percent of our action is.

VentureBeat: Personally, as a Canadian, I noticed you have a hockey team too.

Gilbert: Yeah, the Lake Erie Monsters … so we’re the Colorado Avalanche’s farm team.

VentureBeat: But you haven’t bought the Phoenix Coyotes?

Gilbert: No, no, no … too far away [laughing].

The cafeteria at Quicken Loans

VentureBeat: Detroit Venture Partners, which you own, is raising a round right now. What are you looking for?

Gilbert: Well, I think that Josh [Linkner, CEO of Detroit Venture Partners] is out looking to diversify the funding. But more so than capital, he’s looking for other partners who have connections to Silicon Valley or to others who have invested in technology for a period of time. It’s not so much the money as what are the strings with the money … what’s behind it.

We’re looking for technology-based startup business, or close to startup businesses. They don’t have to be Detroit-based … but a lot of them are in Detroit. There’s a lot of others — one in San Francisco that we funded, but they’re going to put their sales office here, and others that have moved in.

Some people are vewing this — you’ve probably gotten a feel for this — there’s sort of like this whiteboard atmosphere here. You can really have an impact and change in this city. There’s a lot of talent here — and coming.

VentureBeat: Best business decision you’ve ever made?

Gilbert: Good question … oh boy … probably not getting into sub-prime lending [with his Quicken Loans company].

VentureBeat: Because Quicken actually did better — gained market share — during the whole real estate meltdown?

Just in case you forget where you are … the sign in the lobby of M@dison, the home of Detroit Venture Partners

Gilbert: Oh yeah, by a significant, significant amount. It’s sort of one of those things we didn’t do, more so than what we did.

VentureBeat: Did you feel like you were missing out during that period, when it seemed like people were making millions of dollars almost daily?

Gilbert: Yeah, I mean, our sales guys would give us pressure, because they would miss out on deals and ask us why we didn’t have these products … but I mean, we dabbled in a few of alternative products but we never went too far.

VentureBeat: And that saved the company?

Gilbert: Yeah, it would have killed us, for sure. Yeah. Definitely.

VentureBeat: When you’re making an investment personally, what are you looking for in a founder of a company?

Gilbert: We’re looking for a person that is not chasing money, but is building something. One of our things is that money follows, it does not lead. So we want people that are fired up and passionate about their mission … and people that aren’t so married to spreadsheets and thinking that kind of voodoo controls the future, because it doesn’t.

So people that are fired up about building business and not greedy money chasers. We think that eventually those people end up being wealthier anyways.

VentureBeat: You run a lot of companies — over 50. How do you manage your time? How do you stay productive?

Another cafeteria at Quicken Loans

Gilbert: Well, I’m still focused on the flagship businesses: Quicken Loans and RockBridge, the title company, and some of the board stuff in the gaming. The other stuff … I’m aware of, and I’ll definitely get involved in a couple of startups — like this UpTo, it’s one of the startups that has a real shot, if they can get it right.

But we just have great people in a lot of places.

VentureBeat: You’re doing a lot in Detroit. Why is Detroit a good investment?

Gilbert: Well, Detroit’s a good investment because, first of all, the entry fee for everything is lower. And, you’ve got the talent that is here that is ambitious and motivated, so you’re going to get in on a much lower cost structure in every way, shape, or form from labor to buildings to whatever.

I think the competition for talent is probably less — from reading your stuff and others — I think Silicon Valley, it’s like crazy …

There’s still definitely more jobs than engineers here, but you don’t get too much movement, and there’s a Midwest work ethic that sounds hokey but I think there’s some truth to it. And the city, it’s just one of these place that you can really impact the outcome of … you get the feeling that something special is about to happen or is happening.

VentureBeat: When will you know that you’ve won … that Detroit is back?

In the basement of one of Gilbert’s buildings, a chiseled-out image of civil war soldiers on a concrete wall. The image is only visible from an angle, and the artist’s name is a secret.

Gilbert: That’s a great question. I don’t know if there’s ever, like, a finish line, but we sort of envision that there are hundreds and hundreds of entrepreneurial businesses along this corridor, where there’s a lot of residential buildings and people are living down here with great retail.

And that’s all happening, not just with us but with others … a lot of things in the works.

When we know that the vast majority of our brain talent that’s coming out of University of Michigan or Wayne State talent is staying here — that the first thought is not moving to New York or L.A. or San Francisco, or when that’s the small minority — then I think that we’re taking major steps at least.

And … did you meet any of the interns we have down here? We brought in 600 interns from 157 colleges and universities around the country.

Of all the things we’ve done, there’s nothing more important. In a speech I did last Friday, I put some of the comments from the interns, saying things like, before I wouldn’t have considered Detroit, now I’m going to stay. That’s the biggest most important thing you can do … get those young people.

VentureBeat: Best advice you ever got?

Gilbert: It’s sort of hokey, but stick with your instincts, stick with your guts. Ignore the noise.

VentureBeat: Riskiest business decision you ever made?

Gilbert: Buying a pro sports team is risky … especially with one guy who had a few years left on his contract [laughing, referring to Lebron James].

VentureBeat: Greatest legacy? A thriving, vibrant, revived Detroit?

Gilbert: Yes, I’d hope so, I’d hope so. That’d be a legacy we’d be proud of, for sure.

Servers in Quicken Loans headquarters

VentureBeat: If there’s one thing that you want people to know about Detroit for a business office or tech startup, what would it be?

Gilbert: Get here and get the feel, because it sells itself. Don’t miss out, because you have an opportunity on the ground floor of something very unique.

VentureBeat: Thanks for your time.

Gilbert: No problem, thanks for coming.

photo credit: paul bica via photo pin cc

Disclosure: Quicken Loans invited me to come to Detroit after I wrote about the city. The company paid most of my expenses, including flight and hotel. My reporting, however, is my own.

This article originally appeared on VentureBeat

When patients want to book a doctor’s appointment online, a number of sites are there to make that process easier, from ZocDoc to HealthLeap to AppointmentCity.

But what about when they need to cancel those appointments on short notice? Physician practices then play phone tag with patients they’ve manually entered into a wait list to fill the canceled appointment, or deal with the lost time. Patients, meanwhile, have to wait all over again for a new appointment.

“The nature of life is that people cancel appointments,” said Tashfeen Ekram, the founder of health IT startup SchedFull. “Surprisingly, penalizing them doesn’t work that well. It might actually make them less likely to come back.”

That’s where SchedFull comes in. It’s an online waiting list that matches openings in a physician’s schedule with patients who could potentially fill the time slot. Physician practices would purchase access to the Web-based software and generate wait lists by inputting information about their patients’ availability and scheduling preferences. When a cancellation comes in, they would be able to alert specific patients whose availability and preferences match the appointment via email or SMS. Patients who receive those messages could ignore them, call the office or reply to the text message to be connected with the office automatically.

SchedFull is in its early stages and being tested by beta users in clinics that Ekram has engaged with personally, but he’s hoping to bring more beta testers on board, with the goal of accumulating a big enough user base that he can feel confident it’s a valuable, scalable product. Ekram, a physician by training, is bootstrapping the company’s efforts for now.

He’s gotten some valuable insight from its testing so far, though. For one, Ekram said he’s discovered another problem with cancellations: they’re usually the earliest sign that patients won’t be returning to the doctor. That’s why there’s another component to SchedFull, one that generates email and text follow-ups to patients who cancel appointments, with the hope that they just need a reminder to prompt them to reschedule their appointments.

Ekram emphasizes that SchedFull is not full-scheduling software and works independently of any scheduling programs. It is, however, in the works to integrate with what he referred to as a “well-known, Web-based EMR.” If all goes well, he said, he’d like to pursue more EMR integrations in the future.

He’d also like to develop a separate interface that would allow patients to log in and manage their preferences themselves, a project that’s in the works now.

With all of this, he hopes to bridge a disconnect in the world of patients and physicians. In a 2009 survey to determine average wait times for appointments in 15 metropolitan areas (PDF), Merritt Hawkins & Associates called more than 1,100  physician offices and found average wait times as high as 63 days in Boston to as low as seven days in Miami.

The average wait time for Detroit, where Ekram and SchedFull are based, was two weeks. “There are openings in most doctors’ schedules,” he said, “but patients have such a hard time getting an appointment.”

Company name: 

Industry: medical devices — diagnostics.

Location:  East Lansing, Michigan.

Solution/product: The Retia monitor is a cardiovascular signal processing device that is less invasive and based on technology licensed from Michigan State University and MIT. It is designed to monitor patients who go into shock. The product is aimed at anesthesiologists and intensivists.

Money raised: $7 million in a series A funding.

How it will be used: Funds will be used to complete product development and commercialize the product.

Investors: Pritzker/Vlock Family Office run by Michael Vlock and Karen Pritzker.

Management team: Marc Zemel, co-founder and CEO; Ramakrishna Mukkamala, co-founder and chief technology officer.

Market: The market for less-invasive cardiac monitoring technology can be as large as $2 billion, said Zemel, and the product can benefit at least 15 million surgical patients and 3 million intensive care patients. Retia’s direct competitors are Edwards Lifesciences’ FloTrac system, the Germany-based PULSION Medical Systems and its Picco product, and the U.K.’s LiDCO.

[Photo Credit: freedigitalphotos user Salvatore Vuono]

Stryker announced Monday that the U.S. Food and Drug Administration has cleared a clot removal device to treat patients experiencing acute ischemic stroke.

Ischemic strokes are caused by blocked arteries and constitute the overwhelming majority of strokes, according to the Mayo Clinic.

The Trevo Pro Retrieval System performed better than Merci Retrieval, made by Concentric Medical, now part of Stryker, in getting blood flowing back to the brain, which is critical for stroke patients, according to a company news release. The clinical trial that measured the safety and efficacy of the Trevo system also showed that patients treated with it had shorter hospital stays.

“As we saw with the TREVO 2 data, this technology is helping physicians and patients, and we are very excited to be able to facilitate advances in medical care with game-changing technology like the Trevo Pro Retriever,” said Mark Paul, president of Stryker’s neurovascular division, in a statement.

In its annual shareholder meeting in late April, Curt Hartman, the company’s interim CEO, current chief financial officer and vice president, described stroke as a high-growth segment. He added that the company had entered the complete stroke care market, which it did not play in before, through the $1.5 billion acquisition of the neurovascular business unit of Boston Scientific in 2010 followed by the acquisition of Concentric Medical in August 2011 for $135 million.

“Stroke care is very much in its infancy stages, and the assets that we were able to acquire through the Boston Scientific property and, later, the Concentric acquisition, are two of the market pioneers in this space, and we think will give us long-term growth for many years ahead,” Hartman said, according to Seeking Alpha.

Instead of searching the blood for specific antigens that indicate the presence of cancer, a new diagnostic and prognostic test for certain cancers searches for the autoimmune signals that respond to those antigens.

Armune Bioscience Inc. is developing a test based on serum autoantibodies, which the company says are more stable than antigens and may be easier to detect during early stage cancer. First, the company is focusing on creating an alternative to the low-specificity, prostate-specific antigen test that’s the current standard for detecting prostate cancer. Then, it will turn its focus to using the same technology to help physicians detect and make better treatment decisions about lung and breast cancer, according to its website.

A recent filing with the U.S. Securities and Exchange Commission reveals that Armune has raised almost all of a $1.5 million debt and other securities offering that started in 2009. A message left for President and CEO Eli Thomssen was not immediately returned.

The startup raised a $1.1 million angel round in 2008, won a $500,000 award in December of 2010 from the Accelerate Michigan Innovation Competition and has received additional funding from the Michigan Pre-Seed Capital Fund.

In the U.S., an estimated 2.5 million men are living with prostate cancer, but only 25 percent to 35 percent of men who have a biopsy due to an elevated PSA level actually turn out to have it, according to the National Cancer Institute. Criticism of the test culminated in the U.S. Preventive Service Task Force recommending that not all men get screened with the PSA test.

Earlier this year, the U.S. Food and Drug Administration approved a new urine test for prostate cancer known as the Prostate Health Index to complement diagnostics, and several other researchers and companies are studying this space. Researchers at the University of Pittsburgh are developing a way to determine prostate cancer’s aggressiveness (one of Armune’s later goals), and a UCLA team is looking to reduce false positives. AnalizaDx, TeloVISION are also working on detection tests.

Based on technology licensed from the University of Michigan, Armune was formed in 2008 by members of the Apjohn Group with headquarters in Kalamazoo.

3D Biomatrix Inc. launched its Perfecta3D Hanging Drop Plates at the end of last year and recently secured more international distribution partners. It also has just raised $725,000 from 22 investors, according to recent regulatory filings. A call to the company wasn’t immediately returned.

According to the company, its products enable researchers to gather information about a drug’s behavior in early discovery and allows them to identify early on compounds that would fail later in the process.

Three-dimensional cell growth products better mimic the structure and cell-cell and cell-matrix interactions of the in-vivo environment than traditional 2-D surfaces do, but industry has been slow to adopt tools for 3-D cell growth, the company notes in a blog post. But there’s plenty of competition in the space — Nacalai USA, Life Technologies and Nano3D Biosciences are a few of the other companies making 3-D cell cultures.

Ann Arbor, Michigan-based 3D Biomatrix was also recently awarded a STTR grant from the NIH to develop a high throughput assay for metastatic prostate cancer using its drop plates. This work will facilitate the development of better drugs by providing a high throughput assay that mimics prostate cancer metastasized to bone, the company says.

Formed in 2010, 3D Biomatrix is part of the University of Michigan’s Venture Accelerator.