NEWS SCAN: Global flu update, H5N1 in Japan, Salmonella sprout suspects, public health info network, disease reporting rates

first_img GAO: HHS falls short on planning for public health information networkThe Government Accountability Office (GAO) reports that the Department of Health and Human Services (HHS) has not developed a strategic plan for establishing an electronic public health situational awareness network, a step required by Congress in a 2006 preparedness law. Under the Pandemic and All-Hazards Preparedness Act of 2006, HHS is supposed to work with state, local, and tribal officials to prepare such a plan and present it to Congress, the GAO said in a report released last week. Several offices within HHS have developed related strategies that could contribute to such a strategic plan, but they created them for other purposes, the GAO said. For example, HHS has developed systems to share information for disease and syndromic surveillance, but did not do so as part of a comprehensive strategy as required by the law. HHS also has awarded funds to states and localities to improve the ability to detect public health threats, the report notes. In written comments on a draft, HHS said that a complete strategy would be developed, according to the report.GAO page with report summary and links Sprouts suspected in Illinois Salmonella casesHealth officials in Illinois are investigating a Salmonella serotype I4,5,12,i- outbreak that they suspect is linked to alfalfa sprouts that has sickened 46 people in nine counties. The Illinois Department of Public Health (IDPH) said in a Dec 17 statement that many of the people who became ill ate at Jimmy John’s restaurants. The state has been receiving reports of illnesses matching the Salmonella serotype since Nov 1. State authorities are testing produce for Salmonella and investigating alfalfa sprout producers.Dec 17 IDPH press release Dec 20, 2010 Japan finds H5N1 in swanAnimal health officials in Japan have detected the H5N1 avian influenza virus in a dead tundra swan found on the balcony of a home in Tottori prefecture, located in the western part of the country, Kyodo news service reported today. The house is 4 miles from a poultry farm in Shimane prefecture that reported a recent H5N1 outbreak. Specialists conducting surveillance in the areas around the house and farm found 23 dead birds, which will be tested for the virus. Scientists said examination revealed the virus found in the swan samples is “partially identical” to the strain found on the poultry farm, Kyodo reported. In other developments, South Korean authorities reported a low pathogenic H7N2 outbreak at a poultry farm in Southern Chungcheong province, according to a Dec 17 report from the World Organization for Animal Health (OIE). The virus turned up during surveillance activities. One bird on the poultry farm was sick and all of the 110 birds were culled to control the spread of the virus.Dec 17 OIE reportcenter_img WHO: Flu season under way in Northern HemisphereThe World Health Organization (WHO) said in its latest flu update that the season is starting in some Northern Hemisphere locations such as the East Asia, North America, and most notably the United Kingdom. England is seeing co-circulation of 2009 H1N1 and influenza B viruses. with an increasing number of severe flu cases. The latest data show the 2009 H1N1 strain is epidemiologically and virologically similar to last year’s strain. A genetic analysis of H1N1 samples from England shows several genetic substitutions compared with the vaccine virus, but the WHO said they don’t affect the antigenicity of the virus and are similar to changes that have already been detected in other parts of the world. Small to moderate increases in flu-like illnesses have been noted in 14 European countries, especially in children, with activity rising above baselines in the Russian Federation and the Ukraine. In East Asia, flu activity has recently increased in Mongolia and South Korea, and to a lesser extent, northern China. In tropical countries flu activity is low, except for Sri Lanka, where 2009 H1N1 activity recently peaked. Little flu activity has been reported in sub-Saharan Africa, except for Cameroon, which reported a recent surge in 2009 H1N1 infections.Dec 17 WHO influenza update Study: Reporting of notifiable diseases improving but still limitedResearchers in North Carolina found that the rate of reporting of notifiable infectious diseases in the state improved over more than a decade but remained low, according to an article published online today by Emerging Infectious Diseases. The researchers, from the University of North Carolina at Chapel Hill and the North Carolina Department of Health, studied the reporting of 53 notifiable diseases by eight healthcare systems from 1995-97 and 2000-06. They examined healthcare system records to identify all patients who were assigned a diagnostic code for a reportable communicable disease and then compared the resulting data with the number of cases reported to the North Carolina Department of Health and Human Services. They found that the completeness of reporting varied from 2% to 30% among the eight health systems and improved with time. Reporting rates for specific diseases ranged from 0% to 82%, “but were generally low even for diseases with great public health importance and opportunity for interventions,” the report says. They suggest that the combination of electronic health records and automated case-finding and data collection will be the key to substantially improving disease reporting.Dec 20 Emerg Infect Dis studylast_img read more

CDC expert reports some anomalies in Jordan MERS cases

first_imgEditor’s note: This story was revised on Jun 20 to correct information about the detection of an asymptomatic infection. The previous version stated erroneously that the person who had an asymptomatic infection was a household contact of one of the confirmed case-patients.Eight Jordanians who had MERS-CoV (Middle East respiratory syndrome coronavirus) infections in a hospital outbreak more than a year ago, as determined by recent blood tests, didn’t quite match the profile of more recent cases, according to a CDC expert.Most of the eight people did not have preexisting diseases, and one of them had no symptoms, said Mark Pallansch, PhD, director of the CDC’s Division of Viral Diseases.The majority of MERS-CoV cases reported in recent months involved patients who had preexisting health problems such as diabetes or heart disease. And the asymptomatic case appears to be the first one reported.The eight cases were associated with a hospital outbreak in Zarqa, Jordan, in April 2012. The cause of the outbreak was a mystery at the time, because MERS-CoV was not discovered until June of last year, when a Saudi man died of his infection.The Jordan outbreak involved 11 cases, 2 of them fatal. Samples from the patients were stored, and later analysis led to confirmation of the virus in the two fatal cases. The WHO said the other cases probably were MERS, but that couldn’t be confirmed.Earlier this week a Canadian Press report revealed that serologic (antibody) tests of 124 people related to the Jordan cluster had turned up 8 more cases, raising the number of confirmed cases in the outbreak to 10. The testing was done by the CDC in collaboration with Jordanian health officials.Pallansch provided more details on the study in an interview. He cautioned that the findings are preliminary, because the CDC has had few serum samples from MERS-CoV patients with which to validate the two new serologic tests that were used.”There’s always a caveat that we could have subsequent testing change some of the results,” he said.Six of the eight cases were in healthcare workers and were part of the hospital illness cluster, Pallansch said.One of the other two, the asymptomatic case, was in a healthcare worker who worked at the same hospital as the others. The other case involved a household contact of one of the confirmed cases, he reported. That person “by recall did have an illness, but was not considered part of the cluster at the time,” he said.Among the other six case-patients, “there was a range of illness, but all were hospitalized, so it was reasonably severe,” Pallansch said.He said he is not aware of any other asymptomatic MERS-CoV cases. Such cases are considered important because they suggest that people who aren’t sick can unknowingly spread the virus. Asymptomatic cases are likely to be discovered only through serologic tests, which for MERS-CoV have become available only recently.Pallansch said he couldn’t give any information about how the first case-patient in the Jordanian cluster might have caught the virus or about the patients’ possible animal exposures. Officials are still working on their report, he explained.”This is a report that will go back to the Jordanian Ministry of Health, and they’ll make decisions about how it will be disseminated or published,” he said.See also:Related Jun 17 CIDRAP News storyNov 30, 2012, CIDRAP News storylast_img read more

Guinea goes a week with no new Ebola detections

first_imgGuinea reported no Ebola cases last week, a period of high alert, given that the most recent cluster of family-linked cases generated several risky exposures, the World Health Organization (WHO) said today.Looking at the bigger picture, the number of cases in Guinea has stayed at four or fewer for the past 16 weeks, the WHO noted in its weekly snapshot of the outbreak. Guinea’s lull in cases came in the wake of its neighbor Sierra Leone being declared free of the disease on Nov 7, becoming the second of the three outbreak countries to reach that status.Still following high-risk contactsAll of the 69 contacts still being monitored are from the Forecariah district village where the family members were infected, the WHO said. They included a 25-year-old woman who died from Ebola after delivering a baby, who also tested positive for the virus and whose illness was announced last week. The two other patients in the cluster are the woman’s two other young children.The illnesses had links to the last known transmission chain that began in Conakry’s Ratoma area. Sixty of the contact are considered high risk, and one contact from the district has been lost to follow-up, the WHO said in its weekly update.”Therefore, there remains a near-term risk of further cases among both registered and untraced contacts,” it said. Guinea’s contacts will complete their 21-day follow-up period on Nov 14.Response objectivesThe WHO said Liberia and Sierra Leone have both reached the first objective in phase 3 of the response framework: ending Ebola transmission. Now they are working on the second objective, which is to manage and respond to residual risks of the disease.All three countries have put systems in place that allow members of the public to report any illness or death that they think might be linked to Ebola. Guinea recorded 24,634 such alerts last week from all of its districts. For comparison, Sierra Leone logged 1,690 alerts from 12 of 24 districts through the week ending Oct 25. Similar data weren’t available for Liberia.Liberia and Sierra Leone are both in a 90-day enhanced surveillance period.Overall, the total for the outbreak—which began in early 2014—is at 28,599 confirmed, probable, or suspected cases. So far 11,299 deaths have been reported.A call to end Canada’s visa banIn related news, an Ottawa law professor today called for Canada’s new Prime Minister Justin Trudeau to end the country’s ban on issuing visas to people from the three affected outbreak countries.Writing in the journal Policy Options, Steven Hoffman, with the University of Ottawa’s Centre for Health Law, Policy, and Ethics, said it’s been a year since Canada took the step, which he said was an overreaction that, among a host of problems, hurt the outbreak response and went against the International Health Regulations. The journal is published by the Montreal-based Institute for Research on Public Policy, a nonpartisan public policy think tank.Hoffman said the restrictions are still in effect for two of the countries, even though the outbreak has been contained and public health experts have said the bans don’t work and can impair the outbreak response. “Canada ending its visa restrictions would have the added benefit of bringing our country into compliance with its international legal obligations. Such a move would also be in line with evidence-based public health guidance,” he wrote.Model finds missed control opportunitiesA statistical model that includes data from Sierra Leone’s health ministry mapped the spread of the virus during the outbreak, highlighting two critical opportunities health responders had to curb the outbreak.The analysis was conducted by a research team based at Columbia University’s Mailman School of Public Health and was published today in the Journal of the Royal Society Interface. The model includes the patient’s home district, population of the district, and distance between districts.The team found that the first window to control Sierra Leone’s outbreak was before the virus reached Kenema, a period that lasted 1 month. The second was before it reached Port Loko, a much shorter interval. The authors said Kenema and Port Loko were critical junctions during the outbreak, due to their many connections to other districts.Jeffrey Shaman, PhD, senior author of the study and associate professor at the Mailman school, said in a Columbia University press release, “While this analysis is too late to be used for application to and intervention in the Ebola epidemic, the method we used could be useful for future disease outbreaks, and not just for Ebola.”See also:Nov 11 WHO Ebola situation updateNov 11 Policy Options editorialNov 11  J R Soc Interface abstractNov 11 Columbia University press releaselast_img read more

Stewardship / Resistance Scan for Jan 31, 2017

first_imgStudy finds resistance genes are abundant in Chinese estuariesA team of researchers has detected a high abundance and diversity of antibiotic resistance genes in Chinese coastal estuaries, according to a study yesterday in Nature Microbiology.For the study, researchers tested sediment from 18 estuaries over 4,000 km of coastal China and examined their relationship with bacterial communities, antibiotic residues, and socioeconomic factors. They found a total of 259 resistance genes in the estuary samples, with an average of 118 in each estuary at levels around 1 million resistance genes per gram of sediment. The detected genes conferred resistance to almost all major classes of antibiotics used in humans and animals, the authors said, and represented all major resistance mechanisms, including antibiotic deactivation, efflux pumps, and cellular protection.The most common resistance genes found at each estuary were multidrug and beta-lactam resistance genes, followed by aminoglycoside and tetracycline resistance genes. Vancomycin resistance genes were found at all estuaries.        When the researchers analyzed antibiotic residues in estuary samples, they found five major antibiotic classes: diaminopyrimidines, tetracyclines, sulfonamides, fluoroquinolones, and macrolides. The concentrations of tetracyclines and macrolides were positively correlated with the total abundance of resistance genes.Analysis of the relationship between socioeconomic factors and resistance-gene abundance showed that total population, gross domestic product, sewage, and aquaculture production were correlated with the abundance of aminoglycoside, multidrug, and sulfonamide resistance genes.The authors conclude that anthropogenic activity “appears to be the major driver of abundance and diversity” of resistance genes found in estuaries, and that wastewater streams from municipal sewage treatment and aquaculture are a likely contributor. Jan 30 Nat Microbiol abstract Antibiotic use in travelers linked to colonization with MDR bacteriaA new study from researchers in Sweden and Finland has found that antibiotics taken during travel to subtropical regions can predispose travelers to colonization by drug-resistant bacteria with a high rate of co-resistance to other antibiotics.In the study, which appeared yesterday in Travelers Medicine and Infectious Disease, the researchers analyzed the isolates of 90 people who had contracted extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) while traveling abroad. The 90 participants were part of an earlier investigation, in which the researchers found that taking antibiotics for traveler’s diarrhea (TD) increased the risk of colonization by ESBL-PE, particularly when traveling to regions with poor hygiene and weak antibiotic policy (such as South and Southeast Asia). One of the main takeaways of that study was that travelers should be advised against taking antibiotics for mild or moderate TD.For this study, the researchers were trying to determine what percentage of those isolates were also co-resistant to non-beta-lactam antibiotics, as co-resistance can complicate treatment of ESBL-PE infections. They considered four major risk factors of colonization, including destination, age, TD, and antibiotic use.Of the ESBL-PE isolates, 53%, 52%, 73%, and 2% were co-resistant to ciprofloxacin, tobramycin, co-trimoxazole, and nitrofurantoin, respectively. The rates were similar among those with TD and without TD. But when they compared the isolates of the travelers who had taken fluoroquinolones (FQs) to those who had taken no antibiotics, they found co-resistance rates for ciprofloxacin were 95% versus 37%, for tobramycin were 85% versus 43%, for co-trimoxazole were 85% versus 68%, and for nitrofurantoin were 5% versus 2%.”Thus, use of FQs predisposes not only to contracting ESBL-PE strains but, indeed, also to selecting ESBL-PE strains co-resistant to certain clinically important non-beta-lactam antibiotics,” the authors write.”The data reveal that the perils of antibiotic use during travel are even greater than hitherto recognized.”Jan 30 Travel Med Infect Dis studylast_img read more

Controversy over data in hydroxychloroquine COVID-19 study grows

first_imgThe editors of The Lancet yesterday issued a statement acknowledging the criticism of a recent study that concluded that the antimalaria drugs hydroxychloroquine and chloroquine did not benefit COVID-19 patients and were associated with higher risk of death and serious heart rhythm complications.The statement comes in response to a letter signed by more than 100 scientists and clinicians worldwide that raised questions about the data behind the large observational study.The Lancet said in its statement that important scientific questions had been raised about the data reported in the paper, and that an independent audit of the data commissioned by the authors is ongoing.The study, published in The Lancet on May 22, compared outcomes in patients treated with hydroxychloroquine and chloroquine (with or without macrolide antibiotics) with those who received neither drug, and was the largest to date on the use of hydroxychloroquine and chloroquine in COVID-19 patients. But in the days following publication, several scientists took to social media to express skepticism about the study and the data on which it was based, and that criticism has continued.In an open letter to Lancet Editor Richard Horton late last week, critics raised concerns about the methodology of the study, asked that a group convened by the World Health Organization (WHO) perform an independent validation of the analysis, and requested that the journal make peer review comments on the study openly available.Concerns about bias and confoundingAmong the concerns laid out in the letter are that there was inadequate adjustment for known and measured confounders, such as severity of illness.That’s been a common criticism of several of the observational studies on use of hydroxychloroquine and chloroquine for COVID-19: that many of the patients treated with the drugs in these studies have been sicker. Experts say that the inability to fully account for more severe disease among patients treated with the drug skews the results.”Because it is an observational study, we know that bias and confounding can really affect the results,” said Ruanne Barnabas, MBChB, DPhil, a physician and associate professor of global health at the University of Washington who signed the letter. “My concern about it being observational was that it [hydroxychloroquine] was used compassionately for people who were more sick and likely to do worse anyway…so we would not be able to assess the impact using the study design.”That criticism is one of the main reasons why there is a consensus among experts that randomized controlled trials (RCTs)—the gold standard for evaluating whether a drug is truly safe and effective against a disease—are needed to determine whether the drugs can help COVID-19 patients.The letter also argued that the authors of the study have not released their code or data, that no ethics review was performed, and that some of the mean daily doses of hydroxychloroquine given to patients in the study are higher than US Food and Drug Administration recommendations. And it raised specific questions about some of the data points.In particular, the critics note that data from Australia are not compatible with country reports on COVID-19 cases, with too many cases for just five hospitals and more in-hospital deaths than had occurred in the entire country during the study period. In addition, data from Africa indicated that 25% of COVID-19 cases and 40% of deaths on the continent occurred in Surgisphere-associated hospitals, a claim that the letter said seems unlikely.In a correction published in The Lancet on May 30, the authors of the study provided revised numbers on participants from Asia and Australia, and said that a hospital self-designated as belonging to the Australasia continental designation should have been assigned to the Asian continental designation. But there were no changes to the findings of the paper.Data origins, validity questionedIn addition, the critics raised red flags about the origins of the data used in the study. The analysis of 96,032 patients from 671 hospitals on six continents used data from the Surgical Outcomes Collaborative, a database that collects de-identified patient information from electronic health records, supply chain databases, and financial records. The database is owned by Surgisphere, a company founded by study co-author Sapan Desai, MD, PhD.”There was no mention of the countries or hospitals that contributed to the data source and no acknowledgments of their contributions,” the letter states. “A request to the authors for information on the contributing centers was denied.””You can understand that individual patients don’t want to share their data, but at a minimum, knowing which hospitals contributed would be important,” Barnabas said, noting that in most observational studies, you know the hospitals where the data came from, and investigators from those hospitals are often co-authors.”Although an independent audit of the provenance and validity of the data has been commissioned by the authors not affiliated with Surgisphere and is ongoing, with results expected very shortly, we are issuing an Expression of Concern to alert readers to the fact that serious scientific questions have been brought to our attention,” The Lancet said.An emailed statement sent to CIDRAP News on behalf of lead study author Mandeep Mehra, MD, medical director of the Brigham and Women’s Hospital Heart and Vascular Center, said the goal of the independent third-party auditor is to verify the source data and assess the accuracy of the database and the authors’ findings.”Upon completion of the reviews, the auditor will simultaneously provide its findings directly to the editors of the journal and to the co-authors, independent of Surgisphere,” the statement said. “I eagerly await word from the independent audits, the results of which will inform any further action.”In a statement on its website, Surgisphere said the company’s data use agreements with hospitals prevent it from sharing customer names.”Our strong privacy standards are a major reason that hospitals trust Surgisphere and we have been able to collect data from over 1,200 institutions across 46 countries,” the company said. “While our data use agreements with these institutions prevents us from sharing patient level data or customer names, we are able to complete appropriate analyses and share aggregate findings to the wider scientific community.”The company also said it stands behind the integrity of its studies, scientific researchers, clinical partners, and data analysts.Surgisphere data were also used in another COVID-19 study, published in the New England Journal of Medicine on May 1, that has come into question. NEJM Editor-in-Chief Eric Rubin, MD, PhD, yesterday issued an Expression of Concern about that study, saying the journal has asked the authors to provide evidence that the data are reliable.     Study results, media coverage affecting clinical trialsAnother issue raised in the letter from the 100-plus scientists and clinicians is that the findings of The Lancet study, and subsequent media attention, have caused concern among those currently participating in RCTs. Barnabas, who is the principal investigator in an RCT looking at whether hydroxychloroquine can prevent illness in those who’ve been exposed to people with a confirmed or pending COVID-19 diagnosis, said the findings have affected recruitment.”Certainly our trial has seen a decrease in recruitment and enrollment with every news story that comes out,” Barnabas said. “When you talk to participants and you present all the information, they understand the impact of observational studies and they are willing to participate, but then a family member or a friend will encourage them not to participate, and we have had people withdraw.”Barnabas said an independent data safety and monitoring board has reviewed and analyzed all the unblinded safety data from the trial, along with data from other ongoing RCTs studying the use of hydroxychloroquine in COVID-19 patients, and recommended continuing the study. “They had no safety concerns,” she said.The WHO, meanwhile, after announcing last week that it was pausing recruitment to the hydroxychloroquine arm of its SOLIDARITY trial, said today that its data safety monitoring board had not found a safety signal, and that the study will resume.Barnabas said data from RCTs are “absolutely essential” for determining whether hydroxychloroquine can help prevent or treat COVID-19.”We definitely need those trials to go forward,” she said. “And we don’t need just one trial, we need several trials, in different populations, asking the question in slightly different ways, so that we can understand whether there is a role here for hydroxychloroquine.”last_img read more

Topper Volleyball Undefeated In District Play

first_imgLAHS Girls Topper Volleyball finished the season Saturday night with a 9-0 record and a 3-2 victory in the District Tournament Championship. Photo by John McHale/ SPORTS News:Los Alamos completed a clean sweep of District opponents and finished the season with a 9-0 record and a 3-2 victory in the District Tournament Championship game played Saturday night in Griffith Gymnasium.The Toppers kept things interesting dropping the first two sets before taking control in the last three. The first two sets were plagued with 9 hitting errors, 4 serving errors and 17 serve / receive errors. Once the Toppers shored this up they set sail for a dominating three sets.Natalie Gallegos wrecked the Pintos with 37 kills followed by Nadia Gallegos with 8 kills. Edkin, Gonzales and Schmierer combined for 14 kills. The Bigs combined for 23 Solo Blocks for Kills led by Natalie Gallegos with 10. Gracie Swensen led the way from the service line with 3 Aces and 14 points off serve.The Toppers mitigated service errors with 7 in 5 sets. Swensen and Maestas settled in for the last 3 sets and delivered spot on passing to Olivas. Olivas extended the Toppers leads with 4 (3 point runs) and 17 points on serve to help seal the last three sets. Next up is State!The Toppers were awarded the number 4 seed in the State Tournament and will play the Pojoaque Elkettes in the opening round at 9:45 a.m. Thursday on court 4 played at the Santa Ana Star Center in Rio Rancho.last_img read more

Maritime Design to Assist Construction of U.S. LNG Vessels

first_imgJim Konopasek, president of Maritime Design, Inc. since 1983, has recently completed and attained certification from the American Bureau of Shipping in the design and construction of LNG carriers at the ABS Shanghai, China office.Maritime Design, Inc. offers to assist Jones Act vessel owners and operators in conveying their small scale LNG fleet needs through early development to construction.Mr. Konopasek is principal owner of Maritime Design, Inc. and has been involved in the design, engineering and consulting of many specialized vessel types including general service vessels to the offshore oil industry, offshore platforms, oil tankers, heavy lift barges, oceanographic research vessels, patrol boats, cable laying ship and auto/passenger ferries.[mappress]LNG World News Staff, August 14, 2013; Image: Maritime Designlast_img read more

New contracts for Prosafe’s accommodation rigs

first_imgProsafe and BG Group have agreed a change to the Safe Bristolia accommodation support vessel work programme in 2014 to allow inclusion of a contract award from ConocoPhillips Petroleum Company U.K. Limited for the provision of the vessel at the Judy platform in the U.K. sector of the North Sea.Operations at Judy are planned to start in May for a firm period of 4 months. Thereafter, from September 2014, the Safe Bristolia will relocate to BG Group’s Everest platform for a firm period of approximately 3 months. As a result, the overall work programme for the vessel increases by 24 days and has a value of approximately USD 8.3 million.Also, Prosafe has  secured extension for the Safe Astoria accommodation rig with Singapore’s Swiber. The contract, originally signed in December last year, has been extended by a firm period of 43 days at the same dayrate. The contract value of the extension is USD 4.7 million.[mappress]April 14, 2014last_img read more

Referral ban ‘will not reduce costs’

first_imgBanning referral fees will harm the legal profession and will have no effect on reducing law firms’ marketing costs, the chair of the Claims Standards Council (CSC) said last week. Speaking at the CSC annual conference in Manchester, Accident Advice Helpline managing director Darren Werth said it is ‘shocking’ that the Law Society and Lord Justice Jackson want to ban referral fees. ‘It will drive businesses underground,’ he said, creating ‘a future not in line with a modern commercial world’ by ‘legislating against market forces’. The Legal Services Board’s consumer panel recently commissioned management consultants Charles River Associates to undertake an ‘economic study’ of referral fees. Jackson concluded in his final report on civil litigation costs that referral fees should be banned in personal injury cases, while the Law Society Council voted at the end of last year to press for a ban on referral fees. SRA chief executive Antony Townsend said last week that the SRA ‘supports and is contributing to the cross-sector review of referrals by the LSB’. Werth said: ‘In any economy where solicitors run businesses for profit, they need referrals. Solicitors don’t market their businesses very well. If a solicitor spends half of his marketing budget with an advertising company and the other half with a claims management company, which is the bigger evil? ‘Abolishing referral fees would have no impact on marketing costs. Without them, there would be far less competition in the marketplace with only large firms surviving. You outsource to the most effective provider, which will most likely be a CMC. ‘It’s ridiculous to single out referral fees as some kind of problem. Jackson fails to recognise the millions of pounds that CMCs have spent on promoting access to justice. There has been no government-led campaign on this.’last_img read more

Blame where its due

first_imgTo continue enjoying, sign up for free guest accessExisting subscriber? LOGIN Subscribe now for unlimited access Subscribe to Building today and you will benefit from:Unlimited access to all stories including expert analysis and comment from industry leadersOur league tables, cost models and economics dataOur online archive of over 10,000 articlesBuilding magazine digital editionsBuilding magazine print editionsPrinted/digital supplementsSubscribe now for unlimited access.View our subscription options and join our community Get your free guest access  SIGN UP TODAY Stay at the forefront of thought leadership with news and analysis from award-winning journalists. Enjoy company features, CEO interviews, architectural reviews, technical project know-how and the latest innovations.Limited access to industry news as it happensBreaking, daily and weekly e-newsletterslast_img read more