Little did Kermit the Frog know when he lamented, "it's not easy being green," that in the not-too-distant future everyone would be going green. And now the newest member of Club Green is DaVita Inc., the renal industry's second largest dialysis provider, who is trying to resize its carbon footprint from a potential Big Foot track to that hardly noticeable imprint of a mouse.

In 2007, the company created the "DaVita Village Green" program to reduce DaVita's business practice's environmental impact. Starting with the fundamentals, DaVita Village Green published a facility handbook in the fall of 2007 and distributed it to the company's more than 650 centers and business offices around the world. The handbook focused on energy and resource conservation; recycling; and environmentally thoughtful purchasing.

"Our hope with DaVita Village Green is that teammates, patients, and doctors will take a few extra minutes to think about their decisions and recognize that small modifications in everyday routines can create a significant impact," said Misha Palecek, DaVita divisional vice president and Village Green director.

Reduced paper consumption
One of the first changes the company started to implement was reducing its paper usage. DaVita started working with a new, more environmentally-friendly office supply vendor and the company changed its default paper type to be 30% post-consumer recycled content paper, boasting a two-year average of saving enough trees to fill a forest the size of New York City's Central Park.

On top of switching actual paper stock, DaVita tried to use less paper by utilizing certain technologies. As of June 2008, information securely stored in the company's data centers is no longer printed automatically in dialysis centers. This modification will lower DaVita's annual paper consumption by 7%, which equates to 20 million pieces of paper, or approximately 2,000 trees.

Another large paper-saving change was switching the company's method of distributing payroll information from the common biweekly paper-based system to an electronic viewing system.

Reduced oil consumption
In addition to paper-waste, DaVita Village Green has focused on lowering the amount of oil used. In tandem with printing less, the company will save 1,500 gallons of oil annually through reduced need for printer toner. Another significant oil-saver comes from reducing the amount of medical waste, which in kidney care comes from dialyzers.

Reuse
Because dialyzer components are made entirely from crude oil, the non-degradable parts add up to more than 60 million pounds of medical waste each year. If DaVita only offered single-use dialyzers, the waste alone would contribute upwards of 20 million pounds of that amount.
But right now DaVita currently saves more than eight million pounds of medical waste each year by offering reuse dialyzers in addition to single-use. And because dialyzers rely on crude oil for their components, DaVita hopes this reuse will help relieve America's dependence on foreign oil In NN&I's ranking of the largest renal providers in the United States (see July 2008 NN&I), seven of the 10 dialysis companies practiced dialyzer reuse).

A new way to purchase
Beyond office supplies and reuse, DaVita's procurement team continues to secure environmentally thoughtful purchasing contracts. Last year, for example, DaVita began purchasing sharps containers that contain 30% recycled plastic. Using these new containers, more than 120,000 pounds of plastic are kept out of landfills and oceans annually.

DaVita's information technology team is spearheading national recycling programs for toner cartridges, electronics, and cell phones to raise money for charitable programs. DaVita's toner recycling program, for example, will raise approximately $20,000 annually for The Kidney TRUST, a nonprofit organization started by DaVita and dedicated to raising awareness of kidney disease through public education and testing programs across the country.

Since coming to life in 2007, Village Green has grown roots throughout DaVita. In Southern California, DaVita is building a Leadership in Energy and Environmental Design-certified center, which is slated to finish construction by the end this year.

"It's about making the commitment and taking the time to kick old habits," Palecek said.





With important diabetes drug recalled, Wall Street assesses its future

With the Aug. 26 report by Eli Lilly and Amylin Pharmaceuticals Inc. of four new deaths in patients taking the diabetes drug Byetta, their stock prices have been a question of concern.

Both companies split worldwide sales of Byetta, which grew more than 50% to $650 million in 2007, and even with obvious questions and dipping stocks following the announcement of the deaths, Wall Street still continues to maintain a positive outlook for the drug and the next-generation formula.

Leerink Swann & Co. analyst Jonas V. Alaenas, reaffirmed an "outperform" rating on Amylin following the recall, calling the pancreatitis concerns "overblown." Also in the week following the announcement, Goldman Sachs analyst Meg Malloy reaffirmed a "buy" rating with a similar comment.


Approved in 2005, Byetta was the first in a new class of diabetes medications that have shown improved ability to control blood sugar levels. The drug is expected to face competing products as soon as next year.

In June, Danish drugmaker Novo Nordisk reported data showing its experimental drug liraglutide was more effective than Byetta at controlling blood sugar levels. Swiss firm Roche is also working on its own next-generation diabetes medication.

Lower revenues from the drug would impact the bio-tech company Alkermes Inc., which helped develop the longer-acting formula and is slated to receive royalties from its sales.

In the weeks following the announcement of the four deaths related to Byetta, prescriptions for the twice-daily treatment fell 2.1%, according to pharmaceutical data firm IMS Health. Eli Lilly Medical Director James Malone, in an effort to ease concerns about the timeline for Eli Lilly's long-acting version of Byetta-aimed at use once a week rather than twice daily-told the Associated Press that both Eli Lilly and Amylin still hope to bring the drug to market by mid-2009 and that there are no plans for additional studies, despite the FDA's safety concerns.


U.S. regulators clear Fresenius buyout of APP

APP Pharmaceuticals Inc. said Sept. 2 that U.S. regulators cleared the way for its purchase by German dialysis-clinic operator Fresenius Medical Care AG.

In July, Hamburg-based Fresenius announced its plan to purchase APP for $3.7 billion in cash, or $23 per share, plus potential contingent payments of $970 million, or $6 per share. APP said Sept. 2 it expects the deal to close by mid-September, now that the Federal Trade Commission has completed its review of the transaction. German authorities previously signed off on the deal.

APP makes injectable drugs, including heparin, used by patients on dialysis. Fresenius' purchase of the company will make it the primary producer of heparin in the United States.

Shares of APP Pharmaceuticals rose 15 cents to $23.82 after the announcement, while shares of Fresenius Medical Care AG fell 13 cents to $53.40.


Baxter named to Dow Jones Sustainability Index for 10th straight year

Baxter International Inc. announced Sept. 5 that it has been named 2008 Medical Products Industry Leader of the Dow Jones Sustainability World Index (DJSI World) and the Dow Jones Sustainability North America Index (DJSI North America). This marks the tenth consecutive year that the company has been listed in the DJSI and the seventh year the company has been named Medical Products Industry Leader since the launch of the DJSI in 1999.

The DJSI World Index tracks the financial performance of the top 10% of the 2,500 largest companies in the Dow Jones Global Index in terms of social, economic and environmental performance. The DJSI North America Index includes the top 20% in each of 57 sectors out of the largest 600 North American companies in the Dow Jones Global Index.





With Hawaiians in need of renal care, island dialysis centers expand

Fresenius Medical Care and Liberty Dialysis Hawaii LLC, the two companies providing outpatient and acute dialysis services in Hawaii, are expanding facilities in an effort to meet growing needs of residents with kidney disease.

Hawaii has one of the highest rates of kidney disease in the nation, and cases are continuing to increase, primarily associated with diabetes, Glen Hayashida, National Kidney Foundation of Hawaii chief executive officer, told the Honolulu Star-Bulletin. He said 156,000 islanders have one of five stages of chronic kidney disease, and another 100,000 are at risk, with no signs or symptoms. About 2,300 people statewide have renal or kidney failure and need dialysis or a transplant to sustain life, he said.

Jane Idica, manager for the western Honolulu area, told the Star-Bulletin that Fresenius is providing dialysis services at Castle Medical Center, Kapiolani Medical Center at Pali Momi, Straub Clinic & Hospital, and Wahiawa General Hospital.

Jane Gibbons, executive vice president for Liberty Dialysis Hawaii, which took over former St. Francis Medical Center's outpatient renal dialysis program in 2005, told the Star-Bulletin that the company has 14 clinics on five islands, each with a different capacity, and they are adding shifts.