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To: TokyoMex who wrote (6433)7/5/1998 9:58:00 AM
From: TokyoMex  Read Replies (1) | Respond to of 8798
 
AGPH and IMNR ?

Prevention Remains the Best Hope in Fight Against AIDS

By LAWRENCE K. ALTMAN

GENEVA -- The 12th World AIDS Conference ended here Friday in a somber mood.

A series of reports about new problems with anti-AIDS drugs and setbacks in vaccine trials left many participants thinking that their best hope against the epidemic is the strategy they have had since it began -- prevention.

But many of them said this last hope was not being pursued as aggressively as it should be.

The mood was a sharp contrast to the euphoria at the last AIDS meeting, in Vancouver, British Columbia, two years ago. There, scientists reported that combinations of new drugs, called protease inhibitors, had allowed many people infected with HIV, the AIDS virus, to leave their deathbeds, even to return to work.

But this year, the talk was of problems. Vaccine researchers gave the disheartening news that a promising candidate vaccine, tested in monkeys, caused the disease rather than prevented it. Doctors told of patients who failed in spite of the new drugs, or who developed side effects while taking them.

And even when the drugs offered hope, still other speakers said, it is hope beyond the reach of the vast majority of the 34 million people now infected with the AIDS virus. Those patients cannot afford the treatment. It can cost about $15,000 to provide the drugs to one person a year, a sum greater than the entire health budget of many a Third World village.

As Dr. Hoosen Coovadia, of Durban, South Africa, explained it, AIDS affects 40 percent of the children he treats in a large black hospital there. Yet, Coovadia, who is chairman of the next World AIDS Conference in 2000 in Durban, said that he had never used any anti-HIV drugs. His hospital cannot afford them, he said.

Reports like these lead inexorably to the conclusion that the best hope for easing the epidemic is still prevention, speakers said. Yet "over 100 times more money is being spent on therapeutics now than on the development of prevention technologies," said Dr. Catherine Hankins, an epidemiologist at Montreal General Hospital in Canada. Among them are chemicals that could be inserted into the vagina before sexual intercourse to kill HIV. Hankins left the meeting saying she did not feel "terribly optimistic."

Sex education, needle-exchange programs, condom distribution, among other preventions, could save millions of people from AIDS, speaker after speaker told those gathered at the meeting. At the same time, though, many of the 13,775 participants from 177 countries concluded that people and their government leaders were not paying enough attention to those relatively simple steps, and that industry was doing too little to develop more effective prevention methods.

Speakers urged that health workers combine preventions as they had drugs and adopt a community-based approach to promote them. They called for more programs to treat sexually transmitted diseases because those diseases can increase the risk of spreading HIV, in part by creating open sores.

Programs to promote sex education, use of male and female condoms, and needle exchanges worked well and did not promote promiscuity or drug use, a number of health workers said. Yet, they added, government and community leaders often become near hysterical when such programs are broached, often because they fear criticism from the clergy or political opponents. In the United States, there has been widespread opposition to condom-distribution programs, and the Clinton administration announced recently that it would not support needle-exchange programs.

"We know what prevention works, but we don't do enough of it," said Dr. Werasit Sittitrai of Thailand. He cited several effective measures, including counseling about sexual health, education from peers who had been trained to advise in prevention, and access to friendly and confidential clinics that treat sexually transmitted diseases.

But older people often stand in the way because they forget what it was like to be young, Sittitrai said. "We forget the fear, the laughter, the craziness, the boredom, and all those bubbling, boiling hormones," he said, and "how much sex occupied our thoughts."

Speakers called on conference participants to return to their homes and rally others to become more involved in the political process to promote HIV-prevention efforts.

The meeting's theme was "bridging the gap" between what is available to HIV-infected people in developed and developing countries, where, said Dr. Peter Piot, executive director of the United Nations AIDS program, the virus is causing "a runaway epidemic."

The enormous complexity of dealing with a raging epidemic in a poor country was underscored by a report from Dr. Alan Smith, a virologist at the University of Natal in South Africa, who discussed blood tests for the virus.

The standard HIV test detects proteins known as antibodies that are usually formed about six weeks after the virus enters the body. A more precise test, which detects a portion of the AIDS virus known as P24, appears to be far better, but most developing countries cannot afford it, said Smith, who studied the problem in a prenatal clinic. Accurate testing during pregnancy is particularly crucial to enable doctors to try to prevent transmission of the virus from mother to child.

Other studies showed that giving pregnant women the anti-viral drug AZT and delivering their babies by planned Caesarean section could reduce the risk of a baby's contracting the virus from its mother to about 1 percent. The drug and surgery therapies are widespread in developed countries, said Dr. Augusto Semprini of the San Paolo Biomedical Institute in Milan, Italy.

But he added that many obstetricians in developing countries do not perform Caesarean sections because of the increased risks of the surgery and inadequate infection-control measures in their hospitals. And many developing countries can not afford AZT.

But some gaps that need to be bridged lie nearer to home.

Mark Harrington of Treatment Action Group, an AIDS advocacy group in New York City, said gaps in care existed in the United States as well as the Third World. "When we talk about the North-South gap, we must remember that the South includes Mississippi, and it includes the South Bronx," where the prevalence of HIV is high, Harrington told participants at the meeting.

He called for pressure on politicians to get prevention methods and treatment to more people.

The mood shift seen between the Vancouver and Geneva meetings is not unusual in research and public health because progress often resembles a roller-coaster ride, particularly in the first years after scientists confront a new disease.

AIDS was recognized in 1981 as an immunological disorder several years before HIV was identified several years later. But thereafter immunologists and virologists often worked apart. Now scientists in both fields are beginning to bridge that gap in seeking ways to bring the immune system into play during antiviral therapy, said Dr. Jay Levy of the University of California at San Francisco.

But it can be difficult to put any new findings into clinical practice. For example, the effectiveness of combination anti-HIV therapy has been documented in clinical trials. As valuable as the trials are, most last little longer than four or six months, and drug companies are generally reluctant to compare new drugs in head-to-head trials because the trials are costly and might show that a competitor's drug is more effective.

That often leaves many doctors and their patients in a quandary over how aggressive they should be in starting new anti-HIV drugs and answering a number of other questions, said Dr. Wafaa El-Sadr, who treats many HIV-infected people at Harlem Hospital in New York.

El-Sadr described a patient, Lester, who has stopped injecting illegal drugs and has read extensively about HIV. "He reads and asks the toughest questions," El-Sadr said, such as: "'I have done so well till now on no treatment; have they looked at these cocktails in people like me? Are you sure I am better off to start now?"'

El-Sadr said she could not answer those questions in Lester's case and many others for additional patients because the clinical trials did not provide the crucial information. To help get it, El-Sadr called on Federal health officials to start a program to monitor anti-HIV treatment in practice.

New drugs in the pipeline are expected to simplify treatment regimens by decreasing the number of times pills must be taken each day. There are now 11 anti-HIV drugs approved by the Food and Drug Administration and marketed in the United States, and the number may soon reach 15.

The drugs are generally given in combinations of three and sometimes four. That will leave 204 possible combinations of three drugs, and 1,028 possible combinations of four drugs, said Dr. Richard Horton, the editor of The Lancet, an international medical journal published in London.

Dr. Julio Montaner, who heads the AIDS program at the University of British Columbia in Vancouver, said that HIV therapy was so complex that even experts like him had difficulty keeping track of therapeutic advances. But many doctors who are inadequately informed about the disease prescribe drugs for HIV patients, and "there is a lot of suffering among infected people because they were given suboptimal treatment," Montaner said.

If doctors do not know how to use the new drug cocktails appropriately, or if patients abandon precautions in intercourse, the results can be disastrous for them and eventually for society. If doctors do not prescribe the drugs correctly or if patients do not use them correctly, the virus can mutate into drug-resistant strains.

Doctors from the University of California at San Francisco reported about a man who became infected with a strain resistant to six of the 11 anti-HIV drugs now in use.

Additional cases of multiple drug-resistant strains of HIV were reported by doctors in Geneva, raising warnings of a potentially even more serious public health problem.

Other Places of Interest on The Web 12th World AIDS Conference.

Sunday, July 5, 1998
Copyright 1998 The New York Times



To: TokyoMex who wrote (6433)7/5/1998 10:04:00 AM
From: TokyoMex  Read Replies (1) | Respond to of 8798
 
Gorging on a Diet of Deals

By REED ABELSON

They are serial acquirers -- companies that play Pac-Man by gobbling up other companies, paying for the purchases with high-priced stock. It's a cycle that feeds voraciously on itself: The more a company acquires, the higher the stock price, fueling even more acquisitions.

The buyers include companies like Republic Industries and Nationsbank, Cendant and Worldcom. They promise investors that they will make money by transforming industries, providing tremendous economies of scale and greater efficiencies.

Early in the cycle, it may indeed work out that way. But investors can find it impossible to tell when the game is about to come to a grinding halt -- rudely punishing the acquirer's stock.

Shares in the newly formed Cendant Corp. lost nearly half their value after the company disclosed in April that one of its businesses, the former CUC International, had overstated earnings. Waste Management's troubled accounting and ill-fated diversification attempts eventually crushed its shares and are driving the company into the arms of a rival.

U.S. Office Products' profits have slumped and the company recently ended up spinning off four units composed of some of its purchases.

What all serial acquirers -- the successful and the not-so-successful -- have in common is that their finances can confound even the most sophisticated investors. Buyers of these companies' stocks must decide whether to risk being swept up in the deal-making in the hopes of riding a stock up further.

The sheer complexity of putting together dozens of companies or more -- in each of its most frantic years, Waste Management bought as many as 100 companies -- makes it nearly impossible to see whether the acquiring company's strategy is working.

Adding to the confusion is that many of these companies employ accounting sleight of hand; in perfectly legal maneuvers, they mask the real cost of their acquisitions through write-offs, leaving the buyers looking more profitable than they really are.

In sorting this out, investors get little help from Wall Street analysts, who often play along. After all, corporations can come down hard on naysayers. Thomas K. Brown, until recently a banking analyst for Donaldson, Lufkin & Jenrette, long criticized the acquisition strategy of First Union Corp., which has made more than 70 acquisitions since 1985.

As a result, he said, he was excluded from one-on-one meetings at First Union's headquarters in Charlotte, N.C. (First Union said it had never refused to meet with Brown.)

Another analyst, who asked not to be identified, recalled being threatened with a lawsuit by one serial acquirer after publicly questioning its purchases. Why the heavy-handed treatment? "So much depends on the stock price," he surmised.

Analysts can also be reluctant to look too closely at any one transaction for fear that their company might lose the lucrative investment banking fees on the acquirer's next deal.

A result of this combination of complexity and analysts' see-no-evil, speak-no-evil approach is that the guidepost usually followed by investors -- the analysts' estimated growth rate of earnings -- can vary so wildly for these companies as to be nearly meaningless.

Analysts following Worldcom, for example, peg its annual earnings growth rate at anywhere from 20 percent to more than 50 percent, a range that suggests they are doing little more than guessing.

Enthusiastic analysts are not always wrong, of course, and many investors enjoy long rides up with the stock of acquisition-happy businesses. "Lots of companies have successfully changed the profitability of an industry by acquiring," said John W. Ballen, the chief equity officer for MFS Investment Management in Boston, citing Republic Industries, Computer Associates and Cardinal Health as examples. But other seasoned investors and analysts are so wary of the serial acquirers that they simply steer clear. "I don't feel comfortable covering a company that makes so many acquisitions," said Stephen Sanborn, the research director for Value Line of New York, which provides stock analysis to individual investors.

Value Line does not cover Starwood Hotels and Resorts, for example, whose buying spree of about 40 businesses in the last three years includes this year's purchase of ITT Corp. for $15 billion.

As a company gets larger, said Robert A. Olstein, a portfolio manager in Purchase, N.Y., "the pressure on keeping that going is growing." Olstein, who has spent decades scrutinizing companies' financial statements, also avoids these stocks. Eventually, he said, the chief executive "reaches too far," making an acquisition that leads the company to stumble.

Sometimes, of course, the game goes on so long that analysts and investors catch on. First Union has been engaged in its feeding frenzy for more than a dozen years, and the drops in its stock price after several of the bank's recent acquisitions indicate that many on Wall Street have grown tired of the game.

But because of the deals' complexities, the so-called experts can be just as ignorant as the average investor about an acquirer's true performance, and the rapid rise in many of these companies' stocks suggests that the game remains as popular as ever.

A close look at three of these companies -- Worldcom, First Union and U.S. Filter -- illustrates the challenges for investors in evaluating a serial acquirer.

Looking at the financial results of a serial acquirer is difficult enough -- the footnotes in its reports are full of references to actual results and pro forma results, depending on how the company is putting together the numbers for different businesses.

But making it even more difficult to decipher performance are accounting techniques that allow companies to erase "good will" -- a measure of how much a company pays over the book value of an acquisition -- and thereby insure that their future earnings do not reflect the hefty price of their purchases.

For Worldcom Inc., the strategy of gobbling up other telecommunications players, mostly through stock-based purchases, has been a raging success to date.

"They actually understand their business and make moves that are strategically intelligent," said Michael J. Mahoney, who owns the stock as the manager of the AIM Global Telecommunications fund. Shares of Worldcom, which is based in Jackson, Miss., have gained an average of around 50 percent annually over the last three years.

The overwhelming majority of analysts who follow Worldcom continue to urge investors to buy the stock, despite the drastic changes ahead as the company swells more than four times its current size with its pending $37 billion acquisition of the MCI Communications Corp. (The final purchase price depends on a number of factors, including the price of Worldcom's stock.)

The analysts' logic goes something like this:

Worldcom is expected to earn $1.95 a share in 1999. With an estimated long-term growth rate around 30 percent a year, the stock can command a price-to-earnings multiple of 25 to 30, roughly in line with its growth rate. Presto: The stock is worth $48.75 to $58.50, making it a buy at its current price of $50.1875.

In that equation, however, the key number is the growth rate. On its own, MCI has been a much slower grower than Worldcom, says Anthony F. Ferrugia, an analyst at A.G. Edwards and one of the rare members of his profession not pushing the stock.

And Worldcom is paying a huge premium for MCI. So while there may be substantial savings when the two companies combine, it is not at all clear to him how fast the combined company can grow.

"When I look at all those numbers, I don't have a crystal ball," Ferrugia said.

Mahoney acknowledges that achieving the projection of 30 percent-plus growth "takes everything working."

It also takes a little accounting magic. Over the last two years, Worldcom has managed to bolster its future earnings by a little more than $2.5 billion by making a like amount of good will vanish through write-offs, which are usually discounted by investors as one-time anomalies.

The technique used by Worldcom is becoming increasing popular, particularly when, because they have been buying back stock or for other reasons, companies cannot treat an acquisition as a pooling of interests, in which no good will is created.

Instead, the buyer contends that some part of the price of a purchase is acquired research, which must be written off immediately under current accounting rules.

That, effectively, increases future earnings by reducing the amount of good will amortized each year, a figure that is subtracted from earnings on a company's income statement. For acquirers, the attraction of this technique is that management gets to determine how much good will it can write off: it is the buyer that assigns a value to the acquired research, although managements bring in appraisers to help.

"It is a very, very subjective estimate," said Baruch Lev, a professor at New York University's Stern School of Business who has recently completed a study of the technique.

What concerns Lev is the possibility that investors are failing to discount such companies' future higher earnings. "Some of this growth in earnings and high return on equity will turn out to be bogus," he predicted.

Look at what would happen to Worldcom's earnings-per-share numbers if the company had not taken those write-offs in the last two years. If it had amortized the good will over 20 years -- Worldcom's practice varies from 10 years to 40 years -- it would have eliminated roughly $125 million a year in goodwill expenses, or around 12 cents a share.

If estimated 1999 earnings were, therefore, $1.83 a share, the stock, at a multiple of 25 to 30, would today be worth $45.75 to $54.90. And that would make it less of a buy.

Investors should be prepared to see the same technique used when Worldcom completes its merger with MCI, which is expected to result in about $25 billion in good will, the premium it is paying for MCI. Worldcom may write off some of that sum as acquired research -- about $3 billion, according to the company.

"It could very well be a higher number," added Gary Brandt, Worldcom's vice president for investor relations.

Brandt argues that Worldcom is already being penalized by its accounting for earlier purchases, from which the amortization of good will wipes out about 50 cents of earnings per share a year, he said. The company, he added, relies on independent appraisals to determine how much it can write off for research and stays well within accepted accounting practice.

Kevin M. Moore, an analyst with BT Alex. Brown, dismisses the significance of Worldcom's accounting treatment. "The creation of good will is an accounting charge and does not change its cash flow," Moore said, adding that the latter is the most important measure in determining what a company is worth.

And he is not concerned about how Bernard J. Ebbers, Worldcom's chief executive, arrives at his results. "As long as they do $2, however they do it is fine with me," he said.

Lev counters that analysts rely heavily on earnings in valuing companies, so how they come up with those numbers is important.

"Accounting is accountability," he said, adding that managers have little incentive to pay less for an acquisition if they do not have to account for its full price.

Serial acquirers are so difficult to analyze because of the guesswork in determining even the most basic information about a company. How fast would it grow if it had made no acquisitions? How fast are its new businesses growing?

Few companies have been shopping as busily as U.S. Filter Corp., which has completed more than 150 acquisitions since 1991 -- roughly 60 in the last year alone -- to become the nation's largest provider of water-treatment systems.

There is a logic to the strategy of the company, which is based in Palm Desert, Calif. "You have an industry that's just ripe for consolidation," said Patrick S. Adams, a portfolio manager for Berger Associates in Denver who owns the stock.

But keeping track of all of U.S. Filter's activities is nearly impossible. Its frenetically acquired operations range from waste-water treatment plants to the sale of bottled water. And the sheer number of purchases means that most investors do not know how quickly certain businesses are growing and how profitable they are.

"How many people have done real in-depth models for every division they've acquired?" asked one portfolio manager, who has owned the stock but asked not to be identified. "Probably no one."

The real mystery may be the company's internal growth rate, which is the measure of how quickly U.S. Filter is increasing its business without the benefit of all of its acquisitions. Like a lot of companies, U.S. Filter will tell curious analysts what that rate is -- somewhere in the vicinity of 10 percent -- but the figure never appears in the financial statements available to the average investor.

"It is an estimate, yes," said Tim L. Traff, a co-founder of the company and its executive vice president for development.

And while U.S. Filter has been quick to supply anecdotal evidence of how its purchases have fared, a more systematic appraisal is essentially impossible, because the company does not provide detailed information about every purchase, said Rod Lache, an analyst at Deutsche Bank Securities.

Lache, who nevertheless recommends the stock, concedes that the anecdotes "are not helpful in modeling" the company's future performance.

In fact, figuring out how U.S. Filter's purchases have fared proved so challenging that the Securities and Exchange Commission asked the company earlier this year to improve the disclosure in the company's public financial statements.

The SEC declined to comment, and the company said its discussions with the commission were routine.

"We give out as much information as we humanly can on a daily basis," Traff said.

Like Worldcom, U.S. Filter seems to be a master of accounting wizardry, which contributes to the difficultly in estimating future earnings growth.

According to the Center for Financial Research and Analysis, a group in Rockville, Md., that studies corporate accounting for professional investors, U.S. Filter took several charges in its December quarter that could help inflate future earnings.

The company's acquisition last month of Culligan Water Technologies for $1.5 billion in stock complicates matters further because Culligan itself made more than 35 acquisitions in its most recent fiscal year and took several charges.

U.S. Filter defends its accounting as appropriate and has promised to take away at least some of the mystery. Starting with its quarterly results due out in August, the company said, it plans to disclose more information about its individual divisions, like their revenues and operating margins.

"It's the first time we'll be able to dissect the company and judge the progress of the company," said Lache, who, with the information that is available, has projected an earnings growth rate of 25 percent or more for U.S. Filter.

Eventually, analysts and investors can judge the results of a serial acquirer's strategy. If they grow skeptical -- even sending the stock down on news of another purchase -- a company may send its Pac-Man strategy packing. First Union seems to be taking that step.

In the whirl of acquisitions among banks, First Union has been among the busiest, growing from a single-state bank with about $7 billion in assets in 1984 to a 12-state banking giant with $220 billion in assets.

But some analysts and investors have grown sharply critical of the bank's strategy and say its acquisitions have diluted its earnings. The market's judgment is that First Union has overpaid for its purchases, using stock with a relatively low price-to-earnings multiple to pay for companies with higher P/E ratios.

"Guess what -- that causes dilution," said Brown, the early critic of First Union. He is now working for Tiger Management, a money manager in New York.

The company's stock has certainly suffered. Over the last five years, First Union has returned 184 percent, compared with a 304 percent gain in the Standard & Poor's large-bank index. On the day last November when First Union announced it would buy Corestates Financial in a $17.1 billion deal, First Union's stock lost more than $2 a share -- roughly a 4 percent drop.

Regardless of the bank's efforts to show that its acquisitions make sense, "the market is saying that these deals do not have as much economic value," said David Ellison, a portfolio manager for the brokerage firm Friedman, Billings, Ramsey.

First Union has apparently heard Wall Street's complaints, although the bank declined to comment on its strategy. Edward E. Crutchfield, its acquisitive chairman, is now telling analysts and investors that the bank will not pursue deals in which it must pay a premium, like its acquisition of Corestates, but instead will look for a partner with which to achieve a "merger of equals."

Ellison, for one, is not so easily convinced. He said First Union's management, having watched the bank's stock suffer, would try to increase the P/E ratio. Cynics might argue that executives are trying to get "the currency up so they can do a deal," he said.

In general, it pays to be skeptical of any company whose fast growth is largely a result of a frenetic buying spree. The company will almost surely stumble, said Ballen of MFS, who is a big shareholder in one recent sufferer, Cendant. "It's going to happen," he said. "I'm sure that it's happened to every company that makes acquisitions."

And that is why investors who are interested in reducing their risks might want to consider sitting out this particular game.

Sunday, July 5, 1998
Copyright 1998 The New York Times



To: TokyoMex who wrote (6433)7/5/1998 4:14:00 PM
From: Turboe  Read Replies (2) | Respond to of 8798
 
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