New home test shakes up colon cancer screening

Starting Monday, millions of people who have avoided colon cancer screening can get a new home test that's noninvasive and doesn't require the icky preparation most other methods do.

The test is the first to look for cancer-related DNA in stool. But deciding whether to get it is a more complex choice than ads for "the breakthrough test ... that's as easy as going to the bathroom" make it seem.

On one hand, the test could greatly boost screening for a deadly disease that too few people get checked for now.

On the other hand, it could lure people away from colonoscopies and other tests that, unlike the new one, have been shown to save lives.

It might even do both.

"It looks promising," but its impact on cancer risk and survival isn't known, said Dr. Barnett Kramer, a National Cancer Institute screening expert.

David Smith, 67, a retired teacher from Northfield, Minnesota, shows the test's potential. He has never been screened for colon cancer and his doctor ran through the options, including a barium enema or a scope exam.

"He pulled out one of those really colorful brochures they have for all those procedures," Smith said, but he had suffered an infection from a prostate biopsy years ago and didn't want another invasive test. When the doctor mentioned the new DNA test, "I said, well, sign me up."

The test was approved by the Food and Drug Administration last month and will be offered by prescription at the Mayo Clinic in Minnesota, where it was developed, and soon nationwide. It's called Cologuard and is sold by Exact Sciences Corp. of Madison, Wisconsin. Mayo Clinic and one of its doctors get royalties from the test.

Here are some things to know about it:

HOW IT WORKS

Many current stool tests look for blood that could suggest a tumor. Cologuard does this plus detects DNA that could be a sign of cancer or precancerous growths called polyps. People send a stool sample to a lab where it is tested.

If the test is positive, the next step is a diagnostic colonoscopy. A thin tube with a tiny camera is passed through the large intestine and growths can be removed and checked for cancer. When this is done for screening and precancerous polyps are removed, it can prevent cancer, not just detect it. It requires drinking laxatives the day before to clean out the bowel.

A sigmoidoscopy is a similar scope exam but only looks at the lower portion of the bowel and does not require full sedation.

ADVERTISED BUT NOT ENDORSED

The best measure of a screening test's worth is whether it lowers the risk of death from a disease, and it's too soon to know whether Cologuard will. The U.S. Preventive Services Task Force, which sets widely followed screening advice, has not yet considered it.

For healthy adults age 50 to 75 at average risk for colon cancer, the task force backs three methods: annual stool blood tests, a sigmoidoscopy every five years plus stool tests every three years, or a colonoscopy once a decade.

ACCURACY

Cologuard was not directly tested against colonoscopy for screening but now is being marketed as an alternative. A large study compared Cologuard to one of the older stool blood tests and found it detected 92 percent of colorectal cancers and 42 percent of advanced precancerous growths compared to 74 percent of cancers and 24 percent of growths for the older test.

"Colonoscopy is the gold standard," but the new test "is pretty darn good" at detecting cancer, though it misses more pre-cancers than previous studies of colonoscopy show, said Dr. Harold 'Hal' Sox, a Dartmouth professor who formerly headed the preventive services task force.

Cologuard also had a downside — more false alarms. It correctly ruled out colon cancer only 87 percent of the time versus 95 percent for the older test.

"One could look at it and say that's a glass half empty, half full," Kramer said. It leads 13 percent to have follow-up colonoscopies they really didn't need — because they didn't have cancer. Yet if the alternative is to screen everyone with a colonoscopy in the first place, Cologuard could avoid 87 percent of them.

COST

Cologuard costs $599 versus about $25 for current stool blood tests, and "you don't know whether you need to take it every year — intervals have not been tested," Kramer said.

If you have the DNA test every three years, it would be $1,800 — about the cost of a colonoscopy, which is good for 10 years unless polyps are found, he said.

Medicare covers the new test but private insurers aren't covering it yet.

BOTTOM LINE

Many cancer experts say the best screening test is the one that people are willing to get.

Colorectal cancer is the second leading cause of cancer deaths in the United States and the fourth worldwide. More than 143,000 new cases and 52,000 deaths from the disease are expected this year in the U.S. alone. Only about 60 percent of people recommended to get screened do so now.

Dr. Kenneth Lin, a Georgetown University family physician and former staff doctor for the preventive services task force, said, "You'd rather have more options than not, but I don't think there's enough data to declare this test superior to any other test" because of the false positives and lack of proof that it will save lives, Lin said. "It definitely has some promise."

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Online:

Screening guidelines: http://bit.ly/f2eT5q

FDA on Cologuard test: http://tinyurl.com/o5a7fb2

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Poor health systems in Asia cause for Ebola alarm

SINGAPORE — The longer the Ebola outbreak rages in West Africa, the greater chance a traveler infected with the virus touches down in an Asian city.

How quickly any case is detected — and the measures taken once it is — will determine whether the virus takes hold in a region where billions live in poverty and public health systems are often very weak. Governments are ramping up response plans, stepping up surveillance at airports and considering quarantine measures. Still, health experts in the region's less developed countries fear any outbreak would be deadly and hard to contain.

"This is a non-treatable disease with a very high mortality rate. And even a country like the United States has not been able to completely prevent it," said Yatin Mehta, a critical care specialist at the Medanta Medicity hospital near New Delhi. "The government is trying. They are preparing and they are training, but our record of disaster management has been very poor in the past."

More than 10,000 people have been infected with Ebola and nearly half of them have died, according to the World Health Organization. The Ebola epidemic in West Africa is the largest ever outbreak of the disease with a rapidly rising death toll in Guinea, Liberia and Sierra Leone. There have also been cases in three other West African countries, Spain and the United States.

Early symptoms of Ebola include fever, headache, body aches, cough, stomach pain, vomiting, and diarrhea, and patients aren't contagious until those begin. The virus requires close contact with body fluids to spread so health care workers and family members caring for loved ones are most at risk.

Asia, home to 60 percent of the world's population, scores higher than West Africa on most development indexes and includes emerging or developed countries like Singapore, Malaysia, South Korea and Japan. But countries like India, China, the Philippines and Indonesia have vast numbers of poor, many of whom live in crowded slums, and underfunded health systems.

The Philippine government estimates there are up to 1,700 Filipino workers in Liberia, Sierra Leone and Guinea, plus more than 100 peacekeeping troops in Liberia. The Department of Health is suggesting a 21-day quarantine period before its citizens leave those three countries, but doesn't know how it will pay for that, said spokesman Lyndon Lee Suy.

"The DOH is doing its part, but it is downstream, it is on the receiving end," said Dr. Antony Leachon, president of the Philippine College of Physicians. "What is important is that Ebola shouldn't be able to enter. Since we have 10 million migrant workers, we have problems containing that."

Indonesia has put 100 hospitals that have experience of treating patients suffering from bird flu on standby for Ebola, said Tjandra Yoga Aditama, head of the Health Ministry's research and development board.

The only way of ensuring that the virus doesn't spread into a country is enforced quarantine for people coming from countries with an outbreak or — even more effective — a total travel ban. But those measures would mean that doctors and other experts trying to beat the virus at its source in West Africa would be less willing or unable to help, making the outbreak worse.

Airports in Asia have stepped up their defenses: screening passengers who have travelled from affected countries, taking any with high temperature for observation and trying to keep contact them with for 21 days — the incubation period. Even assuming these measures are carried out effectively, people can and do lie about their travel history, and common drugs like Paracetamol are effective in reducing fever.

Authorities in China say 8,672 people have entered southern Guangdong province from Ebola-ridden areas since Aug. 23.

There are more than 160 direct flights per month from Africa to the region's capital, Guangzhou, a reflection of the booming economic ties between China and Africa. All arrivals are subject to medical observation, which, according to guidelines from the Health Ministry, involves medical staff visiting or calling them morning and evening for 21 days to ask them about their temperature. People whose temperature is above normal should be immediately quarantined for three weeks.

In Hong Kong, around 15 passengers a day arrive from the affected region, chief port health officer Dr. Edwin Tsui Lok-kin said. Prior to the Ebola outbreak, Singapore had an average of about 30 people arriving a month collectively from Guinea, Liberia and Sierra Leone, the government says.

Dale Fisher, the head of the infectious diseases' division at the Singapore National University Hospital, said governments in the region should be educating health workers about the disease and the need to ask anyone presenting with a fever at a medical facility about their travel history.

"Asia is very diverse in its capacity, and there are some countries with people that travel a lot that may not have the best infrastructure and are at greater risk," said Fisher, who has twice been to Liberia to assist in the WHO's response. "If an index case arrived back in a large Asian city and they were to sit in an open ward vomiting, then you would have a pretty big job on your hands."

He said that an outbreak could be brought under control with quick isolation and effective tracing of anyone who might have been in contact with the patient, citing the example of Nigeria, African's most populous country. It was declared Ebola free after confirming 19 cases, seven of them fatal.

Asian health systems and workers have experience in countering infectious diseases, including severe acute respiratory syndrome, or SARS, which first appeared in Hong Kong in 2003, infecting more than 8,000 people and killing about 800. The region grappled a highly pathogenic strain of bird flu around the same time that killed about 800 people in 12 countries, and new strains continue to crop up.

Sujatha Rao, a former Indian health secretary, said India's health system kicked into overdrive when confronted with a health crisis, as was seen during the 2009 H1N1 pandemic. "In India we're very good at crisis management, but we are hopeless at routine care," Rao said.

Asked whether the country was prepared for Ebola, she added: "We are not ready. But that said, there is only so much preparation that any country can do."

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Associated Press writers Oliver Teves in Manila, Philippines, Nirmala George in New Delhi, Kelvin Chan in Hong Kong, Ali Kotarumalos in Jakarta, Indonesia, and Louise Watt and AP researcher Yu Bing in Beijing contributed to this report.

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Follow Chris Brummitt on Twitter at https://twitter.com/cjbrummitt

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Minivan loses fluid and dashboard lights up

We have 184,000 miles on our 2005 Chrysler Town & Country van with 3.8-liter engine. The other day my wife drove it down the block and didn't notice the red path of oil on the road. She came back immediately when she noticed the van would only "rev up and not go." The check engine light came on and she barely made it back. I found that one of the hoses from the transmission control solenoid to the radiator had burst. This was an easy fix and I added 2.5 quarts of transmission fluid. The van runs and shifts normally. However, the check engine light remained on and my scan tool showed four codes — PO732, PO700, PO734 and PO700. I understand the 732 and 734 codes are for gear ratio misalignment and the 700 code is merely an informational code. My scan tool wouldn't let me clear these codes, but later that day the check engine light went off after about 30 miles of driving. Can the check engine light reset itself? Is there anything else I should be concerned about?

No, the computer cannot erase those codes from its memory. But it can turn off the check engine light after a certain number of key on/off cycles if it does not see the problem again. This allows the system to illuminate the check engine light again if the same or some other failure occurs.

The total fluid capacity of the 41TE-AE transmission is 9.7 quarts, so the vehicle lost less than one-third of its fluid. Adding the fact that it has survived 184,000 miles, I wouldn't be particularly worried — I don't think any significant damage was done.

I have an annoying whine in my 2010 Chevy Impala steering wheel. I understand it is the clock spring and would be rather expensive to fix. Can you explain what the function of the clock spring is and are there any inexpensive fixes? Are there any potential problems just living with it?

Actually, the total cost to replace the clock spring, according to my ALLDATA labor guide, is roughly $300. The clock spring assembly provides electrical continuity to the driver air bag through the entire range of steering wheel movement. If there is an electrical issue with the clock spring, the restraint system warning light would be illuminated.

But I question whether the whine you're hearing is actually coming from the steering column/wheel. If it is originating from the front of the vehicle as you turn the wheel, the issue is more likely related to the power steering pump or fluid. A complete flush and refill with correct power steering is inexpensive and a good preventive maintenance procedure.

I hope you can answer questions concerning timing belts and timing chains. I own a 2004 2.4-liter four-cylinder Toyota Camry with 82,000 miles. My mechanic says it has a timing chain, but the maintenance schedule says to replace the timing belt at 90,000 miles, but only for those models with the six-cylinder engine. Toyota dealers advise replacing the timing belt at 60,000 miles. Does my vehicle have a timing belt or a timing chain and when should a belt or a chain be replaced? I get a bit apprehensive when I am on the highway going 65 mph.

Your mechanic is correct, as is the owner's manual. The camshafts in this engine are driven by a steel-link roller timing chain, not a rubber cogged belt. There is no routine replacement called for with timing chains, which is an advantage over timing belts. Coupled with the fact that this is a non-interference engine, meaning there would be no valve-to-piston contact should the chain fail, no worries. As you noted, the 3- and 3.3-liter V6 engines available in this vehicle featured timing belts that require replacement at 90,000 mile intervals.

Paul Brand, author of "How to Repair Your Car," is an automotive troubleshooter, driving instructor and former race-car driver. Readers may write to him at: Star Tribune, 425 Portland Ave. S., Minneapolis, Minn., 55488 or via email at paulbrandstartribune.com. Please explain the problem in detail and include a daytime phone number.

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Ebola: NY had jump-start, Dallas had to learn fast

NEW YORK — Talk about a tale of two cities: A Dallas hospital got a pop quiz in Ebola and made an early mistake. New York got a peek at the answer sheet and was better prepared at the start.

The contrast in handling two Ebola diagnoses highlights how differently cities and hospitals prepare for health emergencies.

"The lesson I would take from New York is you have to practice," Dr. Amesh Adalja, a representative of the Infectious Diseases Society of America. "Preparedness isn't something you just make a plan for and put it on the shelf."

Ebola came to New York via a doctor who had volunteered to treat patients in Ebola-stricken Guinea. Dr. Craig Spencer alerted his aid agency that he had developed a fever, and was transported to Bellevue Hospital Center by specially trained emergency workers wearing protective gear.

In Dallas last month, a hospital initially sent home a sick Thomas Eric Duncan, who had traveled from Liberia and who days later would become the nation's first Ebola diagnosis.

A look at differences between the two cases:

HOW NEW YORK PREPARED

New York health officials are known for holdings drills on handling emergencies, and Ebola is no exception. Bellevue, the country's oldest public hospital, had been preparing in earnest for an Ebola patient since August.

The patient registration staff and triage nurses were trained to ask people with certain symptoms about international travel. Actors posed as patients to be sure that anyone who answered "yes" was immediately put into one of the ER's nine isolation rooms. Along the way came some false alarms, sick patients who turned out not to have Ebola.

On the seventh floor is the full isolation unit, originally set up to treat people with drug-resistant tuberculosis. It was overhauled for Ebola in recent weeks and now houses a separate lab for Ebola-infected specimens.

Bellevue isn't alone. New York health authorities designated eight hospitals statewide as capable of properly caring for suspected Ebola patients.

Beyond hospitals, the city's fire department trained an ambulance crew to transport suspected Ebola patients, and 911 dispatchers now ask people calling for an ambulance if they've traveled to West Africa recently.

Also, "New York has the benefit of being the second city to have an imported Ebola case," Adalja said.

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LESSONS LEARNED

Texas Health Presbyterian Hospital in Dallas has apologized for initially misdiagnosing Duncan.

Duncan had told an emergency room nurse he recently had arrived from Africa, and he temporarily spiked a 103-degree fever shortly before his discharge. He returned two days later, sicker, and then was tested for Ebola. He died Oct. 8. Two nurses who cared for him became infected; both have since been declared virus-free.

On Friday, the Dallas hospital announced some changes, saying it had learned from its experiences treating Duncan and was sharing them with other hospitals in a stark then-and-now chart.

Patients will be asked about their travels within five minutes of entering the ER. Electronic medical records will highlight that information in a large red box. Nurses and doctors are encouraged to talk face to face rather than rely solely on records.

A new triage procedure calls for high-risk patients to be isolated immediately by a nurse in full protective gear. Before discharge, vital signs are to be rechecked and doctors notified of abnormalities.

"We learn more each day and we will continue to share these important lessons with the health care community and first responders nationwide," said Barclay Berdan, chief executive of Texas Health Resources, the hospital's parent company.

Dr. Michael Bell of the Centers for Disease Control and Prevention began working with the hospital after the nurses became ill, stressing improved infection control as a possible legacy.

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PREPARATION IS KEY

The National Institutes of Health and other hospitals with special biocontainment units regularly "do drills about how you need to protect yourself," said Dr. Anthony Fauci, the NIH's infectious diseases chief. The Dallas hospital had transferred infected nurse Nina Pham to NIH; she was discharged Friday.

The isolation unit at Nebraska Medical Center, which has treated two other Ebola patients infected abroad, says it holds drills about every three months on different diseases.

Before the New York case, Fauci praised Bellevue for similar training, while cautioning that, "it would be, logistically, really difficult to get every major hospital in the country drilled to do this."

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FEDERAL HEALTH OFFICIALS ADJUSTED, TOO

The government is adjusting to gaps in the Ebola safety net.

Facing its own criticism for not helping the Dallas hospital enough, the CDC has tightened guidelines on protective gear, and greatly expanded education for hospitals and health workers. The agency will send SWAT-like response teams to help hospitals with cases.

Anyone flying in from Ebola-stricken West African countries now is funneled through five U.S. airports for symptom checks and must report their temperature to local health officials for 21 days, Ebola's incubation period.

The governors of New York and New Jersey went a step further, ordering quarantine for travelers who've had contact with Ebola patients.

Adjustments are part of dealing with a public health emergency, said Michael Leavitt, who served as Health and Human Services secretary for President George W. Bush.

"In the midst of a crisis, we ought not to expect perfection," Leavitt said. While that doesn't excuse mistakes, "everyone in this process is going to be acting, adapting, improving. That's the nature of emergency response."

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Neergaard reported from Washington.

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The Ticker

Groups question Entergy's finances

Nuclear watchdog groups in three states are questioning Entergy Corp.'s financial ability to operate plants in New York and Massachusetts.

The groups are focusing on the Fitzpatrick plant in upstate New York and the Pilgrim reactor in Massachusetts — as well as Vermont Yankee — citing USB Investment Services reports from earlier this year saying the Vermont and New York plants are facing negative cash flows by next year.

Entergy Corp. announced last year it would close Vermont Yankee by the end of this year due to poor economic performance.

Hub gets $25G
Agriculture grant

Mayor Martin J. Walsh and the city of Boston's Office of Food Initiatives announced the receipt of a $25,000 planning grant from the Department of Agriculture Local Food Promotion Program to support the hiring of an independent facilitator to develop a vision for food production in Boston as a whole.

TOMORROW

• National Association of Realtors releases pending home sales index for September.

TUESDAY

• Commerce Department releases durable goods for September.
• Standard & Poor's releases S&P/Case-Shiller index of home prices for August.
• The Conference Board releases the Consumer Confidence Index for October.
•  Federal Reserve policy makers begin a two-day meeting to set interest rates.

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Robots may battle Ebola

An international effort is underway to stop the spread of the deadly Ebola virus with logistics and training, and health care companies are scrambling to produce promising treatments and vaccines, but a number of high tech solutions also have emerged as potential keys to addressing the outbreak.

In about two weeks, an elite group of robotics researchers from academia and the private sector will meet at Worcester Polytechnic Institute and two other universities around the country for a U.S. government-sanctioned event to try to develop ways robots can be used to help combat the disease that has killed nearly 5,000 people.

"I do believe that technology interventions at the right place, at the right time, robotics technologies or other technologies can be impactful," said Taskin Padir, a robotics professor at WPI.

One of the most useful jobs for robots could be decontamination, said Velin Dimitrov, a doctoral candidate at WPI. He said a robot called Aero could easily be modified to disinfect areas that have been contaminated with the Ebola virus.

Robots also could be used to bury those who have died from Ebola, as well as removing personal protective gear worn by health workers.

"If we can minimize the contact, we can minimize the risk," Padir said.

In the unlikely event that there is an outbreak in Massachusetts, state officials say they are well prepared thanks to an existing tool called MAVEN. Officially called the Massachusetts Virtual Epidemiologic Network, MAVEN is an early detection tool that allows state epidemiologists to track and get real-time alerts for suspected and confirmed cases.

"MAVEN has been set up to respond automatically to different pieces of information," said Gillian Haney, director of surveillance and informatics at the state Department of Public Health's bureau of infectious disease. "What it allows us to do is to have real time information sharing on reportable disease events."

One of these pieces of information is a confirmed test, notification of which is automatically pushed to state health officials thanks to the electronic testing procedures put in place by many health-care facilities.

Alerts for some diseases — including Ebola — are automatically sent to the state when there is a suspected case. Local health departments and other necessary personnel are then notified.

Haney said Massachusetts is better positioned than many other states to deal with an epidemic of any kind, in part because more than 90 percent of the state's lab tests are part of the state health information exchange, which feeds into MAVEN.

Technology giants also are getting involved in the Ebola fight. Microsoft last week said that it would give academics researching Ebola access to its Azure cloud computing platform to boost their storage and computing power.

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13 Europe banks flunk test, must find 10B euros

FRANKFURT, Germany — The European Central Bank says 13 of Europe's 130 biggest banks have flunked an in-depth review of their finances and need an extra 10 billion euros ($12.5 billion) to cushion themselves against any future crises.

ECB officials said Sunday the test had been tougher than similar reviews in 2011 and 2010, which gave a pass to banks that later needed bailouts.

They argued the review ensures banks, some of which have been reluctant to offer credit because they were nursing bad investments, will be ready to lend when the European economy finally picks up, removing an obstacle to recovery.

Yet after months of talk about banks that were "zombies" — walking dead, too weak to lend — it appeared unlikely that any would be put out of business by the test.

Most of those that flunked either have only small shortfalls to make up, or can point to ongoing restructuring plans as sufficient to bring them across the finish line.

The ECB said 25 banks in all were found to need stronger buffers. Of those, 12 had already made up their shortfall during the months in which the ECB was carrying out its review. They found money by issuing new shares, or by shedding risky investments or loan businesses. The remaining 13 now have two weeks to tell the ECB how they plan to increase their capital buffers up to nine months to actually carry out the plan.

The ECB checked the worth of banks' holdings and subjected the banks to a stress test that simulates how their finances would fare in an economic downturn.

The exercise is aimed at strengthening the banking system so lenders can provide more credit to companies, boosting business activity and, hopefully, jobs. The economy has been plagued both by banks' unwillingness to lend at affordable rates and by weak demand from companies that see no reason to risk borrowing.

ECB Vice President Vitor Constancio said the stress test and review were "quite strict" and that "the results guarantee that going forward the economic recovery will not be hampered by credit supply restrictions."

The 13 banks that fell short were:

— Greece's Eurobank and National Bank of Greece

— Cyprus' Hellenic Bank Public Company

— Italy's Monte dei Paschi di Siena, Banca Carige, Banca Popolare di Milano and Banco Popolare di Vicenza.

— Franco-Belgian Dexia

— Austria's Oesterreichischer Volksbank Verbund

— Ireland's Permanent TSB

— Portugal's Banco Comercial Portugues

— Slovenia's Nova Ljubljanska Banka and Nova Kreditna Bank Maribor

The bank with the biggest shortfall was Italy's Monte dei Paschi di Siena, which was found to need another 2.11 billion euros.

Five of the banks — Eurobank, National Bank of Greece, Nova Ljubljanska Banka, Nova Kreditna Banka, and Dexia — will be able to make up for their capital shortfall by sticking to their current restructuring plans.

Most of the other banks that failed were short amounts less than 1 billion euros and in several cases less than 200 million euros. They can find the money by issuing shares, selling holdings, or holding back any profits instead of paying them out as dividends.

The bank review and stress tests pave the way for the ECB to take over on Nov. 4 as the Europe's central banking supervisor. The test is supposed to make sure hidden troubles in the system are fixed before landing in the ECB's lap.

The ECB's new role is aimed at strengthening the euro currency union in the wake of its crisis over government debt. It would do that by toughening oversight of banks and keeping their troubles from turning into huge losses for national governments through bailouts. The ECB is taking over as supervisor for the biggest banks from national supervisors, who were considered to take it too easy on their home banks and not step in to ward off problems. National supervisors will still look after smaller banks.

Banks are key to the functioning of the European economy because they are where most firms — especially small and medium-sized ones — go for the credit they need to operate and expand. In the United States, companies turn more often to financial markets by selling bonds to raise money.

The 18 countries that use the euro currency showed no growth at all in the second quarter, after four quarters of weak recovery from a crisis over too much government debt.

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Netflix deals, Windows collapse loom large at Produced by Conference

Netflix's move into the feature film world loomed large at the Produced By Conference in New York City Saturday as producers and actors struggled to determine if the streaming service represents an opportunity or a threat.

The company is upending old business models by releasing four Adam Sandler movies exclusively to subscribers without releasing them in theaters. It is also partnering with the Weinstein Company and Imax on a sequel to "Crouching Tiger, Hidden Dragon" that will debut simultaneously on Netflix and in theaters.

Most major theatrical releases adhere to a 90-day delay between when they hit multiplexes and their home entertainment debuts, but that window is eroding. Netflix isn't the only player tinkering with tradition. Movies such as "Margin Call" and "Arbitrage" have opted to be released concurrently on demand and in theaters.

"I still think there's a premium in comedy and in horror in having a kind of collective experience of a film," said "Talented Mr. Ripley" producer William Horberg. "There's a platform agnosticism as well."

"I don't think everything needs to be theatrical," he added, noting that more producers are asking themselves today whether or not a project warrants theatrical distribution.

Sometimes going day-and-date on a particular project is an economic necessity, Jake Gyllenhaal noted during a talk at the conference. His twisty thriller "Enemy" might not have been made were it not for the additional revenue it received by premiering on iTunes and other platforms at the same time that it was screening in theaters.

"It's specific based on the material and based on the release strategy," he said.

However, Gyllenhaal stressed that higher profile films such as "Gone Girl" benefit from spacing out their theatrical release from their debut in homes.

"We live in a culture of convenience ... patience is an amazing thing," he said.

Horberg's remarks came as he was moderating a panel with "Brokeback Mountain" producer and former Focus Features chief James Schamus. The indie film veteran argued that change is coming more slowly than it might appear.

"I don't believe the windowing strategies are going to change any time soon in any major way," he said.

Any time new technologies emerge or new ways of consuming entertainment grow more popular, people predict the end of movies, Schamus said. He noted that studios were initially hostile to the growth of videotapes and television was viewed as an existential threat to moviegoing. Today they produce important revenue for films that make more money selling DVDs and television rights than they do filling theater seats.

"The best way to make sure cinema doesn't matter is when you think about movies, the first thing you think of is do movies matter?" said Schamus.

Netflix, Google and other new media and technology players are shaking up the business in another way, he said. The data they collect on consumer behavior is increasingly prized by the people who write the checks that finance films.

"The river of money is flowing to the people with the algorithms...you're not creating movies, you're creating the occasion for increased surveillance and data points," Schamus said.

© 2014 Variety Media, LLC, a subsidiary of Penske Business Media; Distributed by Tribune Content Agency, LLC

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Drugmakers bet on Ebola vaccines, treatments

Drugmakers are racing to develop vaccines and drugs to address the worst outbreak of Ebola in history. It's unclear who will pay for their products, but companies are betting that governments and aid groups will foot the bill.

There are no proven drugs or vaccines for Ebola, in large part because the disease is so rare that up until now it's been hard to attract research funding. And the West African nations hardest hit by the outbreak are unlikely to be able to afford new Ebola vaccines and drugs.

But governments and corporations now are shifting millions of dollars to fight Ebola in the wake of the outbreak that has infected nearly 10,000 people and killed over 4,800. Experts say drugmakers are wagering that international groups and wealthier governments like the U.S. will buy Ebola vaccines and drugs in mass quantities to stockpile them for future use once they're deemed safe.

"The political bet is that the U.S. and World Health Organization have been so embarrassed and burned by this event that they will be willing to change the way they do business," said Professor Lawrence Gostin of the Georgetown University Law School, who studies global health issues.

Drugmakers have benefited from stockpiling before. During the bird flu pandemic of 2009, Western governments spent billions to stock up on drugs and vaccines that mostly went unused. Shelf-life varies by product, but can be as little as a year.

Still, it's unclear who will pay for the Ebola vaccines that are in development, even after a WHO meeting on Thursday that included government officials, drugmakers and philanthropic groups.

"Something concrete needs to be developed soon," said Dr. Manica Balasegaram of Doctors Without Borders, who attended the meeting. "This needs to done in tandem for us to prepare for when these vaccines are deployed in the larger scale beyond clinical trials."

Even with the uncertainty, drug companies are rushing to begin testing in patients.

Johnson & Johnson said last week it will begin safety testing in early January of a vaccine combination that could protect against an Ebola strain that is "highly similar" to the virus that triggered the current outbreak.

The New Brunswick, New Jersey, company is spending up to $200 million to speed up production of the vaccine, which it licensed in part from a Danish company last month. If safety tests are successful, the company hopes to begin large clinical trials in May 2015.

The two leading Ebola vaccines in the pipeline have largely been funded by government efforts, but their testing is being completed by a combination of corporate and public financing.

Human trials of a vaccine co-developed by the U.S. National Institutes of Health and GlaxoSmithKline are being funded by the company, its charitable trust and funds from the U.S. and U.K. governments. It is being tested for safety in the U.S., U.K. and Mali. GSK said it might be able to make about 1 million doses of its vaccine per month by the end of 2015, assuming that some logistical and regulatory hurdles can be overcome.

A small U.S. drugmaker, NewLink Genetics, holds the license on the second front-runner vaccine, which was initially developed by the Public Health Agency of Canada and has been sent to the U.S. Walter Reed Army Institute of Research in Maryland for testing on healthy volunteers, with preliminary safety results expected by December.

Dr. Marie-Paule Kieny from the U.N. health agency told reporters last week that millions of doses could be available in 2015 in West Africa if early tests proved that the two leading experimental vaccines are safe and provoke enough of an immune response to protect people from being infected with Ebola. Kieny also said five other possible Ebola vaccines should start being tested in March, but she gave no details about who is making them, or where those five vaccines would be tested.

Virologist Ben Neuman said the unprecedented focus on Ebola also will benefit smaller companies that are developing drugs that can slow the diseases, such as MAPP Pharmaceuticals of San Diego and Tekmira Pharmaceuticals of Canada.

"There are lots of very promising options out there," said Neuman, a professor at the University of Reading in Britain. "One of the treatments or vaccines that they are trying now is going to work. But we don't know which one."

While there are no reliable estimates of the potential market size for an Ebola drug or vaccine, some drugmakers have already seen their stocks rise on the potential of the therapies in their pipelines.

Neuman noted that while Ebola was only confirmed at the end of March, there were reports of suspected Ebola in January. Tekmira's stock price tripled between January and April of this year.

"For small pharma, the fate of the company can turn on one drug like these," he said.

In 2009, Roche saw sales of its Tamiflu antiviral medication jump by $1.74 billion as governments around the world snapped up drugs in anticipation of a bird flu outbreak that never materialized. The U.S. has provided billions of dollars of incentives to reinvigorate flu vaccine production by companies like Glaxo and Novartis. Because of complex testing and manufacturing procedures, vaccines are expensive to produce and only a handful of companies compete in the space.

The U.S. government's Biomedical Advanced Research and Development Authority also awards federal contracts to keep drugmakers producing other emergency countermeasures, including antibiotics, anthrax vaccines and treatments for botulism. But since September, the agency has allocated more than $32 million toward companies working on vaccines and drugs for Ebola.

"To me, Ebola is a game changer," Gostin said. "All the things we thought about in terms of research priorities and development of drugs and vaccines need to be rethought."

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Fauci: Quarantine can have unintended consequences

WASHINGTON — Mandatory 21-day quarantines on health care workers returning from Ebola-ravaged West Africa, like those put in place by three states, can have the unintended consequence of discouraging them from volunteering, a top federal health official said Sunday.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that as a physician and scientist, he would have recommended against a quarantine.

"The best way to protect us is to stop the epidemic in Africa, and we need those health care workers so we do not want to put them in a position where it makes it very, very uncomfortable for them to even volunteer to go." he said.

He said active and direct monitoring can accomplish the same thing as a quarantine because people infected with Ebola do not become contagious until they start showing symptoms. Ebola is transmitted through direct contact with the bodily fluids of an infected person.

New York, New Jersey and Illinois imposed mandatory quarantines after Dr. Craig Spencer, a Doctors Without Borders physician who treated patients in Guinea, was diagnosed with Ebola last Thursday. The doctor, who is now in isolation at New York's Bellevue Hospital, had been on the subway, went bowling and to a park and restaurant before showing symptoms

Gov. Chris Christie, R-N.J., said he concluded the quarantine was necessary to protect public health in his state and that he thinks the Centers for Disease Control and Prevention "eventually will come around to our point of view on this."

Christie said Fauci was counting on "a voluntary system with folks who may or may not comply."

The governor pointed to an NBC News crew that had returned from West Africa was supposed to self-quarantine because its cameraman was hospitalized with Ebola. "Two days later they were out picking up takeout food in Princeton and walking around the streets of Princeton," he said. The cameraman has recovered and has been released from the hospital.

Fauci said Spencer did exactly what he should have done by putting himself in isolation as soon as he developed a fever. "No one came into contact with his body fluids," Fauci said. "The risk is essentially zero, vanishingly small."

Fauci said the health care workers returning from treating Ebola patients are responsible and know that if they have symptoms there's the possibility of transmitting the disease. "They don't want to get anyone else infected," he said.

As for the unintended consequences, he said, "If we don't have our people volunteering to go over there, then you're going to have other countries that are not going to do it and then the epidemic will continue to roar," he said.

Samantha Power, the U.S. ambassador to the United Nations who is on a trip to West Africa to highlight the need for increased international support to combat Ebola, spoke of a need to ensure that returning U.S. health care workers "are treated like conquering heroes and not stigmatized for the tremendous work that they have done."

Fauci appeared on "Fox News Sunday," ABC's "This Week, NBC's "Meet the Press," CBS' "Face the Nation" and CNN's "State of the Union." Christie was interviewed on Fox and Power spoke to NBC.

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