Rick Santorum addresses supporters in Lafayette, La., after winning Tuesday's Alabama and Mississippi primaries. Photo by Sean Gardner/Getty Images.
In the battle for the hearts and minds of Republican voters, it appears that the hearts won out on Tuesday.
"The time is now for conservatives to pull together," former Pennsylvania Sen. Rick Santorum told supporters at a rally in Lafeyette, La., after clinching narrow victories in the Alabama and Mississippi primaries. "The best chance to win this election is to nominate a conservative to go up against Barack Obama who can take him on on every issue."
Watch Santorum's speech
here or below:
As Christina
wrote Tuesday night, exit polls told a familiar tale:
In both states, Santorum was winning voters who found the most important candidate quality to be "true conservative" or "strong moral character," and [Mitt] Romney did best among voters who were looking for the candidate most likely to defeat President Obama.
Despite his third-place finishes in the two Southern states, Romney still
emerged with the most delegates from Tuesday's contests after picking up decisive caucus wins in Hawaii and American Samoa.
"I am pleased that we will be increasing our delegate count in a very substantial way after tonight," Romney said in a statement released late Tuesday by his campaign. The former Massachusetts governor did not hold an evening event after spending the day campaigning in Missouri, which holds its caucuses on Saturday.
Tuesday's results also dealt a double-blow to Newt Gingrich, whose campaign had earlier dubbed Alabama and Mississippi must-wins, before later backing off that claim.
At his Tuesday night rally in Birmingham, Ala., the former House speaker showed no signs that he was preparing to drop his White House bid. Instead, he challenged Romney's status as the perceived front-runner.
"The fact is, in both states, the conservative candidates got nearly 70 percent of the vote," Gingrich said, adding,"If you're the front-runner and you keep coming in third, you're not much of a front-runner."
Before the votes came in, Gingrich adviser Randy Evans and political director Martin Baker outlined their candidate's path forward in a memo for the campaign staff.
They argued that the Louisiana primary March 24 is "halftime" in the race for the nomination, and that the nomination "will not be decided until the fourth quarter" in June. The pace ahead "favors Newt," the staffers argued.
They walked through the contests on the calendar and noted that Wisconsin, which votes April 3, is the home state of Gingrish's wife Callista. They note there's a plethora of unbound delegates who could be free to choose the Republican of their choice at the convention.
Gingrich asked supporters for money in an early morning fundraising email, saying his rationale for staying in the race is the administration's response to his $2.50 gas price plan. "The past few weeks have provided additional evidence that I am the candidate best prepared to take the fight to President Obama and defeat him in November," Gingrich wrote.
View the full results of Tuesday's contests in our
Vote 2012 Map Center.
NEXT UP, LOUISIANA
As we mentioned above, Santorum chose to give his remarks Tuesday night from Lafayette, La. He also attended a fundraiser after his victory speech. The March 24 contest is already heating up.
The Louisiana Republican Party noted in an email that "the Romney campaign has verified that Mitt Romney will be in the state this month, but details will be forthcoming."
The Santorum super PAC the Red White and Blue Fund announced a $260,000 TV ad buy in Louisiana focusing on energy.
(STILL FOCUSED ON ROMNEY
President Obama's re-election team and the Democratic National Committee remain focused on Romney. The DNC came out with a web video Wednesday morning that features Romney saying repeatedly he would "get rid" of Planned Parenthood.
Watch the video
here or below:
That follows a new MoveOn 60-second TV spot called "GOP War on Women." The ad will run on national cable, and you can watch it
here.
And a new group called Ultraviolet hits Romney in a 30-second television spot for not criticizing Rush Limbaugh. You can watch that spot
here.
On Tuesday, the Obama campaign slammed Romney in a press release for telling Fox News he's to the right of Santorum.
"These comments were just the latest in a long string of attempts from Romney to appeal to the most conservative elements of the Republican base," the campaign wrote. "From embracing economic policies that would give massive tax breaks to millionaires and billionaires to espousing extreme positions on immigration and women's health to proudly declaring that he is 'severely conservative,' Mitt Romney indeed has moved to the right of Rick Santorum on many of the key issues facing our nation."
2012 LINE ITEMS
A poll released Wednesday by the Pew Research Center found that President Obama's approval rating stood at 50 percent, up from 47 percent in February and 44 percent in January.
In Tuesday's Morning Line, we wrote about the New York Times/CBS News poll that showed President Obama's approval rating had dropped nine points in the past month to 41 percent. Read more about Pew's survey
here.
A Quinnipiac Univeristy poll of Pennsylvania GOP voters released Wednesday shows Santorum leading Romney by 14 points, 36 percent to 22 percent. Santorum also looks stronger against President Obama in a general election matchup, trailing by one point, 45 percent to 44 percent. The president tops Romney in the Keystone State by six points, 46 percent to 40 percent.
Romney will
not attend a GOP presidential debate in Portland, Ore., scheduled for Monday and sponsored by Oregon Public Broadcasting. The NewsHour's Ray Suarez and the Washington Times' Ralph Z. Hallow are the moderators. An aide to the Romney campaign says the candidate will be campaigning in Illinois ahead of the state's primary next Tuesday.
"If the general election were held today, President Obama would lose to Mitt Romney -- according to the latest poll from Washington Post-ABC News," Obama campaign manager Jim Messina writes in a fundraising email. "We cannot underestimate someone like Romney who has shown he will spend and say anything to win." Romney's team uses the message to do its own fundraising blast, noting they agree with Messina's assessment.
The AFL-CIO endorsed President Obama's re-election bid on Tuesday and pledged to deploy
hundreds of thousands of union volunteers to assist with voter outreach efforts.
A new American Future Fund ad running on cable in Virginia hits President Obama for his administration's ties to Wall Street.
Watch.
Bain Capital
defended its business model in a letter to investors Tuesday, Reuters reports.
"In the middle of Sunshine Week, when news organizations and advocacy groups promote government transparency, the Obama administration urged Congress on Tuesday to
keep secret a whole new category of information even under the Freedom of Information Act, the Associated Press notes.
Bloomberg's Margaret Talev writes that another thing will be shrouded from the American public at Wednesday's White House state dinner for British Prime Minister David Cameron:
the price of the wines selected for the festivities.
Both Santorum and Texas Rep. Paul picked up Hill backers Tuesday: Rep. Tim Johnson of Illinois endorsed Paul, and Santorum scooped up Rep. Alan Nunnelee of Mississippi.
At South by Southwest, former Vice President Al Gore talks about Votizen, an effort he is backing
to engage citizens and encourage voting.
TOP TWEETS
Looks like 26 of 28 incumbents renominated so far in this anti-incumbent year.
March 14, 2012
Launch Day! Featuring @
LeavenworthSt @
NewNebraska
politicsinstereo.com/state/nebraska
March 13, 2012
OUTSIDE THE LINES
Kwame Holman reports on
the White House's push to get the president's judicial nominees approved.
Rep. Spencer Bachus, under ethical scrutiny,
weathered a GOP primary challenge in Alabama.
Ray Suarez talked with the American Enterprise Institute's Kenneth Green and Daniel Weiss of the Center for American Progress about
what can actually be done about high gas prices.
Freshman GOP Rep. Bob Turner, who won a surprise victory when Anthony Weiner resigned,
will challenge New York Sen. Kirsten Gillibrand.
American Crossroads
goes after Democratic Senate candidate and former Nebraska Sen. Bob Kerrey, who
starts running his ads.
Sen. Ben Nelson, who won't seek re-election in Nebraska,
donated his campaign cash to the Democratic Senatorial Campaign Committee, Politico reports.
President Obama has
his Final Four picks set: Kentucky, Ohio State, Missouri and North Carolina. The last two years the president picked Kansas to win it all; both times the Jayhawks were bounced early from the bracket.
Judy Woodruff will interview Secretary of Education Arne Duncan on March 27 at a town hall hosted by The Atlantic called "Jobs and Economy of the Future: Educating the Next Generation to Compete."
ON THE TRAIL
All events are listed in Eastern Time.
President Obama holds a joint press conference with British Prime Minister David Cameron in the East Room of the White House at 11:55 a.m. and hosts a state dinner at 7 p.m.
Mitt Romney attends campaign fundraisers in New York and Connecticut but has no public events scheduled.
Rick Santorum campaigns in San Juan, Puerto Rico, participating in a photo-op with Gov. Luis Fortuno at 11:30 a.m., holding a town hall at 2 p.m. and meeting with religious leaders at 6 p.m.
Newt Gingrich campaigns in Illinois, holding a rally in Rosemont at 4:30 p.m. and addressing the Northwest Suburban Republican Lincoln Day Dinner in Palatine at 8 p.m.
Ron Paul holds a town hall in Champaign, Ill., at 8 p.m.
All future events can be found on our
Political Calendar:
For more political coverage, visit our
politics page.
Sign up here to receive the Morning Line in your inbox every morning.
Questions or comments? Email Christina Bellantoni at cbellantoni-at-newshour-dot-org.
Follow the politics team
on Twitter:
@cbellantoni,
@burlij,
@elizsummers and
@suddinengel.
This post was updated March 14 at 10:08 a.m.
Men wanting to become fathers should “put down that English breakfast” the Daily Mail has today declared, as research has linked a diet high in saturated fat to a reduced sperm count.
The study used surveys to examine the diets of 99 men attending a US fertility clinic, comparing how their food intake related to the quality of their sperm samples.
Researchers found that men with a higher fat diet had both lower sperm counts and sperm concentrations. The third of men with the highest total fat intake had 43% lower total sperm count and 38% lower sperm concentration than men with the lowest third. Researchers said this association was driven mainly by saturated fat intake. Higher omega-3 intake was also linked to improved sperm quality.
While these results have received a lot of attention on the internet, the design of this small study means it cannot prove a cause and effect relationship between diet and sperm quality. This is because it did not follow the participants over time to see how their diet related to later sperm quality. To confirm or refute the results, larger studies that follow more men over time are required.
This study cannot, and does not, prove that a high-fat diet causes lower fertility. However, a balanced diet has many known health benefits and the study does reinforce the idea that a healthy diet is essential for good health and wellbeing.
Where did the story come from?
The study was carried out by researchers from the Harvard Medical School in Boston and was funded by grants from the National Institute of Environmental Health Sciences and National Institute of Diabetes and Digestive Kidney Diseases in the US.
It was published in the peer-reviewed medical journal Human Reproduction.
Media reports generally over-stated the implications of the results of this small cross-sectional study. However, both the Daily Mail and BBC did include quotes from experts in the field warning of the numerous limitations of this type of study, balancing out the initial attention-grabbing headlines.
What kind of research was this?
This study looked at the association between diet and semen quality using a cross-sectional analysis, meaning it looked at both factors at a single point in time. A cross-sectional study can never prove a cause and effect relationship, as without observing factors over time it is not possible to know which event came first.
In this study, for example, it was not possible to tell whether men with low sperm counts happened to have had a bad diet or whether eating a bad diet actively caused their sperm counts to reduce. A cohort study, which follows people over a set time, would shed more light on whether differences in diet are likely to be causal. It might also be technically possible to conduct a trial looking at men’s sperm quality before and after modifying their diet, although such trials can be harder to perform than studies with a cohort design.
The research authors suggest there is a lack of research on modifiable factors that influence male fertility. As a result, they aimed to investigate a suspected association between dietary fats and semen quality among men attending a fertility clinic.
What did the research involve?
A total of 173 men were recruited from couples attending the Massachusetts General Hospital Fertility Center in the US. The men were attending the centre in order to use their own semen to conceive using assisted reproductive technology.
Dietary information was assessed using a validated 131-item food frequency questionnaire that asked men how often, on average, during the previous year they had consumed specific amounts of each food, beverage or supplement listed in the questionnaire.
Semen was collected after a period of 48 hours of ejaculation abstinence. Sperm counts, concentration and percentage motility (the percentage of the sperm that were mobile were measured within 45 minutes of collection using standard laboratory techniques.
Reference standards from the World Health Organization were used to assess sperm concentration and motility. The way the sperm looked (morphology was also assessed.
Fatty acid levels in the sperm and seminal fluid were also analysed in a sub-set of 23 of the men based on the availability of stored semen.
There were 99 men with complete data on semen quality and dietary habits. They were divided into three groups according to the proportion of their total calories that were derived from fats. Low, intermediate and high fat intake groups were defined as consuming 26%, 32% and 37% of their total calories from fat respectively. Participants were also grouped depending on the major fat categories they consumed (saturated, monounsaturated, polyunsaturated, and omega-6 and Omega 3 . The analysis took account of differences in:
- total energy intake
- age
- abstinence time
- BMI
- smoking
- intake of alcohol and caffeine
What were the basic results?
Men in the study were largely Caucasian (89% and had an average age of 36.4 years. The majority were also overweight or obese (71% and reported never smoking (67% . Overall, 41% of the men had semen categorised as normal, 12% had a low sperm concentration, 53% had less than half their sperm able to move and 32% had abnormal sperm morphology. The main findings were as follows:
- The third of men with the highest total fat intake had 41% lower total sperm count (95% CI -14% to -62% and 38% lower sperm concentration (95% confidence interval [CI] -10% to -58% than the third of men with the lowest.
- Researchers reported that the association between total fat intake and sperm count and concentration appeared to be driven by saturated fat intake.
- Men in the highest third of saturated fat intake had 41% lower sperm concentration then men in the lowest (95% CI -14% to -60% . This was after statistical adjustment for total energy intake, age, abstinence time, BMI, smoking, intake of alcohol and caffeine.
- Higher intake of omega-3 polyunsaturated fats was related to more favourable sperm morphology. The third of men with the highest intake of omega-3 fatty acids had 1.9% (95% CI 0.4% to 3.5% higher rates of normal sperm morphology than men in the lowest third.
- In the subsample of 23 men, higher levels of saturated fatty acids in sperm, and to a lesser extent in seminal fluid, were associated with lower sperm concentration and motility. Conversely, higher levels of omega-3 were related to higher sperm concentration and motility.
- There were no results reported on whether the men tested were able to conceive a child with their partners.
How did the researchers interpret the results?
The researchers conclude that: ‘In this preliminary cross-sectional study, high intake of saturated fats was negatively related to sperm concentration whereas higher intake of omega-3 fats was positively related to sperm morphology’.
They that say further studies with larger samples are required to confirm these findings.
Conclusion
This small, cross-sectional study has attempted to find any associations between higher fat intake and lower sperm count and concentration. It also examined whether higher intake of omega-3 polyunsaturated fats was associated with a higher proportion of sperm showing ‘normal’ appearance and physical characteristics.
However, given that the study assessed diet and sperm quality at the same point in time, it cannot prove there is a cause and effect relationship between the two. It is not possible to know, for example, whether a bad diet causes low sperm counts or whether men with low sperm counts tend to have both a bad diet and lower sperm count due to some unknown factor linking the two. The small number of participants involved also increases the risk that the results have been influenced by chance.
The study has other limitations that should be considered when interpreting and assessing the implications of its findings. These include:
- Dietary intake is notoriously hard to measure accurately in studies of this kind. The method used in this study is adequate but still asked participants to recall food and drink consumed in the past year. This long recall timespan is likely to be subject to inaccuracy.
- Most men in this study were overweight, but lower sperm concentration was only found in those who had higher fat intakes. This is interesting as previous studies may have grouped men according to their weight and missed such an association, as they did not measure dietary fat intake.
- There were no results reported on whether the men tested were able to conceive a child with their partners. It is possible that even men with the lowest quality sperm may have been able to conceive naturally or with the assistance of reproductive technology.
- All the men in the research were attending a fertility clinic in order to use assisted reproductive treatment, although the specific reasons for this are unclear. This means we cannot tell how typical their sperm was compared to that of the general population or how well the results apply to other men not seeking this type of help.
- The researchers made multiple comparisons, increasing the risk they would discover a link by chance alone.
This study cannot, and does not, prove that a high-fat diet causes lower fertility. Larger, prospective cohort studies that follow more diverse groups of men, which assess their diet and sperm quality over time, are needed to confirm or refute these findings. However, this study does reinforce the general perception that a healthy diet may is essential for good health and wellbeing. There are many existing reasons to limit dietary saturated fat if you are a man or a woman as it is known to be linked to many diseases including cardiovascular disease.
Analysis by Bazian
Links To The Headlines
Want to become a father? Put down that English breakfast: Study shows diets high in saturated fat damage sperm. Daily Mail, March 14 2012
Diet 'linked' to low sperm counts. BBC News, March 14 2012
Links To Science
Attaman JA, Toth TL, Furtado J et al. Dietary fat and semen quality among men attending a fertility clinic. Human Reproduction, First published online March 13 2012
“Experts are calling for controversial metal-on-metal hip implants to be banned,” according to The Guardian. The newspaper said that research has found “unequivocal evidence” of high failure rates of these implants, particularly among women.
In recent months there has great deal of scrutiny about the safety of some types of metal-on-metal hip replacements, with concerns they wear out much faster than implants featuring plastic and ceramic parts.
To examine the issue, researchers working on behalf of the National Joint Registry in England and Wales analysed data on 402,051 hip surgeries performed using implants attached to the thigh bone by a metal stem, including 31,171 metal-on-metal implants. Researchers found that these had higher failure rates than other types of hip replacement, with an overall five-year failure rate of 6.2%. Those with larger ‘heads’ (the part of the implant fitting into the hip joint socket had a higher failure rate than those with smaller heads, as did hip implants in women.
This study provides more information on the longer-term performance of metal-on-metal hip replacements, and supports claims that they do not last as long as other types of hip implants.
The use of this type of implant in England and Wales is reported to have dropped dramatically since 2008, and the ongoing concerns seem likely to reduce its use further. Overall, this study supports the recent recommendations by UK health regulators. It states that people with large-headed metal-on-metal implants should be monitored carefully over time to identify whether their implants are wearing down at a faster rate.
Where did the story come from?
The study was carried out by researchers from the Universities of Bristol and Exeter, and the Centre for Hip Surgery at the Wrightington Hospital in Lancashire. It was performed on behalf of the National Joint Registry of England and Wales, which also funded the research.
The study was published in the peer-reviewed medical journal The Lancet.
This story was covered in a balanced way by the Guardian.
What kind of research was this?
In recent months there has been some concern over the use of certain all-metal hip implants, particularly over whether they wear down at a faster rate compared to other types of implants.
Hip implants come in a variety of different sizes and materials, but the debate has centred on large-headed ‘metal-on-metal’ implants. These implants are designed so that both the ball replacing the top of the thigh bone and the artificial socket placed in the pelvis are made from metal.
This research was a registry study looking at data on hip implants collected by the National Joint Registry of England and Wales, which records all hip and knee replacement surgeries. This includes the first operation to install the implant, and any revision operations carried out to replace or remove part of the original implant.
Just like with natural bone, metal hip implants experience wear and tear and can eventually deteriorate. This means any implant may eventually need revision surgery, although analysing the revision rate gives an estimate of how often and how soon implants fail early. While the revision rate is an important indicator of the outcomes of hip replacement, it should be noted that not all hip implants that do not function well or cause pain will be replaced.
The researchers say that due to their resistance to wear, large diameter metal-on-metal hip stemmed implants have become popular. ‘Large diameter’ refers to the size of the ‘head’ part of the implant that sits in the hip socket section of the implant. Stemmed means the head is attached to an elongated stem that sits inside the top of the high bone and holds the head in place.
The study’s authors note that there have been concerns about the high failure rate of one particular brand of metal-on-metal hip stemmed implant called ASR, which was withdrawn from use in 2010. Given this withdrawal and fresh concerns about other types of metal-on-metal implants, the researchers aimed to look at whether general metal-on-metal hip stemmed implants fail any more regularly than other hip implants (ceramic-on-ceramic or metal-on-polythene . They also looked at whether large diameter hip implants lasted any longer than implants with smaller diameter heads.
This type of registry analysis is useful for monitoring the long-term performance of devices once they are in use. It can help to identify any problems that are occurring with the implants. Ideally, data on the comparative performance of different implants would come from randomised controlled trials, but the researchers report that there are few such studies available.
What did the research involve?
The researchers looked at 402,051 first total-hip replacements using a stemmed implant carried out in England and Wales between April 2003 and September 2011. They then identified any revision operations carried out on these hip implants. This allowed them to determine how long it took before a revision operation was needed for each type.
The researchers did not include data on ASR implants in their analysis, because they are already known to have much higher revision rates than other brands and have already been withdrawn from the market. The researchers also only included data on hip replacements that had sufficient data recorded to allow them to identify which operations were revisions of which earlier hip replacements. This allowed them to analyse data on 82% of all first total-hip replacements using a stemmed implant performed in the study period.
The researchers tried to make sure the hip implant operations being compared were as similar as possible. For example, they only included those where the implants were not ‘cemented’ in, and where the operation was being performed in ‘typical’ patients.
Typical patients were defined as those whose hip replacement was needed due to osteoarthritis only, and who were generally healthy or with only mild illness at the time of primary surgery. This was defined using a recognised measure of pre-operative health. The researchers also took into account the age of the patient, and looked at men and women separately.
What were the basic results?
The researchers found that metal-on-metal hip implants were used in 8% of the 402,051 first total hip replacements using a stemmed implant. This equated to 31,171 replacements. Use of these types of implants peaked around 2008 but then reduced sharply after this.
Overall, metal-on-metal implants required revision due to failure more quickly than other implants, with a 6.2% needing revision within five years of implantation. The size of the head of the metal on metal implant affected the failure rate in men and women, with larger heads failing earlier. Overall, each 1mm increase in head size increased the risk of revision over time by about 2% (hazard ratio [HR] 1.020 in men, 95% confidence interval [CI] 1.004 to 1.037; HR in women 1.019, 95% CI 1.001 to 1.038 .
In men aged 60 years, the five-year revision rate was 3.2% for 28mm head metal-on-metal implants, and 5.1% for 52mm head implants. In younger women, the five-year revision rate was 6.1% for 46mm head metal-on-metal implants, compared with 1.6% for 28mm head metal-on-polyethylene implants.
Revision rates for metal-on-metal implants were higher for women than men, even with implants with the same head size. For example, a 36mm head metal-on-metal implant in women aged 60 had a five-year revision rate of 5.1% compared to 3.7% among men of the same age and implant head size.
However, larger head sizes were more durable for ceramic-on-ceramic hip implants. In men aged 60 years, the five-year revision rate was 3.3% with 28mm head ceramic-on-ceramic implants, and 2.0% with 40mm head ceramic-on-ceramic hip implants.
Age also had an effect on hip implant survival for women, with younger women receiving hip implants more likely to have revision surgery.
The most common reasons for revisions were loosening and pain, and these were more common in people who had metal-on-metal implants.
How did the researchers interpret the results?
The researchers concluded that metal-on-metal stemmed hip implants have a higher failure rate than other options, and should no longer be used. They say all patients with these types of implants should be carefully monitored, particularly young women whose hip implants have large diameter heads. They say that their findings support the continued use of large diameter ceramic-on-ceramic bearings as they seem to perform well.
Conclusion
Metal-on-metal hip implants have been under intense scrutiny in recent months, and this analysis provides useful data on how often they require revision and how they compare to hip implants made of other materials. Overall, this research indicates that metal-on-metal hip implants have higher revision rates (rates of replacement than other types of hip implants in England and Wales.
As with all such studies, there is the possibility that factors other than the implant type differed between the groups being compared, and that these other factors may influence the results. The researchers tried to minimise the risk of this by:
- comparing similar operations in similar patients
- looking at men and women separately
- looking at the effect of age and implant head size
However, there are other factors such as activity levels that could still be having an effect.
As the data used in this study came from a surgical registry, not a lot of information was available about factors such as body mass index (BMI or activity levels. These two factors could potentially influence the stress implants are placed under and therefore the wear that they display. The researchers say that in their opinion there is no obvious reason to suppose that these factors would vary to a large extent between people receiving the different large head metal and ceramic hip implants.
Due to these inherent limitations with observational research it is difficult to conclude that the differences seen are definitely due to the implants alone. The advantage of this registry data is that a large number of people were assessed. Furthermore, this is not a selected subsample of people receiving hip implants but all patients from different surgeons and using different implants. The researchers say that these strengths and the consistency of their findings support the suggestion that these findings do represent the true effects of the implant types.
Overall, these findings do seem to suggest that metal-on-metal hips do require revisions more frequently than other types of hip implants. This study reports that since 2008 there has been a dramatic reduction in the use of metal-on-metal hip implants in England and Wales. Overall it found that most hip replacements analysed in the study period (92% between April 2003 and September 2011 did not use metal-on-metal implants.
It seems likely that based on this study their use may decline further. It is important to bear in mind that the overall five-year revision rates with metal-on-metal hips is 6.2%, so the majority of these implants have not needed revision in this time. This study supports the authors’ suggestion and MHRA recommendation that people with these implants should be monitored carefully over time, to identify when such revisions might be required.
Analysis by Bazian
Links To The Headlines
Metal-on-metal hip replacements 'high failure rate'. BBC News, March 13 2012
Ban metal-on-metal hip replacements, experts urge. The Guardian, March 13 2012
ALL metal hip joints 'must be banned': Failure rate 'four times higher than other types'. Daily Mail, March 13 2012
Links To Science
Smith AJ, Dieppe P, Vernon K et al. Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. The Lancet, Early Online Publication March 13 2012
Botox injections may help women with urinary incontinence, The Daily Telegraph has today reported. The newspaper said that injecting the muscle-freezing toxin into the wall of the bladder can have a long-lasting impact on overactive bladder syndrome, a major cause of incontinence.
The newspaper’s story is based on a UK medical trial that investigated whether the paralysing properties of botox were effective at reducing the symptoms such as frequently using the toilet, feeling an urgent need to urinate, and leakage in patients with overactive bladder syndrome.
The trial featured 240 women who had not responded to medical treatments for overactive balder syndrome. The researchers found that women who received the botox injection experienced these symptoms significantly less frequently than women who received a dummy injection of saltwater. However, women given botox were more likely to get urinary tract infections.
The results of the study indicate that botox may be effective in treating a common and upsetting health condition. However, if it does get adopted into use in this way there are several other treatment options (including lifestyle measures, bladder training exercises and medication that would be considered first. Botox may be considered as an option only if these treatments fail, and the benefits would have to be considered in relation to its potential harms.
Where did the story come from?
The study was carried out by researchers from the University of Leicester and was funded by the Moulton Charitable Trust and the women’s health charity Wellbeing of Women.
The study was published in the peer-reviewed medical journal European Urology.
The Telegraph covered this study appropriately, covering the study size and design, as well as the treatment benefits and harms.
What kind of research was this?
While it is hard to gauge the true scale of the problem, research suggests that around 13% of women in the UK may have some form of urinary incontinence. Although many conditions and factors can cause urinary incontinence, one major cause is overactive bladder syndrome. The condition is marked by uncontrolled contraction of the bladder that results in an urgent need to pass urine. While this can lead women to need the toilet frequently, some also experience a form of leakage called urge incontinence.
An overactive bladder can be a cause of urge incontinence, which is when urine leaks at the same time or just after you feel an intense urge to pass urine. Urge incontinence differs from stress incontinence, where the pelvic floor muscles are too weak to prevent urination. This causes urine to leak when your bladder is placed under pressure from actions such as coughing or laughing.
This was a placebo-controlled randomised controlled trial that examined the effectiveness and safety of using botulinum toxin (botox as a treatment for overactive bladder syndrome. A randomised controlled trial is the best way to measure the effectiveness of a treatment, as the randomisation process helps to ensure that any patient characteristics that may influence the outcome have an equal chance of appearing in either treatment group. This allows researchers to be confident that any observed effect is due to the treatment under study.
What did the research involve?
The researchers enrolled 240 women with bladder muscle overactivity, or overactive bladder syndrome, that had not responded to previous treatment. The women were randomly allocated injections of either Botulinum toxin A (botox or placebo (saltwater into the wall of the bladder. Women with another common type of incontinence, stress incontinence, were not included in the study.
The participants kept a diary over three days, recording the number of times they:
- emptied their bladder
- felt an urgent need to empty their bladder
- experienced an unintentional passing of urine (or leakage
The women also completed a questionnaire that assessed their quality of life, as overactive bladder syndrome often has a significant negative impact on patient quality of life.
The researchers conducted follow-up sessions with the women on average at six weeks, three months and six months after treatment. They assessed differences in the frequency of the above three symptoms between the two treatment groups. They also compared quality of life scores, treatment complications and time until troubling symptoms returned between the two groups.
The researchers used appropriate statistical methods to assess differences in frequency of symptoms between the two groups.
What were the basic results?
There were 122 women allocated to the botox treatment group and 118 women allocated to the placebo group.
The researchers compared the outcomes in the botox and placebo groups at the six-month follow-up. They found that in any 24-hour period women in the botox group:
- emptied their bladders less often: 8.33 times versus 9.67 times, a difference of 1.34 (95% confidence interval [CI] 1.00 to 2.33, p=0.0001
- experienced fewer leakage episodes: 1.67 versus 6.00, a difference of 4.33 episodes (95% CI 3.33 to 5.67, p
<0.0001 - experienced fewer episodes of urgency to urinate: 3.83 versus 6.33, a difference of 2.50 episodes (95% CI 1.33 to 3.33, p
<0.0001
Almost a one-third of women in the botox group (31.3% developed bladder control (or continence following their treatment, compared to 12.0% in the placebo group (Odds Ratio [OR] 3.12, 95% CI 1.49 to 6.52, p=0.002 .
However, urinary tract infection was reported at least once during six months by a one-third of women in the botox treatment group, compared to 10% in the placebo group (OR 3.68, 95% CI 1.72 to 8.25, p=0.0003 .
Those given botox also reported greater difficulty emptying their bladders, which required self-catheterisation to remove their urine: 16% of the botox group compared to 4% of the placebo group (OR 4.87, 95% CI 1.52 to 20.33, p=0.003 .
How did the researchers interpret the results?
The researchers concluded that injections of botulinum toxin A into the bladder wall is an effective and safe treatment for overactive bladder syndrome in women who have not responded to previous treatment.
Conclusion
Urinary incontinence can be a distressing and problematic condition, and although we cannot be sure of the number of people affected, research suggests it is surprisingly common.
While there is a range of potential treatments and ways to manage urinary incontinence (including medication, bladder training, lifestyle changes and surgery not all people respond to them, and they can have problems. This randomised controlled trial provided good evidence that botox injections may be a useful treatment option for women with incontinence due to overactive bladder syndrome that has proven difficult to treat with other methods.
The researchers say that the relief of symptoms reported by the participants was considerably better than those who used oral anticholinergic drugs. These drugs act on the nerve supply to the bladder and are the standard medical treatment used for this condition. They add that other randomised controlled trials have reported similar effects.
The researchers say that since they designed their trial, other studies have published results that support using a lower recommended dose of botox for this type of treatment. Therefore, it is unclear if the same results would be found at this reduced dose. They also say that their study recruited participants with severe cases of overactive bladder syndrome, and that it is unclear if the treatment would be as effective in less severe cases.
It is important to note that the study participants did not have stress incontinence, which is a common cause of urinary incontinence. Therefore, the results of this study cannot be generalised to all women with symptoms of overactive bladder or incontinence, but can only be applied to those with diagnosed overactive bladder syndrome (or detrusor overactivity .
Botox is not routinely used by the NHS in this way, but if it were then it would probably be considered as an option only among women who have required specialist referral for their condition. This would be given after they had tried other treatment options first, which may include lifestyle measures and bladder training exercises in addition to oral medications. If these treatments fail, the benefits of botox would have to be considered in relation to its potential harms.
Links To The Headlines
Botox 'stops the call of the bathroom'. The Daily Telegraph, March 12 2012
Links To Science
Tincello DG, Kenyon S, Abrams KR et al. Botulinum Toxin A Versus Placebo for Refractory Detrusor Overactivity in Women: A Randomised Blinded Placebo-Controlled Trial of 240 Women (the RELAX Study . European Eurology, Published online 5 January 2012
Traffic fumes, weather and dirty air from northern England and France add up to worst air pollution since 2008's more stringent index
Air pollution in London hit record levels on Thursday due to a combination of traffic fumes, relatively still weather and an influx of dirty air from the north of England and northern France. Poor conditions are affecting a swath of the country as far north as Leeds and York.
Official monitoring stations in the capital show that particles, nitrous oxide, sulphur dioxide and other pollutants have reached levels not recorded since stringent new measurements were introduced in 2008. Pollution levels in London are even higher than last Easter, when the government was forced to issue a smog alert. The record high will worry officials preparing for the arrival of the world's best athletes and hundreds of thousands of spectators for the Olympics in four months time.
Health advice from the Department for Environment, Food and Rural Affairs (Defra says that adults and children with lung problems, adults with heart problems and all older people should not take any "strenuous physical activity" while pollution is at the recorded levels. The general population is advised to reduce exercise too.
Recirculated dirty air from Europe and the north of England is partly to blame, along with a lack of wind, said Gary Fuller, senior lecturer in air quality measurement at King's College London. "Still conditions mean that the pollution from the cars and lorries on the roads today is simply not blowing away. On top of this, the air over England today was in northern France yesterday and in northern England on Tuesday where it picked up a lot of air pollution from coal burning industries, domestic heating and traffic."
He added that poor air quality was affecting as far north as Leeds and York, and his forecasts suggested the high levels of pollution would continue into tomorrow.
The Met Office said that winds would be light on Friday morning but would be picking up by lunchtime with gusty winds of 25mph, followed by further winds on Saturday which should bring pollution levels down.
Simon Birkett, director of the Clean Air in London campaign, said: "The failure by the mayor to warn Londoners about five smog episodes in a row proves he is desperate to avoid the air pollution issue ahead of the mayoral election.
"It's clear the mayor, who would rather suppress pollution in front of official air quality monitoring stations than save lives, is more concerned about getting re-elected than he is about those he represents. This may be the biggest public health fraud for a generation."
This month, a report suggested that the 2012 Olympics would have no significant impact on air quality in London. Changes to road management during the Games are likely to have "broadly neutral impact on air quality", Transport for London said.
Since December 2008, air quality stations in London have been monitoring smaller particles called PM2.5s, which are able to enter the bloodstream more easily and cause more respiratory damage than larger particles, such as PM10s. Fuller said the levels on Thursday were the highest since the new regime was introduced.
A Defra spokeswoman said: "We want to keep improving air quality and reduce the impact it can have on human health and the environment. Our air quality has improved significantly in recent decades and is now generally very good, and almost all of the UK meets EU air quality limits for all pollutants.
"There are some limited areas where air pollution remains an issue, but that's being dealt with by the air quality plans, which set out all the important work being done at national, regional and local levels to make sure we meet EU limits as soon as we can."
Last month, the environment secretary, Caroline Spelman, was criticised by an influential group of MPs for rejecting their recommendations to cut pollution on the grounds that it was too costly. Poor air quality has been linked to nearly one in five deaths a year in London. The capital's poor air quality, caused largely by traffic, has seen the UK facing ?300m in fines for breaching EU targets. The government has successfully lobbied Europe to push back the deadline for meeting the targets.
The number of people of all ages who died from gastroenteritis more than doubled from 1999 to 2007 in the United States, according to the Centers for Disease Control and Prevention (CDC , and most of the deaths from infectious causes can be attributed to two stomach bugs -- Clostridium difficile and norovirus.
While C. diff continues to be the leading cause of deaths from gastroenteritis here and throughout the world, a new study shows for the first time that norovirus is likely the second leading infectious cause of gastroenteritis deaths.
The analysis, presented by the CDC Wednesday at the International Conference on Emerging Infectious Diseases in Atlanta, used data from the National Center for Health Statistics.
Over the eight-year study period, the CDC said, gastroenteritis-associated deaths from all causes ballooned from nearly 7,000 to more than 17,000 per year.
Adults over 65 years old accounted for 83 percent of those deaths.
Norovirus was associated with about 800 deaths annually, though the CDC said there were 50 percent more deaths in years when epidemics were caused by new strains of the virus. Norovirus fatalities are often a result of severe dehydration.
Norovirus is the leading cause of gastroenteritis in the U.S., and about half of all food poisoning cases are caused by norovirus. Highly contagious, it spreads through person-to-person contact and through food, water and surfaces contaminated with vomit or feces. Although people can get norovirus illness throughout the year, the incidence generally peaks from December through February.
Norovirus is said to cause about 70,000 hospitalizations each year in the U.S.
People infected with norovirus are contagious as soon as they feel ill and can remain contagious for about three days and up to two weeks after they recover, the CDC says. So far there is no specific vaccine or treatment, but a nasal spray vaccine is being tested and at least one other vaccine and an antiviral medication are in development.
Cooking foods -- especially oysters and other shellfish -- and carefully washing fruits and vegetables to be eaten raw, cleaning and disinfecting kitchen and bathroom surfaces and frequent hand washing are the basic ways to prevent the spread of norovirus.
Nevertheless, there has been a fivefold increase in deaths from C. diff, from approximately 2,700 to 14,500 per year. Much of the recent increase in the incidence and mortality of C. difficile is attributed to the emergence and spread of a hypervirulent, resistant strain known as North American pulse-field type 1 (NAP1 , according to the CDC.
About one-quarter of C. diff cases are linked to hospitals, but in the other 75 percent the symptoms first surfaced in nursing home patients or people who recently had received care at a doctor's office or clinic. Often those stricken have been taking antibiotics.
To reduce C. diff infections, the CDC recommends prescribing and using antibiotics carefully; isolating infected patients; using gloves and gowns, even when performing routine care; using bleach or other spore-killing products to clean surfaces; and notifying other facilities when sick patients are transferred.
People who seek medical treatment because of profuse diarrhea and vomiting are sometimes told they have gastroenteritis and sent home. The way to determine if the symptoms are caused by norovirus, C. diff., Shiga-toxin producing E. coli, Salmonella, Shigella, Campylobacter, Staphylococcus and other bugs is through a stool anaylsis.
Because gastroenteritis is a major cause of death, "by knowing the causes of gastroenteritis-associated deaths and who's at risk, we can develop better treatments and help health care providers prevent people from getting sick," noted Dr. Aron Hall, DVM, MSPH, the CDC's lead author of the gastroenteritis study.
The partners in the GRSB include Cargill, JBS, McDonald's, Merck Animal Health, the National Wildlife Federation, Rainforest Alliance, the Nature Conservancy, Walmart and the World Wildlife Fund.
It is surprising to see these groups banding together to work on an issue when there may be significant conflicts of interest: the environmental and conservation groups are seeking to reduce the environmental impact of beef production; the industry groups want to continue producing beef at a level to meet increasing global demand; and the retail groups want to dispel alleged myths about beef production and increase consumers' trust in their products.
Jason Clay, World Wildlife Fund's Senior Vice President for Markets Transformation, initiated the roundtable approach and said WWF is encouraged to see such a strong commitment from the major stakeholders in the beef industry to work collaboratively to create a more sustainable beef supply chain.
"At World Wildlife Fund, we recognize that these collaborative efforts are instrumental to our goal of preserving the most important biological places on earth and, ultimately, living in harmony with nature," Clay commented.
Why Sustainability?
Although beef consumption in the United States is declining, global consumption is on the rise. Scott Hanson, managing director of Meat & Livestock Australia, said "[global] demand is set to grow increasingly over the next five years, vastly outstripping the globe's capacity to supply." In 2011, global beef consumption reached 64.5 million metric tons (about 142 billion pounds and is estimated to climb 24 percent by 2020.
Conservation and environmental groups have long criticized the beef industry for its significant contributions to a number of environmental problems. For example, beef production requires an enormous amount of land and water. Crop production and grazing activities take up 58 percent of the earth's habitable area. Beef production alone uses 60 percent of all the land used to produce food, but provides only 1.3 percent of the calories. The threat of increased deforestation to make room for more cow operations is a major concern. In terms of water use, one liter of water produces just one calorie of beef. Concentrated animal feeding operations (CAFOs are linked to water and air quality issues, including increased levels of greenhouse gases and degradation of water sources.
The environmental impacts of beef production, which are already quite serious, become even more significant in light of a growing world population and projected increase in demand for beef.
The Global Conference on Sustainable Beef
The idea for the Global Roundtable came out of the Global Conference on Sustainable Beef held in November 2010 in Denver, CO.
In the opening session of that meeting, Bryan Weech, Director of Livestock at World Wildlife Fund, said the purpose of the conference was to begin a dialogue about sustainable beef production. Weech was quick to note that this event was not an attack on or defense of industry, but an effort to bring together representatives from all steps of beef production to discuss sustainability.
Bob Langert, Vice President of Corporate Social Responsibility at McDonald's, explained why McDonald's was participating in the conference.
Langert noted that McDonald's had commissioned a group of students from the University of California - Berkeley to examine McDonald's entire beef system for its sustainability.
The students pointed to several ways McDonald's could improve its system. One suggested improvement was to use preferred suppliers who meet certain environmental, animal welfare and labor benchmarks (see 2006 Corporate Social Responsibility Report, pages 26a - g . Additionally, the students recommended pilot projects to demonstrate environmental stewardship, for example using methane generators on waste lagoons.
The second reason McDonald's participated in the conference had to do with building trust with their consumers. Langert said part of earning consumers' trust is showing that the products McDonald's buys (like beef are produced in a responsible way. Consumers expect a socially responsible supply chain, and Langert said McDonald's continued success requires serving food in a convenient, safe, fun and very responsible way.
Langert cited what he called the mischaracterization of sustainability as the third reason McDonald's was invested in the conference. He said sustainability, in general, has been incorrectly defined by too many stakeholders. In his view, the food industry is under attack and is being negatively portrayed by "opinion makers."
Langert said media portrayals, whether in coverage of obesity or health or environmental degradation issues, sometimes do not give an accurate picture of what is truly going on. "What the heck?" he continued, "The guy that heads up the U.N. effort on climate change called on people to eat less beef."
Animal welfare abuses and food safety threats are being defined as part of the total umbrella of factory farming, and Langert thinks "the real story is that the beef industry is made up of excellent men and women and processors that take pride in what they are doing and manage their businesses responsibly."
For this reason, McDonald's approached the World Wildlife Fund more than a year ago to suggest this conference. Langert said that "today there is window of opportunity to come together and demonstrate that we all can be very proactive and strategic in our approach and tell our story even more."
McDonald's has had past successes working with "really incredible third parties that focus on science and market-based solutions." Langert said that World Wildlife Fund is committed to coming up with socially, environmentally and economically viable solutions and, because of that, McDonald's was willing to work in collaboration on the issue of sustainable beef production.
In closing, Langert presented some thoughts from the steering committee, including its earnest desire to improve the sustainability of beef globally (from environmental, social and economic perspectives ; its strong support for working collaboratively with a variety of stakeholders involved in beef production to find science-based solutions; and its commitment to continue to do more for sustainable beef, both locally and globally.
The rest of the conference involved presentations by international beef producers and organizations, discussions about defining sustainability, and presentations by groups that are already working toward sustainable beef production (for example, the California Rangeland Conservation Coalition working to preserve and increase grazing land in California .
The purpose of the conference was to bring together a number of different stakeholders with different interests and goals to begin the conversation about defining sustainability and finding ways to accomplish their goal. One of the conclusions of the conference was the idea for a Global Roundtable for Sustainable Beef.
Global Roundtable for Sustainable Beef
The aim of the GRSB, as listed on its website, is to advance continuous improvement in the sustainability of the global beef value chain through a number of actions. Those steps include:
- "Identifying, evaluating, and enabling increased adoption of current leading production and supply chain practices, policy, and technology;
- Promoting the adoption of leading employment and economic development practices;
- Supporting action-oriented, regional, and local multi-stakeholder initiatives focused on producing measurable outcomes;
- Addressing high-priority issues related to sustainability by sharing locally relevant and science based information; and
- Providing a forum and opportunities for constructive engagement, information exchange, and technical problem solving."
The website does not provide any examples of how the Roundtable is going to accomplish these goals, but lists a few existing initiatives, such as the Brasilian Sustainable Beef Working Group, the Florida Ranchlands Environmental Services Project, and the California Rangeland Conservation Coalition.
GRSB Registers as Non-Profit
One of the first steps the GRSB did was to register as a non-profit. Ruaraidh Petre, president of the Roundtable, said that the formation of the non-profit "reaffirms our collective support of activities that deliver measurable, science-based outcomes that are focused on high priority environmental and industry-related issues. More efficient, environmentally sustainable approaches to bringing beef from farm to fork will help conserve our planet's finite resources while also supporting our communities and our members' bottom lines."
It is unclear how the GRSB is going to accomplish those goals.
GRSB registered under Article 60 of the Swiss code, which allows it to support local, regional and national roundtable members who propose new innovations, technologies, and share best practices in beef production systems. The group will also be able to distribute several million euros that the Dutch government pledged for new trainings and technologies to improve the efficiency and productivity of smallholder and frontier farms.
Since November 2010, GRSB has initiated a number of dialogues in key beef producing regions to share information and practices across the diverse beef industry, including in Argentina, Australia, and Brazil.
GRSB has more activities planned for the near future: it will participate in the Australian Beef Conference in May 2012 and hopes to host the second Global Conference on Sustainable Beef later this year so that global stakeholders can review and comment on the new statutes and bylaws.
The members of the GRSB are strange bedfellows, to be sure, so keep an eye on what comes out of this Roundtable in the coming months (and perhaps years .
-----------------------
Alli Condra is pursuing her LL.M. in Agricultural and Food Law at the University of Arkansas, and is the recipient of the Marler Clark Graduate Assistantship.
Guess what? They do!
In a statement issued by the committee, the bishops insisted that they are "strongly unified and intensely focused" in their "opposition to the various threats to religious freedom." Religious freedom, as we all know by now, means their right to demand that women be denied access to health care the bishops don't like.
The bishops then proceed to do some serious false-witness-bearing:
This is not about access to contraception, which is ubiquitous and inexpensive, even when it is not provided by the Church’s hand and with the Church’s funds.First, yes, this is about access to contraception. Second, no , it is not inexpensive. Third, no one is requiring the Church to provide it. And fourth, no one is forcing the Church to pay for it.
But the lies don't end there:
The mandate includes an extremely narrow definition of what HHS deems a “religious employer” deserving exemption—employers who, among other things, must hire and serve primarily those of their own faith.Riiiiiiight. That "extremely narrow" definition of "religious employer" is so narrow, it doesn't even cover someone who opens a Taco Bell! Which, as you may recall, was the demand issued by Anthony Picarello, general counsel for the U.S. Conference of Catholic Bishops.
But the false witnessing doesn't end there. Oh no. According to the bishops, the mandate also is a "violation of personal civil rights":
The HHS mandate creates still a third class, those with no conscience protection at all: individuals who, in their daily lives, strive constantly to act in accordance with their faith and moral values.That's a whole steaming pile of Ninth Commandment violation right there too. Why? Because the mandate doesn't force any individual to do anything. The government is not preventing any individuals from going on about their lives, believing whatever they want to believe, living in accordance with whatever they think their faith demands of them. You think your faith prohibits you from using birth control? Guess what? You are still free to not use birth control! Your religious liberty is still totally intact!
The bishops have laid out the "next steps" in their war on women's health care, including "pursu[ing] legislation" and "explor[ing] our options for relief from the courts." And, oh yes, continuing to beg American Catholics, who have roundly rejected this idiocy, to support them in their war. Good luck with that one, fellas.
The bishops conclude by stating:
Prayer is the ultimate source of our strength—for without God, we can do nothing; but with God, all things are possible.Suuuuuure. Of course, they don't really believe that either, and they're not going to take their chances by leaving it up to God and prayer. Hell no! Thus, they'll continue to spend millions of dollars lobbying their Republican friends in Congress and perhaps even seek "relief from the courts."
Who would Jesus sue, right?
The government in India has granted the rights to an indigenous pharmaceutical group to manufacture a generic version of the cancer treatment drug Nexavar.
For the first time, an Indian drugs firm has been approved to produce a medication under licence when the original's still patent-covered.
As a result of the agreement, the firm - Natco Pharma - is obliged to forward six per cent in royalties back to Bayer, which presently markets Nexavar alongside Onyx Pharmaceuticals.
Bayer, meanwhile - according to reports - isn't best pleased with the Indian government's move. "We are disappointed about this decision", company representative Sabrina Cusimano stated in comments made to the Associated Press. "We will see if we can further defend our intellectual property rights in India".
Nexavar Cancer Drug
Nexavar is the market name for sorafenib, an orally-taken medication now approved to treat two types of cancer - advanced hepatocellular carcinoma (liver cancer and advanced renal cell carcinoma (kidney cancer .
The kidney cancer approval came first, in 2005, when the US FDA declared its satisfaction with the product. It did the same for the drug as a liver cancer treatment two years later and, with clinical trials now in progress, thyroid cancer could be the next condition added to this approved treatment list.
Controversially, the drug's not available as a UK liver cancer treatment, after being rejected - on grounds of cost - by the National Institute for Health and Clinical Excellence in November 2009.
Natco Generic Nexavar Approval
The Natco generic Nexavar approval decision will see the production of drug copies priced at the equivalent of £112 for a box of 120: less than £1.00 each. This is dramatically cheaper than the original drug, with the same quantity presently priced at over 30 times that cost.
The Indian pharmaceutical firm believes that the drug's availability is key to the treatment of close to 9,000 cancer patients in India.
"This is a victory for Indian patients and for India's generic manufacturers, which are under attack", Natco Pharma's General Manager, Madineedi Adinarayana, stated according to the BBC, adding: "many more such cases will follow."
When it comes to screening for cancer, a common belief held by doctors as well as patients is "more is better." It seems only logical that more frequent screening with the newest technologies translates to more cancers detected at the earliest possible time and, ultimately, more lives saved.
Cervical cancer is an example of why this is not necessarily so. Dating back to the late 1940s, the Pap test has been detecting not only early cervical cancers, but changes in the cervix ("pre-cancers" that when treated or removed lead to actual prevention of cancer in addition to early detection. For decades, the majority of women in this country have scheduled their doctor appointments around their "annual Pap." As a result of widespread Pap testing, mortality rates dropped by 70% and the Pap test became the biggest success story for cancer screening in history.
In the late 1980s, it was discovered that cervical cancer is caused by HPV, the human papilloma virus. Studies of the natural history of HPV and cervical cancer showed that it takes, on average, 10-20 years from the time a woman is first infected with HPV until the time a cervical cancer might appear.
In 1987, the American Cancer Society, and several other national organizations, recommended that most women could safely be screened for cervical cancer with the Pap test every 3 years rather than every year. Twenty-five years later, studies show that the majority of health care providers still recommend annual screenings and that the majority of women expect annual screenings.
Ten years ago, the American Cancer Society and others recommended that a new screening test, one that detects the HPV virus, could be used along with the Pap test to screen women aged 30 years and older for cervical cancer.
New cervical cancer screening guidelines
Now the American Cancer Society, working with 25 other organizations, recommends that women ages 30-65 should be screened with both the HPV test and the Pap test, called "co-testing," as the
preferred
strategy. (Screening with the Pap test alone every 3 years is still acceptable.
The risk of getting cancer for a woman who is screened every 3 years with the Pap test is extremely low, and similar to the risk of cancer when screened every 5 years with both the HPV test and the Pap test. In fact, in the United States, most women who get cervical cancer have not been screened in at least 5 years. About half of them have never been screened in their lifetime.
You can see the full revised guideline
here.
Guidelines often ignored
Many studies have shown that a large number of doctors screen women for cervical cancer more frequently than recommended. One recent study, for example, found that most health care providers (65%-85%, depending on the situation not only recommend yearly Pap tests but, when screening with both the HPV test and the Pap,
still
recommend repeating at least 1 of the tests every year. In one situation in the study, only 14% of doctors would recommend the next test in 3 years, as guidelines recommended.
Why is this? Why have doctors been so slow to incorporate evidence-based guidelines into their practices? One reason is that many doctors think that patients want and/or expect annual screening. They may want to avoid having a discussion with patients about why this is not needed. Some may fear litigation if a cancer is missed, while others may simply be unaware of the guidelines. Lastly, there may be financial incentives to test more frequently.
Little benefit, more harm with too-frequent screening
Coming back to where we started, there is a common belief that more screening is better. In fact, annual Pap tests offer very little if any benefit compared to screening every 3 years.
But there are harms to screening more frequently. False positives are very common with cervical cancer screening, and more frequent screening leads to more frequent need for follow up tests that can be invasive and have unwanted side effects, including problems related to future pregnancies and delivery, as well as increased anxiety and time away from work or home.
With the
new guidelines, the American Cancer Society recommends
against
annual screening.
Here are a few points to remember:
- Screening with the Pap test alone every 3 years is extremely safe and will decrease the number of false positive results without leading to an increase in cancer or cancer deaths
- For women ages 30 years and older, testing with both the HPV test and the Pap test further decreases the risk of cancer and advanced pre-cancers. When both tests are normal, no cervical cancer screening test should be done again for 5 years.
- Women younger than age 21 do not need to be screened for cervical cancer.
- Women over the age of 65 who have been regularly screened, and women who have had a hysterectomy (with removal of the cervix for reasons not related to cervical cancer or pre-cancer, should no longer be screened.
- Women should talk to their doctors about what screening test to use and how often, and should question their doctors if they think they are being screened too often.
- Women can and should still see their doctors more often than every 3 or 5 years - just not for a Pap test. Doctor visits should be scheduled for general wellness, with Pap tests and HPV tests given according to guideline.
To see an American Cancer Society Behind the Science video detailing the new guidelines,
click here.
Saslow is director of breast and gynecologic cancer for the American Cancer Society.
Nestled within the results of a new joint lifestyle survey conducted by Yahoo! Finance and Fitness magazine is an interesting little NBA nugget. Asked to identify people who make way more money than they deserve, nearly a quarter of survey respondents picked LeBron James.
In addition to questions about monthly finances, planned uses for tax refunds, spending preferences and how money impacts relationships, 2,000 Americans were asked, "Who do you think makes way more money than she/he deserves to?" The most popular choice was mom-and-wife-to-be Nicole "Snooki" Polizzi of "Jersey Shore" fame, picked by 51 percent of those surveyed. She was followed closely by Kim Kardashian (45 percent , with whom we are all very familiar.
There's a big gap after the two reality stars — the third-most popular answer didn't get even a quarter of respondents' votes — but James is No. 3 on the list. Twenty-four percent of the 2,000 people surveyed said the Miami Heat superstar and two-time league Most Valuable Player gets paid more money than he deserves.
[Related: LeBron James to sell pork donuts in China for Dunkin' Donuts]
The view on James was pretty consistent across age groups, with 24 percent of respondents in both the 18-34 and 35-54 demographics calling him overpaid, and 25 percent of participants 55 and older agreeing. The only real differential came in the gender split — 27 percent of men said they think LeBron is overpaid, compared to 21 percent of women. (The data wasn't broken down along racial/ethnic lines; a Y! consumer communications spokesperson told me that only age and gender get analyzed in these surveys.
The results make sense in real-world terms, of course — most people would likely argue that nobody "deserves" to make $16 million a year to do anything, let alone play a sport as a job. That, of course, to some degree trivializes not only the incredible amount of work that NBA players do, but also the value of the natural talent they must have to reach and remain at the highest level of their chosen profession, but still, it makes sense.
It also shows just how large a chasm exists between the "real world" and the world of the NBA. Because in the latter, if anything, LeBron James is underpaid.
[Related: Surprising names land on list of highest-paid athletes of all time]
For the record, James, 27, is making just over $16 million to play during the 2011-12 season, the second year of the six-year, $109.8 million contract he signed with the Cleveland Cavaliers before being traded to the Heat in July 2010. He's slated to make $17.55 million next year, just under $19.1 million in 2013-14, $20.6 million in 2014-15 and $22.1 million in the final year of the deal, according to the ShamSports.com salary database.
Heading into this season, James had earned $76.5 million in NBA salary; factoring in his myriad endorsement deals and holdings, some estimates peg his net worth at somewhere between $100 million and $120 million.
The $16,022,500 that James is being paid by the Miami Heat this year puts him in a tie with teammate Chris Bosh for the 16th-highest salary in the NBA, according to HoopsHype's salary listings. He makes less than Kobe Bryant, Rashard Lewis, Tim Duncan, Kevin Garnett, Gilbert Arenas, Dirk Nowitzki, Pau Gasol, Carmelo Anthony, Amar'e Stoudemire, Joe Johnson, Dwight Howard, Elton Brand, Deron Williams, Chris Paul and Kevin Durant.
Some of those names are obvious outlier-laughers; others are legitimate, world-shaking stars. But even if you don't think James "deserves" to make more than all 15 of those players — if, say, you favor Paul's contributions from the point over LeBron's contributions from the wing, as Wins Produced often tends to — that metric still suggested James would be worth roughly $27 million more than the $16 million he's making in a league unfettered by salary structures and rules about how much players could make.
And that was back in 2010 — if you check the numbers, you see that this year James is performing at an even higher level than he did back then, producing at a level of efficiency that, if sustained, would rank as arguably the greatest regular season in NBA history. Even if you don't buy the numbers, just watch LeBron this year — the range of defensive assignments he takes on, the responsibility he has for keying Erik Spoelstra's high-octane attack on both sides of the ball, the bad shots he's taken out of his game, the increased emphasis on post work, and on, and on. He's been the best player on the floor all regular-season long, and frankly, it hasn't been close.
Those two words — "regular season" — will probably present a sticking point for a lot of fans. OK, fair enough — if you think LeBron's overpaid because he hasn't won a title yet, you're probably going to think that no matter what he does (averaging 40-12-9 a night, hitting 80 percent of his shots, not committing another turnover for the next calendar year, whatever until he wins one. But there are a lot of guys in the league making more money for a lot less work than James, and if you think there aren't 29 general managers in the league who, given a blank checkbook and a wide-open market, wouldn't fall all over themselves to pay LeBron James more than any one of them, you're kidding yourself.
Fine print: Conducted online in partnership with Ipsos MediaCT in November 2011, the Yahoo! Finance Financially Fit survey asked 2,000 Americans "representative of the U.S. online population" between the ages of 18 and 64 an array of questions related to their spending and saving habits, according to a statement. The results appear in the April 2012 issue of Fitness, which hit newsstands Tuesday, as well as online at the Yahoo! Finance and Fitness Online websites.
Related NBA video on Yahoo! Sports
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Submitted by Charles Hugh Smith from Of Two Minds
We Have No Other Choice
America is just going through the motions because we have no other choice--or so we believe.
I have long thought that America Is Just Going Through the Motions--of caring about the deficit, of financial "reform," and everything else:
Let's be honest, shall we? There never was any fire for real reform of the financial sector. It was all rote, a foul, stupid play-act, a passionless pantomime of "caring" and fake-"progressiveness" displayed for propaganda purposes.
I now think we're just going through the motions because we have no other choice than to "extend and pretend" the Status Quo. Choice is of course a matter of perception, a situation where perception defines what is "possible" and what is "impossible."
Interestingly enough, the "possible" is what we think we can manage, while the "impossible" is what happens to us whether we thought it possible or not.
Consider the Federal Reserve. Liberal media mainstay The Atlantic published a fawning puff-piece lauding Ben Bernanke as the man who "saved the economy": The Villain: The left hates him. The right hates him even more. But Ben Bernanke saved the economy— and has navigated masterfully through the most trying of times.
We all know what Ben "saved," and it wasn't the economy--it was the fraud-based crony-capitalist financial sector. In case you missed the primer that explains the fundamental frauds at the heart of our economy:
Money from Nothing: A Primer on Fake Wealth Creation and its Implications (Part 1
(P
art 2
Claiming that "saving the financial sector was necessary to save the economy" is akin to claiming that saving the massive tapeworm coiled inside the patient is necessary to save the patient: the logic is backward. The financial sector (tapeworm is the cause of the economy's (the patient weakness and collapse.
Ben is no genius nor is he a hero. He is simply doing what he has to because he has no other choice. What would happen if Ben didn't funnel hundreds of billions of dollars into the financial tapeworm? It would die, and the "too big to fail" banks--for all intents and purposes, the Fed's partners, and the generous funders of political toadies--would cease to exist. Extremely wealthy and powerful people-- the top 1/100 of the top 1%--would lose great wealth and the power it buys.
In a system that has become dependent on crony-capitalism and fraud for its very survival, then that is obviously not even a choice.
How about the political class of toadies, sycophants, leeches and cowards who passed a 2,300-page "reform" bill that nobody read, much less actually understands? Senator Dodd recently penned a bloviated defense of his "save the poor tapeworm" legislation, the Dodd–Frank Wall Street Reform and Consumer Protection Act in The Economist, claiming that it was "impossible" to "reform" our "complex" financial system with a mere 37 pages of legislation, the length of the original Glass-Steagal Act that separated commercial and investment banking: What If We're Beyond Mere Policy Tweaks? (February 6, 2012
Consider the Glass-Steagall Act, at 37 pages in length, and the 2,319-page monstrosity of the “Dodd-Frank Wall Street Reform and Consumer Protection Act:" ( Source
Back in December, Nick Schulz helped put the size of the 2,074-page healthcare bill into some historical context by comparing its length to some previous bills that rank among the most consequential in U.S. history, like the 82-page Social Security Act of 1935 and the 74-page Civil Rights Act of 1964.
Now that Congress has passed the “Dodd-Frank Wall Street Reform and Consumer Protection Act,” it might be a good time to compare the 2,319-page financial reform bill (245 pages longer than the healthcare bill to the previous bills listed below (and see graph that are considered among the most consequential legislative acts for banking and finance.
1. Federal Reserve Act (1913 – 31 pages.
2. Glass-Steagall Act (1933 – 37 pages.
Actually, the entire fraudulent tapeworm could be killed with a single page of legislation, or more correctly, a single five-point paragraph: To wit:
1. Commercial banks cannot conduct any investment banking, and investment banks cannot conduct any commercial banking. Any financial institution that accepts deposits or issues loans or financial instruments of any nature will be regulated as a bank.
2. All assets of any nature must be listed at the close of business daily marked to market, as in the futures and options markets. If there is no regulated market for a class of financial instruments, the Treasury is instructed to establish and regulate a market for that class of financial instruments. Holding assets off-balance sheet is a criminal offense with a minimim fine of $10 billion per asset. If the fine cannot be paid in full, the FDIC is instructed to seize the bank and liquidate its assets in an orderly and timely manner.
3. No bank will be permitted to have assets or liabilities in excess of the smallest gross domestic product (GDP of the 50 states.
4. No private banks may create any money through debt. All loans must be made out of existing deposits and equity. (via David V.
5. No exceptions or exemptions are allowed to these statutes.
That would pretty much do it. Separate commercial from investment banking, require all assets to be marked to market every day, and limit banks from expanding to the point of being able to blackmail the nation, i.e. "too big to fail."
Instead, by one count, Dodd-Frank requires regulators to create 243 rules, conduct 67 studies, and issue 22 periodic reports. Does anyone seriously believe this complexity will "fix" anything?
But the legislators had no other choice. If they killed the TBTF banks, they would have killed their good friends and generous donors, so that was never a possibility. Ditto with healthcare "reform" and all the other phantom "reforms"--actually changing the Status Quo would cause immense financial pain in the class of wealthy people who fund the politicos and lobbyists, and trim money flows elsewhere in the system.
"Having no other choice" is a social fractal. Why do families persist in taking on $100,000 student loans for mostly mediocre educations with mostly mediocre "benefits" in the job market? Because they feel they have no other choice.
Why do people persist in mortgaging their future and accepting the yoke of debt-serfdom to own a house? Because they feel they have no other choice, and owning a house has become integral to the "American dream."
Why do local state, county and city politicos continue playing absurd budget games, shuffling funds, borrowing from their employees' pension plans to make this year's pension plan contribution and similar threadbare tricks? You guessed it: they have no other choice, lest someone somewhere feel some pain.
Why do our Federal "leaders" borrow $1.5 trillion each and every year now, fully 10% of the nation's total output, knowing full well that this level of borrowing will bankrupt the nation? (Don't forget to add in the "supplemental" off-budget borrowing. You know: they have no other choice, lest someone somewhere feel some pain.
So instead they keep the accelerating vehicle pointed straight for the cliff. There are only two end-states to this level of borrowing: hyper-inflation or default. Any other "choice" is mere fantasy.
As noted above, what's possible is what you perceive, and what's impossible is what happens later whether you thought it possible or not. The Status Quo of a fraudulent financial system and a borrow-trillions-every-year-til-Doomsday Central State will implode, regardless of how many people think it "impossible."
If you take a star of sufficient heft such that it burns through its fuel at a rapid clip, then it will implode in a supernova whether you thought it possible or not.
"We have no other choice" is partly "deer in the headlights," partly fear of consequence and partly intellectual laziness, i.e. a continuing failure of imagination. Just to take two examples of many: anyone who is convinced they "have no other choice" but to enslave themselves with $100,000 in student loans should read Debt-Free U: How I Paid for an Outstanding College Education Without Loans, Scholarships, or Mooching off My Parents. Yes, it requires sacrifices and hard work, but it does outline a debt-free choice.
The Status Quo depends on debt-serfs who feel they "have no other choice" for its survival, but there are other ways of perceiving our financial options, for example Early Retirement Extreme: A philosophical and practical guide to financial independence.
OK, so these options may not be for everyone, but to deny they exist is delusional.
Consider America's second favorite obsession (the first being achieving "fame" by appearing on broadcast TV , losing weight. Here are two articles on the physics of weight loss by a UC-Berkeley physicist who lost 30 pounds: (via Ken R.
The Physics Diet
Is it "convenient" to lose weight? no, it is generally inconvenient and requires sacrifice, discipline and embracing responsibility--all the attributes of life we avoid by perceiving no other choice.
What's possible is what we perceive, and what's impossible is what happens later whether we thought it possible or not. The "impossible" systemic collapse will happen because we've left no other option open. We will get "wake-up calls" along the way, but these will be ignored because to change anything in the Status Quo will cause pain to someone somewhere, i.e. it is inconvenient.
Could we choose another future other than collapse? At this point, the answer is no, because we have no other choice.
One Pennsylvania doctor in 2008 wrote 1,913 prescriptions for the antipsychotic drug Risperdal - a bit more than 5.2 per day in that leap year, counting weekends and holidays - costing Medicaid $341,273.71.
The top 10 prescribers in Pennsylvania's system that year wrote 9,557 Risperdal scripts costing Medicaid $1.76 million, according to figures provided by a state official to U.S. Sen. Charles Grassley (R., Iowa , who has pushed for disclosure of such information and the relationship between doctors and pharmaceutical companies.
The numbers raised questions for Grassley, and Pennsylvania officials sent letters to scores of doctors emphasizing the need for safety in prescribing antipsychotic drugs. Twelve were suspended, dropped from Medicaid, or are under investigation, according to a copy of a letter to Grassley released Tuesday by the state welfare department.
The numbers also play a role in the U.S. Department of Justice's efforts to fight health care fraud. In the case of Risperdal, the Justice Department is negotiating with Johnson & Johnson, whose Janssen subsidiary makes the drug, to address allegations that the company illegally promoted it to doctors and through Medicaid programs.
Medicaid is the taxpayer-funded insurance plan for poor Americans and is administered by the federal and state governments.
J&J previously disclosed that it set aside money to settle criminal and civil charges in the Risperdal litigation, though it had not specified the amount.
Reports over the weekend from the Wall Street Journal and Bloomberg News said the Justice Department had demanded a payment of about $1.8 billion, an increase from the $1 billion figure reportedly negotiated by the U.S. Attorney's Office in Philadelphia in December.
Spokesmen for J&J, the Justice Department, and the U.S. Attorney's Office declined to comment.
The $1.8 billion figure would be the largest settlement for a case involving a single drug, but some of the other big settlements also involved antipsychotic drugs.
"Both Sen. Grassley and the Department of Justice are making great headway in the battle against Medicaid fraud," said Allen Jones, the former investigator for Pennsylvania's Office of Inspector General whose findings were ignored by state officials in 2004.
Jones was fired by state officials when he took the information to the New York Times, but his whistle-blower lawsuit resulted in J&J's paying $158 million to settle charges that it illegally marketed Risperdal through the Texas Medicaid system. Jones will get a portion of that settlement. He now works as an adviser to attorneys in related litigation.
Eli Lilly & Co. paid $1.7 billion to settle charges of illegal marketing of its antipsychotic drug Zyprexa. Pfizer Inc. paid $2.3 billion to settle charges of illegal marketing of several drugs, notably Bextra, but also its antipsychotic Geodon. Late in 2011, GlaxoSmithKline P.L.C. said it had reached a deal to pay $3 billion to settle charges related to several drugs, including Avandia, but the Justice Department has declined to comment on that one as well.
Jones provided The Inquirer with state figures sent to Grassley's office in 2010 by Michael Nardone, then an official with the Pennsylvania Medical Assistance Program.
New Jersey never responded to Grassley's 2010 request for information nor a follow-up letter dated Jan. 24. State officials could not be reached for comment Tuesday. Delaware Medicaid officials responded to Grassley in 2010 and again in February.
J&J's Risperdal lost patent protection at the end of 2007, so the 2008 figures were the beginning of the decline in costs as generic versions were used more often.
As a comparison, AstraZeneca P.L.C.'s antipsychotic, Seroquel, is just now losing patent protection on most versions.
In 2008, the top 10 prescribers in Pennsylvania wrote 18,705 prescriptions for Seroquel, costing Medicaid $3.67 million. State officials provided The Inquirer with the most recent response to Grassley. That letter says the top 10 prescribers wrote 17,692 scripts for Seroquel, costing Medicaid $5.73 million.
In 2010, AstraZeneca paid $520 million to settle charge of illegal marketing of Seroquel.
"I liken the DOJ effort to a storm surge building for a long time," Jones said, crediting Grassley and a few others in Congress for helping to push the issue. "They have a clear eye on the dirty ways of fraudulent marketing and are systematically exposing it. It is changing the way antipsychotic drugs are marketed in America."
Contact David Sell at 215-854-4506 or dsell@phillynews.com.
NEW YORK (Reuters Health - Heavy men are more likely than their normal-weight peers to have low sperm counts or no sperm production at all, suggests a new report. The review of past studies can't prove that overweight or obese men will have more trouble fathering a child. But researchers said that how many sperm men make is one of the key ways doctors measure their fertility. "In general you expect that men with lower sperm counts will have a greater frequency of difficulty conceiving than men with higher sperm counts, but it's not completely straightforward," said Dr. ...
Category: Health News
Created: 3/12/2012 2:05:00 PM
Last Editorial Review: 3/13/2012
Logic seems to dictate that the New Orleans Hornets should do
something
before Thursday afternoon's NBA trade deadline — the team isn't playing for anything this year and has to go about the business of planting roots for the future. The $64,000 question, though: What exactly
should
GM Dell Demps do?
More to the point: What can the Hornets front office do, with the sale of the team — perhaps to a California-based ownership group that includes former NBA coach and general manager Mike Dunleavy — reportedly close? Is the deadline about stockpiling assets or clearing up the books as best Demps can?
A season that was likely going to be lost anyway following December's Chris Paul fiasco has been totally doomed by injuries and apocalyptic offense, as a crawl-it-up Hornets squad that's been without Eric Gordon for 40 games, Carl Landry for 18 and Emeka Okafor for 15 has averaged less than one point per possession this season. The only team worse at putting the ball in the hole? The Charlotte Bobcats, who beat the Hornets in New Orleans on Monday night in a ghastly affair.
Despite game work from the likes of point guard Jarrett Jack, 26-year-old Mexican rookie Gustavo Ayon and head coach Monty Williams, the Hornets have struggled to the league's third-worst record through 42 games, and look like a sound bet to stay in the Western Conference's cellar for the duration of the 2011-12 campaign, casting their eyes skyward with a "wait 'til next year" gaze all the while. But what about next year?
Demps aimed to lock up Gordon, the centerpiece of the Paul trade and one of the precious few viable young scoring options at off-guard in today's NBA, with a four-year deal back in January. But the combination of the Hornets' stewards in the league office not approving a max deal for Gordon and the Indiana University product reportedly wanting to see if some other team would max him out led him to
eschew an extension in favor of pursuing restricted free agency this offseason.
That could be a good thing for New Orleans in the long run, but it also puts the Hornets in a position where just about nothing is certain — a look at the Hornets' roster reveals relatively few assets worth hanging onto for the long term.
Looking into the future, New Orleans has four players on rookie deals — Ayon, Al-Farouq Aminu, Greivis Vasquez and Xavier Henry — who are under the team's control through the 2014-15 season at a total cost of $33,101,728, according to the ShamSports.com salary database. Ayon and Vasquez have both shown this season a capacity to contribute — the former, in particular, could prove to be a massive frontcourt bargain if the efficient work he's doing in the screen-and-roll and on the defensive end hold up.
On the other side of the coin, Aminu has mostly looked worse on both ends of the floor for New Orleans than he did in his rookie year with the Los Angeles Clippers, but he is putting up strong rebound rates for a swingman at age 21, so there may be something salvageable there. Similarly, Henry hasn't looked especially impressive in 22 games since coming over from the Memphis Grizzlies, but both player and team are still very much figuring out who he is after a right knee injury cost him more than half his rookie season and torn ligaments in his right ankle delayed his New Orleans debut until late January. His combination of size, athleticism, the rumor of a 3-point stroke and outings like his recent 19 points in 24 minutes effort against the defending champion Dallas Mavericks make the 20-year-old an intriguing low-cost option for Demps to nurture.
None of those cheap young things look to be world-beaters, though, which is why it would make sense for Demps to jettison as much veteran talent as he can in search of future draft choices. But while several of the Hornets' vets could help contenders on paper, it's difficult to see many teams lining up to, say, offer New Orleans draft picks and young players for the right to pay Trevor Ariza $15 million for the next two years.
The contracts of veterans Landry, Marco Belinelli and Chris Kaman all come off the books after this season, which could make them more appealing to teams looking for rentals, though it's unlikely that the former two would inflame opposing GMs' interest or return much in trade. (A healthy Landry might be a different story, since frontcourt scoring's always in demand, but he's been out for a month with a
PCL strain, although he's reportedly close to return. While
several teams have expressed interest in Kaman as a frontline contributor on the offensive end, rumors that New Orleans could look to buy the big man out if no deal gets struck by the March 15 deadline may make it hard for Demps to get much of value for him.
As it stands now, New Orleans holds two first-round picks in the 2012 NBA draft — its own, which is likely to carry with it quite a few ping-pong balls, and whichever is "the more favorable" between the first-round selections of the Los Angeles Clippers and Minnesota Timberwolves, a pick that came over in December as part of the Chris Paul trade. With the Paul-led Clippers battling for a top-four slot in the Western Conference, it always seemed like the Wolves' pick was the prize there ... and then Kevin Love became the best power forward alive, Nikola Pekovic became a center that nobody wanted to play against, Ricky Rubio became America's basketball sweetheart and the Wolves became a playoff contender.
Losing Rubio for the season to an ACL tear, however, figures to make it awful tough for Rick Adelman's squad to continue its postseason push, which could give New Orleans two lottery picks in what has frequently been referred to as a deep 2012 draft. The Hornets don't have a second-round pick this summer, though; they traded 2010 and 2012 second-rounders to the Miami Heat for the rights to Marcus Thornton following the '09 draft, and the Heat flipped the 2012 No. 2 to the Cleveland Cavaliers as part of the sign-and-trade package that brought LeBron James to Miami. As a matter of fact, according to the future pick debt chart at RealGM.com, past trades will have New Orleans shelling out second-rounders until 2016.
If Demps can locate a team willing to pay a second-rounder for Landry on the chance that his knee comes back strong enough to provide toughness and scoring down the stretch, he should take it. If he can find one desperate enough for a spot-up 3-point shooter to give up a far-future No. 2 for Belinelli, he should say yes as fast as humanly possible and say three Hail Marys as soon as he gets off the phone.
While Kaman's a significantly more valuable player than Belinelli, and while sources have told SI.com's Sam Amick that New Orleans is considering extending the 29-year-old center's deal, it's hard to imagine the Hornets being able to bring Kaman back at a price he's worth to a team unlikely to be competitive until he's well into his 30s. Unless Kaman's willing to come back at a steep discount — and as a 7-footer who can score in the NBA, why would he be? — it probably makes the most sense for Demps to get whatever draft choices he can for the former Clipper and move on.
Sadly, the most intriguing option for the Hornets might be taken off the table by (what else? injury. The prospect of Rubio's absence making the Minnesota first-rounder into a lottery pick could open the door to packaging a No. 1 with New Orleans' most onerous contract — the two years and roughly $28 million owed to Okafor, a defensive-minded big who could help any of the myriad contenders that seem to be one frontline rotation piece short — to sweeten the deal.
To be sure, a potential lottery pick would be an awful steep price to pay to send Okafor packing, but doing so would eliminate the last serious financial obligation on Demps' books without totally sacrificing the chance to import an elite talent in the 2012 draft, giving the Hornets' incoming ownership group (which is seriously like five minutes away, the NBA swears — they just called from the car, they're right down the block as close to a clean start as they'd ever get. It would definitely make business sense; since Okafor figures to have no role on the next competitive iteration of the Hornets, you could argue it would make sense from a roster-building perspective, too.
Okafor's continued absence with a sore left knee, which is apparently undergoing even more tests, likely scuttles that option, though, putting the Hornets back in a holding pattern. Which, of course, is where they've been since George Shinn sold the team in December 2010. That's life over a barrel in the NBA, where for some of the sport's most diehard fans, even the promise of next year always seems out of reach.
Related NBA video on Yahoo! Sports:
Category: Health News
Created: 3/13/2012 11:00:00 AM
Last Editorial Review: 3/13/2012
Category: Health News
Created: 3/14/2012 10:05:00 AM
Last Editorial Review: 3/14/2012
Category: Health News
Created: 3/14/2012 11:00:00 AM
Last Editorial Review: 3/14/2012
Category: Health News
Created: 3/13/2012 11:00:00 AM
Last Editorial Review: 3/13/2012
Category: Health News
Created: 3/14/2012 10:05:00 AM
Last Editorial Review: 3/14/2012
the stock market is rising
because somebody who thinks
just like him will soon be president.
CAVUTO: You think that’s a genuine factor? You think that the markets are getting bubbly in anticipation of a Republican taking the White House?Wow. Whoa. WTF.WEST: Oh, absolutely. Well, I think that there is a hope that may be out there, is that we can get a person that has practical viable solutions for job creation here in the United States of America [in the presidency].
Remember three years ago when Republicans were blaming the guy who had just arrived in the White House less than two months previously for the plunge in the stock market (which had been dropping for 17 months ? The guy gets the blame for what happened on somebody else's watch but doesn't get the credit for what is happening on his watch? Now that is GOP politicking at peak performance, something we can't say about the economy when they are in charge.
Republicans, not just Allen West, love telling people that the Democrats are bad for the economy. That the Democrats will put the average guy into the poor house (a relic Republicans seem determined to resurrect in place of the social safety net they're shredding .
It's important to remember in all the hoopla about the stock market that it is not the greatest measure of the health of the overall economy and well-being of the average person. The vast majority of Americans own just a tiny sliver of outstanding stock, including that held in the private pension funds that fewer and fewer of them have.
The truth is that the stock market's ups and downs are a product of far more than any president's or political party's maneuvers. As we've seen over the past three years, government policies can take a long time to have an impact, and determining just how much impact is not all that simple. But, since West and other Republicans want to play that game, let's
do it:
[S]ince John F. Kennedy was inaugurated, $1,000 invested in a hypothetical fund that tracks the S&P 500 "only when Democrats are in the White House would have been worth $10,920 at the close of trading yesterday [Feb. 20, 2012]. That's more than nine times the dollar return an investor would have realized from following a similar strategy during Republican administrations."The New York Times did a more thorough analysis in October 2008. Going back 75 years (excluding the disaster under Republican President Herbert Hoover , investing $10,000 in the S&P market index would have turned into $300,371 under Democrats only (39.9 years and $51,211 under Republicans only (35.7 years ."The Democratic edge is so large that the party comes out ahead even without counting Bill Clinton (the Democrat with the biggest S&P 500 gain and George W. Bush (the Republican with the worst market record . A hypothetical $1,000 investment under Democrats excluding Clinton was worth $3,539 versus $3,296 invested under Republicans except Bush."
Now, in the real world, there are plenty of quibbles about those analyses. What about inflation and dividends, for instance, which the Times leaves out? There are just so many variables that hard and fast numbers aren't that easy to have confidence in.
What we can be confident about, however, is that Allen West won't be the last Republican on the campaign trail to say that the improvement in the stock market, the improvement in the job market and the improvement in consumer sentiment about the economy in general have nothing to do with the policies of Barack Obama. The only thing he's responsible for, as we're already hearing from the GOP every day, is the rising price of gasoline. In West's twisted world, Obama was no doubt responsible for the soaring gasoline prices in 2008, too, because back then Americans expected him to become president.
A major new study of pain relief during labour was widely reported in the papers today, with the Daily Express claiming that drugs work better than drug-free alternatives such as massage, and the Daily Mail reporting that painkillers are more effective than hypnosis or electronic pain-relief machines.
In fact, these headlines were misleading and oversimplified the results of this large review, which looked at all high-quality research on pain management during labour. It found there is generally better evidence available for the effectiveness of drugs to relieve labour pains (including epidurals , and less robust evidence for non–drug approaches such as hypnosis.
However, saying there is less evidence on certain methods is not the same as saying these methods ‘do not work as well’. As the authors make clear, it means that, to date, there have been few good quality studies confirming how effective they may or may not be.
The review also points out that most drug-based approaches can have side effects. Epidurals, for example, increase the risk of further interventions such as forceps. It is also noteworthy that one of the interventions for which there is little evidence is the use of intramuscular painkillers such as pethidine, which is commonly used in many obstetric units.
This review provides good insight into what options women might prefer during birth, which can be discussed and noted when making a birth plan.
Where did the review come from?
The review was undertaken by researchers from the Cochrane Collaboration, a respected international research group that carries out independent reviews of the evidence on healthcare treatments. The rigorous methods these reviews employ mean that they are among the best evidence sources for evaluating medical procedures.
In this particular review the researchers drew together the results of a number of previous systematic reviews on the subject of pain relief during labour. They then used well-established methods to identify relevant research and to assess its quality. In total, they brought together 15 previous Cochrane reviews on the subject and three non-Cochrane reviews, and used them to assess a range of pain relief options.
Why was this review needed?
The type and intensity of pain that women experience during labour can vary greatly. It can be affected by many physiological and psychosocial factors, including fear and anxiety, prior experience and the degree of emotional support they receive. Most women require some form of pain relief.
While there are several drug and non-drug options available, the reviewers point out there has not yet been a single evidence source pulling together all the evidence from good trials on pain management in labour. The new overview aims to provide a summary of all the good quality evidence, both for medical professionals and pregnant women.
What pain relief methods did it look at?
The review covered a number of pain relief methods including:
- epidurals: is an injection of anaesthetic drugs in between the spinal bones but outside the spinal cord, and can be delivered either through single injections or fed as needed through a fine tube left in the lower back
- Combined spinal epidurals (CSE : as per a regular epidural a CSE is a low dose injection of fast-acting pain relief (a mini-spinal , but an epidural tube is also placed so that further drugs can be given as the effects of the mini-spinal wear off. The aim of CSEs is to provide faster pain relief than epidurals alone.
- inhaled analgesia: known as Entonox or ‘gas and air’
- injected or intramuscular opioid painkillers (such as pethidine
- non-opioid painkillers: such as paracetamol, ibuprofen and so on.
- local anaesthetic nerve blocks
- sterile water injections: injected into the skin over the base of the spine
- immersion in water: when a woman uses a special pool during labour
- relaxation methods: such as breathing and yoga
- acupuncture
- massage
- hypnosis
- biofeedback: where the woman receives signals as to her pulse, heart rate etc.
- aromatherapy: the use of essential oils
- Transcutaneous electrical nerve stimulation (TENS : a mild electric current is passed through the skin to reduce nerve pain signals
What did the reviewers find?
The reviewers divided the different pain relief methods into different categories, according to how much good quality evidence had been carried out on each of them. The three categories were
- what works
- what may work
- insufficient evidence to make a judgement
What works?
The reviewers found that there is good evidence for both forms of epidurals, and that CSEs gave faster pain relief than standard epidurals alone. There was more limited evidence for gas-based pain relief (inhaled analgesia methods during labour, although the research still supported their use.
Both epidurals and inhaled analgesia can have adverse effects. The review found that inhaled analgesia is associated with nausea and vomiting, while epidurals increased the number of vaginal births needing a forceps or ‘ventouse intervention’, a technique using a suction cup to help deliver the baby. Epidurals also increased the risk of low blood pressure for the mother, as well as other side effects such as being unable to pass urine and having difficulty moving one’s legs.
What may work?
The review found there is some evidence to suggest that immersion in water, relaxation, acupuncture, massage, local anaesthetic nerve blocks and non-opioid drugs (for example, paracetamol and NSAIDs may help to manage labour pains, with few adverse effects.
Women reported satisfaction with the pain relief they gained from all these interventions, apart from massage.
Relaxation and acupuncture reduced the need for forceps and ventouse interventions, and acupuncture reduced the number of caesarean sections. However, the researchers point out the evidence for each of these methods was mainly limited to a few individual trials (rather than systematic reviews .
Where is more evidence needed?
The researchers found ‘insufficient evidence to make a judgement’ on the effectiveness of:
- hypnosis
- biofeedback
- sterile water injections
- aromatherapy
- TENs
- injected or intramuscular opioids
What happens now?
The reviewers say that the trials they looked at showed ‘considerable variation’ in how outcomes such as pain intensity were measured and that some important outcomes were never included. For example, no studies examined a woman’s sense of control during labour, the effect of pain relief on the ability to breastfeed and on mother-baby bonding, despite surveys showing that these factors are important to women.
Designing future trials that include these factors is essential, the researchers argue. In addition, further good quality research on the effectiveness of non-drug interventions during labour is needed.
The authors say that during pregnancy women should be told about the benefits and the potential adverse effects of all available pain relief methods, both for them and their babies. They should feel free to choose whatever pain management they think would help them most.
What kind of pain relief should I choose?
The choice of pain relief during labour will be an individual one, and clearly there are benefits and drawbacks to each that must be considered. However, this review provided a good overview of the various types of pain relief available during labour, and how much evidence there is supporting their use.
Women do not have to make this choice alone, as they can get medical advice from their doctor or midwife on what may suit them best. Women can do this when creating a birth plan setting out other options such as where they will give birth.
Importantly, women who choose non-drug pain management should feel free to move on to a drug-based intervention if needed, and might benefit from planning a back-up pain relief option if their initial choice is not effective during the birth.
Links To The Headlines
Painkillers ‘best in labour’. Daily Express, March 14 2012
Painful reading for fans of natural birth. The Daily Telegraph, March 14 2012 [Print only]
Links To Science
Jones L, Othman M, Dowswell T et al. Pain management for women in labour: an overview of systematic reviews (Review (PDF, 1.41MB . The Cochrane Library 2012 Issue 3
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