Medical Institutions

Each of these major Medical Center facilities boasts its own large campus, occupies multiple buildings and employs a large portion of the more than 30,000 healthcare specialists and countless volunteers and others who work in the Medical Center each day.

We’ve come to play a vital role in the health of San Antonio and South Texas. And whatever reason brings you here, we hope we can be of help.

Additional Institutions

Patient Care

Research

Other

Upcoming Events

  • Huevos Rancheros 5K Walk, Run, Ride

    What: San Anto Cultural Arts Presents: Huevos Rancheros: Run: 5K, Bike: 5-Mile, Walk: 1-Mile 5K and Bike participants get free entry to the Huevos Rancheros Gala.

    When: October 4, 2014 6:30 AM

  • Free Lecture and Q&A - Hormone Therapy and Fertility Preservation

    What: Jennifer Knudtson, M.D., and Georgia McCann, M.D., will lay out the latest treatment options and the issue of fertility preservation for younger women. They will also explain hormone treatment options, explaining the concerns that arose with the Women’s Health Initiative data and breast cancer rates, as well as who is really at risk and what other options are available. The lecture, which is open to the public, will be Thursday, Oct. 9 from 6 to 7 p.m. on the fourth floor of the CTRC’s Grossman Building, 7979 Wurzbach Rd., San Antonio. For more information call (210) 450-1152. It will be streamed live online at www.CTRC.net/LIVE.

    When: October 9, 2014 6:00 PM

Neuroscience Articles

  • Colorado, CDC probing 10 cases of virus-related paralysis in kids

    By Julie Steenhuysen

    CHICAGO (Reuters) - U.S. health officials are investigating at least 10 cases of children in Colorado who developed limb weakness or paralysis after testing positive for a respiratory virus, state health officials said on Monday.

    Of the 10, four children tested positive for enterovirus D68 (EV-D68), a virus that is causing severe respiratory infections in 40 U.S. states and the District of Columbia.

    From mid-August to September 26, 2014, the U.S. Centers for Disease Control and Prevention or state public health laboratories have confirmed a total of 277 people infected with the virus, according to the CDC website.

    Dr. Larry Wolk, chief medical officer of the Colorado Department of Public Health and Environment, said some of the children have been ruled out for enterovirus D68 infection and others are awaiting test results.

    All of those experiencing limb weakness have recently been diagnosed with either some form of enterovirus or rhinovirus, two large classes of common viruses that cause respiratory infections. The common cold, for example, is caused by a rhinovirus.

    "Just because it's not specific for D68 doesn't mean it's not another, similar virus," Wolk said.

    "There is a very high number of kids who have viral respiratory illness this time of year," he said, adding that limb paralysis is "a rare complication of all of these viruses."

    The CDC is investigating the cases and asking other states whether they are also are seeing higher than normal cases of limb weakness associated with a respiratory virus infections, according to its website.

    "It's obviously not just D68 in and of itself," Wolk said. "The question is, is there something else that ties these 10 cases together."

    All of the children in the Colorado cluster are under 21, and most live in the Denver area. Of those involved, six have been discharged from the hospital. Nine of the 10 were treated at Children's Hospital Colorado in Aurora.

    Magnetic resonance imaging (MRI) scans of all 10 cases show lesions in the spinal column. Symptoms range from weakness in arms or legs to total paralysis of a limb, Wolk said.

    The CDC said it is focusing its testing efforts on cases in which people develop severe respiratory illness, although it is likely that many more people with milder symptoms are infected with the virus.

    Enterovirus D68 is one of more than 100 non-polio enteroviruses, a group of viruses that cause 10 million to 15 million infections in the United States each year.

  • Florida marijuana campaign heats up, could raise Nov. turnout

    By Bill Cotterell

    TALLAHASSEE (Reuters) - Opponents of a proposal to let doctors in Florida prescribe marijuana are poised to launch a $1.6 million advertising campaign on Monday, with potential side effects for the state's heated race for governor in November.

    Political consultants say a public battle over the proposed constitutional amendment to allow medical marijuana, included on this year's midterm election ballot, could boost turnout among young voters for Democrat Charlie Crist, who supports the measure. The extra support may be enough to help him defeat incumbent Republican Governor Rick Scott, who opposes it.

    But opponents of Amendment 2 got a major boost when Sheldon Adelson, Las Vegas casino magnate and a major Republican fundraiser, put up $2.5 million of the $3.2 million raised by Drug Free Florida.

    The ads will attack "loopholes," which law enforcement authorities say could lead to recreational use of the drug, said Sarah Bascom, whose Tallahassee consulting firm is handling the Drug Free Florida campaign.

    "Our message is, this is not about sick people," she said. Even if more young voters turn out for the marijuana referendum, Bascom said "a vote down-ticket doesn't mean they're going to vote up-ticket" in the governor's race.

    Some 23 U.S. states and the District of Columbia already have passed laws allowing medical marijuana in some form, beginning with California in 1996.

    The public petition campaign that put the amendment on the Florida ballot promised relief for suffers of diseases like cancer, AIDS and ALS, also known as Lou Gehrig's disease. But the measure would also allow doctors to prescribe marijuana whenever they determine benefits outweigh potential risks.

    The no campaign is being supported by wide-ranging "Don't Let Florida Go To Pot" coalition of medical and law-enforcement organizations arguing that the amendment does not provide any minimum age or residency requirements for obtaining marijuana.

    Orlando trial lawyer John Morgan, a Crist backer who figures on spending $6 million of his own money on the medical-marijuana initiative, believes the referendum will draw up to 4 percent more voters to the polls Nov. 4, including college students who believe marijuana is no big deal, elderly voters who have friends who covertly puff some pot to relieve nausea from chemotherapy and libertarians who believe it is none of the government's business.

    Morgan, who has been touring the state in a motorcoach, said the amendment might help Crist in what is expected to be a close race, but denied sponsoring the drive for that reason.

    "We're registering people who never registered before, so I think turnout is going to be 2, 3, maybe even 4 points higher than we might have seen, but for this," he said during a visit to the University of Florida last week.

    While supporting the amendment, Crist has distanced himself a little from the medical marijuana campaign.

    "It might get more younger voters to turn out," Crist, a former Republican who was governor 2007-11, said in an interview. "I really don't know is the honest answer," he added. "It may well increase turnout because if you're educating people about this being on the ballot, who otherwise might not have known it, then you're ginning it up."

    Supporters of the amendment say polling shows nearly 70 percent of likely voters back the measure with only 28 percent opposed.

    But a recent Public Policy Polling survey showed just 61 percent support and a poll by the Tampa Bay Times/Bay News 9 and the Bob Graham Center at the University of Florida showed only 57 percent backing. Florida constitutional amendments require 60 percent support to pass.

    Steve Schale, a member of the Crist campaign and a senior aide in President Barack Obama's two Florida campaigns, said amendment supporters might favor Crist more than Scott, but jobs, education and many other issues will be more decisive.

    David Johnson of Strategic Vision in Atlanta, a Republican campaign planner, said it was hard to see young voters turning out in large numbers over one issue.

    However, he cautioned, "Remember, even an uptick of 1 or 2 percent in a close race could make the difference."

  • REFILE-You're more likely to try again if the setback was your fault

    (Refiles story to removes repeated word in 12 paragraph.)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - If at first you don't succeed, and you think you can control the outcome next time, you're more likely to persist, suggests a new study.

    Using brain scans, researchers found different brain areas activated in response to a setback if the failure was perceived as something under the person's control versus a random or uncontrollable cause, and blaming oneself led to greater persistence.

    Studies dating to the 1970s have found that believing a failure was under your control and not due to an external force encourages persistence (for example, when failing a test was due to not studying enough rather than to unfair test design).

    Seeing the same thing in the current study "was more of a confirmation of existing findings," said the new report's senior author Mauricio R. Delgado of the psychology department at Rutgers University in Newark, New Jersey.

    But finding that different areas of the brain respond to a setback depending on where blame seems to lie is new, he said.

    That result suggests that a sense of control or lack of it leads to calculations about whether to try again through two different types of thought processes, the researchers conclude.

    "Sometimes you feel like it's beyond your control, but that doesn't mean that you don't persist in those goals," Delgado told Reuters Health by phone. "We persist by two different mechanisms."

    For the new study, 30 people from the Rutgers community played an "academic degree decision game" while undergoing functional magnetic resonance imaging (fMRI) scans, which detect blood flow changes in the brain.

    Players chose a course of study and encountered setbacks during the game, like failed exams and course cancellations. Each round was a chance to earn points, and total points affected how much each player would be paid for volunteering for the study.

    The researchers manipulated the game so that losses, or setbacks, seemed either under the player's control or out of his control. For exams, the player could determine the correct move by trial and error, but the computer determined course cancellations at random.

    After each setback, the player chose whether to persist with their original goal or choose a different goal for the game.

    Players tended to persist with their original goal more often after setbacks they could control, according to the results published in Neuron.

    After a controllable setback, a "primitive" area of the brain called the ventral striatum lit up on the fMRI. That region is associated with assigning value to an experience, suggesting the brain was processing the negative outcome as part of a calculation about whether to persist, the study team writes.

    After uncontrollable setbacks, the ventromedial prefrontal cortex (VMPFC), which is associated with emotional regulation, lit up.

    "For controllable setbacks, activity in the ventral striatum might help signal that a change in strategy or behavior is needed," said Allison Troy, an assistant professor of psychology at Franklin and Marshall University in Lancaster, Pennsylvania.

    "For uncontrollable setbacks, the VMPFC may help us to assess the situation and our emotions about the situation to make a decision about whether to persist or not," Troy, who was not involved in the study, told Reuters Health by email.

    "You'd have to take it to the clinic and test this out, but it might be that you could develop therapy that includes these different areas of the brain," Delgado said.

    "Perceiving control and thinking you are in control is a very good thing," he said. "Having confidence is good even if you perceive you do not have control, not all hope is lost."

    In certain situations persistence is a good choice, like being on a diet and failing to reach a weight loss goal, Delgado said. It may be possible to use therapy to train people who tend to give up in the face of setbacks to feel more control over the outcome, which could promote persistence, but that question wasn't addressed in his study.

    The new research incorporates a long history of studies from social psychology and health psychology showing that we process outcomes very differently if we have control over the situation, said Luke Clark, director of the Center for Gambling Research at the University of British Columbia in Vancouver.

    "For example, the physical impacts of stress like stomach ulcers are much more severe if the stress is uncontrollable, even when the amount of objective stress is kept the same," Clark, who was not part of the new study, told Reuters Health by email.

    In this scenario, persistence was always the best choice, but that's not the case in real life, Delgado noted.

    "Control also plays a central role in gambling behavior: gamblers experience an 'illusion of control' that they are developing some skill or expertise over a game that is basically chance," Clark said.

    If the brain activity changes seen in these experiments underlie the tendency of gamblers to chase losses due to a misplaced sense of control, that could have provocative implications for gambling addiction research, he said.

    SOURCE: http://bit.ly/1uG6Vw3 Neuron, online September 4, 2014.

  • Genes influence taste, and possibly use, of alcohol

    By Ronnie Cohen

    NEW YORK (Reuters Health) - Genetically determined taste perceptions could lead some people to become teetotalers and others to become alcoholics, a new study suggests.

    John E. Hayes and colleagues at Pennsylvania State University studied the genetic make-up of 93 adults, looking in particular for so-called bitter-receptor genes, which are responsible for people's sensitivity to bitter tastes.

    The researchers then asked participants to taste and rate alcohol samples in a laboratory.

    The findings suggest that two genetic variations influence perceptions about the taste of alcohol and may shape how people respond to their first sips of beer, wine or booze, according to the study published in Alcoholism: Clinical and Experimental Research.

    "Some people might be more vulnerable because of how they experience bitterness, and that's because of differences in their genetics," Hayes told Reuters Health in a telephone interview. "If it's more bitter, you like it less, is the assumption."

    Hayes is a food science professor at Pennsylvania State in University Park.

    "The bitterness they perceived was influenced by which gene they had, and it was exactly the same direction as we would have expected from the previous work on alcohol intake," he said.

    Prior research, he said, shows that the more people taste bitterness, the less likely they are to drink alcohol, and vice-versa.

    "The study suggests that people may or may not be predisposed toward liking alcoholic beverages when they first try them. Just like people can be color blind, it turns out some of us are more or less taste blind," Hayes said.

    Humans have about 25 different bitter-taste receptor genes, he said. He studied two: TAS2R13 and RAS2R38. Both of these have been linked in previous studies to a tendency to drink when the gene is "turned off" and not to drink when it is turned on, Hayes said.

    The findings show that participants with one of the variants of the bitterness gene rated the taste of alcohol as 25 percent more intense, he said.

    People with the bitterness variant of the RAS2R38 gene drank half as often as those without it, Hayes said.

    "Biology is not destiny, but it could play a role. Environment's hugely important too," Hayes said.

    "Some people might find it easier to drink, but they still might not drink more because of religion, culture. There's lots of factors that can influence what we choose to eat," he said.

    Hayes said he and his team have asked the National Institutes of Health for a grant to follow 1,000 college students for their first year at school, to see how genetic differences in taste perception might influence their drinking habits.

    If they find in the students what they found in the laboratory, it could confirm that these genes might be good targets for biologically tailored interventions to prevent and treat alcoholism, Hayes said.

    Researchers first identified a genetic basis for variability in the perception of bitterness in 1932, Hayes noted in a previous report. Natural selection to avoid eating bitter plant toxins may have driven the genetic variation.

    Nowadays, alcoholic beverages frequently are sweetened, reducing the effect of the bitter-taste receptor, he and his colleagues point out in their current paper.

    Russell Keast, a professor of sensory and food sciences at Deakin University in Australia, issued a statement with a press release accompanying the article.

    "The link between genetic variations in receptors and taste is an area of growing importance," he said. Keast was not involved with the current study.

    "However, it does get more complex because alcoholic beverages contain flavors and tastes that may mask any aversive effects of bitterness - for example, the sweetness of a sherry, or the aromas of a cocktail."

    Hayes stressed that people can make their own choices despite their genetics.

    "Some individuals may learn to overcome their innate aversions to bitterness and consume excessive amounts of alcohol," he said, "while others who do not experience heightened bitterness may still choose not to consume alcohol for myriad reasons unrelated to taste."

    SOURCE: http://bit.ly/1t0ZxsR Alcoholism: Clinical and Experimental Research, online September 25, 2014.

  • REFILE-You're more likely to try again if the setback was your fault

    (Refiles story to removes repeated word in 12 paragraph.)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - If at first you don't succeed, and you think you can control the outcome next time, you're more likely to persist, suggests a new study.

    Using brain scans, researchers found different brain areas activated in response to a setback if the failure was perceived as something under the person's control versus a random or uncontrollable cause, and blaming oneself led to greater persistence.

    Studies dating to the 1970s have found that believing a failure was under your control and not due to an external force encourages persistence (for example, when failing a test was due to not studying enough rather than to unfair test design).

    Seeing the same thing in the current study "was more of a confirmation of existing findings," said the new report's senior author Mauricio R. Delgado of the psychology department at Rutgers University in Newark, New Jersey.

    But finding that different areas of the brain respond to a setback depending on where blame seems to lie is new, he said.

    That result suggests that a sense of control or lack of it leads to calculations about whether to try again through two different types of thought processes, the researchers conclude.

    "Sometimes you feel like it's beyond your control, but that doesn't mean that you don't persist in those goals," Delgado told Reuters Health by phone. "We persist by two different mechanisms."

    For the new study, 30 people from the Rutgers community played an "academic degree decision game" while undergoing functional magnetic resonance imaging (fMRI) scans, which detect blood flow changes in the brain.

    Players chose a course of study and encountered setbacks during the game, like failed exams and course cancellations. Each round was a chance to earn points, and total points affected how much each player would be paid for volunteering for the study.

    The researchers manipulated the game so that losses, or setbacks, seemed either under the player's control or out of his control. For exams, the player could determine the correct move by trial and error, but the computer determined course cancellations at random.

    After each setback, the player chose whether to persist with their original goal or choose a different goal for the game.

    Players tended to persist with their original goal more often after setbacks they could control, according to the results published in Neuron.

    After a controllable setback, a "primitive" area of the brain called the ventral striatum lit up on the fMRI. That region is associated with assigning value to an experience, suggesting the brain was processing the negative outcome as part of a calculation about whether to persist, the study team writes.

    After uncontrollable setbacks, the ventromedial prefrontal cortex (VMPFC), which is associated with emotional regulation, lit up.

    "For controllable setbacks, activity in the ventral striatum might help signal that a change in strategy or behavior is needed," said Allison Troy, an assistant professor of psychology at Franklin and Marshall University in Lancaster, Pennsylvania.

    "For uncontrollable setbacks, the VMPFC may help us to assess the situation and our emotions about the situation to make a decision about whether to persist or not," Troy, who was not involved in the study, told Reuters Health by email.

    "You'd have to take it to the clinic and test this out, but it might be that you could develop therapy that includes these different areas of the brain," Delgado said.

    "Perceiving control and thinking you are in control is a very good thing," he said. "Having confidence is good even if you perceive you do not have control, not all hope is lost."

    In certain situations persistence is a good choice, like being on a diet and failing to reach a weight loss goal, Delgado said. It may be possible to use therapy to train people who tend to give up in the face of setbacks to feel more control over the outcome, which could promote persistence, but that question wasn't addressed in his study.

    The new research incorporates a long history of studies from social psychology and health psychology showing that we process outcomes very differently if we have control over the situation, said Luke Clark, director of the Center for Gambling Research at the University of British Columbia in Vancouver.

    "For example, the physical impacts of stress like stomach ulcers are much more severe if the stress is uncontrollable, even when the amount of objective stress is kept the same," Clark, who was not part of the new study, told Reuters Health by email.

    In this scenario, persistence was always the best choice, but that's not the case in real life, Delgado noted.

    "Control also plays a central role in gambling behavior: gamblers experience an 'illusion of control' that they are developing some skill or expertise over a game that is basically chance," Clark said.

    If the brain activity changes seen in these experiments underlie the tendency of gamblers to chase losses due to a misplaced sense of control, that could have provocative implications for gambling addiction research, he said.

    SOURCE: http://bit.ly/1uG6Vw3 Neuron, online September 4, 2014.

Oncology Articles

  • French pharmacies shuttered in protest against reform plans

    By Reuters Staff

    PARIS (Reuters) - All but a handful of France's pharmacies were closed on Tuesday to protest the Socialist government's plans to introduce more competition into the sector.

    Pharmacists were the latest profession to challenge President Francois Hollande's plans to deregulate their activities following a first-ever street protest earlier this month by notaries.

    Economy Minister Emmanuel Macron hopes to give the euro zone's second-biggest economy a boost by shaking up regulations that currently give 37 professions, ranging from court clerks to taxi drivers, a monopoly-like grip on their industry.

    Pharmacists are worried that the reform will allow supermarkets to sell over-the-counter drugs and pave the way to big outside investors buying up owner-run pharmacies.

    About 97 percent of the pharmacies not ordered by law to remain open remained shuttered on Tuesday, according to the national order of pharmacists.

    Big retailers like supermarket chain E.Leclerc are lobbying hard to win the right to sell non-prescription drugs, including by airing prime-time television spots.

    Macron, a 36-year-old former investment banker who was also previously Hollande's top economic adviser, said there were many false ideas circulating about the deregulation bill, which he aims to present at the end of the year.

    "The bill aims to modernise the country in order to create activity wherever it's possible and to lower prices for households and companies," Macron said in an interview with regional newspaper Paris-Normandie.

  • Roche breast cancer drug "unprecedented" in extending lives

    By Ben Hirschler

    MADRID (Reuters) - A new breast cancer drug from Roche has shown "unprecedented" benefits in extending lives in a clinical trial and experts urged its widespread use for women with an aggressive form of the disease.

    Patients with a type of breast cancer known as HER2 positive, which makes up about a quarter of all breast cancers, who were given Perjeta on top of older medicine Herceptin and chemotherapy lived 15.7 months longer than those on Herceptin and chemotherapy alone.

    That is the longest extension to survival ever seen for a drug studied in metastatic breast cancer and also an unusually good result for any type of metastatic cancer, where disease has spread to other parts of the body.

    The result is a vindication of combining medicines that fight tumour cells in a variety of ways.

    Both Herceptin and Perjeta are antibodies designed to block the function of HER2, a protein produced by a cancer-linked gene. Perjeta, also known as pertuzumab, binds to a different part of the same protein, which makes combining the two drugs extra effective.

    "The results, I think, are phenomenal," lead researcher Sandra Swain from the Washington Hospital Center told the European Society for Medical Oncology (ESMO) annual congress in Madrid on Sunday.

    "The survival improvement of nearly 16 months ... is unprecedented among studies of metastatic breast cancer."

    Perjeta, which was approved by regulators two years ago, was tested in the Roche-backed study involving more than 800 women.

    Researchers had previously reported the Perjeta drug regimen significantly extended progression-free survival, or the period of time patients live without their disease worsening, but the final overall survival data has taken longer to collect.

    The median overall survival time was 56.5 months for those given Perjeta against the already impressive 40.8 months for patients taking only the older drugs.

    Looking at the study results a different way, the risk of dying was reduced by 32 percent for women who received the Perjeta regimen compared to those who got Herceptin and chemotherapy.

    While both Perjeta and Herceptin have side effects, including rash, diarrhea and a potentially adverse impact on heart function, using the two drugs together did not make these issues any worse.

    "I think these data are really compelling," said Eric Van Cutsem of the University of Leuven, who was not involved in the research. "When you see in breast cancer such a big change in survival with not a lot of cardio-toxicities then that is really practice-changing."

    REMARKABLE RESULTS

    Swain and Javier Cortes, another researcher on the study from the Vall D'Hebron Institute of Oncology in Barcelona, said the results suggested using Perjeta should now be the standard of care for HER2 positive breast cancer patients.

    A favorable reaction from oncologists will underpin expectations of strong sales for Perjeta, which analysts currently expect to sell $3.1 billion a year by 2018, according to consensus forecasts compiled by Thomson Reuters Cortellis.

    But it poses a challenge for healthcare providers, since Perjeta and Herceptin are costly injectable drugs and the multiple-drug regimen promises to strain budgets.

    In the United States, the monthly price of Perjeta is approximately $5,900, while Herceptin costs around $5,300, a Roche spokeswoman said. Prices in Europe are lower.

    For Roche, Perjeta is an important new product that should help defend its position in breast cancer, following the success of Herceptin, which was first approved in 1998.

    The company said the latest data would be submitted to regulatory authorities around the world for inclusion in the prescribing information for Perjeta.

    The Swiss drugmaker also has another related drug called Kadcyla, which is also being tested in combination with Perjeta. Some analysts believe Kadcyla's prospects could be curbed if results from that combination are not better than the impressive findings reported this weekend.

  • Florida marijuana campaign heats up, could raise Nov. turnout

    By Bill Cotterell

    TALLAHASSEE (Reuters) - Opponents of a proposal to let doctors in Florida prescribe marijuana are poised to launch a $1.6 million advertising campaign on Monday, with potential side effects for the state's heated race for governor in November.

    Political consultants say a public battle over the proposed constitutional amendment to allow medical marijuana, included on this year's midterm election ballot, could boost turnout among young voters for Democrat Charlie Crist, who supports the measure. The extra support may be enough to help him defeat incumbent Republican Governor Rick Scott, who opposes it.

    But opponents of Amendment 2 got a major boost when Sheldon Adelson, Las Vegas casino magnate and a major Republican fundraiser, put up $2.5 million of the $3.2 million raised by Drug Free Florida.

    The ads will attack "loopholes," which law enforcement authorities say could lead to recreational use of the drug, said Sarah Bascom, whose Tallahassee consulting firm is handling the Drug Free Florida campaign.

    "Our message is, this is not about sick people," she said. Even if more young voters turn out for the marijuana referendum, Bascom said "a vote down-ticket doesn't mean they're going to vote up-ticket" in the governor's race.

    Some 23 U.S. states and the District of Columbia already have passed laws allowing medical marijuana in some form, beginning with California in 1996.

    The public petition campaign that put the amendment on the Florida ballot promised relief for suffers of diseases like cancer, AIDS and ALS, also known as Lou Gehrig's disease. But the measure would also allow doctors to prescribe marijuana whenever they determine benefits outweigh potential risks.

    The no campaign is being supported by wide-ranging "Don't Let Florida Go To Pot" coalition of medical and law-enforcement organizations arguing that the amendment does not provide any minimum age or residency requirements for obtaining marijuana.

    Orlando trial lawyer John Morgan, a Crist backer who figures on spending $6 million of his own money on the medical-marijuana initiative, believes the referendum will draw up to 4 percent more voters to the polls Nov. 4, including college students who believe marijuana is no big deal, elderly voters who have friends who covertly puff some pot to relieve nausea from chemotherapy and libertarians who believe it is none of the government's business.

    Morgan, who has been touring the state in a motorcoach, said the amendment might help Crist in what is expected to be a close race, but denied sponsoring the drive for that reason.

    "We're registering people who never registered before, so I think turnout is going to be 2, 3, maybe even 4 points higher than we might have seen, but for this," he said during a visit to the University of Florida last week.

    While supporting the amendment, Crist has distanced himself a little from the medical marijuana campaign.

    "It might get more younger voters to turn out," Crist, a former Republican who was governor 2007-11, said in an interview. "I really don't know is the honest answer," he added. "It may well increase turnout because if you're educating people about this being on the ballot, who otherwise might not have known it, then you're ginning it up."

    Supporters of the amendment say polling shows nearly 70 percent of likely voters back the measure with only 28 percent opposed.

    But a recent Public Policy Polling survey showed just 61 percent support and a poll by the Tampa Bay Times/Bay News 9 and the Bob Graham Center at the University of Florida showed only 57 percent backing. Florida constitutional amendments require 60 percent support to pass.

    Steve Schale, a member of the Crist campaign and a senior aide in President Barack Obama's two Florida campaigns, said amendment supporters might favor Crist more than Scott, but jobs, education and many other issues will be more decisive.

    David Johnson of Strategic Vision in Atlanta, a Republican campaign planner, said it was hard to see young voters turning out in large numbers over one issue.

    However, he cautioned, "Remember, even an uptick of 1 or 2 percent in a close race could make the difference."

  • "Collateral" death toll expected to soar in Africa's Ebola crisis

    By Kate Kelland

    LONDON (Reuters) - Deaths from infectious diseases like malaria, diarrhea and pneumonia are likely to soar in West African countries where a vast outbreak of Ebola has crushed health systems and killed nurses and doctors.

    Specialists on deadly diseases say deaths from malaria alone, which even before the Ebola crisis killed around 100,000 a year in the West Africa region as a whole, could increase four-fold in Ebola-hit countries as people miss out on life-saving treatments.

    Even at this point, said Professor Chris Whitty of the London School of Hygiene and Tropical Medicine in London, in countries facing the worst of the Ebola outbreak, "many more people are dying of other things that are not Ebola".

    As the epidemic continues, these so-called "collateral" deaths - including from complications in childbirth and chronic conditions such as heart disease - will rise as the clinics and health workers that would normally treat them are overwhelmed.

    Carolyn Miles, head of the international charity Save the Children, said children under five - of which there are an estimated 2.5 million living in the affected areas - are at great risk, both from Ebola and knock-on effects including the psychological stress caused by parents and relatives dying.

    "The health services of West Africa have to a very large degree broken down," said Jeremy Farrar, director of the Wellcome Trust international health charity. "That means care of women in childbirth, of people with malaria, of people with conditions like diabetes and mental illness are all suffering.

    "That will have huge secondary consequences way beyond Ebola, no matter how bad this epidemic becomes."

    RIPPLE EFFECT

    The World Health Organization's (WHO) latest update says the Ebola virus has killed almost 3,000 people in the West Africa outbreak, which began early this year in Guinea and has spread to Liberia, Sierra Leone, Nigeria and Senegal.

    The United Nations health agency says at least 208 health workers in the region have been killed by Ebola, from a total of 373 so far infected with the virus.

    Jimmy Whitworth, the Wellcome Trust's head of population health, said the crisis might cause malaria deaths to quadruple to around 400,000 in the coming year, with patients too afraid to come to clinics for fear of contracting Ebola, and therefore not getting anti-malarial drugs and care.

    Deaths from diarrhea and pneumonia, some of the biggest killers of children in sub-Saharan Africa, will also rise, he predicted, as will deaths of women in childbirth. Routine immunization programs will grind to a halt, putting children at higher risk of diphtheria, polio and tuberculosis.

    "The ripples from this crisis are very worrying," he told Reuters. "The hospitals are full of Ebola patients and there is not space for any other type of patient, and in health clinics, there are essentially no staff any more."

    Sierra Leone - one of the countries worst hit by the Ebola epidemic - "even at the best of times had just about the worst maternal mortality ratios in the world," said Whitworth. "We're at a very low base, and now even that is being eroded away."

    The WHO's director-general Margaret Chan said last week her agency was acutely aware that in the three hardest-hit countries there are high numbers of deaths from causes other than Ebola.

    "The size of this 'emergency within the emergency' is not precisely known, as systems for monitoring health statistics, not good to begin with, have now broken down completely," she said.

    She argued, however, that these deaths should not be classed as "collateral damage".

    "They are all part of the central problem: No fundamental public health infrastructures were in place, and this is what allowed the virus to spiral out of control."

  • European agency collects data on experimental Ebola treatments

    By Reuters Staff

    LONDON (Reuters) - The European Medicines Agency said on Friday it had started collecting data from pharmaceutical companies trialling experimental medicines to treat Ebola in a bid to speed up the process to find an approved cure for the virus.

    "I have therefore asked the EMA Committee for Medicinal Products for Human Use, CHMP, to scrutinize all the available information about experimental treatments and compile everything we know to date about their efficacy, safety and quality," EMA Executive Director Professor Guido Rasi said in a statement.

    The agency said the Ebola outbreak in West Africa is the largest and most complex to date with over 5,300 reported cases and more than 2,600 deaths.

    Companies invited to submit data to the agency include U.S.-based Biocryst, Canada's Tekmira and France's Fab'entech.

Orthopedic Articles

  • Studies criticize U.S. medical device approval process

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Information on the safety and effectiveness of medical devices before and after they are cleared by U.S. health regulators can be improved, according to two new studies.

    One study found many U.S. Food and Drug Administration (FDA)-cleared medical devices meant to be implanted in the body were not backed by publicly available evidence that they are similar to a device already on the market.

    "Let the buyer beware before getting an implant in their body, because there may be no evidence the implant is going to benefit them and no study done in case it might harm them," said Diana Zuckerman, the study's lead author and president of the National Center for Health Research in Washington, D.C.

    The new report is not the first time researchers have criticized the process the FDA uses to evaluate many medical devices.

    In 2011, the Institute of Medicine issued a report that the medical device evaluation process known as 510(k) is fatally flawed and should be replaced. The FDA, which requested the report, disagreed. (See Reuters story of July 29, 2011 here: http://reut.rs/qAKdUv.)

    The 510(k) process allows medical devices to get to market faster if they are "substantially equivalent" to devices already being sold. Certain information that's submitted to the FDA about the devices must be made publicly available as a summary, Zuckerman and her colleagues write in JAMA Internal Medicine.

    For the new study, the researchers evaluated the publicly available information for implantable devices cleared by the FDA through the 510(k) process between 2008 and 2012. Because those devices are supposed to be similar to another device already on the market, the researchers also looked at the available information for those original devices.

    Overall, they were looking for information on 50 devices cleared between 2008 and 2012 and 1,105 previously cleared devices.

    They found enough evidence to support the claim that eight (or 16 percent) of the 50 new devices were substantially equivalent to previously cleared devices. Of those previously cleared devices, only 31 (or about 3 percent) were supported by publicly available evidence.

    "The study relied on publicly available information, and as noted by the authors, this information is generally limited because manufacturers are only required by law to provide either a safety summary or a safety statement for the public," the FDA said in a statement to Reuters Health.

    "However, the FDA reviews a significant amount of data - far more than what is publicly available - to determine whether or not to clear an implantable device under a 510(k). This approach has served the American public well by balancing the need for robust evidence to assure safety while expeditiously bringing new technologies to the patients who need them," the statement continued.

    Zuckerman said the companies are not providing sufficient summaries of its evidence, which are required by law.

    "I think this is a report card going forward," she said. "Clearly the FDA and companies are failing to provide information to doctors and patients so they can make reasonable judgments to affect their lives."

    In another study in the same journal, researchers led by Ian Reynolds at The Pew Charitable Trusts in Washington, D.C. found that barriers may decrease the usefulness of studies completed after medical devices are approved by the FDA.

    The researchers found the FDA ordered more than 223 studies for 158 medical devices between the start of 2005 and the end of 2011. Only one of the studies led to an action by the FDA other than a change of the devices label.

    "We encourage the agency to work together with all stakeholders to evaluate how these studies can more effectively be used to improve the public health," they write.

    In a commentary accompanying the new study, Elisabeth Dietrich from the University of California, San Francisco and Maryland's Secretary of Health and Mental Hygiene Dr. Joshua M. Sharfstein write that the FDA has already taken steps to address many of the issues pointed out in the new studies.

    "It is important to recognize and support this progress, even as the FDA's performance continues to be monitored through research and oversight," they write.

    SOURCES: http://bit.ly/1xusqo1, http://bit.ly/1u6xFYp, http://bit.ly/1wRBQqJ and http://bit.ly/Zl8KFp JAMA Internal Medicine, online September 29, 2014.

  • Too little research supports newer joint implants: study

    By Kathryn Doyle

    NEW YORK (Reuters Health) - There is not much hard evidence that new artificial joint devices, including ceramic-on-ceramic bearings for hip replacement and high flexion knee replacement, are better than older options - and in some cases they may be worse - according to a new review.

    Senior author Dr. Art Sedrakyan and his team reviewed clinical trials, comparative studies and registries for evidence that five new implantable device innovations were effective and safe.

    Similar research published in 2011 led to manufacturers withdrawing some metal-on-metal hip replacement options, which turned out to have higher failure rates than others because the metal parts rubbing together created debris that could lead to inflammation and tissue damage.

    "Back in 2011 when we published the first paper on metal-on-metal hips, hundreds of people contacted me and asked if they should be worried about hip replacement in general," said Sedrakyan, of the Patient Centered Comparative Effectiveness Program and U.S. Food and Drug Administration Medical Device Epidemiology Science and Infrastructure Center at Weill Cornell Medical College in New York.

    "The answer is 'no' because the procedure is generally very safe and outcomes are generally good," he told Reuters Health.

    However, new product designs tend to be based on engineering data more than on clinical data, he said. It seems, logically, like a new design may have an advantage over the old, but that often isn't supported by evidence with real patients, he said.

    Sedrakyan and his team looked for evidence supporting five recently introduced and well-known hip and knee devices, including ceramic-on-ceramic bearings, modular femoral necks and uncemented monoblock cups for total hip replacement, as well as high-flexion knee replacement and gender-specific knee replacement.

    All these technologies are already "implemented" in patients, the authors write in the journal BMJ.

    The 118 studies comparing outcomes with these devices versus older options were of varying quality and few were high-quality randomized trials, the study team found.

    None of the five devices appeared to improve functioning or survival more than the older versions. And some of them had up to twice the rate of needing replacement in a subsequent "revision" surgery compared to existing options.

    Registries showed modular femoral necks were revised 1.9 times as often as predecessor technologies, and ceramic-on-ceramic hip bearings and high-flexion knee bearings were also replaced more often, according to the results.

    None of the newer devices appeared to have poor enough outcomes that their use should necessarily be discontinued, Sedrakyan said, but there was generally a lack of evidence in their favor.

    "The technologies that are supposed to be better are not proving to be better and some which are widely used happen to be worse," Sedrakyan said.

    The data show that not all new orthopedic devices are being studied carefully, and when they are being studied, the studies themselves may be limited in quality, said Dr. Aaron S. Kesselheim of Brigham and Women's Hospital in Boston who co-authored an editorial on the topic in BMJ.

    Older implants may not always be safer, but since they have been around longer and used in more patients it's easier for safety issues to come to light, he said.

    "Of course, that issue would only emerge if someone's looking for it, and unfortunately, safety data on implants are not systematically collected all the time," Kesselheim told Reuters Health by email.

    Hospital administrators usually choose and purchase the devices that end up inside patients, he said. But patients can have a voice, and should ask their surgeons if the device slated for their surgery has been proven effective and safe, not just that it is widely used or popular with some patients, Sedrakyan said.

    Many patients do not know to ask this question, and the implant itself may be decided on at the time of surgery, Kesselheim said.

    "Stakeholders like surgeons, regulators and patients need to work together to demand a different and improved system of surveillance of these new products," Sedrakyan said.

    SOURCE: http://bit.ly/1xHna1p and http://bit.ly/1Dl6VY4 BMJ, online September 9, 2014.

Transplant Articles

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Women’s Health Articles

  • Women who have been unemployed have fewer kids -US study

    By Reuters Staff

    BOSTON (Reuters) - Women who were unemployed in their youth tend to have fewer children into middle-age than women who worked, according to a U.S. study released on Monday.

    Janet Currie and Hannes Schwandt, two researchers at Princeton University in New Jersey, used more than 140 million U.S. birth records to track groups of women and found that those with higher unemployment rates in their early twenties had fewer babies.

    Previous studies have suggested unemployment has a short-term impact on women's fertility as they may not have the financial resources to support their children.

    "A one percentage point increase in the average unemployment rate experienced between the ages of 20 and 24 reduces the short-run fertility of women in this age range by six conceptions per 1,000 women," according to the study, published in the Proceedings of the National Academy of Sciences.

    It added that the long-run effect was even greater: when the same women reached age 40 the one percentage point increase in the unemployment rate experienced at ages 20-24 lead to an overall loss of 14.2 conceptions.

    "This larger long-term effect is driven largely by women who remain childless," it said.

    The study pointed out that previous research had discovered the short-term correlation between unemployment and fertility, but that none had yet tested the longer-run effects.

    "Scholars have been examining the relationship between fertility and unemployment for more than a century... but it is not known whether these negative effects persist, because women simply may postpone childbearing to better economic times," the study said.

    SOURCE: http://bit.ly/1rwPdL7 Proceedings of the National Academy of Sciences, September 29, 2014.

  • Long-acting reversible contraceptives best for teens: pediatricians

    By Will Boggs MD and Nancy Lapid

    NEW YORK (Reuters Health) - For adolescents who choose not to abstain from sex, the American Academy of Pediatrics (AAP) favors long-acting reversible contraceptives, such as contraceptive implants and intrauterine devices.

    All methods of hormonal birth control, including contraceptive pills, are safer than pregnancy, Dr. Mary A. Ott from the Indiana University School of Medicine in Indianapolis, Indiana told Reuters Health by email.

    But long acting reversible contraceptive (LARC) methods, including the contraceptive implant and the intrauterine device (IUD), should be the first-choice contraceptive methods for adolescents who choose not to be abstinent, she added.

    Today in the medical journal Pediatrics, Ott and colleagues on the AAP's Committee on Adolescence updated the organization's 2007 policy statement on prescribing contraception for adolescents.

    After reviewing such issues as confidentiality, discussing a teen's sexual history, and counseling about abstinence and contraception, the policy statement advises pediatricians to counsel teens about a broad range of contraceptive services, with a special focus on long-acting reversible contraceptives.

    The policy statement also urges pediatricians to ensure that adolescents have access to these methods. In order to do so, they must be familiar not only with national best practice recommendations for confidential care, but also with state and federal laws regarding consent to contraceptive care and information disclosure, the paper notes.

    Once an appropriate contraceptive method has been selected, the pediatrician should encourage its consistent use along with consistent and correct use of condoms with every act of sexual intercourse.

    These principles should also apply to the care of adolescents with chronic illnesses and disabilities, while recognizing that those illnesses may complicate the contraceptive choices.

    Finally, the AAP says, pediatricians must recognize that the contraceptives discussion is ongoing, and this requires time for their adolescent patients to have their needs addressed in a "developmentally appropriate" way.

    "The Bright Futures best practice guidelines from the American Academy of Pediatrics and the Maternal and Child Health Bureau recommend starting to speak to adolescents confidentially about puberty, relationships, and sexual behaviors starting in early adolescence," at ages 11 to 14, Ott explained.

    "Bright Futures recommends that counseling be developmentally tailored to the adolescent, with a stronger focus on abstinence in early adolescence gradually focusing more on healthy relationships and sexually transmitted infection prevention and contraception by late adolescence," or ages 18 to 21, she continued.

    "Adolescents are capable of understanding complex messages about sexual health," Ott said. "Adolescents trust pediatricians and understand that their pediatricians can simultaneously encourage abstinence and provide non-judgmental contraceptive information and care."

    Dr. Hatim Omar, Division of Adolescent Medicine chief at the University of Kentucky in Lexington, told Reuters Health, "Teens are less likely to be compliant and because of their development are not fully aware about consequences ('it won't happen to me'), so proper counseling and using long-acting reversible contraceptives are the most effective means of preventing unwanted pregnancy."

    "Counseling should always include abstinence, STIs, and condom use," Omar concluded.

    Not all parents will welcome the interventions, however.

    Eric Scheidler, executive director of the Chicago-based Pro-Life Action League, told Reuters Health that as a father of daughters he finds it "horrifying" that their pediatrician would promote contraception.

    "I'd prefer for this discussion about teen sexuality to be a discussion between parents and children and not a girl and her doctors," he said in a phone call. "It's not just a medical decision, it's a moral decision. It ties into a girl's aspirations, her personality, her state of mind" - things a parent knows better than the child's doctor, he added.

    "The recommendation from the APP can't replace the parental relationship," Scheidler said.

    SOURCES: http://bit.ly/1u6tgVw and http://bit.ly/1wRJnFM Pediatrics, online September 29, 2014.

  • Clintons say granddaughter Charlotte's life off to 'good start'

    By Reuters Staff

    (Reuters) - Chelsea Clinton has given birth to a girl, she said in a statement on social media, giving former President Bill Clinton and former Secretary of State Hillary Clinton their first grandchild.

    "Marc and I are full of love, awe and gratitude as we celebrate the birth of our daughter, Charlotte Clinton Mezvinsky," Clinton said in the post on her Twitter and Facebook profiles, referring to her investment banker husband Marc Mezvinsky.

    The messages came out after midnight on the U.S. East Coast. Details on the baby's height and weight have not been released.

    Later on Saturday, Charlotte's new grandparents shared their excitement about the birth in a joint statement.

    "We are thrilled to be with our daughter and her husband as they welcome their daughter into the world," the senior Clintons said.

    "Chelsea is well and glowing. Marc is bursting with pride. Charlotte's life is off to a good start," they said.

    Chelsea Clinton announced her pregnancy in April while sitting side-by-side with her mother in armchairs on a stage at a New York City event on empowering women.

    It remains unclear how the birth of the first Clinton grandchild will affect the political ambitions of Hillary Clinton, who is considering a run for the White House in 2016.

    In 2011, former President Clinton told reporters in Davos, Switzerland: "I would like to have a happy wife, and she won't be unless she's a grandmother ... It's something she wants more than she wanted to be president."

  • Walking is the superfood of fitness, experts say

    By Dorene Internicola

    NEW YORK (Reuters) - Walking may never become as trendy as CrossFit, as sexy as mud runs or as ego-boosting as Ironman races but for fitness experts who stress daily movement over workouts and an active lifestyle over weekends of warrior games, walking is a super star.

    For author and scientist Katy Bowman, walking is a biological imperative like eating. In her book, "Move Your DNA: Restore Your Health Through Natural Movement," she suggests there are movement nutrients, just like dietary nutrients, that the body needs.

    "Walking is a superfood. It's the defining movement of a human," said Bowman, a biomechanist based in Ventura, California. "It's a lot easier to get movement than it is to get exercise."

    Researchers say emerging evidence suggests that combined physical activity and inactivity may be more important for chronic disease risk than physical activity alone.

    "Actively sedentary is a new category of people who are fit for one hour but sitting around the rest of the day," Bowman said. "You can't offset 10 hours of stillness with one hour of exercise."

    Last year researchers at the University of Texas School of Public Health asked 218 marathoners and half marathoners to report their training and sitting times. Median training time was 6.5 hours per week. Median total sitting time was eight to 10.75 hours per day, suggesting that recreational distance runners are simultaneously highly sedentary and highly active.

    Leslie Sansone, creator of the "Walk at Home: Mix & Match Walk Blasters" DVD, said too many people believe that spending grueling hours at the gym is the only way to fitness.

    "There's this "Biggest Loser" idea out there that if you're not throwing up and crying you're not getting fit," she said, referring to the popular television weight-loss show.

    She added that a small study of non-obese men published in the journal Medicine & Science in Sports and Exercise by scientists at Indiana University suggests that three five-minute walks done throughout three hours of prolonged sitting reverses the harmful effects of prolonged sitting on arteries in the legs.

    Three miles (5 kilometers) per hour is a good beginning, gradually working to 4 miles per hour, she said about walking.

    Dr. Carol Ewing Garber, president of the American College of Sports Medicine (ACSM), notes that fitness-walking guidelines of 10,000 steps per day may be too much for many.

    "About 7,500 steps may be more accurate," she said, adding that current ACSM recommendations call for at least 150 minutes of activity each week.

    Garber, a professor of movement sciences at Columbia University in New York, said research suggests that even one bout of exercise causes beneficial physiological effects.

    But she concedes that walking does not do everything. It is less beneficial for bones than running, and for strength, it is better to lift weights.

    "Still," she said, "If you're going to pick one thing, research says it should be walking."

  • Roche breast cancer drug "unprecedented" in extending lives

    By Ben Hirschler

    MADRID (Reuters) - A new breast cancer drug from Roche has shown "unprecedented" benefits in extending lives in a clinical trial and experts urged its widespread use for women with an aggressive form of the disease.

    Patients with a type of breast cancer known as HER2 positive, which makes up about a quarter of all breast cancers, who were given Perjeta on top of older medicine Herceptin and chemotherapy lived 15.7 months longer than those on Herceptin and chemotherapy alone.

    That is the longest extension to survival ever seen for a drug studied in metastatic breast cancer and also an unusually good result for any type of metastatic cancer, where disease has spread to other parts of the body.

    The result is a vindication of combining medicines that fight tumour cells in a variety of ways.

    Both Herceptin and Perjeta are antibodies designed to block the function of HER2, a protein produced by a cancer-linked gene. Perjeta, also known as pertuzumab, binds to a different part of the same protein, which makes combining the two drugs extra effective.

    "The results, I think, are phenomenal," lead researcher Sandra Swain from the Washington Hospital Center told the European Society for Medical Oncology (ESMO) annual congress in Madrid on Sunday.

    "The survival improvement of nearly 16 months ... is unprecedented among studies of metastatic breast cancer."

    Perjeta, which was approved by regulators two years ago, was tested in the Roche-backed study involving more than 800 women.

    Researchers had previously reported the Perjeta drug regimen significantly extended progression-free survival, or the period of time patients live without their disease worsening, but the final overall survival data has taken longer to collect.

    The median overall survival time was 56.5 months for those given Perjeta against the already impressive 40.8 months for patients taking only the older drugs.

    Looking at the study results a different way, the risk of dying was reduced by 32 percent for women who received the Perjeta regimen compared to those who got Herceptin and chemotherapy.

    While both Perjeta and Herceptin have side effects, including rash, diarrhea and a potentially adverse impact on heart function, using the two drugs together did not make these issues any worse.

    "I think these data are really compelling," said Eric Van Cutsem of the University of Leuven, who was not involved in the research. "When you see in breast cancer such a big change in survival with not a lot of cardio-toxicities then that is really practice-changing."

    REMARKABLE RESULTS

    Swain and Javier Cortes, another researcher on the study from the Vall D'Hebron Institute of Oncology in Barcelona, said the results suggested using Perjeta should now be the standard of care for HER2 positive breast cancer patients.

    A favorable reaction from oncologists will underpin expectations of strong sales for Perjeta, which analysts currently expect to sell $3.1 billion a year by 2018, according to consensus forecasts compiled by Thomson Reuters Cortellis.

    But it poses a challenge for healthcare providers, since Perjeta and Herceptin are costly injectable drugs and the multiple-drug regimen promises to strain budgets.

    In the United States, the monthly price of Perjeta is approximately $5,900, while Herceptin costs around $5,300, a Roche spokeswoman said. Prices in Europe are lower.

    For Roche, Perjeta is an important new product that should help defend its position in breast cancer, following the success of Herceptin, which was first approved in 1998.

    The company said the latest data would be submitted to regulatory authorities around the world for inclusion in the prescribing information for Perjeta.

    The Swiss drugmaker also has another related drug called Kadcyla, which is also being tested in combination with Perjeta. Some analysts believe Kadcyla's prospects could be curbed if results from that combination are not better than the impressive findings reported this weekend.